Pulmonology Coding Alert

Not sure which ICD-10 code to list first? Consider these strategies.

Diagnosis coding often comes down to the details — how many characters you should assign to a particular code, which order should you list diagnoses, and even how many total diagnosis you can report. That’s what makes this part of the coding process challenging.

To ensure that you are on top of the latest rules surrounding ICD-10 coding, check out three questions submitted to Pulmonology Coding Alert, along with expert answers to guide you.

How Can You Report COVID-19, Flu Concurrently?

Question 1: Our pulmonologist saw an inpatient who was confirmed to have both influenza A and COVID-19, and treated her for respiratory manifestations. Is there a combination code for these two diagnoses?

Answer 1: Unfortunately, ICD-10 doesn’t include one single code that will cover both of these conditions. If a patient is confirmed to have both influenza A and COVID-19 during the encounter, you will report each code separately, with the code for the novel coronavirus being listed first, as follows:

• U07.1 (COVID-19)
• J09.X2 (Influenza due to identified novel influenza A virus with other respiratory manifestations)

You should almost always report U07.1 as your first-listed diagnosis code, the Centers for Disease Control (CDC) notes in its “ICD-10-CM Official Coding and Reporting Guidelines,” which the agency updated effective April 1, 2020. “When COVID-19 meets the definition of principal diagnosis, code U07.1, COVID-19, should be sequenced first, followed by the appropriate codes for associated manifestations, except in the case of obstetrics patients,” the CDC notes.

Therefore, unless the patient your pulmonologist saw was pregnant, then sequencing U07.1 first is correct.

Which Code Applies to a Patient Post-COVID-19 Recovery?

Question 2: We treated a coronavirus patient in the hospital and he later went home after recovering from the disease. He came to our outpatient practice for a follow up complaining of a feeling of being constantly tired, and the pulmonologist diagnosed him with low iron levels and generalized weakness. Do we use the COVID-19 code for this visit?

Answer 2: No, if the patient no longer has an active case of COVID-19, you should not report U07.1. Instead, you’ll report the codes for the diagnoses the pulmonologist addressed, as well as the appropriate “Z” codes to represent the history of coronavirus. Therefore, your coding would appear as follows:

• E61.1 (Iron deficiency)
• R53.1 (Weakness)
• Z09 (Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm)
• Z86.19 (Personal history of other infectious and parasitic diseases)

The American Hospital Association’s (AHA’s) “Frequently-Asked Questions Regarding ICD-10-CM Coding for COVID-19” advises practices to report these two Z codes “when a patient who previously had COVID-19 is seen for a follow-up exam and the COVID-19 test is negative.” These two codes should be sequenced after the conditions that the pulmonologist actually treated, which in this case puts them in the third and fourth positions.

How Should You Report COVID-19 Diagnosed After the Fact?

Question 3: Our pulmonologist saw a patient in the hospital who had a suspected case of COVID-19, and we treated the patient for a collapsed lung. We found out after the patient had been discharged that he had indeed tested positive for the novel coronavirus. Which diagnosis code do we report?

Answer 3: You’ll use the COVID-19 code as your primary diagnosis, followed for the appropriate code that describes the collapsed lung, such as J98.11 (Atelectasis). Although your pulmonologist was primarily treating the collapsed lung and didn’t know for sure at the time that the patient had a positive case of COVID-19, the patient did ultimately test positive for the disease, and therefore the coronavirus code should be placed in the primary position.

“If a test is performed during the visit or hospitalization, but results come back after discharge positive for COVID-19, then it should be coded as confirmed COVID-19,” the AHA says in its FAQs.