Updated 1/8 -CMS PDPM Grouper Updates completed & New COVID related Dx effective: 1/1/2021


In follow up to our earlier notice of the 6 new COVID related diagnosis, CMS has now completed and posted an update to the PDPM Grouper including these new codes for use with assessments on or after 1/1/2021. This latest version (V1.0009) can be downloaded in the ZIP file marked PDPM_V1.0009_Package and the second ZIP file marked PDPM_ICD_Codes_for_I0020B_01-01-2021.

Please note: M35.81 (Multisystem Inflammatory Syndrome) and M35.89 (Other specified systemic involvement of connective tissue) replace code M35.8 (Other specified systemic involvement of connective tissue), which should no longer be used on assessments with target date on or after January 1, 2021.


CMS 2021 COVID related ICD-10 updates and link to FY 2021 ICD-10 Guide included below:


6 New Diagnosis Codes Eff 1/1/2021 include:

  • J12.82--Pneumonia due to COVID-19

  • M35.81--Multisystem Inflammatory Syndrome

  • M35.890--Other specified systemic involvement of connective tissue

  • Z11.52--Encounter for screening for COVID-19---Per ICD-10-CM coding guidelines, this code should NOT be used during the pandemic.

  • Z20.822--Contact with and suspected exposure to COVID-19

  • Z86.16--Personal History of COVID-19

Sequencing and Primary Code Assignment surrounding COVID:

"When COVID-19 meets the definition of principal diagnosis, code U07.1, COVID-19, should be sequenced first, followed by the appropriate codes for associated manifestations, except when another guideline requires that certain codes be sequenced first, such as obstetrics, sepsis, or transplant complications.

Acute respiratory manifestations of COVID-19

When the reason for the encounter/admission is a respiratory manifestation of COVID-19, assign code U07.1, COVID-19, as the principal/first-listed diagnosis and assign code(s) for the respiratory manifestation(s) as additional diagnoses.”

Let's Get to the Point:

Please collaborate with your interdisciplinary team to ensure diagnoses are coded correctly, the resident’s needs are appropriately care planned, and the bill is submitted accurately.
Let us know if our QRM reimbursement team members can be of assistance.