Part B Insider (Multispecialty) Coding Alert

If a patient presents to your practice and is unvaccinated for COVID-19 — or even partially vaccinated — you’ll soon have a way to code that condition.

The Centers for Disease Control and Prevention (CDC) released a new ICD-10-CM code set effective April 1 for coding COVID-19 vaccination status, indicates CMS in an MLN Matters release (Change Request 12578) on Jan. 14.

The offerings include the subcategory code Z28.31 (Underimmunized for COVID-19 status) and three additional diagnosis options:

• Z28.310 (Unvaccinated for COVID-19)
• Z28.311 (Partially vaccinated for COVID-19)
• Z29.39 (Other underimmunized status)

Note: The CDC adds a note to the codes in Chapter 21 of the ICD-10-CM tabular list and addendum: “These codes should not be used for individuals who are not eligible for the COVID-19 vaccines, as determined by the healthcare provider.” Find more details at https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2022/icd10cm-tabular-addenda-2022-April-1.pdf.

Additionally, the ICD-10 guidelines also offer more clarity. “Underimmunization for COVID-19 Status Code Z28.310, Unvaccinated for COVID-19, may be assigned when the patient has not received at least one dose of any COVID-19 vaccine. Code Z28.311, Partially vaccinated for COVID-19, may be assigned when the patient has received at least one dose of a multi-dose COVID-19 vaccine regimen, but has not received the full set of doses necessary to meet the Centers for Disease Control and Prevention (CDC) definition of ‘fully vaccinated’ in place at the time of the encounter. For information, visit the CDC’s website https://www.cdc.gov/coronavirus/2019-ncov/vaccines/,” explain the guidelines.

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