ICD-10-CM Official Coding and Reporting Guidelines Updated for COVID-19

April 8th, 2020 - Wyn Staheli, Director of Research
Categories:   Diagnosis Coding   Covid-19  
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The ICD-10-CM Official Coding and Reporting Guidelines have just been updated to include COVID-19 reporting. Additional information beyond the previously released interim guidelines are included. These are the rules that should be followed for claims submission. The notice states that this is for April 1, 2020 through September 30, 2020. At which time, the usual October 1, 2020 update will take place.

In summary:

  • New Code Usage: Only use the new U07.1 code for confirmed cases — including patients that are not experiencing any symptoms. “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.”
  • Sequencing: Code U07.1 is a principal diagnosis and should be reported first on the claim unless this is an obstetric patient, in which case use a code from subcategory O98.5- “Other viral diseases complicating pregnancy, childbirth and the puerperium” first and then the U07.1 code. Any other manifestations/symptoms are reported after the principal diagnosis. They also noted that if the infection progresses to sepsis, “see Section I.C.1.d. Sepsis, Severe Sepsis, and Septic Shock.”
  • Exposure: “For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation”, use code Z03.818 “Encounter for observation for suspected exposure to other biological agents ruled out.” For actual exposure to someone “who is confirmed or suspected to have COVID-19, and the exposed individual either tests negative or the test results are unknown”, use code Z20.828 “Contact with and (suspected) exposure to other viral communicable diseases.”
  • Screening: For no known exposure and no symptoms, use code Z11.59 “Encounter for screening for other viral diseases”. For exposure or suspected exposure, see above.

Please see the link to the new guidelines in the References below for more complete information.

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