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 Code | Description | CC | MDC | MS-DRG |
| J12.82 | Pneumonia due to coronavirus disease 2019 | MCC | 04 / 25 | 193, 194, 195 / 974, 975, 976 |
| M35.81 | Multisystem inflammatory syndrome | CC | 08 | 545, 546, 547 |
| M35.89 | Other specified systemic involvement of connective tissue | CC | 08 | 545, 546, 547 |
| Z11.52 | Encounter for screening for COVID-19 | N | 23 | 951 |
| Z20.822 | Contact with and (suspected) exposure to COVID-19 | N | 23 | 951 |
| Z86.16 | Personal history of COVID-19 | N | 23 | 951 |
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 Code | Description |
| XW013H6 | Introduction of other new technology monoclonal antibody into subcutaneous tissue, percutaneous approach, new technology group 6 |
| XW013K6 | Introduction of leronlimab monoclonal antibody into subcutaneous tissue, percutaneous approach, new technology group 6 |
| XW013S6 | Introduction of COVID-19 vaccine dose 1 into subcutaneous tissue, percutaneous approach, new technology group 6 |
| XW013T6 | Introduction of COVID-19 vaccine dose 2 into subcutaneous tissue, percutaneous approach, new technology group 6 |
| XW013U6 | Introduction of COVID-19 vaccine into subcutaneous tissue, percutaneous approach, new technology group 6 |
| XW023S6 | Introduction of COVID-19 vaccine dose 1 into muscle, percutaneous approach, new technology group 6 |
| XW023T6 | Introduction of COVID-19 vaccine dose 2 into muscle, percutaneous approach, new technology group 6 |
| XW023U6 | Introduction of COVID-19 vaccine into muscle, percutaneous approach, new technology group 6 |
| XW033E6 | Introduction of etesevimab monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6 |
| XW033F6 | Introduction of bamlanivimab monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6 |
| XW033G6 | Introduction of REGN-COV2 monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6 |
| XW033H6 | Introduction of other new technology monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6 |
| XW033L6 | Introduction of CD24Fc immunomodulator into peripheral vein, percutaneous approach, new technology group 6 |
| XW043E6 | Introduction of etesevimab monoclonal antibody into central vein, percutaneous approach, new technology group 6 |
| XW043F6 | Introduction of bamlanivimab monoclonal antibody into central vein, percutaneous approach, new technology group 6 |
| XW043G6 | Introduction of REGN-COV2 monoclonal antibody into central vein, percutaneous approach, new technology group 6 |
| XW043H6 | Introduction of other new technology monoclonal antibody into central vein, percutaneous approach, new technology group 6 |
| XW043L6 | Introduction of CD24Fc immunomodulator into central vein, percutaneous approach, new technology group 6 |
| XW0DXM6 | Introduction of baricitinib into mouth and pharynx, external approach, new technology group 6 |
| XW0G7M6 | Introduction of baricitinib into upper GI, via natural or artificial opening, new technology group 6 |
| XW0H7M6 | Introduction of baricitinib into lower GI, via natural or artificial opening, new technology group 6 |
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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