The CDC has released ICD-10-CM Official Coding and Reporting Guidelines for the newly implemented code U07.1 (COVID-19). These guidelines are effective April 1, 2020 through Sept. 30, 2020.
 
The guidance for this code is located under the Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99) guidelines, in a section titled  “g. Coronavirus Infections.”
 
The code for COVID-19 should be assigned for confirmed cases only.
 
“Code only a confirmed diagnosis of the 2019 novel Coronavirus disease (COVID-19) as documented by the provider, documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result,” guidelines state.
 
Additionally, coding guidance states that presumptive positive COVID-19 test results should be coded as confirmed. This means any patient who has tested positive for the virus at the state or local level but has not yet been confirmed by the CDC.
 
For patients with documentation that includes terms such as “suspected”, “possible”, or “inconclusive,” guidelines state not to assign U07.1. Instead assign the code or codes that explain the reason for the encounter (such as fever) or Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.
 
As for sequencing of the codes, guidelines state 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 in the case of obstetrics patients as indicated in Section I.C.15.s. for COVID-19 in pregnancy, childbirth, and the puerperium.”
 
Acute respiratory illnesses due to COVID-19
 
The guidelines provide the following coding guidance for acute respiratory illnesses due to COVID-19
  • Pneumonia: Assign codes U07.1 (COVID-19) and J12.89 (Other viral pneumonia).
  • Acute bronchitis: Assign U07.1 and J20.8 (Acute bronchitis due to other specified organisms). Note: Bronchitis not otherwise specified (NOS) due to COVID-19 should be coded using code U07.1 and J40 (Bronchitis, not specified as acute or chronic).
  • Lower respiratory infection: If the COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, assign U07.1 and J22 (Unspecified acute lower respiratory infection). If the COVID-19 is documented as being associated with a respiratory infection, NOS, assign U07.1 and J98.8 (Other specified respiratory disorders).
  • Acute respiratory distress syndrome: Assign U07.1 and J80 (Acute respiratory distress syndrome).
Additional COVID-19 guidance:
 
  • Exposure: For patients where there is a concern about a possible exposure to COVID-19, but this is ruled out following evaluation, guidelines state to assign Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out). Additionally, if the patient had an actual exposure to another person who is confirmed or suspected of having COVID-19 – and the “exposed” individual either tests negative or results are unknown – assign Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases).
  • Screening: For patients who are being screened for COVID-19, have no known exposure, and with test results that are either negative or unknown, assign Z11.59 (Encounter for screening for other viral diseases). For patients who are being screened due to a possible or actual exposure to COVID-19, refer to guideline d.
  • Signs and symptoms without definitive diagnosis of COVID-19: For patients who have any symptoms that are associated with COVID-19, but a definitive diagnosis has not be confirmed, assign the appropriate codes for each of the symptoms such as R05 (Cough), R06.02 (Shortness or breath) or R50.9 (Fever, unspecified). For a patient who has symptoms and has had contact or exposure with someone who has COVID-19, also assign Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases). This is an exception to guideline [I.C.21.c.1].
  • Asymptomatic individuals who test positive for COVID-19: For patients who are asymptomatic and test positive for COVID-19, assign U07.1.
 
To view the full guidelines, visit https://bit.ly/2xKQqvl.