ICD-10-CM Coding for COVID-19 (Updated Aug 3, 2020)
Post written by Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA Approved ICD-10- CM/PCS Trainer.
Updated on August 3, 2020
With our nation and the world continuing to be in a stressful and unique situation due to the COVID-19 pandemic and a state of Public Health Emergency (PHE) here in our homeland, we all are looking for information, facts, and details about this disease. For Health Information Management (HIM) Coding and Clinical Documentation Improvement/Integrity (CDI) professionals this is time of great attention to documentation specifics as well as staying current with clinical knowledge and clinical coding guidance and information.
The “COVID-19” virus, so named by the World Health Organization (WHO) in early February 2020, began in the country of China in mid-November 2019. The “2019 Novel Coronavirus” as it was called at that time, was spreading fast across communities and countries. Primary symptoms are fever, cough, shortness of breath and fatigue. Although this infection starts out similar to the flu, it evolves into a more serious lung infection, often leading to pneumonia and hospitalization, especially for those patients with chronic conditions and/or comorbidities (i.e., Heart Disease, Lung Disease, Diabetes, Suppressed Immune system). Additional clinical complications can occur with this lung infection such as acute respiratory disorder, respiratory failure, acute myocardial infarction, sepsis, and even septic shock. Serious patients often require mechanical ventilator support to survive, and for those inpatient hospital services, we would assign ventilator codes from ICD-10-PCS.
The confirmed COVID-19 infections can cause a range of signs and symptoms, from little to no symptoms at all, to those affected being severely ill and some even die rather quickly. Some patients can be treated as an outpatient while others will need to be hospitalized and could need to be in the intensive care unit (ICU).
As mentioned above, the primary symptoms can include fever, cough, fatigue, and shortness of breath. However, the CDC has added to the list of primary symptoms which now includes the following:
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
(Per the CDC, this list does not include all possible symptoms.)
Symptoms may appear from 2 to 14 days after exposure, based on the incubation period for other coronaviruses, such as the MERS (Middle East Respiratory Syndrome) viruses. https://www.cdc.gov/ coronavirus/2019-ncov/about/symptoms.html
There current are two (2) kinds of tests are available for COVID-19: viral tests and antibody tests.
A viral test tells you if you have a current infection.
An antibody test might tell you if you had a past infection. An antibody test might not show if you have a current infection because it can take 1–3 weeks after infection for your body to make antibodies. Having antibodies to the virus that causes COVID-19 might provide protection from getting infected with the virus again. If it does, we do not know how much protection the antibodies might provide or how long this protection might last.
Because the coding guidelines and instructions have recently been changed during this year, we need to look first at encounters prior to April 1st, 2020. Prior to that date the published guidance from the Centers for Disease Control (CDC) should be followed. Here are some key COVID-19 scenario’s that provide direction on the clinical coding of encounter prior to 4/1/2020:
Pneumonia (prior to 4/1/2020): For a pneumonia case confirmed as due to the COVID-19, assign codes J12.89, Other viral pneumonia, and B97.29, Other coronavirus as the cause of diseases classified elsewhere.
Acute Bronchitis (prior to 4/1/2020): For a patient with acute bronchitis confirmed as due to COVID-19, assign codes J20.8, Acute bronchitis due to other specified organisms, and B97.29, Other coronavirus as the cause of diseases classified elsewhere. Bronchitis not otherwise specified (NOS) due to the COVID-19 should be coded using code J40, Bronchitis, not specified as acute or chronic; along with code B97.29, Other coronavirus as the cause of diseases classified elsewhere.
Visit the website via this link at the CDC: https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf; https://www.cdc.gov/nchs/covid19/coding-and-reporting.htm
For encounters on or after April 1, 2020 the following coding guidance should be followed in accordance with the update to the Official Guidelines for Coding and Reporting, go to the following website to download your copy: https://www.cdc.gov/nchs/icd/icd10cm.htm
Additions to ICD-10-CM Chapter 1 Certain Infectious and Parasitic Diseases (A00-B99) and Chapter 15 Pregnancy, Childbirth, and the Puerperium (O00-O9A) were released 4/1/2020. The following is a portion of the guidelines, the full content should/must be reviewed carefully:
Chapter 1 A00-B99
g. Coronavirus Infections
1) COVID-19 Infections (Infections due to SARS-CoV-2)
a) Code only confirmed cases. Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider, documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result. For a confirmed diagnosis, assign code U07.1, COVID-19. This is an exception to the hospital inpatient guideline Section II, H. In this context, “confirmation” does not require documentation of the type of test performed; the provider’s documentation that the individual has COVID-19 is sufficient.
Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or state level, but it has not yet been confirmed by the Centers for Disease Control and Prevention (CDC). CDC confirmation of local and state tests for COVID-19 is no longer required.
If the provider documents "suspected," "possible," "probable," or “inconclusive” COVID19, do not assign code U07.1. Assign a code(s) explaining the reason for encounter (such as fever) or Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.
b) Sequencing of codes. 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 in the case of obstetrics patients as indicated in Section . I.C.15.s. for COVID-19 in pregnancy, childbirth, and the puerperium.
For a COVID-19 infection that progresses to sepsis, see Section I.C.1.d. Sepsis, Severe Sepsis, and Septic Shock
See Section I.C.15.s. for COVID-19 in pregnancy, childbirth, and the puerperium
c) Acute respiratory illness due to COVID-19
(i) Pneumonia. For a pneumonia case confirmed as due to the 2019 novel coronavirus (COVID-19), assign codes U07.1, COVID-19, and J12.89, Other viral pneumonia.
(ii) Acute bronchitis. For a patient with acute bronchitis confirmed as due to COVID-19, assign codes U07.1, and 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.
(iii) 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.
Note that for FY2021, the Official Guidelines for Coding and Reporting has added guidance for coding of COVID-19. These guidelines are similar to the ones released for encounters 4/1/2020 and after and should be reviewed thoroughly.
The American Hospital Association and AHIMA have partnered to produce and release a “COVID-10 FAQ”, which is immensely helpful. This document is being updated regularly, so it is important to check every few weeks on any updates. Go to: https://www.aha.org/fact-sheets/2020-03-30-frequently-asked-questions-regarding-icd-10-cm-coding-covid-19
Here are three examples from the Questions and Answers that have been posted:
Q: If a patient has both aspiration pneumonia and pneumonia due to COVID-19, may code J12.89, Other viral pneumonia, be assigned with code J69.0, Pneumonitis due to inhalation of food and vomit? There is an Excludes1 note at category J12, Viral pneumonia, not elsewhere classified, that excludes pneumonia not otherwise specified (J69.0). (posted 4/28/2020)
A: Yes, both codes may be assigned, as aspiration pneumonia and pneumonia due to COVID-19 are two separate unrelated conditions with different underlying causes. This meets the exception to the Excludes1 guideline as a circumstance when the two conditions are unrelated to each other.
Q: How should we code neonates/newborns that test positive for COVID-19? (posted 5/26/2020)
A: When coding the birth episode in a newborn record, the appropriate code from category Z38, Liveborn infants according to place of birth and type of delivery, should be assigned as the principal diagnosis. For a newborn that tests positive for COVID-19, assign code U07.1, COVID-19, and the appropriate codes for associated manifestation(s) in neonates/newborns in the absence of documentation indicating a specific type of transmission. For a newborn that tests positive for COVID-19 and the provider documents the condition was contracted in utero or during the birth process, assign codes P35.8, Other congenital viral diseases, and U07.1, COVID-19.
Q: A patient was diagnosed with "Guillian-Barre Syndrome which is likely a Para infectious complication of recent COVID-19 infection." The patient no longer has COVID-19. How should this be coded? (posted 7/22/2020)
A: Assign code G61.0, Guillain-Barre syndrome, as the principal diagnosis, followed by code B94.8, Sequelae of other specified infectious and parasitic diseases.
In addition to the resources and websites mentioned above it also critical for HIM Coding and CDI professionals to obtain and read the AHA Coding Clinic on ICD-10-CM. This publication is obtained through a subscription and is published quarterly. The second quarter issue for 2020 does contain a section regarding the coding of COVID-19, so this is another required resource for coding accuracy and compliance.
These remain challenging times for healthcare. We are all in this together. We MUST stay informed, watch the encounter, or discharge date in order to apply the appropriate guidelines. The COVID coded data is extremely valuable for the infectious disease, epidemiologist and researchers who will have this data to help in moving the crisis to a state of “normalcy” while addressing and improving patient care.
References: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html; https://www.cdc.gov/nchs/covid19/coding-and-reporting.htm; https://www.aha.org/fact-sheets/2020-03-30-frequently-asked-questions-regarding-icd-10-cm-coding-covid-19