This past year has been one for the record books with the ever-evolving changes surrounding COVID-19. ICD-10-CM ushered in new reporting guidelines taking effect October 1, 2020 and it is no surprise there were changes on reporting COVID-19. Some of these changes clarify reporting confirmed cases, manifestations of COVID-19, follow-up visits once infection has resolved, personal history of COVID-19, screening for asymptomatic patients, and antibody testing.
We have prepared coding examples to help you understand these guideline changes.
- Confirmed diagnosis with positive test – U07.1 “COVID-19.”
- When COVID-19 meets the definition of principal diagnosis, code U07.1 should be sequenced first, followed by associated manifestations, except when another guideline requires that certain codes be sequenced first. See guideline I.C.1.g.1.a
- Asymptomatic individuals who test positive for COVID-19, code U07.1.
- *If the provider documents “suspected”, “possible”, “probable” or “inconclusive” – code signs and/or symptoms* assign the signs and symptoms reported. See guideline I.C.1.g.1.g.
- Hospital inpatient exception – confirmation does not require documentation of a positive test result for COVID-19; the provider’s documentation that the patient has COVID-19 is sufficient to code U07.1. Reference: 2021 ICD-10-CM Official Coding Guidelines, section II H.
Exposure to COVID-19 – Guideline I.C.1.g.1.e
- Asymptomatic person with actual or suspected exposure – Z20.828 “Contact with and (suspected) exposure to other viral communicable diseases.”
- If infection is ruled out or test inconclusive/unknown, assign Z20.828.
Code as exposure Z20.828 “Contact with and (suspected) exposure to other viral communicable diseases.”
- Encounters for testing including preoperative testing also code as exposure Z20.828.
Signs and Symptoms Without Definitive Diagnosis of COVID-19 Guideline I.C.1.g.1.g/
- Patient presenting with any sign or symptom associated with COVID-19 (fever, cough, shortness of breath etc.) but a definitive diagnosis is not established, assign appropriate code(s) for each sign and/or symptom.
- If the patient has had suspected contact with or exposure to COVID-19, assign Z20.828 as an additional code.
Respiratory Association-Guideline I.C.1.g.1.c
- Acute respiratory manifestations – When admission/encounter is for Respiratory Associated COVID-19 diagnosis, assign U07.1 as principal diagnosis. Assign code(s) for the respiratory manifestation(s) as additional diagnoses.
- Pneumonia- confirmed as due to COVID-19, assign U07.1 and J12.89 “other viral pneumonia” as secondary.
- Acute Bronchitis- confirmed as due to COVID-19, assign U07.1 and J20.8 “Acute Bronchitis due to other specified organism” as secondary.
- Bronchitis, NOS – confirmed due to COVID-19, assign U07.1 and J40 as secondary.
- Lower Respiratory Infection, NOS or Acute respiratory infection, NOS) – code U07.1 as primary and J22 “unspecified acute lower respiratory infection” as secondary.
- Respiratory Infection, NOS – COVID-19 documented as being associated w/ a respiratory infection, NOS, code U07.1 as primary and J98.8 “other specified respiratory disorders” as secondary.
- Acute respiratory distress syndrome – (ARDS) due to COVID-19 assign U07.1 as primary, and J80 “acute respiratory distress syndrome” as secondary.
- Acute Respiratory Failure- due to COVID assign U07.1 as primary, and J96.0-, “Acute respiratory failure” (additional 5th digit required) as secondary.
Non-Respiratory Manifestations of COVID-19- Guideline I.C.1.g.1.d
- When reason for encounter/admission is a non-respiratory manifestation (e.g. viral enteritis) code U07.1 as principal diagnosis and assign code(s) for manifestation(s) as additional diagnosis(es).
History of COVID-19 -Guideline I.C.1.g.1.i/I.C.1.g.1.j
- Follow up visit after COVID-19 treatment is completed/resolved, assign Z09 “encounter for follow up” and Z86.19 “Personal history of other infectious and parasitic diseases.”
Antibody Testing -Guideline I.C.i.g.i.k
- Assign Z01.84 “Encounter for antibody response examination.”
Patient with a history of recent COVID-19 positive diagnosis 8/21/20, who was admitted for acute hypoxic respiratory failure due to COVID pneumonia.
#1 Acute Hypoxic Respiratory Failure
#2 COVID Pneumonia
With CXR concerning of viral pneumonia with bilateral infiltrates, positive COVID test and worsening oxygen requirements, likely patient has developed COVID pneumonia. Will initiate remdesivir and continue dexamethasone. Continue isolating precautions.
ICD-10-CM Codes: U07.1, J12.89, J96.01
Patient with recent COVID-19 exposure at workplace, currently asymptomatic.
#1 COVID-19 exposure
COVID test pending. Continue isolating precautions until results return.
ICD-10-CM Code: Z02.828
Patient with fever of 101 F and cough, presents for possible COVID-19 infection.
COVID test pending. Continue isolating precautions until results are back.
ICD-10-CM Codes: R50.9, R05