Otolaryngology Coding Alert

Home in on sequencing rules, suspected vs. positive cases, and more.

These sweeping updates allow for coders to begin reporting code U07.1 (COVID-19) for COVID-19 positive cases from a date of service (DOS) of April 1 and on. However, there are plenty of rules and guidelines to consider before finalizing your code selection.

Keep reading for a list of brand-new codes to consider, in addition to all the respective guidelines you’ll need to know to properly report them.

Incorporate a Whole New Chapter Into the Mix

First, the ICD-10-CM 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. But before doing so, you’ll want to have a look at 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).

Add These Pertinent Guidelines to Your Knowledge Base

Those new details in the Tabular List are only a tiny subset of coding instruction on how to properly report COVID-19- related, and unrelated, cases. To get the full scoop, you’re going to want to have a look at the updated ICD-10-CM Official Coding and Reporting Guidelines at 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 CDC/NCHS, you may report code U07.1 “as documented by the provider, documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result.” Furthermore, the CDC/NCHS points out this is applicable to inpatient and outpatient guidelines:

“This is an exception to the hospital inpatient guideline Section II, H. 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’ve also got to know what constitutes a “presumptive” positive test result. According to the CDC/NCHS, this 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 CDC. CDC confirmation of local and state tests for COVID-19 is no longer required.”

Similar to your typical outpatient coding guidelines, you should code signs and symptoms for COVID-19 cases that use terminology such as “suspected, possible, probably, or inconclusive.” However, if there is documentation to support that the patient had contact or exposure to an individual with a COVID-19 diagnosis, then you should instead report Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases).

Consider Guidance for Pulmonary Manifestations, Complications

Furthermore, you’ve got a set of specific rules to follow if and when a patient experiences acute respiratory illness due to COVID-19. In the updated version of the ICD-10-CM Official Coding and Reporting Guidelines, you’ve got a set of codes to report as secondary diagnoses when COVID-19 manifests as a respiratory condition.

Example: 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. You can find additional coding instruction in the guidelines on how to report the following three conditions alongside a COVID-19 diagnosis:

• Acute bronchitis,
• Lower respiratory infection, and
• Acute respiratory distress syndrome.

Food for thought: A COVID-19 diagnosis and (some) manifestations like pneumonia do not currently factor into risk adjustment. “The trick may be to code other elements like respiratory distress or dependence on a ventilator — those diagnoses do risk adjust,” explains Sheri Poe Bernard, CPC, of Poe Bernard Consulting in Salt Lake City.