Updates to FAQs for COVID-19 Immunization Reactions, Sequelae, & Other Issues
The FAQs document published by AHIMA and AHA has provided valuable information on the coding of COVID-19-related cases since March 2020, before the U07.1 code took effect on April 1, 2020 (Journal of AHIMA, 2021).AHIMA/AHA update the FAQs are updated as people make inquiries and new information is available. The group released ten new FAQs on March 2, 2021, concerning diagnosis coding, FAQs No. 45-54. Four of the questions were related to immunization reactions, and several were related to sequela of COVID-19 and miscellaneous topics, such as a COVID-19 diagnosis with negative test results. Review the FAQs in their entirety at the AHIMA or AHA website (Journal of AHIMA, 2021). Check this site periodically for updates.
Do you want to learn how to apply the new 2022 ICD-10 COVID-19 codes? Sign up for our COVID-19 ICD-10 Coding Learning Path and find out how to code Coronavirus infections, symptoms, screening, post-COVID-19 condition, treatments and vaccines. The webinar provides an update to the FY2022 Official Coding Guidelines for COVID-19.
Questions related to immunization concentrated on allergic reactions, adverse effects, and anaphylactic reactions to the COVID-19 vaccine. While these reactions are uncommon, consistent coding will allow for data collection on outcomes due to the COVID-19 vaccine. Provider documentation is key to code assignment, with different code assignments based on the diagnosis. See FAQs No. 45-48.
Also, note that question No. 48 states that coders should code expected side effects as adverse effects if the patient requires additional care as a result of the side effect, such as fever.
From reviewing the FAQs, note that there are three descriptions covered with coding based on this documentation.
Sequela vs. Personal History of COVID-19 & Negative Test Results
As providers treat more cases of long-term COVID-19 or post-acute sequelae of COVID-19 (NIH Director’s Blog, 2021), coders must make an important distinction between coding Z86.16, personal history of COVID-19, and B94.8, sequela of other infectious and parasitic diseases, as a secondary code.
Note that guidelines state that the personal history codes “explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring” (CDC, 2021). Sequela, in contrast: “is the residual effect (condition produced) after the acute phase of an illness or injury has terminated” (CDC, 2021). Applying these definitions, a patient treated for a sequela or late effect of COVID-19 would not qualify as having a personal history code assigned. Review questions No. 49, 50, and 53 for these issues.
Also note that if the patient is experiencing an acute manifestation of COVID-19, such as pneumonia, coders list code U07.1, COVID-19, first, followed by the code J18.82, pneumonia due to coronavirus disease 2019, regardless of negative COVID-19 test results, as this does not qualify as a sequela. See question No. 51 for this scenario.
Question No. 52 also emphasizes that coders assign codes U07.1 and J18.82 for COVID-19-associated pneumonia, regardless of a negative test result.
COVID-19 & Pneumothorax Barotrauma
Finally, question No. 54 addressed the issue of a patient with COVID-19 pneumonia and pneumothorax due to mechanical ventilation. In this case, the COVID-19 diagnosis does not affect the coding of the complication codes, though coders list the U07.1 and J18.82 codes first. See the FAQs for complete information.
Review our COVID-19 Resource Center for the latest Coronavirus coding guidelines and training.
Ann Zeisset, RHIT, CCS, CCS-P, co-authored this article with Teri Jorwic, MPH, RHIA, CCS, CCS-P, FAHIMA.