Medicare Compliance & Reimbursement

Boost ICD-10 coding with 7 COVID-19-specific scenarios.

With coronavirus not expected to subside any time soon, Medicare providers can’t let their guard down this fall. Luckily, ICD-10 updates offer coders clarity and guidance on coding for COVID-19.

Details: Revisions to the 2021 ICD-10-CM guidelines are fairly manageable this year. This is particularly the case for the COVID-19-related updates. The Centers for Disease Control and Prevention (CDC) first established COVID-19 guidelines in April of this year, so you will likely be familiar with most of the guidelines, effective on Oct. 1.

Unsurprisingly, “the major changes to the guidelines for [fiscal year] FY 2021 involve the addition of rules with regard to COVID-19,” says Melanie Witt, RN, CPC, MA, 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.

Pocket This COVID-19 Coding Guideline Breakdown

As a refresher, review these guidelines for guidance on how to code the following scenarios:

1. 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.

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

3. Signs and symptoms: In cases of a “suspected,” “possible,” “probable,” or “inconclusive” COVID-19 diagnosis: Code for signs and symptoms.

4. 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).

5. Screens: For COVID-19 screens: Use Z20.828.

6. Follow-up visits: For “individuals who previously had COVID-19 and are being seen for follow-up evaluation, and COVID-19 test results are negative”: Use Z09 (Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm) and Z86.19 (Personal history of other infectious and parasitic diseases).

7. Antibody testing: “For an encounter for antibody testing that is not being performed to confirm a current COVID-19 infection, nor is a follow-up test after resolution of COVID-19”: Use Z01.84 (Encounter for antibody response examination).

Coding alert 1: ICD-10 2021 also offers specific guidelines for COVID-19 infection in pregnancy, childbirth, and the puerperium and guidelines for COVID-19 infection in newborns in chapter-specific guidelines C.15.s and C.16.h, respectively.

Coding alert 2: “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.

Resource: Download a pdf of the full 2021 ICD-10 guidelines at www.cdc.gov/nchs/data/icd/10cmguidelines-FY2021.pdf.