Home Health & Hospice Week

Check out an entirely new section on coding guidelines for the novel coronavirus.

There’s no end in sight to when you’ll need to be assigning COVID-19 diagnosis codes. At least ICD-10 updates offer coders clarity and guidance on coding for COVID-19.

The Centers for Disease Control and Prevention first established COVID-19 guidelines in April of this year, effective on Oct. 1. And The CDC’s National Center for Health Statistics implemented a new ICD-10-CM diagnosis code, U07.1 (COVID-19), effective April 1.

Unsurprisingly, “the major changes to the guidelines for FY 2021 involve the addition of rules with regard to COVID-19,” says RN and certified coder Melanie Witt, an independent coding expert based in Guadalupita, New Mexico.

Though they are not new, they appear in an entirely new section of the chapter-specific coding guidelines, section 1.C.1.g., which spells out in detail what you must do when coding for COVID-19.

Take a look at a few of the new guidelines on how to code the following scenarios:

Principal diagnosis and respiratory manifestations. When U07.1 (COVID-19) meets the definition of principal diagnosis, and the patient has respiratory manifestations: Sequence U07.1 as the principal/first-listed diagnosis, then code for associated manifestations, such as J20.8 (Acute bronchitis due to other specified organisms) or J98.8 (Other specified respiratory disorders) for a respiratory infection NOS associated with COVID-19.

Non-respiratory manifestations. When the reason for the admission is a non-respiratory manifestation, sequence U07.1 as the principal/first-listed diagnosis, then code for any manifestations as additional diagnoses.

Inconclusive and unknown. “For asymptomatic individuals with actual or suspected exposure to COVID-19” and “for symptomatic individuals with actual or suspected exposure to COVID-19 and the infection has been ruled out, or test results are inconclusive or unknown,” use Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases).

“It will be imperative that all coders and providers be familiar with these new guidelines in order to help with correct data collection in the coming months and years as we try and get a handle on this disease,” advises Witt.

Stay tuned: How the Patient Driven Groupings Model case mix system takes these guidelines into account, if at all, remains to be seen.

Last April, Medicare’s HH PDGM Grouper software update v01.1.20 implemented U07.1, along with another new code regarding vaping-related disorders, effective for home health claims with “From” dates April 1 and later. CMS assigned U07.1 to the Medication Management, Teaching and Assessment-Respiratory (MMTA-Respiratory) clinical group for purposes of case-mix adjustment. And CMS added U07.1 to a new comorbidity subgroup, Respiratory 10, and assigned it to the Low Comorbidity adjustment under the PDGM case mix system.

Note: The new ICD-10 code set is at www.cms.gov/medicare/icd-10/2021-icd-10-cm. The full 2021 ICD-10 guidelines is at www.cdc.gov/nchs/data/icd/10cmguidelines-FY2021.pdf. The grouper software is at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/CaseMix­GrouperSoftware.