ICD-10-CM and ICD-10-PCS: Questions and Answers for COVID-19 Coding

Questions and Answers Provided by the AHA Central Office

The following questions and answers were jointly developed and approved by the American Hospital Association’s Central Office on ICD-10-CM/PCS and the American Health Information Management Association.

• ICD-10-CM code U07.1, COVID-19, is applicable for discharges/dates of service on or after April 1, 2020. For detailed information on this code, please refer here. Developed by the World Health Organization (WHO), this code is intended to be sequenced first, followed by relevant codes for associated manifestations when COVID-19 is the principal or first-listed diagnosis. Specific usage guidelines are available here. For guidance prior to April 1, 2020, please consult the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak.

• When COVID-19 is determined as the principal or first-listed diagnosis, code U07.1, COVID-19, should be sequenced first. It should be followed by appropriate codes for any associated manifestations, unless other guidelines dictate a different sequencing order, such as in obstetrics, sepsis, or transplant complications. Conversely, if COVID-19 is not the principal or first-listed diagnosis (e.g., develops after admission), code U07.1 should be used as a secondary diagnosis.

• The Centers for Disease Control and Prevention’s National Center for Health Statistics, the US agency responsible for maintaining ICD-10-CM, is implementing several new ICD-10-CM codes related to COVID-19 on January 1, 2021. For more details, see ICD-10-CM FAQ #44.

• In the US, the HIPAA code set standard for diagnosis coding is ICD-10-CM, not ICD-10. As indicated in the April 1, 2020 Addenda on the CDC website, U07.1 is the sole new code being implemented in the US for COVID-19.

• For encounters related to the COVID-19 coronavirus outbreak, please refer to the supplement to the ICD-10-CM Official Guidelines. For dates after April 1, 2020, consult the Official Guidelines for Coding and Reporting available here.

• No, the code U07.1 is not retroactive. For coding guidance for discharges/services provided before April 1, 2020, please refer to the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak.

• No, code B97.29 is not exclusively for the SARS-CoV-2/2019-nCoV virus responsible for the COVID-19 pandemic. This code does not differentiate between the over 30 types of coronaviruses, some of which cause the common cold. Given the critical need to uniquely identify COVID-19 until the specific ICD-10-CM code became effective on April 1, providers were encouraged to establish facility-specific coding guidelines. These guidelines should limit the assignment of code B97.29 to confirmed COVID-19 cases and prevent its use for any other coronaviruses.

• Diagnosis code B34.2, Coronavirus infection, unspecified, is generally not appropriate for COVID-19. COVID-19 cases have predominantly been respiratory in nature, making the infection site not “unspecified.” Code B97.29, Other coronavirus as the cause of diseases classified elsewhere, was designated as the interim code for reporting confirmed COVID-19 cases. For further details, please refer to the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak. Due to code B97.29 not being exclusive to the SARS-CoV-2/2019-nCoV virus of the COVID-19 pandemic, providers were urged to develop facility-specific coding guidelines. These guidelines should restrict the use of B97.29 to confirmed COVID-19 cases and exclude its use for other coronaviruses.

• Yes, the supplement applies to all patient types. As stated in the supplement guidelines, “If the provider documents “suspected”, “possible” or “probable” COVID-19, do not assign code B97.29. Assign a code(s) explaining the reason for encounter (such as fever, or Z20.828, Contact with and (suspected) exposure to other viral and communicable diseases.”

• The intention of the guideline is to code only confirmed cases of COVID-19. A copy of the confirmatory test or documentation of the test result in the record is not required. The provider’s diagnostic statement that the patient has the condition is sufficient.

• Yes, Presumptive positive COVID-19 test results should be coded as confirmed. 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 necessary.

• Due to the significant need for accurate data on positive COVID-19 cases, it is recommended that providers consider developing facility-specific coding guidelines. These guidelines could advise delaying the coding of inpatient admissions and outpatient encounters until COVID-19 test results are available. This recommendation is specifically for cases related to COVID-19.

• No, the provider is not required to explicitly link the test result to the respiratory condition. 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 effective April 1, code U07.1 may be assigned based on positive test results or when COVID-19 is documented by the provider. This advice is specific to COVID-19 cases and not for coding other laboratory tests. To enhance the unique identification of COVID-19 patients, providers are recommended to consider facility-specific coding guidelines. These guidelines could suggest holding back coding of inpatient admissions and outpatient encounters until COVID-19 test results are available.

• Yes, if a test is performed during a visit or hospitalization, but results come back positive for COVID-19 after discharge, it should be coded as confirmed COVID-19.

• The determination of whether sepsis or U07.1 is assigned as the principal diagnosis depends on the admission circumstances and whether sepsis meets the definition of principal diagnosis. For instance, if a patient is admitted with pneumonia due to COVID-19 and then develops viral sepsis (not present on admission), the principal diagnosis is U07.1, COVID-19, followed by codes for viral sepsis and viral pneumonia. Conversely, if a patient is admitted with sepsis due to COVID-19 pneumonia, and sepsis meets the principal diagnosis definition, the code for viral sepsis (A41.89) should be the principal diagnosis. This is followed by codes U07.1 and the appropriate viral pneumonia code (J12.89, Other viral pneumonia, for discharges/encounters before January 1, 2021, or code J12.82, Pneumonia due to coronavirus disease 2019, for discharges/encounters after January 1, 2021) as secondary diagnoses.

• Coding professionals should query the provider if COVID-19 was documented before test results were available and the results are negative. Providers should have the opportunity to reconsider the diagnosis based on this new information.

• If the provider continues to document and confirm COVID-19 despite negative test results, or if they document disagreement with the test results, assign code U07.1, COVID-19. As stated in the Official Guidelines for Coding and Reporting for COVID-19, “Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider . . . the provider’s documentation that the individual has COVID-19 is sufficient.”

• Assign codes Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, and the appropriate personal history code (code Z86.19, Personal history of other infectious and parasitic diseases, for encounters prior to January 1, 2021, or code Z86.16, Personal history of COVID-19, for encounters after January 1, 2021).

• For encounters for antibody testing not intended to confirm a current COVID-19 infection or as a follow-up after COVID-19 resolution, assign Z01.84, Encounter for antibody response examination.

• Yes, both codes may be assigned. Aspiration pneumonia and pneumonia due to COVID-19 are separate, unrelated conditions with different underlying causes. This scenario meets the exception to the Excludes1 guideline as these two conditions are unrelated.

  Note that effective January 1, 2021, a new code, J12.82, exists for pneumonia due to coronavirus disease 2019.

• Any immunocompromised patient, including HIV patients, has a higher risk of COVID-19 infection. However, HIV does not cause COVID-19. Code both conditions separately, with sequencing based on admission circumstances – similar to patients with diabetes or other chronic conditions increasing COVID-19 risk.

• There is no specific timeframe for assigning a personal history code. If the provider documents that the patient no longer has COVID-19, assign the appropriate personal history code (code Z86.19, Personal history of other infectious and parasitic diseases, for discharges/encounters before January 1, 2021, or code Z86.16, Personal history of COVID-19, for encounters after January 1, 2021).

• COVID-19 infected individuals may range from asymptomatic to experiencing varied symptoms and severity. For coding, signs and symptoms associated with COVID-19 may be coded separately, unless routinely associated with a manifestation. For example, cough should not be coded separately if the patient has pneumonia due to COVID-19, as cough is a pneumonia symptom. Coding additional signs or symptoms not explained by manifestations provides further disease severity information. Because COVID-19 is primarily a respiratory condition, other signs/symptoms should be coded separately unless another definitive diagnosis is established for them. This aligns with Guideline IC.18.b, “Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis.”

• When coding a birth episode in a newborn record, assign the appropriate code from category Z38, Liveborn infants according to place of birth and type of delivery, as the principal diagnosis. For a newborn testing positive for COVID-19, assign code U07.1, COVID-19, and codes for associated manifestation(s) in neonates/newborns if no documentation indicates a specific transmission type. If a newborn tests positive for COVID-19 and the provider documents in utero or birth process contraction, assign codes P35.8, Other congenital viral diseases, and U07.1, COVID-19.

