CMS released the 2021 ICD-10-CM Official Guidelines for Coding and Reporting on July 8, several weeks earlier than usual. The coding guidelines, which take effect October 1, 2020, include new instructions for reporting manifestations of the novel coronavirus (COVID-19), and a detailed review on those guidelines is listed out in this article.
The 2021 ICD-10 CM guidelines include a new section for COVID-19 that expands on the temporary coding guidelines posted in the month of April by the ICD-10-CM Coordination and Maintenance Committee. Coders should also note that the temporary guidelines will expire on September 30, 2020.
COVID-19 Infections (Infections due to SARS-CoV-2):
Code only confirmed cases:
Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) in the following circumstances:
- Documented by the provider
- Documentation of a positive COVID-19 test result
To code the confirmed diagnosis, assign code U07.1, COVID-19.
This is an exception to the hospital inpatient guideline Section II, H where the “confirmation” does not require documentation of a positive test result for COVID-19. Only the provider’s documentation that the individual has COVID-19 is sufficient to report U07.1, COVID-19.
If the provider documents “suspected,” “possible,” “probable,” or “inconclusive” COVID-19, do not assign code U07.1. Instead, code the signs and symptoms reported in the encounter.
Sequencing of codes:
When COVID-19 meets the definition of principal diagnosis, you need to assign the codes in the below sequencing:
Primary diagnosis: Assign code U07.1, COVID-19
Secondary diagnosis: Codes for the associated manifestations.
However, when any other guideline requires that certain codes be sequenced first, such as obstetrics, sepsis or transplant complications, then you need to assign the chapter specific codes as primary diagnosis followed by the code for COVID-19.
Example: COVID-19 infection in pregnancy, childbirth, and the puerperium
When COVID-19 is the reason for admission/encounter during pregnancy, childbirth or the puerperium, then assign the codes in the below sequencing:
Primary diagnosis: Assign code O98.5-, -, other viral diseases complicating pregnancy, childbirth and the puerperium.
Secondary diagnosis: Assign code U07.1, COVID-19 followed by the appropriate codes for associated manifestations.
(Codes from Chapter 15 always take sequencing priority.)
Acute respiratory manifestations of COVID-19:
If the reason for the encounter/admission is a respiratory manifestation of COVID-19, then you need to assign code U07.1, COVID-19 as the principal/first-listed diagnosis and codes for the respiratory manifestations as additional diagnoses.
The following conditions are examples of common respiratory manifestations of COVID-19:
For a patient with pneumonia confirmed as due to COVID-19, assign the below codes:
Primary diagnosis: U07.1, COVID-19,
Secondary diagnosis: J12.89, Other viral pneumonia.
For a patient with acute bronchitis confirmed as due to COVID-19, assign the below codes:
Primary diagnosis: U07.1, COVID-19
Secondary diagnosis: J20.8, Acute bronchitis due to other specified organisms.
Bronchitis not otherwise specified (NOS) due to COVID-19 should be coded using code U07.1 and J40, Bronchitis, not specified as acute or chronic.
Lower respiratory infection
If the COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, codes U07.1 and J22, Unspecified acute lower respiratory infection, should be assigned.
If the COVID-19 is documented as being associated with a respiratory infection, NOS, codes U07.1 and J98.8, Other specified respiratory disorders, should be assigned.
Acute respiratory distress syndrome:
For acute respiratory distress syndrome (ARDS) due to COVID-19, assign the below codes:
Primary diagnosis: U07.1, COVID-19
Secondary diagnosis: J80, Acute respiratory distress syndrome.
Acute respiratory failure:
For acute respiratory failure due to COVID-19, assign the below codes:
Primary code: U07.1, COVID-19
Secondary diagnosis: J96.0-, acute respiratory failure.
Non-respiratory manifestations of COVID-19:
This is a new subsection introduced in 2021 official coding guidelines and not covered in the existing guidelines for COVID-19 published in April by ICD-10 CM Coordination and Maintenance Committee. The existing temporary COVID-19 guidelines are set to expire on September 30, 2020.
If the reason for the encounter/admission is a non-respiratory manifestation (e.g., viral enteritis) of COVID-19, then you need to assign the below codes
Primary diagnosis: U07.1, COVID-19
Secondary diagnosis: Codes for the non-respiratory manifestation(s).
Exposure to COVID-19:
In the existing temporary set of COVID-19 coding guidelines, code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out, is reported for cases when there is a concern about a possible exposure to COVID-19, but ruled out after evaluation.
However in the newly released 2021 official coding guidelines, this code is not included in the exposure to covid-19 section. Below is a simple flowchart to assign the exposure codes based on the new coding guidelines.
For asymptomatic individuals with actual or suspected exposure to COVID-19, you need to assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.
For symptomatic individuals with actual or suspected exposure to COVID-19 and the infection has been ruled out, or test results are inconclusive or unknown, you need to assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.
For symptomatic individuals with actual or suspected exposure to COVID-19, if test results are positive and COVID-19 is confirmed, you need assign code U07.1
Screening for COVID-19:
During the COVID-19 pandemic, a screening code is generally not appropriate. For encounters for COVID-19 testing, including preoperative testing, you need to code it as “exposure to COVID-19” as discussed above.
Signs and symptoms without definitive diagnosis of COVID-19:
For patients presenting with any signs/symptoms associated with COVID-19 (such as fever, etc.) but a definitive diagnosis has not been established, you need to assign the appropriate code(s) for each of the presenting signs and symptoms such as:
• R05 Cough
• R06.02 Shortness of breath
• R50.9 Fever, unspecified
Also if the patient with signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to COVID-19, you need to assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, as an additional code.
Asymptomatic individuals who test positive for COVID-19:
For asymptomatic individuals who test positive for COVID-19, you need to assign code U07.1, COVID-19. Although the individual is asymptomatic, the individual has tested positive and is considered to have the COVID-19 infection.
Personal history of COVID-19: – Z86.19
For patients with a history of COVID-19, assign code Z86.19, Personal history of other infectious and parasitic diseases.
Follow-up visits after COVID-19 infection has resolved:
For individuals who previously had COVID-19 and are being seen for follow-up evaluation and if the COVID-19 test results are negative, then you need to assign the below codes:
- Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm,
- Z86.19, Personal history of other infectious and parasitic diseases.
Encounter for antibody testing:
For an encounter for antibody testing that is not being performed to confirm a current COVID-19 infection, nor is a follow-up test after resolution of COVID-19, assign Z01.84, Encounter for antibody response examination.
Happy learning! Happy coding!