Provider Alert! New COVID 19 Diagnosis Codes and Inpatient ICD-10-PCS Procedure Codes

Date: May 17, 2022

Attention: All Providers              

Effective date: April 1, 2022

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to appeal claims unless denied for other reasons.

Providers should direct questions to their Provider Relations Liaison or send an email inquiry to the Provider Relations Department at providerrelations@texaschildrens.org.

Call to action: Texas Children’s Health Plan would like to inform providers that effective for dates of service on or after April 1, 2022, in response to the COVID-19 public health emergency, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing three new diagnosis codes and the Centers for Medicare and Medicaid Services (CMS) is implementing nine new Procedure Coding System (PCS) inpatient hospital surgical procedure codes in the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM).

How this impacts providers: The following ICD-10 diagnosis codes will be added:

The following ICD-10-PCS inpatient hospital surgical procedure codes will be added and must be submitted only on inpatient hospital claims (as applicable):

These procedure codes are surgical codes used to assign the proper Diagnosis-Related Group (DRG) for an inpatient hospital stay and are processed as informational only.

Next steps for providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.