With COVID-19 rapidly spreading, you need to know when and how to code for it properly.
Assign the code U07.1 (COVID-19) for confirmed cases only. The CDC released ICD-10-CM Official Coding and Reporting Guidelines for the newly implemented code effective April 1, 2020, through Sept. 30, 2020.
“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,” guidelines state. The guidance for this code is located under Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99) guidelines, in a section titled “g. Coronavirus Infections.”
Presumptive Means Positive, But Wording Matters
Additionally, coding guidance states that you should code presumptive positive COVID-19 test results as confirmed. Presumptive positive means any patient who has tested positive for the virus at the state or local level, but has not yet been confirmed by the CDC.
For patients with documentation including terms such as “suspected,” “possible,” or “inconclusive,” guidelines state that you do not assign U07.1. Instead, assign the code or codes that explain the reason for the encounter (such as fever) or Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases).
As for sequencing of the codes, guidelines state that “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.”
More COVID-19 guidance:
- Asymptomatic individuals who test positive for COVID-19: Assign U07.1 for patients who are asymptomatic but test positive for COVID-19.
- Exposure: Assign Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out) for patients when there is possible exposure to COVID-19, but it’s ruled out following evaluation. Assign Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases) for a patient exposed to another person confirmed or suspected of having COVID-19 and the “exposed” individual either tests negative, or results are unknown.
- Screening: Assign Z11.59 (Encounter for screening for other viral diseases) for patients being screened for COVID-19, without known exposure, and with test results that are either negative or unknown. For patients being screened due to possible or actual exposure to COVID-19, refer to guideline d.
- Signs and symptoms but no definitive COVID-19 diagnosis: Assign the appropriate symptom codes such as R05 (Cough), R06.02 (Shortness of breath), or R50.9 (Fever, unspecified) for patients with any symptoms associated with COVID-19, but without a definitive diagnosis confirmed. Also assign Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases) for a patient with symptoms and with contact or exposure with someone with COVID-19, which is an exception to guideline [I.C.21.c.1].
To view the full guidelines, visit https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf.