New ICD-10 Codes, MS-DRG Assignments for COVID-19 Coming Jan. 1

Come January 1, 2021, CMS will implement 21 new ICD-10 procedure codes for COVID-19 vaccines and therapeutics for the novel coronavirus, including baricitinib and monoclonal antibody treatments.

The Food and Drug Administration (FDA) recently approved baricitinib, a rheumatoid arthritis drug sold under the brand name Olumiant, for the treatment of COVID-19 in hospitalized patients when used in conjunction with remdesivir.

The new ICD-10 procedure codes will allow healthcare providers to document the use of the drug, as well as administration of potential COVID-19 vaccines, including second injections, and monoclonal antibodies and immunomodulators approved for use in infected patients.

CMS also assigned Medicare Severity-Diagnosis-Related Groups (MS-DRGs) to six new ICD-10 diagnosis codes for conditions related to COVID-19, according to the latest news announcement on the agency’s MS-DRG Classifications and Software webpage.

The codes that received MS-DRGs were for pneumonia due to COVID-19; multisystem inflammatory syndrome; other systemic involvement of connective tissue; encounter for COVID-19 screening; suspected exposure to COVID-19; and personal history of COVID-19.

Providers will be able to report the ICD-10 diagnosis codes on medical claims on January 1, 2021, CMS announced.

The new ICD-10 procedure codes will not affect the MS-DRG assignment, the agency added.

CMS also noted in the announcement that Medicare will pay for the COVID-19 vaccines and their administration separately from the Diagnosis-Related Group rate.

“As such Medicare expects that the appropriate CPT [Current Procedural Terminology] codes will be used when a Medicare beneficiary is administered a vaccine while a hospital inpatient,” the agency stated.

CMS set the Medicare reimbursement rate for a COVID-19 vaccine last month. The agency said it will pay providers $28.39 for the administration of a single-dose COVID-19 vaccine. In the event an approved COVID-19 vaccine requires multiple doses, CMS will reimburse providers $16.94 for the initial doses and $28.39 for the administration of the final dose in the series.

Providers will be able to bill for the COVID-19 vaccine on single claims for shot administration, CMS added in a toolkit for providers.

Alternatively, providers will be able to submit claims on a roster bill for multiple patients at a time. However, providers must administer the vaccine shots to at least five patients on the same date, unless the roster bill is an institutional claim from an inpatient hospital, according to the toolkit.

If providers participate in a Medicare Advantage (MA) plan, then they will submit COVID-19 claims to Original Medicare for all patients enrolled in the MA plan in 2020 and 2021, CMS also noted.

The ICD-10 MS-DRG Grouper will assign each case into an MS-DRG based on the diagnosis and procedure codes reported by providers, as well as patient demographic information, including age, sex, and discharge status.

The ICD-19 MS-DRG Grouper software package with the new procedure codes for COVID-19 will be effective for discharges on or after January 1, 2021, CMS stated in the latest announcement.

The software, as well as the Definitions Manual Table of Contents and the Definitions of Medicare Code Edits V38.1 manual, will be available from on CMS’ MS-DRG Classifications and Software webpage.

Approval of a COVID-19 vaccine is drawing closer, with Pfizer and Moderna filing separate emergency use authorization requests to the FDA for their respective vaccine candidates.

The companies are currently leading the race to a COVID-19 vaccine and both have reported vaccine efficacy rates of over 90 percent.

FDA has yet to officially comment on the emergency use authorization requests, but FDA Commissioner Hanh has stated that the applications will need to go through the Vaccines and Related Biological Products Advisory Committee (VRBPAC), which is next scheduled to meet on December 10, 2020.

So far, the emergency use authorization filed by Pfizer is on the agenda.