Pulmonology Coding Alert

Question: In a previous issue, you discussed a case where the pulmonologist treated a patient for a collapsed lung in the hospital and suspected the patient had COVID-19. After the patient was discharged, they learned that the patient had tested positive for the novel coronavirus. You advised reporting U07.1 (COVID-19) as the primary diagnosis, followed by J98.11 (Atelectasis) as secondary, because the ICD-10 guidelines indicate that “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 when another guideline requires that certain codes be sequenced first, such as obstetrics, sepsis, or transplant complications.”

Is that applicable in this case? Because when the ICD-10 guidelines refer to “principal diagnosis,” we don’t think that applies to an inpatient. We’d consider the “principal diagnosis” to be the collapsed lung, since that’s what the physician treated in the hospital. Can you advise?

New York Subscriber

Answer: If the clinician’s notes indicate that the collapsed lung was a manifestation of COVID-19, then you can list U07.1 as the principal (first-listed) diagnosis code, followed by J98.11. This comes down to review of multiple references and guidelines, which we break down below.

First, a list of ICD-10-CM questions developed jointly by the American Hospital Association and AHIMA to address ICD-10-CM provides information on when to use the COVID-19 diagnosis code.

“Yes, Presumptive positive COVID-19 test results should be coded as confirmed,” one Q&A states. “A presumptive positive test result means 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 and Prevention (CDC). CDC confirmation of local and state tests for the COVID-19 virus is no longer required.”

In the same document, a question asked whether providers must explicitly link the COVID-19 test results to a respiratory condition as the cause of the respiratory illness before coding a confirmed COVID-19 diagnosis, to which the agencies say no. “The positive test results can be coded as confirmed COVID-19 cases as long as the test result itself is part of the medical record. As stated in the coding guidelines for COVID-19 infections that went into effect on April 1, code U07.1 may be assigned based on results of a positive test as well as when COVID- 19 is documented by the provider.”

Later, the guidelines note, “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.”

These answers together confirm the fact that the scenario in question qualifies for the assignment of code U07.1 to the claim. Then comes the question of whether it should actually be the primary diagnosis.

The document addresses that also, noting that “When COVID-19 meets the definition of principal or first-listed diagnosis, code U07.1, COVID-19, should be sequenced first, and followed by the appropriate codes for associated manifestations, except in the case of obstetrics patients. However, if COVID-19 does not meet the definition of principal or first-listed diagnosis (e.g. when it develops after admission), then code U07.1 should be used as a secondary diagnosis.” This is also supported by the updated ICD-10-CM Official Guidelines.

Therefore, if the pulmonologist saw a patient in the hospital and treated them for a collapsed lung associated with suspected COVID-19, you’re correct in sequencing U07.1 first.