Are You Keeping up with the Official ICD-10-CM Guideline Changes for COVID-19?

October 25th, 2021 - Wyn Staheli, Director of Research
Categories:   Billing   Documentation Guidelines  

Gone are the simpler times when we only had to worry about diagnosis code guideline changes once a year in October. The COVID-19 public health emergency (PHE) has made it interesting and challenging for organizations to keep an eye on the evolving changes to the ICD-10-CM Official Guidelines for Coding and Reporting. For the purposes of this article, we will only be covering the changes related to COVID. There were other changes but they are not discussed in this article.

Tip: makes it easy to review the official ICD-10-CM guidelines at the code level. Just go to the code and click on [ICD-10-CM Official Guidelines] to see the applicable instructions.

January 2021 Updated ICD-10-CM Guidelines

In case you missed it, there were some updates in relation to COVID-19 that became effective January 1, 2021. It should be noted that the official document states that it’s for October 1, 2020 - September 30, 2021 so these changes (as noted below in green) are retroactive. Section 1.C.1.g. is quite extensive so be sure to review that entire section when reporting COVID cases. 

Note: Changes to the official guidelines are in green text.

1) COVID-19 infection (infection due to SARS-CoV-2)

(f) Screening for COVID-19

During the COVID-19 pandemic, a screening code is generally not appropriate. Do not assign code Z11.52, Encounter for screening for COVID-19. For encounters for COVID-19 testing, including preoperative testing, code as exposure to COVID-19 (guideline I.C.1.g.1.e). Coding guidance will be updated as new information concerning any changes in the pandemic status becomes available.

(l) Multisystem Inflammatory Syndrome

For individuals with multisystem inflammatory syndrome (MIS) and COVID-19, assign code U07.1, COVID-19, as the principal/first-listed diagnosis and assign code M35.81, Multisystem inflammatory syndrome, as an additional diagnosis.

If MIS develops as a result of a previous COVID-19 infection, assign codes M35.81, Multisystem inflammatory syndrome, and B94.8, Sequelae of other specified infectious and parasitic diseases.

If an individual with a history of COVID-19 develops MIS and the provider does not indicate the MIS is due to the previous COVID-19 infection, assign codes M35.81, Multisystem inflammatory syndrome, and Z86.16, Personal history of COVID-19.

If an individual with a known or suspected exposure to COVID-19, and no current COVID-19 infection or history of COVID-19, develops MIS, assign codes M35.81, Multisystem inflammatory syndrome, and Z20.822, Contact with and (suspected) exposure to COVID-19.

Additional codes should be assigned for any associated complications of MIS.

— Section 1.C.1.g. Coronavirus infections

October 1, 2021 ICD-10-CM Guideline Updates

Several other guideline changes were made as of October 1, 2021. To view each individual change, it is recommended that you go to the official guidelines (click here) and do a search (Ctrl +F) on the word “covid”. 

The following are SOME of these changes:

(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 when another guideline requires that certain codes be sequenced first, such as obstetrics, sepsis, or transplant complications.

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 infection in pregnancy, childbirth, and the puerperium

See Section I.C.16.h. for COVID-19 infection in newborn

For a COVID-19 infection in a lung transplant patient, see Section I.C.19.g.3.a. Transplant complications other than kidney.

(j) Follow-up visits after COVID-19 infection has resolved

For individuals who previously had COVID-19, without residual symptom(s) or condition(s), and are being seen for follow-up evaluation, and COVID-19 test results are negative, assign codes Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, and Z86.16, Personal history of COVID-19.

For follow-up visits for individuals with symptom(s) or condition(s) related to a previous COVID-19 infection, see guideline I.C.1.g.1.m.

See Section I.C.21.c.8, Factors influencing health states and contact with health services, Follow-up

Also of note are the specific guidelines describing the use of the new post-covid infection code U09.9:

(m) Post COVID-19 Condition

For sequela of COVID-19, or associated symptoms or conditions that develop following a previous COVID-19 infection, assign a code(s) for the specific symptom(s) or condition(s) related to the previous COVID-19 infection, if known, and code U09.9, Post COVID-19 condition, unspecified.

Code U09.9 should not be assigned for manifestations of an active (current) COVID-19 infection.

If a patient has a condition(s) associated with a previous COVID-19 infection and develops a new active (current) COVID-19 infection, code U09.9 may be assigned in conjunction with code U07.1, COVID-19, to identify that the patient also has a condition(s) associated with a previous COVID-19 infection. Code(s) for the specific condition(s) associated with the previous COVID-19 infection and code(s) for manifestation(s) of the new active (current) COVID-19 infection should also be assigned.

Tip: For comprehensive information about the COVID guideline changes including details about proper sequencing we recommend viewing our October 7 : 2021 ICD-10-CM Guideline and Code Changes webinar (available with a Find-A-Code Professional or Facility subscription).


Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

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