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As announced in our recent White Paper, The CDC Posts Interim ICD-10-CM Coding Guidance, the new ICD-10-CM code for COVID-19, U07.1, is now in effect. Be familiar with the official coding guidelines in applying this new diagnosis code:
U07.1 is for use when a provider has documented COVID-19 as the diagnosis
U07.1 is applicable for ‘presumed positive’ cases, meaning a patient has tested positive for the virus at the local or state level but it hasn’t yet been confirmed by the CDC as CDC confirmation of local and state tests is no longer required.
U07.1 is also appropriate when an asymptomatic patient tests positive for COVID-19, following the guidelines’ rationale that even though the patient doesn’t have symptoms, he/she has tested positive and is, therefore, considered to have the COVID-19 infection
To report additional diagnoses documented as associated with the COVID-19 infection, U07.1 will be sequenced first as the primary diagnosis, followed by the ICD-10-CM code for the manifestation such as pneumonia, bronchitis, acute respiratory distress syndrome, etc.
Pay attention to keywords in applying the following coding guidance for other (potential) COVID-19 related clinical scenarios that do not result in an actual COVID infection diagnosis. For example:
• Asymptomatic person with no known exposure to the virus is screened for COVID-19 and test results come back as negative or unknown: Z11.59, Encounter for Screening for other viral disease
• Person with actual exposure to a person confirmed to have COVID-19 and test results are either negative or unknown: Z20.828, Contact with and [suspected] exposure to other viral communicable diseases
• “Suspect,” “probable,” “possible,” or inconclusive cases will typically use a combination of codes to thoroughly describe the condition: code first the reason(s) for the encounter (e.g., R06.02 Shortness of breath, R50.9 Fever) followed by a code that indicates why the condition is suspected such as Z20.828, Contact with and [suspected] exposure to other viral communicable diseases
This should get you started; additional coding information is available from the CDC, including proper coding for obstetric patients:
Please check the APS website at https://apsmedbill.com/whitepapers for our continuing updates of federal and industry actions and guidance implemented in response to COVID-19.