Pediatric Coding Alert

Question: The news is full of stories about COVID-19 vaccinations now becoming available, but have codes been assigned yet? And are there other COVID-19 coding developments we should know about?

Michigan Subscriber

Answer: Here are the most recently assigned COVID-19 vaccination, treatment, and diagnosis codes. The information is accurate at the time of going to press, but we encourage you to monitor the various organization websites for updates.

CPT^® Changes

Vaccines: The AMA has now released three codes for vaccines:

• 91300 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use) for use with the Pfizer vaccine.
• 91301 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use) for use with the Moderna vaccine.
• 91302 (Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use) for use with the AstraZeneca vaccine.

You are instructed not to use current vaccine administration codes 90460/+90461 (Immunization administration through 18 years of age via any route of administration, with counseling …) or 90471/+90472 (Immunization administration …) with any of these codes unless a COVID-19 vaccine/toxoid product “and at least one vaccine/toxoid product from 90476-90749 are administered at the same encounter.” Instead, you will use:

• 0001A (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]) vaccine … first dose) and 0002A (… second dose) with 91300.
• 0011A (… first dose) and 0012A (… second dose) with 91301.
• 0021A (… first dose) and 0022A (… second dose) with 91302.

The Pfizer codes (91300, 0001A, 0002A) became effective on Dec. 11, 2020. The other vaccine and administration codes will become “effective upon receiving emergency use authorization or approval from the Food and Drug Administration,” according to the AMA.

(Source: www.ama-assn.org/system/files/2020-11/covid-19-immunizations-appendix-q-table.pdf).

Treatments: The AMA has assigned codes Q0239 (Injection, bamlanivimab, 700 mg) and Q0243 (Injection, casirivimab and imdevimab, 2400 mg), along with codes M0239 (Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring) and M0243 (Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring) for their administration and monitoring. The treatments are for “mild to moderate COVID-19 in adults and pediatric patients (12 years of age or older weighing at least 40 kilograms [about 88 pounds]),” according to the FDA. All codes are currently effective.

(Source: www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies).

ICD-10 Changes

On Dec. 3, 2020, the Centers for Disease Control and Prevention (CDC) announced the introduction of six new COVID-19-related ICD-10 codes, effective Jan. 1, 2021. Three of them were new encounter codes:

• 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)

The addition of Z20.822 means that you will no longer need to use Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases) if your provider documents an encounter with a patient who may have come into contact with the COVID virus. Additionally, Z11.52 now replaces Z11.59 (Encounter for screening for other viral diseases), which previous CDC guidelines said should be used for an asymptomatic patient with no known exposure when test results are either negative or unknown.

The CDC also introduced three new codes “to identify conditions resulting from COVID-19.” They are:

• J12.82 (Pneumonia due to coronavirus disease 2019)
• M35.81 (Multisystem inflammatory syndrome (MIS))
• M35.89 (Other specified systemic involvement of connective tissue)

Coding alert: J12.82 is a combination code that replaces the CDC’s previous instruction to code pneumonia confirmed due to COVID-19 with U07.1 (COVID-19) and J12.89 (Other viral pneumonia).

(Source: www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-19-508.pdf).