Coding for COVID-19: Latest guidelines, part 2

This blog was posted March 11, 2020. Read the latest coding guidance here.

I have received many questions regarding the coding of COVID-19 and other coronavirus types since the publication of my last blog.  I thought everyone would be interested in reading my responses to some of the questions, along with the latest guidance from AHA Coding Clinic and CMS, which follows the questions. 

Q: If a patient admitted with cough, fever and sore throat with a recent travel history to any of the COVID-19 affected countries with negative COVID-19 results after lab evaluation, do we need to report Z03.818 in this scenario? My understanding is Z03.818 can be reported only if there is no signs or symptoms and there is a concern of exposure to COVID-19. Please clarify.

A: Do not assign code Z03.818 in the scenario provided. According to the instructional note under category Z03, a code from category Z03 is assigned when a person is suspected of having a condition, without signs or symptoms, and after examination and observation, the condition is ruled out.  In this example, it is appropriate to assign codes for the presenting signs or symptoms (cough, fever, sore throat) since the COVID-19 was ruled out and there was no other definitive diagnosis. 

Q: Should we continue using B97.29, Other coronavirus as the cause of diseases classified elsewhere, to report common human coronaviruses? What would you recommend?

A: Yes, code B97.29 is assigned for all types of documented coronavirus as cause of diseases classified elsewhere except severe acute respiratory syndrome (SARS)-associated coronavirus which is classified to code B97.21.  Common types of coronavirus include alpha coronavirus, beta coronavirus and Middle East respiratory syndrome (MERS).

Q: How should you currently code the other types of the coronavirus?

A: At this point, there is no coding difference for COVID-19 and the other coronaviruses apart from severe acute respiratory syndrome (SARS). Codes identifying SARS-associated coronavirus include:

• • • J12.81 (Pneumonia due to SARS-associated coronavirus)
    • B97.21 (SARS-associated coronavirus as the cause of diseases classified elsewhere)

Q: Do you have a direct link to the CDC/NCHS that describes the coding mechanism you have listed? I was unable to find it on the CDC website directly.

A: The link for the supplement to the ICD-10-CM Official Coding Guidelines is:  https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf

If the link does not work, please follow these instructions:

• • • Go to cdc.gov/nchs
    • Click on the tab labeled “Programs”
    • Click on “Classification of Diseases, Functioning, and Disability (ICD & ICF classification)” under Partnerships and Collaboration
    • Click on “ICD-10-CM” under the Classification of Diseases, Functioning, and Disability column
    • Here you will see the links to the two documents on COVID-19 from the National Center for Health Statistics (NCHS)

In addition, AHA Coding Clinic for ICD-10-CM/PCS reprinted the supplemental guidance for coding encounters related to COVID-19 coronavirus outbreak in the first quarter 2020 issue.

Also of interest, the Centers for Medicare and Medicaid Services (CMS) released a frequently asked questions document on March 6, 2020.

The document addresses the coding and billing for COVID-19 for laboratory diagnostic services, physician services and hospital services.  Two new Healthcare Common Procedure Coding System (HCPCS) codes were created so that laboratories performing tests can bill Medicare and other health insurers for services that occurred after February 4, 2020:

• HCPCS code U0001 is used for tests developed by the Centers for Disease Control and Prevention (CDC)
• HCPCS code U0002 is used for laboratories performing non-CDC laboratory tests

According to CMS, the Medicare claims processing systems will be updated to accept these new codes effective April 1, 2020. CMS also released another document about the creation of the HCPCS codes.

We will continue to blog on this topic as new information becomes available.

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