• Assign code T86.812, Lung transplant infection, as the principal or first-listed diagnosis, followed by code U07.1, COVID-19. This sequencing is supported by the Tabular List note at code T86.812 to “use additional code to specify infection.” ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.g.3.a. state that “a transplant complication code is only assigned if the complication affects the function of the transplanted organ.” Here, the COVID-19 infection has affected the transplanted lung’s function.

• Assign code U07.1, COVID-19, as the principal diagnosis, and code J93.83, Other pneumothorax, as a secondary diagnosis. If pneumothorax due to COVID-19 present on the first admission has not resolved, this is ongoing treatment for a COVID-19 manifestation.

  If documentation is unclear whether a condition is an acute manifestation of current COVID-19 or a residual effect from previous COVID-19, query the provider. As per Official Guidelines for Coding and Reporting, provider documentation of COVID-19 is sufficient for coding purposes.

• Assign code J93.83, Other pneumothorax, as the principal diagnosis, followed by code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters before October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021. In this case, the patient no longer has COVID-19, and pneumothorax is a residual effect (sequelae). A personal history code is inappropriate because guideline I.C.21.c.4) states, “Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring.” The patient is clearly receiving treatment for the residual effect of COVID-19.

• Assign code U07.1, COVID-19, as the principal diagnosis, followed by code I26.99, Other pulmonary embolism without acute cor pulmonale, for a patient diagnosed with pulmonary embolism and COVID-19. Pulmonary embolism is a manifestation of COVID-19 infection. The instructional note under code U07.1 directs that COVID-19 should be sequenced as the principal diagnosis and additional codes should be assigned for manifestations.

• Assign code I26.99, Other pulmonary embolism without acute cor pulmonale, as the principal diagnosis, followed by code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters before October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as a secondary diagnosis.

• Assign code U07.1, COVID-19, as the patient still has COVID-19. Do not assign a code for pneumonia as it has resolved.

• Assign code G61.0, Guillain-Barre syndrome, as the principal diagnosis, followed by code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters before October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021.

• Assign code U07.1, COVID-19, as the principal diagnosis, and code J96.01 Acute respiratory failure with hypoxia, as a secondary diagnosis. The instructional note under code U07.1 directs that COVID-19 should be sequenced as the principal diagnosis and additional codes should be assigned for manifestations.

• Assign codes G72.81, Critical illness myopathy, and G57.31, Lesion of lateral popliteal nerve, right lower limb. Assign code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters before October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as a secondary diagnosis for sequelae of COVID-19 infection.

• Assign codes for specific symptoms (e.g., generalized weakness, debility). Assign the appropriate personal history code (code Z86.19, Personal history of other infectious and parasitic diseases, for discharges/encounters before January 1, 2021, or code Z86.16, Personal history of COVID-19, for encounters after January 1, 2021) as a secondary diagnosis.

  Do not assign code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters before October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as debility is due to prolonged hospitalization, not a sequela of COVID-19 infection.

• Assign code U07.1, COVID-19, as the principal diagnosis, and code M35.8, Other specified systemic involvement of connective tissue, for discharges before January 1, 2021, or code M35.81, Multisystem inflammatory syndrome, for discharges after January 1, 2021, as a secondary diagnosis for MIS-C due to COVID-19. MIS-C is a manifestation of COVID-19 infection. The instructional note under code U07.1 directs that COVID-19 should be sequenced as the principal diagnosis and additional codes assigned for manifestations.

  If documentation is unclear whether a condition is an acute manifestation of current COVID-19 or a residual effect from previous COVID-19, query the provider. As stated in the ICD-10-CM Official Guidelines for Coding and Reporting, provider documentation of COVID-19 is sufficient for coding.

• Assign code M35.8, Other specified systemic involvement of connective tissue, for discharges before January 1, 2021, or code M35.81, Multisystem inflammatory syndrome, for discharges after January 1, 2021, as the principal diagnosis for MIS-C. Assign code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters before October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as a secondary diagnosis for sequelae of COVID-19 infection.

  If documentation is unclear whether a condition is an acute manifestation of current COVID-19 or a residual effect from previous COVID-19, query the provider. As stated in the ICD-10-CM Official Guidelines for Coding and Reporting, provider documentation of COVID-19 is sufficient for coding.

