Primary Care Coding Alert

Question: We had an established male patient report today with a cough. One of our providers saw the patient and wanted the patient tested for COVID-19, stating that the patient is “high risk due to a history of hypertension, palpitations, and alcohol abuse.” How do I code for high risk in this situation? Do I use Z91.89? Or is there another way to code this encounter?

Codify Subscriber

Answer: There is no ICD-10 code for a patient at high risk of COVID-19, and using Z91.89 (Other specified personal risk factors, not elsewhere classified) in this situation will not be particularly helpful.

Instead, you would want to follow recent Centers for Disease Control and Prevention (CDC) (https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf) and ICD-10 (https://www.cdc.gov/nchs/data/icd/10cmguidelines-FY2021.pdf) guidelines, which state that “if the provider documents ‘suspected,’ ‘possible,’ ‘probable,’ or ‘inconclusive’ COVID-19 … assign a code(s) explaining the reason for encounter (such as fever) or Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases).”

Since neither you nor your provider indicate the patient had been exposed to COVID-19, you would code the reason for the encounter, which would be R05 (Cough). From there, you could add the other conditions you mention, using codes such as I10 (Essential (primary) hypertension), R00.2 (Palpitations), and F10.10 (Alcohol abuse, uncomplicated) as a secondary or even tertiary diagnoses to support the provider’s order for the test and more clearly indicate the patient’s personal risk factors than Z91.89 allows you to do.