Radiology Coding Alert

Navigate through a series of rules and instructions, with helpful examples to guide you.

The Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) doesn’t typically break from their mold of annual, on-cycle updates to the ICD-10-CM Tabular List of Diseases and Injuries. However, unprecedented times call for unprecedented measures. That’s why the CDC/NCHS recently issued an April 1 addendum that incorporates all the coding essentials for COVID-19 reporting. They followed up that addendum with an equally important update to the ICD-10-CM Official Coding and Reporting Guidelines.

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.

Drive the Point Home With These Examples

Next, take a look at some clinical scenarios and the respective ICD-10-CM codes you’ll use to report for them.

Scenario: A patient presents with concern about a possible exposure to COVID-19, but this is ruled out after evaluation. Report Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out).

Scenario: A patient has been exposed to a suspected or confirmed COVID-19 case. The patient’s test results come back either negative or unknown. Report Z20.828.

Scenario: An asymptomatic patient is screened for COVID-19 without any known exposure and test results come back either negative or unknown. Report Z11.59 (Encounter for screening for other viral diseases).

Scenario: A patient presents with COVID-19 signs and symptoms, but no established diagnosis. Code the signs and symptoms.

Scenario: A patient presents with COVID-19 signs and symptoms, and with actual or suspected exposure to a COVID-19 patient. Report Z20.828.

Scenario: An asymptomatic patient receives a positive COVID-19 test result. Report U07.1.

Sequence As Primary Dx, With 1 Exception

The final point of order to consider is sequencing. In all clinical scenarios outside of those that involve COVID-19 patients in pregnancy, childbirth, and puerperium, you should sequence code U07.1 as the primary, or principal, diagnosis. For patients with a positive COVID-19 diagnosis in pregnancy, childbirth, and puerperium, you’ll report the appropriate code from subcategory O98.5 (Other viral diseases complicating pregnancy, childbirth and the puerperium) as the primary diagnosis. You’ll follow that up with U07.1 and the respective codes for any pulmonary manifestations.

Disclaimer: Information related to COVID-19 is changing rapidly. This information was accurate at the time of writing. Be sure to stay tuned to future issues of Radiology Coding Alert for more information. You can also refer to payer websites, CMS (cms.gov), CDC (cdc.gov), and AAPC’s blog (www.aapc.com/blog) for the most up-to-date information.