Neurosurgery Coding Alert

Remember: Sequence U07.1 as primary diagnosis, with one exception.

ICD-10-CM recently added a brand-new code for reporting confirmed cases of COVID-19, U07.1 (COVID-19). You also received numerous new COVID-19-related guidelines along with this code. These guidelines became effective on April 1, 2020.

“The creation of an ICD-10 diagnosis code for COVID-19 was fast-tracked to fulfill the imperative need to track the diagnosis of this condition as well as its subsequent treatment,” says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. “As many insurers are either voluntarily or by individual state mandate waiving co-pays and prior authorization requirements associated with the evaluation and management of COVID-19 and its related conditions, it is important to include this diagnosis if your patient is COVID-19 positive and is receiving a test or treatment for this illness or its related conditions.”

Read on to learn about how you should handle COVID-19 claims, per the new ICD-10 Official Coding and Reporting Guidelines.

Gain New Chapter in ICD-10-CM

The Tabular List of Diseases and Injuries now includes the following new chapter, section, and category code:

• Chapter 22 - Codes for special purposes (U00-U85)
• Section - Provisional assignment of new diseases of uncertain etiology or emergency use (U00-U49)
• Category Code U07 - Emergency use of U07

For COVID-19 positive patients, you’ll report code U07.1. Make sure you check out the following list of supplemental “Use additional” and Excludes1 notes:

• Use additional code to identify pneumonia or other manifestations
• Excludes1: Coronavirus infection, unspecified (B34.2)
• Excludes1: Coronavirus as the cause of diseases classified elsewhere (B97.2-)
• Excludes1: Pneumonia due to SARS-associated coronavirus (J12.81)

Follow New COVID-19 Guidelines

ICD-10 has added some new guidelines regarding COVID-19. You can read the new guidelines in their entirety here: https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf.

Start by reviewing the rules surrounding Section C.1.g.1.a:

• a) Code only confirmed cases

According to the new guidelines, you should “code only a confirmed diagnosis of the 2019 novel coronavirus (COVID-19) as documented by the provider, documentation of a positive COVID-10 19 test result, or a presumptive positive COVID-19 test result.” For a confirmed diagnosis of COVID-19, you should report U07.1 “This is an exception to the hospital inpatient guideline Section II, H, per the guidelines. “In this context, ‘confirmation’ does not require documentation of the type of test performed; the provider’s documentation that the individual has COVID-19 is sufficient.”

You must also know how to report a presumptive positive COVID-19 test result. Per the guidelines, you should code a presumptive positive result as confirmed. And a presumptive positive test results means that “an individual has tested positive for the virus at a local or state level, but it has not yet been confirmed by the Centers for Disease Control (CDC). CDC confirmation of local and state tests for COVID-19 is no longer required.”

You should not report U07.1 if the physician documents “suspected,” “possible,” “probable,” or inconclusive COVID-19. You would instead report a code explaining the reason for the encounter such as a fever or Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases).

Take a Look at These Rules for Pulmonary Manifestations, Complications

You’ll also have a set of specific rules to follow if and when a patient experiences acute respiratory illness due to COVID-19. Check out these secondary diagnoses when COVID-19 manifests as a respiratory condition.

Coding example 1: For instance, for a COVID-19 patient diagnosed with subsequent pneumonia, the guidelines advise that you report J12.89 (Other viral pneumonia) as a secondary diagnosis code. So, you would report U07.1, J12.89 on your claim.

Coding example 2: For a patient with acute bronchitis confirmed as due to COVID-19, you should report U07.1, J20.8 (Acute bronchitis due to other specified organisms) on your claim. Note: If the patient has bronchitis not otherwise specified (NOS) due to COVID-19, then you would report U07.1, J40 (Bronchitis, not specified as acute or chronic) on your claim.