Post-pandemic ICD-10 coding: Z11.52, Z20.822, U07.1

In today's post-pandemic world, healthcare practitioners and medical coders face the evolving challenge of accurately capturing COVID-19-related encounters. The ICD-10-CM COVID-19 coding guidelines have adapted to reflect this new landscape, creating important distinctions for codes like Z20.822, Z11.52, and U07.1. For coding specialists and managers, understanding these nuances is essential for documentation integrity, billing accuracy, and public health data.

This post breaks down the key differences between coding for exposure versus screening, provides real-world clinical scenarios, and offers clear takeaways to help your team navigate these updates confidently and ensure medical coding audit compliance.
 

The shift in ICD-10-CM COVID-19 coding guidelines

Early in the pandemic, the coding approach was understandably broad. With limited testing and evolving knowledge of the virus, coders often used Z20.822 for nearly any encounter with a potential COVID-19 concern. This code was applied liberally when testing was performed due to possible contact.

As testing protocols matured, the guidelines refined the application of Z20.822 and introduced Z11.52 to better reflect encounters focused on screening without a documented exposure. Today, the distinction between exposure vs screening is more critical than ever for accurate reporting. Proper application supports everything from compliant billing to sound epidemiological tracking. [Internal link: ICD-10-CM Updates Resource Page]
 

Understanding Z20.822, Z11.52, and U07.1

Correctly applying these three codes is foundational to post-pandemic coding. The key lies in the provider’s documentation regarding exposure, symptoms, and test results.

Z20.822 – Contact with and (suspected) exposure to COVID-19

This code should only be applied when there is clear documentation of recent contact with, or suspected exposure to, a person with a confirmed or probable case of COVID-19. It is no longer appropriate to use Z20.822 for every patient being tested, especially if the documentation requirements for exposure are not met.

Z11.52 – Encounter for screening for COVID-19

This COVID-19 screening code is assigned when a patient is screened for the virus during a healthcare encounter without any reported exposure, contact, or symptoms. Common scenarios include pre-operative testing or routine screenings for asymptomatic individuals as part of a facility's protocol.

U07.1 – COVID-19, virus identified

The U07.1 coding guideline remains straightforward: it is assigned for a confirmed diagnosis of COVID-19. This confirmation must come from a positive result on a molecular or antigen test.
 

Real-world coding scenarios

Let’s explore common clinical situations to see how these updated ICD-10 coding guidelines apply.

Scenario 1: Asymptomatic pre-op patient with documented exposure, negative test

A patient presents for elective surgery and is asymptomatic. The medical record indicates recent contact with a person confirmed to have COVID-19. Their pre-operative test result is negative.

• Correct code: Z20.822 (Contact with and suspected exposure to COVID-19) is applied due to the documented contact.
• Do not code: U07.1, as the test is negative.

Scenario 2: Asymptomatic pre-op patient with documented exposure, positive test

A similar asymptomatic patient is tested before surgery and has documented contact with a confirmed COVID-19 case. This time, their test is positive.

• Correct code: U07.1 (COVID-19, virus identified) is assigned for the confirmed diagnosis.
• Note: The exposure code (Z20.822) is not necessary, as the confirmed diagnosis takes precedence.

Scenario 3: Asymptomatic pre-op patient with no documented exposure, negative test

An asymptomatic patient is screened for COVID-19 as part of a routine pre-operative protocol. There is no mention of contact or exposure in the medical record. The test result is negative.

• Correct code: Z11.52 (Encounter for screening for COVID-19).
• Do not code: Z20.822, as there is no exposure history, or U07.1, as the test is negative.

Scenario 4: Symptomatic patient, no documented exposure, positive for influenza B

A patient arrives at the emergency department with fever, cough, and congestion but has no known or suspected exposure to COVID-19. The provider orders a respiratory panel. The results are positive for influenza B and negative for COVID-19.

• Correct code: J10.1 (Influenza due to other identified influenza virus with other respiratory manifestations).
• Do not code: U07.1, Z20.822, Z11.52, or individual symptoms. The testing was diagnostic, and the symptoms are explained by the confirmed influenza diagnosis.

Scenario 5: Symptomatic patient, no documented exposure, all tests negative

A patient presents with a cough and fever. They are tested for COVID-19 and other respiratory viruses, but all results are negative. There is no mention of exposure.

• Correct codes: R05 (Cough) and R50.9 (Fever, unspecified). The signs and symptoms are coded because no definitive diagnosis was made.
• Do not code: U07.1, Z20.822, or Z11.52.

Scenario 6: Asymptomatic patient with documented exposure, positive test

A patient is identified as a close contact of a confirmed COVID-19 case. They are asymptomatic but receive a positive COVID-19 test.

• Correct code: U07.1 (COVID-19, virus identified).
   

Key changes in coding guidelines: Z20.822 vs. Z11.52

One of the most significant changes in ICD-10 COVID-19 coding is the narrow application of Z20.822. Coders must now ensure there is explicit documentation of contact or exposure to a confirmed case before assigning Z20.822. The routine testing of all patients — such as pre-operative COVID screening without any known exposure — should now be coded as Z11.52.

This distinction is critically important for accurate billing and epidemiological tracking. Applying Z20.822 automatically for every patient tested for COVID-19 overstates the incidence of exposure and can skew data crucial for public health planning and response. Proper use of Z11.52 ensures that asymptomatic screening encounters are coded correctly. Equally important is knowing when to report symptoms without a confirmed diagnosis and understanding that a confirmed diagnosis that explains the patient’s symptoms should not be reported. 
 

Key takeaways for coding teams

To ensure accuracy and compliance, your team should focus on these core principles:

• Documentation is key: Only use Z20.822 when exposure is clearly documented. If it isn't mentioned, you cannot code it.
• Distinguish screening from diagnostic testing: Use Z11.52 for routine, asymptomatic screening without known exposure. If symptoms are present, the testing is diagnostic, and Z11.52 should not be used.
• Confirmed diagnoses take priority: A confirmed diagnosis that explains the patient’s symptoms, like influenza, should be coded instead of signs, symptoms, or exposure codes.
• Stay informed: Coding guidelines evolve. Regularly review updates to maintain compliance and protect your organization during audits. You can also check out Solventum webinars on-demand here.

As coding guidelines have evolved in the wake of the COVID-19 pandemic, staying informed is vital for healthcare providers, coders, and administrators. Understanding the subtle but important differences between Z20.822 and Z11.52 helps promote coding integrity, supports accurate public health reporting, and maintains compliance in billing. 

Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT, is a coding analyst at Solventum.