CDC Releases Updated Coding & Reporting Guidelines For Code U07.1, COVID-19, Effective April 1 Through September 30
The COVID-19 Coding Guidelines Webinar provides an overview of the Official Coding and Reporting Guidelines applicable for COVID-19 infections effective April 1, as well as instructions on how to assign codes for given scenarios involving patient encounters related to COVID-19 infection. See more here.
The Novel Coronavirus Disease, COVID-19, was declared a pandemic by the World Health Organization (WHO) on March 11, 2020, and the outbreak was announced as a national emergency in the United States on March 13, 2020 (CDC/NCHS, 2020). These developments resulted in an unprecedented off-cycle update to the coding system and an exception to the process mandated by HIPAA.
Because of the seriousness and the urgent need to capture the reporting of this condition in the U.S. during claims processing and in the analysis of surveillance data, the Centers for Disease Control (CDC), announced an accelerated effective date of new diagnosis code U07.1, COVID-19, from October 1, 2020, to April 1, 2020.
Read the complete CDC announcement here. Our previous article, “Update: New ICD-10 Code For COVID-19 Effective April 1,” explores the decision in more detail.
ICD-10-CM Addenda Changes for April 1, 2020
The complete Index Addenda is posted to the CDC/NCHS website, including the Tabular and Index changes (CDC/NCHS, 2020).
The Tabular notes appearing with the U07.1 code provide instructions to use additional codes to identify pneumonia or other manifestations. This provides the sequencing instructions needed in coding these conditions.
ICD-10-CM Official Coding and Reporting Guidelines
Previously the CDC/NCHS provided the ICD-10-CM Official Coding Guideline Supplement for 2019 Novel Coronavirus (COVID-19) coding, effective February 20, 2020. With the confirmation that the U07.1 code is implemented April 1, 2020, additions to the Official Coding and Reporting Guidelines were released to accompany the new code. These Guidelines appear in the Chapter 1 guidelines for Infectious Disease, and Chapter 15 for Pregnancy, Childbirth and the Puerperium, and are included in this article. The Official Coding and Reporting Guidelines are effective April 1, 2020, through September 30, 2020 (CDC/NCHS, 2020).
1. Chapter 1: Certain Infectious and Parasitic Diseases (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” COVID-19, 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
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.
(iv) Acute respiratory distress syndrome
For acute respiratory distress syndrome (ARDS) due to COVID-19, assign codes U07.1, and J80, Acute respiratory distress syndrome.
d) Exposure to COVID-19
For cases where there is a concern about possible exposure to COVID-19, but this is ruled out after evaluation, assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.
For cases where there is an actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. If the exposed individual tests positive for the COVID-19 virus, see guideline a).
e) Screening for COVID-19
For asymptomatic individuals who are being screened for COVID-19 and have no known exposure to the virus, and the test results are either unknown or negative, assign code Z11.59, Encounter for screening for other viral diseases. For individuals who are being screened due to possible or actual exposure to COVID-19, see guideline d).
If an asymptomatic individual is screened for COVID-19 and tests positive, see guideline g).
f) Signs and symptoms without definitive diagnosis of COVID-19
For patients presenting with any signs/symptoms associated with COVID-19 (such as fever, etc.) but a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as:
- R05 Cough
- R06.02 Shortness of breath
- R50.9 Fever, unspecified
If a patient with signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to someone who has COVID-19, assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, as an additional code. This is an exception to guideline I.C.21.c.1, Contact/Exposure.
g) Asymptomatic individuals who test positive for COVID-19
For asymptomatic individuals who test positive for COVID-19, assign code U07.1, COVID-19. Although the individual is asymptomatic, the individual has tested positive and is considered to have the COVID-19 infection.
15. Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)
s) COVID-19 infection in pregnancy, childbirth, and the puerperium
During pregnancy, childbirth or the puerperium, a patient admitted (or presenting for a health care encounter) because of COVID-19 should receive a principal diagnosis code of O98.5-, Other viral diseases complicating pregnancy, childbirth, and the puerperium, followed by code U07.1, COVID-19, and the appropriate codes for associated manifestation(s). Codes from Chapter 15 always take sequencing priority.
For more information on these ICD-10-CM Official Coding and Reporting Guidelines, view the YES Webinar on COVID-19. This webinar includes scenarios to illustrate the application of these Guidelines.
The latest announcements and coding guidelines are available on the CDC/NCHS website. Review our additional articles “New COVID-19 MS-DRG Assignment, Effective April 1” and “Selecting the Right COVID-19 Code: Should You Use CPT or HCPCS” for additional information.