Coding for COVID-19: Latest guidelines

Since my last blog, the novel coronavirus continues to be a daily top story from all news sources. The World Health Organization (WHO) has declared it to be a public health emergency of international concern. According to the Centers for Disease Control and Prevention (CDC), the virus has been named “SARS-CoV-2” and the disease it causes has been officially named “coronavirus disease 2019” with an abbreviation of “COVID-19.”

Because of the declared public health emergency, the WHO created an emergency ICD-10 code to identify this new coronavirus.  Code U07.1, 2019-nCoV acute respiratory disease, will be implemented into ICD-10-CM with the update effective October 1, 2020.  Since the effective date of the new code is over seven months away, the National Center for Health Statistics (NCHS) developed interim coding advice in a supplement to the ICD-10-CM Official Coding Guidelines effective February 20, 2020.  The interim coding advice states to assign the following ICD-10-CM codes for confirmed cases related to COVID-19:

• Pneumonia due to COVID-19:  J12.89 (Other viral pneumonia) and B97.29 (Other coronavirus as the cause of diseases classified elsewhere)
• Acute bronchitis due to COVID-19: J20.8 (Acute bronchitis due to other specified organisms) and B97.29 (Other coronavirus as the cause of diseases classified elsewhere)
• Bronchitis not otherwise specified (NOS) due to COVID-19: J40 (Bronchitis, not specified as acute or chronic) and B97.29 (Other coronavirus as the cause of diseases classified elsewhere)
• Lower respiratory infection NOS or acute respiratory infection NOS due to COVID-19: J22 (Unspecified acute lower respiratory infection) and B97.29 (Other coronavirus as the cause of diseases classified elsewhere)
• Respiratory infection NOS due to COVID-19: J98.8 (Other specified respiratory disorders) and B97.29 (Other coronavirus as the cause of diseases classified elsewhere)
• Acute respiratory distress syndrome (ARDS) due to COVID-19: J80 (Acute respiratory distress syndrome) and B97.29 (Other coronavirus as the cause of diseases classified elsewhere)

For possible exposure to COVID-19 that is ruled out after evaluation, assign code Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out). If a patient was exposed to someone with a confirmed case of COVID-19, assign code Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases).

If a patient presents with signs or symptoms without an established definitive diagnosis, assign codes for each of the presenting signs and symptoms such as:

• Cough (R05)
• Shortness of breath (R06.02)
• Fever, unspecified (R50.9)

Of special note, it typically would not be appropriate to assign code B34.2, Coronavirus infection, unspecified, for COVID-19 since this code is for unspecified sites and COVID-19 cases have usually been respiratory in nature. 

Do not assign code B97.29 for cases documented as “possible,” “probable” or “suspected.”  Instead, assign codes for the signs or symptoms present or exposure to the virus.

These guidelines may be updated if new clinical information becomes available.  Visit the NCHS website to find information related to the coding of COVID-19.

Audrey Howard, RHIA, is a senior outsource services consultant with 3M Health Information Systems.

Sources:

cdc.gov: Coronavirus Disease 2019 (COVID-19)

World Health Organization, Coronavirus disease 2019 (COVID-19) Situation Report – 34.  https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200223-sitrep-34-covid-19.pdf?sfvrsn=44ff8fd3_2

cdc.gov/nchs:  https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-2-20-2020.pdf; https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf