Pathology/Lab Coding Alert

COVID-19 instruction leads the way.

Code additions, revisions, and deletions aren’t the only changes you need to know from the 2021 ICD-10-CM update, effective Oct. 1.

Many coders think if they review their new ICD-10-CM code book, focusing on new code icons, they will be alerted to all relevant changes; but nothing could be further from the truth, according to Sheri Poe Bernard, CPC, of Poe Bernard Consulting in Salt Lake City.

In addition to the codes, you need to focus on changes to the official guidelines, a new chapter for 2021, revisions to the index, and updates to notes in the tabular list. Read on for lab-relevant information in those categories.

Don’t Miss New Chapter 22

“Chapter 22 and its two codes were actually added to ICD-10-CM on an emergency basis on April 1 this year,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. “Oct. 1, 2020, marks the first time they’ll be reflected in the annual update. If coders aren’t already aware of these codes, they should be,” Moore adds.

Currently, the only two codes in the chapter are provisional codes for “new diseases of uncertain etiology or emergency use” as the introduction to the U00-U49 codes explains. They are:

• U07.1 (COVID-19)
• U07.0 (Vaping-related disorder)

Check Out 2021 Official Guidelines

“The major changes to the guidelines for FY2021 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. Many of those changes are found at the beginning of the chapter-specific coding guidelines.

An entirely new section, 1.C.1.g., spells out in detail what you must do when coding COVID-19. Although the guidelines were established by the Centers for Disease Control and Prevention (CDC) with the April release of code U07.1, the ICD-10-CM Official Guidelines for Coding and Reporting places these in the Oct. 1 update.

The Chapter 1 guidelines address several COVID-19 coding issues, such as:

• Sequencing U07.1 as the principal/first-listed diagnosis when it meets the definition of principal diagnosis. Coders should also assign secondary codes for respiratory manifestations, such as J20.8 (Acute bronchitis due to other specified organisms) or J98.8 (Other specified respiratory disorders), or non-respiratory manifestations.
• Coding for signs and symptoms in cases of a “suspected,” “possible,” “probable,” or “inconclusive” COVID-19 diagnosis.
• Using Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases) “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.”
• Reporting Z20.828 for COVID-19 screening tests.
• Using 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) for 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.”
• Using Z01.84 (Encounter for antibody response examination) “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.”

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

During pregnancy, childbirth or the puerperium, code the case as follows based on the reason for the encounter:

• If COVID-19 is the reason for the encounter, list first O98.5- (Other viral diseases complicating pregnancy, childbirth and the puerperium), and also code U07.1, plus any appropriate codes for manifestations.
• If the reason for the encounter is unrelated to COVID-19 but the patient tests positive during the encounter, code first the reason for the encounter, followed by O98.5 and U07.1 and any appropriate codes for manifestations.

The new ICD-10-CM guidance distinguishes coding for newborns based on transmission method, if known, as follows:

• For newborns with no documentation indicating specific type of transmission with a positive COVID-19 test, code first U07.1, plus any appropriate codes for associated manifestations.
• For newborns who test positive for COVID-19 and the provider documents transmission in utero or during the birth process, assign P35.8 (Other congenital viral diseases), and U07.1.
• “When coding the birth episode in a newborn record, the appropriate code from category Z38, Liveborn infants according to place of birth and type of delivery, should be assigned as the principal diagnosis,” according to the guidelines.

Dive Deeper for Changes to Index and Notes

To round out your understanding of ICD-10-CM changes that impact your lab, you should also look at relevant changes to the Alphabetic Index, as well as notes in the tabular list.

For instance: ICD-10-CM 2021 adds new codes for babesiosis, but a full understanding of the codes requires studying the notes as well as the changes to the index. A look at the notes under each new code further defines or gives examples of the code, as follows:

• B60.00 (Babesiosis, unspecified) Babesiosis due to unspecified Babesia species Piroplasmosis, unspecified
• B60.01 (Babesiosis due to Babesia microti) Infection due to B. microti
• B60.02 (Babesiosis due to Babesia duncani) Infection due to B. duncani and B. duncani-type species
• B60.03 (Babesiosis due to Babesia divergens) Babesiosis due to Babesia MO-1 Infection due to B. divergens and B. divergens-like strains
• B60.09 (Other babesiosis) Babesiosis due to Babesia KO-1 Babesiosis due to Babesia venatorum Infection due to other Babesia species Infection due to other protozoa of the order Piroplasmida Other piroplasmosis

Those same examples appear in the revised 2021 Alphabetic Index to direct you to the new codes. You can see the following relevant index changes in the ICD-10-CM 2021 Addendum file:

Revise from Babesiosis B60.0

Revise to Babesiosis B60.00

Add- due to Add- - Babesia

Add- - - divergens B60.03

Add- - - duncani B60.02

Add- - - KO-1 B60.09

Add- - - microti B60.01

Add- - - MO-1 B60.03

Add- - - species

Add- - - - unspecified B60.00

Add- - - venatorum B60.09

Add- - specified NEC B60.09

More notes: Notes under new code U07.1 (COVID-19) direct coders to use an additional code to “identify pneumonia or other manifestations.” There is also an Excludes1 note that lists the following diagnoses:

• B34.2 (Coronavirus infection, unspecified)
• B97.2- (Coronavirus as the cause of diseases classified elsewhere)
• J12.81 (Pneumonia due to SARS-associated coronavirus)

Remember: An Excludes1 note means “Not coded here,” so the patient can’t have both conditions. An Excludes2 note means “Not included here,” so a patient may have those two conditions at the same time.

Resource: You can access a pdf of the full 2021 ICD-10-CM guidelines at www.cdc.gov/nchs/data/icd/10cmguidelines-FY2021.pdf. These guidelines are effective Oct. 1, 2020 through Sept. 30, 2021.