New ICD-10-CM codes Effective January 1, 2021

There are many updates and changes to COVID-19(SARS-CoV-2) since the pandemic started. Now a special update has been issued with the release of new six codes to the ICD-10-CM code set. These codes are effective for use from January 1, 2021.Let’s look up the code details as below:

New codes:

J12.82             Pneumonia due to coronavirus disease 2019

M35.81            Multisystem inflammatory syndrome

M35.89            Other specified systemic involvement of connective tissue

Z11.52             Encounter for screening for COVID-19

Z20.822           Contact with and (suspected) exposure to COVID-19

Z86.16             Personal history of COVID-19

New code for Pneumonia due to COVID-19:

A new code J12.82 is used to report COVID caused pneumonia effective January 1, 2021. The main purpose of adding this new code is to improve the coding specificity compared to that of the existing coding guidance for COVID-related Pneumonia. The current guidelines instruct the coders to report two diagnosis codes for the condition as below:

U07.1 (COVID-19)

J12.89 (other viral pneumonia).

However the investigation of CMS data showed that using two codes “may substantially under-record pneumonia-related COVID-19, with more than 50% of recorded COVID-19 cases having had ‘other viral pneumonia’ recorded.” Therefore the new code J12.82 is added to solve the problem.

J12.82, pneumonia due to coronavirus disease 2019 

The new code J12.82 also includes the inclusion terms “pneumonia due to COVID-19” and “pneumonia due to severe acute respiratory syndrome coronavirus 2”.

Multisystem Inflammatory Syndrome (MIS):

Multisystem inflammatory syndrome, or MIS, is a hyper-inflammatory condition being seen with past or present COVID-19 patients. It was initially noted in the pediatric population, but it has been seen in adults as well. Currently we use code M35.8, Other specified systemic involvement of connective tissue to represent MIS-C(C indicates its presence in children) as there is no specific ICD-10 CM code. There are also coding instructions provided if the documentation establishes the link between MIS-C and COVID-19.

The proposals are made to create a new code M35.81 to denote the Multisystem inflammatory syndrome associated with COVID-19. It can be assigned for both the childhood form (MIS-C) and the adult form (MIS-A) of the syndrome as both have been seen around the world. Another code M35.89 is also added to the code set to denote the condition unrelated to COVID-19.

COVID-19 and MIS-C:

When the patient has COVID-19 as a current diagnosis and the reason for care, you need to assign U07.1 as the principal or first-listed code, followed by M35.81.

When the patient had COVID-19 previously but is now seen or admitted for MIS, you need to assign M35.81 as the principal or first-listed diagnosis, followed by B94.8 for sequelae of other specified infectious and parasitic disease and the new code Z86.16 for history of COVID-19.

Three new Z codes:

Based on the multiple requests for related codes, the ICD-10 Coordination and Maintenance Committee has added three new Z codes to the code set which would tremendously help with the data collection. The new codes are listed below:

Encounter for screening for COVID-19: Z11.52

The code Z11.52 is to be reported for people who are asymptomatic and the test results are negative.

Contact with and [suspected] exposure to COVID-19): Z20.822

Code Z20.822 will now replace code Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases) in our coding when there is contact or suspected contact with the COVID-19 virus. You can read out here to know about the older code Z20.828.

Personal history of COVID-19: Z86.16

Code Z86.16 will now replace code Z86.19 (Personal history of other infectious and parasitic diseases) in our coding for patients with a documented history of COVID-19.

Happy learning! Happy Coding!

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