Under the National Emergencies Act, Sections 201 and 301, the Centers for Disease Control (CDC) has issued further additions to the current list of ICD-10 codes to capture more information about the condition. The new codes went into effect January 1, 2021. The CDC has developed an ICD-10 tool, free to the public (see below), to search and summarize code use and chapter guidelines. Insurance companies will be adding these to the list of usable codes, yet, each payor will likely have their own policy for specific codes relating to testing.
New codes include:
Encounter for screening for COVID-19 (Z11.52)
Contact with and (suspected) exposure to COVID-19 (Z20.822)
Personal history of COVID-19 (Z86.16)
Multisystem inflammatory syndrome (MIS) (M35.81)
- Note this is applicable to MIS-A, MIS-C, multisystem inflammatory syndrome in adults, multisystem inflammatory syndrome in children, pediatric inflammatory multisystem syndrome, PIMS
Other specified systemic involvement of connective tissue (M35.89)
Pneumonia due to coronavirus disease 2019 (J12.82)
- Requires Covid-19 to be listed as primary (U07.1)
If your practice is looking for easy to use on-line reference tools, we recommend looking at ICD10data.com and ICD10cmtool.cdc.gov – both sites offer an easy search with rules applicable to code order and claim placement. ICD10data.com has a better means of drilling down the code information and highlighting to alert whether a code can be used as primary for purposes of reimbursement. If you are receiving denials due to testing diagnosis codes not being covered, we encourage you to contact providers services for 2021 policy guidance.