Healthcare Professionals
Coding and Insurance Reporting Guidelines
COVID-19 ICD 10 Coding and Insurance Reporting Guidelines 2022
Based on current COVID-19 trends, the Department of Health and Human Services (HHS) is planning for the federal Public Health Emergency (PHE) for COVID-19, declared under Section 319 of the Public Health Service (PHS) Act, to expire at the end of the day on May 11, 2023
2022 ICD-10-CM Code Update Announced
2022 ICD-10-CM code updates were made publicly available by the Center for Disease Control and Prevention (CDC) on Dec. 1, 2021. Diagnosis codes of interest to laboratory and pathology practices includes the addition of three new codes for documenting immunization status effective for dates of service on or after April 1, 2022:
- Z28.310-Unvaccinated for COVID-19 (Use this code when the patient has not received at least one dose of any COVID-19 vaccine. Effective for dates of service on or after April 1, 2022.)
- Z28.311-Partially vaccinated for COVID-19 (Use this code 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 CDC definition of “fully vaccinated” in place at the time of encounter. Effective for dates of service on or after April 1, 2022.)
- Z28.39-Other under immunization status (Use this code for delinquent or lapsed immunization status. Effective for dates of service on or after April 1, 2022.)
Professional and Facility Providers
- COVID Screening Tests (Z11.52 and Z11.59)
As a reminder, during the national Public Health Emergency (PHE) and consistent with the Centers for Disease Control and Prevention (CDC) guidelines, Capital Blue Cross health plans will cover the cost of a COVID-19 diagnostic test without applying member cost share (such as deductibles, copays, and coinsurance) if performed as a result of an individualized clinical assessment, such as a test ordered by a provider or when a provider refers the member for a test. However, Capital will not provide coverage of testing for public health surveillance or employment purposes.
Effective July 1, 2022, claims submitted with a COVID testing procedure code with a diagnosis code indicative of encounter for screening for other viral diseases (Z11.52 and Z11.59) will deny as not covered.
Administrative Notice AN2022-06-002 (capbluecross.com)