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In an off-cycle update to the 2021 ICD-10-CM Coding Guidelines posted in December in response to the current COVID-19 public health emergency, the Centers for Disease Control and Prevention’s National Center for Health Statistics implemented six new diagnosis codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), effective January 1, 2021.

The specifics for these codes can be located on pages 28 to 33 of the update to the 2021 ICD-10-CM Coding Guidelines. It appears these codes would typically be used as secondary diagnoses to further describe COVID-19 status or secondary or associated manifestations of COVID-19. In instances when COVID-19 meets the definition of a principal diagnosis for Minimum Data Set (MDS) item I0020B, code U07.1 should continue to be used for that purpose.

It’s important to note that at this point the Patient-Driven Payment Model (PDPM) ICD-10 Mappings file on the CMS website hasn’t been updated to include these new ICD-10 codes and using them in MDS item I0020B may create problems with completing, locking, and transmitting with some software vendors. It’s also possible that some OBRA assessments and corresponding PDPM state case-mix assignments could be affected.

The new codes include:

  • J12.82 – Pneumonia due to COVID-19
  • M35.81 – Multisystem Inflammatory Syndrome
  • M35.89 – Other specified systemic involvement of connective tissue
  • Z11.52 – Encounter for screening for COVID-19 (not during the pandemic)
  • Z20.822 – Contact with and suspected exposure to COVID-19
  • Z86.16 – Personal history of COVID-19

If you have questions, reach out to your BKD Trusted Advisor™ or submit the Contact Us form below.

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