CMS Releases ICD-10 MS-DRG V38.1



Latest update includes assignments for new COVID-19-related diagnoses and procedures.

The ICD-10 Medicare Severity-Diagnosis Related Group (MS-DRG) V38.1 Grouper Software, Definitions Manual Table of Contents, and the Definitions of Medicare Code Edits V38.1 manual are now available. Use this version for proper DRG assignment for hospital discharges on or after Jan. 1, 2021.

Version 38.1 includes new ICD-10-CM codes for COVID-19-releated diagnoses, which went into effect Oct. 1, 2020, and 21 new ICD-10-PCS codes to describe the introduction or infusion of therapeutics, including monoclonal antibodies and vaccines for COVID-19 treatment.

V38.1 Includes Assignments for New COVID-19 Codes

Assignments of the new ICD-10-CM codes for COVID-19-related diseases is as follows:

Diagnosis CodeDescriptionCCMDCMS-DRG
J12.82Pneumonia due to coronavirus disease 2019MCC04 /
25
193, 194, 195 /
974, 975, 976
M35.81Multisystem inflammatory syndromeCC08545, 546, 547
M35.89Other specified systemic involvement of connective tissueCC08545, 546, 547
Z11.52Encounter for screening for COVID-19N23951
Z20.822Contact with and (suspected) exposure to COVID-19N23951
Z86.16Personal history of COVID-19N23951
Centers for Medicare & Medicaid Services

If diagnosis code M35.81 or M35.89 is reported as a principal diagnosis, Medicare will exclude the following secondary diagnoses from acting as a comorbidity (CC) under the CC Exclusions List:

M35.1         Other overlap syndromes

M35.5         Multifocal fibrosclerosis

M35.81       Multisystem inflammatory syndrome

M35.89       Other specified systemic involvement of connective tissue

V38.1 Includes 21 New ICD-10-PCS Codes

The Centers for Medicare & Medicaid Services (CMS) is implementing 21 new ICD-10-PCS codes for the introduction or infusion of therapeutics, including monoclonal antibodies and vaccines for COVID-19 treatment. This is in addition to the 12 new codes to identify therapeutics released Aug. 1, 2020.

The new procedure codes, effective Jan. 1, 2021, are:

Procedure CodeDescription
XW013H6Introduction of other new technology monoclonal antibody into subcutaneous tissue, percutaneous approach, new technology group 6
XW013K6Introduction of leronlimab monoclonal antibody into subcutaneous tissue, percutaneous approach, new technology group 6
XW013S6Introduction of COVID-19 vaccine dose 1 into subcutaneous tissue, percutaneous approach, new technology group 6
XW013T6Introduction of COVID-19 vaccine dose 2 into subcutaneous tissue, percutaneous approach, new technology group 6
XW013U6Introduction of COVID-19 vaccine into subcutaneous tissue, percutaneous approach, new technology group 6
XW023S6Introduction of COVID-19 vaccine dose 1 into muscle, percutaneous approach, new technology group 6
XW023T6Introduction of COVID-19 vaccine dose 2 into muscle, percutaneous approach, new technology group 6
XW023U6Introduction of COVID-19 vaccine into muscle, percutaneous approach, new technology group 6
XW033E6Introduction of etesevimab monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6
XW033F6Introduction of bamlanivimab monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6
XW033G6Introduction of REGN-COV2 monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6
XW033H6Introduction of other new technology monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6
XW033L6Introduction of CD24Fc immunomodulator into peripheral vein, percutaneous approach, new technology group 6
XW043E6Introduction of etesevimab monoclonal antibody into central vein, percutaneous approach, new technology group 6
XW043F6Introduction of bamlanivimab monoclonal antibody into central vein, percutaneous approach, new technology group 6
XW043G6Introduction of REGN-COV2 monoclonal antibody into central vein, percutaneous approach, new technology group 6
XW043H6Introduction of other new technology monoclonal antibody into central vein, percutaneous approach, new technology group 6
XW043L6Introduction of CD24Fc immunomodulator into central vein, percutaneous approach, new technology group 6
XW0DXM6Introduction of baricitinib into mouth and pharynx, external approach, new technology group 6
XW0G7M6Introduction of baricitinib into upper GI, via natural or artificial opening, new technology group 6
XW0H7M6Introduction of baricitinib into lower GI, via natural or artificial opening, new technology group 6
Centers for Medicare & Medicaid Services

These codes are designated as non-O.R. procedures, so there is no assigned major diagnosis category (MDC) or MS-DRG. The MS-DRG assignment depends on the reported principal diagnoses, any secondary diagnoses defined as a CC or major complication or comorbidity (MCC), procedures or services performed, age, sex, and discharge status.

Use instead the appropriate CPT codes when the Medicare patient is administered a vaccine while a hospital inpatient.

You can download the ICD-10 MS-DRG V38.1 files from the CMS website.

Heads Up! The 2021 Official ICD-10-PCS Coding Guidelines, code tables and index, addendum, codes file, conversion table, and order file are also updated as of Dec. 1, 2020. You can download these files from the CMS website, as well.

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