The new ICD-10-CM code
U07.1 (COVID-19) takes effect today (April 1) and to help you use it, the government has issued
new ICD-10-CM Official Guidelines for Coding and Reporting specific to the code.
Those guidelines, released by the ICD-10 Coordination and Maintenance Committee, take effect today and are set to expire Oct. 1.
Here are some highlights:
- Report code U07.1 only for confirmed cases. That is — code it when the provider documents COVID-19 is the diagnosis. The guidelines explain: “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.”
Also code U07.1 for “presumed positive” cases — that is, when a patient “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),” the guidelines state. Note that CDC confirmation of local and state tests for COVID-19 is no longer required.
- Don’t use U07.1 for “suspect,” “possible,” “probable” or inconclusive cases. For those, code the reason for the encounter (e.g., R50.9 for fever) and report a code such as Z20.828 (Contact with and [suspected] exposure to other viral communicable diseases), the guidelines instruct.
- Code U07.1 when an asymptomatic patient tests positive for COVID-19. The guidelines explain: “Although the individual is asymptomatic, the individual has tested positive and is considered to have the COVID-19 infection.”
- Use a Z code when test results are unknown. For example, if the clinician is concerned “about a possible exposure to COVID-19, but this is ruled out after evaluation,” the guidelines instruct you to assign code Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out).
When there is an actual exposure to a person confirmed to have COVID-19, “and the exposed individual either tests negative or the test results are unknown,” report code Z20.828.
Also code any signs or symptoms, including:
- Cough
- Shortness of breath
- Fever, unspecified
If an asymptomatic person with no known exposure to the virus is being screened for COVID-19 and the test results are either unknown or negative, assign code Z11.59 (Encounter for screening for other viral disease).
Sequencing: For a pregnant patient with COVID-19, follow the new guideline added to Chapter 15, which instructs:
“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.”
Sequencing for other cases: List U07.1 first, followed by codes for the manifestations. For example:
Pneumonia: A patient has pneumonia caused by COVID-19, report codes U07.1 and J12.89 (Other viral pneumonia).
Bronchitis: A patient has acute bronchitis triggered by COVID-19, report codes U07.1, and J20.8 (Acute bronchitis due to other specified organisms).
For bonchitis not otherwise specified (NOS) caused by COVID-19, report codes U07.1 and J40 (Bronchitis, not specified as acute or chronic).
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, assign codes U07.1 and J22 (Unspecified acute lower respiratory infection).
For a case where COVID-19 is documented as associated with a respiratory infection NOS, report codes U07.1 and J98.8 (Other specified respiratory disorders).
Acute respiratory distress syndrome: When a patient has COVID-19 with acute respiratory distress syndrome (ARDS), report codes U07.1, and J80 (Acute respiratory distress syndrome).
The addition of the new official guidelines for code U07.1 appears to complete the coding picture for the new temporary code. Last week, practices also received: