CMS also released Medicare Severity Diagnosis-Related Group (MS-DRG) V39.1

The Centers for Disease Control and Prevention (CDC) released its April 1, 2022 diagnosis files on Dec. 23, 2021. The updated files include a Tabular Addendum, Index Addendum, Official Coding and Reporting Guidelines update, ICD-10-CM Order File, and List of Codes and Descriptions. The Tabular Addendum and Index Addendum include minor updates to the classification, in addition to the new diagnosis codes.

The April 1 new diagnosis codes include:

  • Z28.310 – Unvaccinated for COVID-19;
  • Z28.311 – Partially vaccinated for COVID-19; and
  • Z28.39 – Other under-immunized status.

These codes have coding instructions. There is a note for the codes in subcategory Z28.31, which notes that “these codes should not be used for individuals who are not eligible for the COVID-19 vaccines, as determined by the healthcare provider.” The inclusion terms for Z28.39 include delinquent immunization status and lapsed immunization schedule status.

None of the new ICD-10-CM codes are designated as major complication/condition (MCC) or complication/condition (CC) status. These codes will become effective April 1, 2022, along with the previously released seven ICD-10-PCS codes.

In addition to the diagnosis codes released, the Centers for Medicare & Medicaid Services (CMS) also released Medicare Severity Diagnosis-Related Group (MS-DRG) V39.1, which also becomes effective April 1, 2022. The grouper update was created to include the new diagnosis and procedure codes.

There is also an update to the Medicare Code Editor (MCE). A new edit for unspecified laterality has been created as well. The diagnosis codes that trigger the new MCE are listed in the FY22 Inpatient Prospective Payment System (IPPS) Final Rule, Table 6P.3a.

There were also updates to the National Coverage Determination for Artificial Heart and Related Devices, with three procedure codes being removed from the Noncovered Procedure List and Limited Coverage Procedure List. These procedures are the following:

  • 02RK0JZ (Replacement of right ventricle with synthetic substitute, open approach);
  • 02RL0JZ (Replacement of left ventricle with synthetic substitute, open approach); and
  • 02WA0JZ (Revision of synthetic substitute in heart, open approach).

The National Coverage Determination for Ventricular Assist Devices was also updated, with the removal of these procedure codes from the Noncovered Procedure List:

  • 02WA3QZ (Revision of implantable heart assist system in heart, percutaneous approach); and
  • 02WA4QZ (Revision of implantable heart assist system in heart, percutaneous endoscopic approach).

These two codes were removed from the Limited Coverage Procedure List for the Ventricular Assist Devices as well:

  • 02HA0QZ (Insertion of implantable heart assist system into heart, open approach); and
  • 02WA0QZ (Revision of implantable heart assist system in heart, open approach).

In addition to the grouper update, CMS has also publicized the process to request new procedure codes and MS-DRG changes. Currently, dedicated mailboxes are used to request changes.

At the Coordination and Maintenance Committee meeting in March 2022, the Medicare Electronic Application Request Information System (MEARIS), which is an electronic application system, will be introduced. This system will have a soft launch in January 2022. CMS also plans to have a discussion regarding the new system in the FY23 rulemaking process.

Programming Note:

Listen to Laurie Johnson and her coding report every Tuesday on Talk Ten Tuesdays, 10 Eastern.

Facebook
Twitter
LinkedIn

Laurie M. Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer

Laurie Johnson is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an AHIMA-approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and is a permanent panelist on Talk Ten Tuesdays

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.

December 3, 2025

Proactive Denial Management: Data-Driven Strategies to Prevent Revenue Loss

Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.

November 25, 2025
Sepsis: Bridging the Clinical Documentation and Coding Gap to Reduce Denials

Sepsis: Bridging the Clinical Documentation and Coding Gap to Reduce Denials

Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.

September 24, 2025

Trending News

Featured Webcasts

AI in Claims Auditing: Turning Compliance Risks into Defensible Systems

As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.

January 13, 2026
Surviving Federal Audits for Inpatient Rehab Facility Services

Surviving Federal Audits for Inpatient Rehab Facility Services

Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.

November 13, 2025
E/M Services Under Intensive Federal Scrutiny: Navigating Split/Shared, Incident-to & Critical Care Compliance in 2025-2026

E/M Services Under Intensive Federal Scrutiny: Navigating Split/Shared, Incident-to & Critical Care Compliance in 2025-2026

During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.

August 26, 2025

Trending News

Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more

Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24