As of now, we are in the second phase of the global pandemic and we have come across many coding updates and changes on Covid-19. ICD-10-CM codes are one of a kind. It needs complete attention while applying to Covid-19. As the pandemic involves various mutants as well as symptoms, the diagnosis and procedures will be based on the same. So, the coding also must be according to it.
Verify the ICD-10-CM codes for Covid-19 and choose to give the accurate one to avoid less confusion. These codes are new to the professionals and therefore would require many answers for unaddressed questions. In this article let’s focus on various frequently asked questions on ICD-10-CM codes for Covid-19.
What is the ICD-10-CM code for COVID-19?
- ICD-10-CM code U07.1, COVID-19, may be used for discharges or date of service on or after April 1, 2020. The code was developed by the World Health Organization (WHO) and is intended to be sequenced first followed by the appropriate codes for associated manifestations when COVID-19 meets the definition of principal or first-listed diagnosis.
Is the new ICD-10-CM code U07.1, COVID-19 a secondary code?
- If COVID-19 meets the definition of principal or first-listed 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. However, if COVID-19 does not meet the definition of principal or first-listed diagnosis, then code U07.1 must be used as a secondary diagnosis.
Are there additional new codes to identify other situations specific to COVID-19?
- The Centers for Disease Control and Prevention’s National Center for Health Statistics, the US agency is responsible for maintaining ICD-10-CM in the US. They have implemented several new ICD-10-CM codes pertaining to COVID-19 on January 1, 2021.
It has been told that the World Health Organization (WHO) has approved an emergency ICD-10 code of “U07.2 COVID-19, virus not identified.”
- The HIPAA code set standard for diagnosis coding in the US is ICD-10-CM, not ICD-10. As of April 1, 2020, the only new code that has been implemented in the US for COVID-19 is U07.1.
Is the ICD-10-CM code U07.1, COVID-19 retroactive to cases diagnosed before April 1, 2020?
- No, the code is not retroactive. It’s advised to refer to ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak for guidance for coding of discharges/services provided before April 1, 2020.
Is code B97.29, Other coronavirus as the cause of diseases classified elsewhere, limited to the COVID-19 virus?
- No, code B97.29 is not exclusive to the SARS-CoV-2/2019-nCoV virus responsible for the COVID-19 pandemic. The code does not distinguish more than 30 varieties of coronavirus, some of which are responsible for the common cold. Due to the heightened need to uniquely identify COVID-19 until the unique ICD-10-CM code was effective from April 1, providers were urged to consider developing facility-specific coding guidelines that limit the assignment of code B97.29 to confirmed COVID-19 cases and preclude the assignment of codes for any other coronavirus.
What is the difference between ICD-10-CM codes B34.2 & B97.29?
- Diagnosis code B34.2, Coronavirus infection, unspecified, would in general not be appropriate for the COVID-19. It is because the cases have universally been respiration related. So the site of infection would not be “unspecified.” Code B97.29, other coronavirus as the cause of diseases classified elsewhere has been designated as interim code to report confirmed cases of COVID-19.
Should presumptive positive COVID-19 test results be coded as confirmed?
- Of course, yes. 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 the COVID-19 virus is no longer required.
How should we handle cases related to COVID-19 when the test results aren’t back yet?
- Due to the enormous requirement to capture accurate data on positive COVID-19 cases, healthcare professionals are recommended to consider developing facility-specific coding guidelines to hold back coding of inpatient admissions and outpatient encounters until the test results for COVID-19 testing are available. This advice is limited to cases related to COVID-19.
Based on the recently released guidelines for COVID-19 infections, does the healthcare provider need to link the results of the COVID-19 test to the respiratory condition as the cause of the respiratory illness to code it as a confirmed diagnosis of COVID-19?
- No, the provider does not need to explicitly link the test result to the respiratory condition. The positive test results can be coded as confirmed COVID-19 cases as long as the test result itself is part of the medical record. As stated in the guidelines, infections that went into effect on April 1, code U07.1 may be assigned based on results of a positive test as well as when COVID-19 is documented by the provider. But this advice is limited to cases related to COVID-19 and not the coding of other laboratory tests.
Please provide guidance on correct coding when the provider has documented COVID-19 as a definitive diagnosis before the test results are available, and the test results come back negative.
- Medical coding professionals must put forward a query to the healthcare professional if the provider documented COVID-19 before the test results were back and the test results come back negative. Healthcare providers should be given the opportunity to reconsider the diagnosis based on the new information.
How should an encounter for COVID-19 antibody testing be coded?
- For an encounter for antibody testing that is neither being performed to confirm a current COVID-19 infection, nor is being performed as a follow-up test after resolution of COVID-19, assign Z01.84, encounter for antibody response examination.
For a patient who has HIV/AIDS and is diagnosed with COVID-19, the guidelines don’t assume a relationship between COVID-19 and HIV. So does the provider need to link the two conditions for coding?
- Any immune-compromised patient including the patients with HIV is at higher risk of getting infected with COVID-19. But HIV does not cause COVID-19. Code both conditions separately, with sequencing depending on the circumstances of admission, just like a patient suffering from diabetes or any other chronic condition that puts them at higher risk for the COVID-19 infection.
Coding with accuracy is extremely significant. As seen in the article, various situations need to be coded as per the disease and diagnosis. Outsourcing companies would find it even easier to help professionals with medical coding business.
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