CMS Releases Update to PDPM Grouper

January 18, 2021

In early January, CMS released an update to the PDPM Grouper and an updated PDPM ICD-10-CM Codes for I0020B file (dated 1-01-2021). This update added new diagnoses since the Oct. 1, 2020, ICD-10-CM update and added ICD-10-CM codes that were inadvertently excluded from the non-therapy ancillary (NTA) PDPM component calculation.

New diagnosis codes added:

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

NTA diagnoses added (inadvertently excluded in the V1.006):

• T8484XA – Pain due to internal orthopedic prosthetic devices, implants and grafts, initial encounter
• T8389XA – Other specified complication of genitourinary prosthetic devices, implants and grafts, initial encounter
• T8321XA – Breakdown (mechanical) of graft of urinary organ, initial encounter
• T82399A – Other mechanical complication of unspecified vascular grafts, initial encounter
• T82392A – Other mechanical complication of femoral arterial graft (bypass), initial encounter
• T83021A – Displacement of cystostomy catheter, initial encounter

Source: aanac.org