COVID-19 and sepsis coding: New guidelines
April 2, 2020 | Audrey Howard
During a pandemic, healthcare information is gathered, studied, and published rapidly by scientists, epidemiologists and public health experts without the usual processes of review. Our understanding is rapidly evolving and what we understand today will change over time. Definitive studies will be published long after the fact. 3M Inside Angle bloggers share thoughts and expertise based on currently available information.
On March 31, 2020, the National Center for Health Statistics (NCHS) posted the ICD-10-CM Official Coding Guidelines for COVID-19 – April 1, 2020 through September 30, 2020. In this document, there is a guideline on the sequencing of codes related to COVID-19 (1.g.1b) which states:
b) Sequencing of codes
When COVID-19 meets the definition of principal diagnosis, code U07.1, COVID-19, should be sequenced first, followed by the appropriate codes for associated manifestations, except in the case of obstetrics patients as indicated in Section I.C.15.s. for COVID-19 in pregnancy, childbirth, and the puerperium.
For a COVID-19 infection that progresses to sepsis, see Section I.C.1.d. Sepsis, Severe Sepsis, and Septic Shock
See Section I.C.15.s. for COVID-19 in pregnancy, childbirth, and the puerperium
This official guideline updates all previous advice and information that was published or stated on COVID-19 and sepsis.
The guideline tells us that when COVID-19 and sepsis are documented in the record, refer to the sepsis coding guidelines that are printed in the ICD-10-CM Official Guidelines for Coding and Reporting, FY2020, pp. 24-27. The sequencing of COVID-19 and sepsis will depend on the circumstances of admission. Here are a few examples of sequencing and coding of sepsis and COVID-19:
- COVID-19 and sepsis both documented and present on admission: A41.89 (POA=Y) + U07.1 (POA=Y)
- COVID-19 present on admission and sepsis develops after admission: U07.1 (POA=Y) + A41.89 (PNA=N)
- If the documentation is not clear whether the sepsis was present on admission, the provider should be queried for clarification
Based on these new coding guidelines, the slide from my presentation during the "3M Special Webinar Series – COVID-19: Implications for HIM and CDI" has been updated as follows:
ICD-10-CM/PCS coding for COVID-19
| Diagnosis/procedure | Prior to April 1, 2020 | Effective April 1, 2020 | |
| Respiratory system principal diagnosis with mechanical ventilation less than 96 hours | ICD-10-PCS: 5A1935Z or 5A1945Z MS-DRG 208 APR DRG depends on principal diagnosis | ICD-10-PCS: 5A1935Z or 5A1945Z MS-DRG 208 APR DRG *pending | |
| Respiratory system principal diagnosis with mechanical ventilation greater than 96 hours | ICD-10-PCS: 5A1955Z MS-DRG 207 APR DRG 130 | ICD-10-PCS: 5A1955Z MS-DRG 207 APR DRG 130 | |
| Sepsis due to COVID-19 (includes mechanical vent less than 96 hours) | PDx: A41.89 SDx: B97.29 MS-DRGs 871/872 APR DRG 720 | Sepsis POA PDx: A41.89 SDx: U07.1 MS-DRGs 871/872 APR DRG 720 | Sepsis not POA PDx: U07.1 SDx: A41.89 (POA=N) MS-DRG 208 APR DRG *pending |
| Sepsis due to COVID-19 with mechanical vent greater than 96 hours | PDx: A41.89 SDx: B97.29 ICD-10-PCS: 5A1955Z MS-DRG 870 APR DRG 720 | Sepsis POA PDx: A41.89 SDx: U07.1 ICD-10-PCS: 5A1955Z MS-DRGs 870 APR DRG 720 | Sepsis not POA PDx: U07.1 SDx: A41.89 (POA=N) ICD-10-PCS: 5A1955Z MS-DRG 207 APR DRG 130 |
We are learning that everything about COVID-19 is fluid and fast-changing---even in the coding arena. Stay tuned for more updates as they are announced.
Audrey Howard, RHIA, is a senior outsource services consultant with Solventum.
References:
Centers for Disease Control and Prevention, National Center for Health Statistics
ICD-10-CM Official Guidelines for Coding and Reporting, FY 2020
