ED Coding and Reimbursement Alert

Check these strategies to select your ICD-10 codes.

Diagnosis coding can be challenging, and that’s truer than ever now that new ICD-10 codes have been released due to the coronavirus pandemic. Understanding how to select the right codes and in which order you should sequence them can spark confusion among even the most seasoned ED coders.

To ensure that you are on top of the latest rules surrounding ICD-10 coding, check out three questions submitted to ED Coding Alert, along with expert answers to guide you.

How Can You Report COVID-19, Flu Concurrently?

Question 1: Our ED physician saw a patient who was confirmed to have both influenza A and COVID-19, and treated them for respiratory manifestations. Is there a combination code for these two diagnoses?

Answer 1: Unfortunately, ICD-10 doesn’t include one single code that will cover both of these conditions. If a patient is confirmed to have both influenza A and COVID-19 during the encounter, you will report each code separately, with the code for the novel coronavirus being listed first, as follows:

• U07.1 (COVID-19)
• J09.X2 (Influenza due to identified novel influenza A virus with other respiratory manifestations)

You should almost always report U07.1 as your first-listed diagnosis code, the Centers for Disease Control (CDC) notes in its “ICD-10-CM Official Coding and Reporting Guidelines,” which the agency updated effective April 1, 2020. “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,” the CDC notes.

Therefore, unless the patient your ED physician saw was pregnant, then sequencing U07.1 first is correct.

Which Code Applies to a Patient Post-COVID-19 Recovery?

Question 2: We treated a coronavirus patient in the ED and they later went home after recovering from the disease. They came to our ED a few weeks later complaining of a feeling of being constantly tired, and the ED physician diagnosed them with low iron levels and generalized weakness. Do we use the COVID-19 code for this visit?

Answer 2: No, if the patient no longer has an active case of COVID-19, you should not report U07.1. Instead, you’ll report the codes for the diagnoses the ED physician addressed, as well as the appropriate “Z” codes to represent the history of coronavirus. Therefore, your coding would appear as follows:

• E61.1 (Iron deficiency)
• R53.1 (Weakness)
• Z09 (Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm)
• Z86.19 (Personal history of other infectious and parasitic diseases)

The American Hospital Association’s (AHA’s) “Frequently-Asked Questions Regarding ICD-10-CM Coding for COVID-19” advises practices to report these two Z codes “when a patient who previously had COVID-19 is seen for a follow-up exam and the COVID-19 test is negative.” These two codes should be sequenced after the conditions that the ED physician actually treated, which in this case puts them in the third and fourth positions.

How Should You Report COVID-19 Diagnosed After the Fact?

Question 3: Our ED physician saw a patient who had a suspected case of COVID-19, and we diagnosed the patient with a collapsed lung and admitted them to the hospital. We found out after the patient had been discharged that they had indeed tested positive for the novel coronavirus. Which diagnosis code do we report?

Answer 3: You’ll use the COVID-19 code as your primary diagnosis, followed by the appropriate code that describes the collapsed lung, such as J98.11 (Atelectasis). Although your ED physician was primarily treating the collapsed lung and didn’t know for sure at the time that the patient had a positive case of COVID-19, the patient did ultimately test positive for the disease, and therefore the coronavirus code should be placed in the primary position.

“If a test is performed during the visit or hospitalization, but results come back after discharge positive for COVID-19, then it should be coded as confirmed COVID-19,” the AHA says in its FAQs.