• During the COVID-19 pandemic, a screening code is generally not appropriate. For COVID-19 testing encounters, including preoperative testing, code as exposure to COVID-19 (code Z20.828 for encounters before January 1, 2021, or code Z20.822, Contact with and (suspected) exposure to COVID-19, for encounters after January 1, 2021). The ICD-10-CM Official Guidelines for Coding and Reporting state that codes in category Z20, Contact with and (suspected) exposure to communicable diseases, are for patients suspected to have been exposed to a disease via close personal contact with an infected individual or in an epidemic area.

  For preoperative COVID-19 testing encounters, assign code Z01.812, Encounter for preprocedural laboratory examination, as the first-listed diagnosis and code Z20.828 or Z20.822 (depending on encounter date) as an additional diagnosis.

  Coding guidance will be updated as new pandemic status information emerges.

  Note: This advice aligns with updated ICD-10-CM Official Guidelines for Coding and Reporting effective October 1, 2020. AHA and AHIMA clarified appropriate COVID-19 testing codes in advance of the revised official coding guidelines’ effective date due to unprecedented times.

• For asymptomatic individuals with actual or suspected COVID-19 exposure, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, for encounters before January 1, 2021, and code Z20.822, Contact with and (suspected) exposure to COVID-19, for encounters after January 1, 2021.

  For symptomatic individuals with actual or suspected COVID-19 exposure, where infection is ruled out, or test results are inconclusive/unknown, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, or code Z20.822, Contact with an (suspected) exposure to COVID-19, depending on the encounter date.

  If COVID-19 is confirmed, assign code U07.1 instead of code Z20.828 or Z20.822.

  Note: This advice aligns with updated ICD-10-CM Official Guidelines for Coding and Reporting effective October 1, 2020. AHA and AHIMA clarified appropriate COVID-19 testing codes in advance of the revised official coding guidelines’ effective date due to unprecedented times.

• Assign codes U07.1, COVID-19, and D68.8, Other specified coagulation defects.

  If disseminated intravascular coagulation (DIC) is documented, assign code D65, Disseminated intravascular coagulation [defibrination syndrome], instead of code D68.8. Not all COVID-19 associated coagulopathy progresses to DIC.

• Assign codes U07.1, COVID-19, and D68.8, Other specified coagulation defects, and L99, Other disorders of skin and subcutaneous tissue in diseases classified elsewhere.

• Viral shedding can indicate either active (current) COVID-19 infection or a personal history of COVID-19. Code assignment depends on provider documentation.

  For viral shedding documentation in a patient with active COVID-19 infection, assign code U07.1, COVID-19.

  For viral shedding documentation in a patient with a personal history of COVID-19 infection, not an active infection, assign code Z86.19, Personal history of other infectious and parasitic diseases, for discharges/encounters before January 1, 2021, or code Z86.16, Personal history of COVID-19, for encounters after January 1, 2021.

  If documentation is unclear about active COVID-19 infection or personal history, query the provider.

• [Effective 10/1/21:]

  For discharges/encounters on or after October 1, 2021, assign codes R53.1, Weakness, R63.0, Anorexia, and U09.9, Post COVID-19 condition, unspecified, for post COVID-19 syndrome diagnosis with generalized weakness and lack of appetite. This is supported by the instructional note at code U09.9 to “code first the specific condition related to COVID-19 if known.”

  [Prior to 10/1/21:]

  For discharges/encounters before October 1, 2021, unless the provider specifically documents symptoms as results of COVID-19, assign code(s) for specific symptom(s) and a code for personal history of COVID-19. “Post COVID-19 syndrome” indicates temporality, but not that current symptom(s) or clinical condition(s) are a residual effect (sequelae) of COVID-19. As stated in the ICD-10-CM Official Guidelines for Coding and Reporting, in the absence of Alphabetic Index guidance for coding syndromes, assign codes for documented syndrome manifestations.

  The appropriate personal history code is Z86.19, Personal history of other infectious and parasitic diseases, for discharges/encounters before January 1, 2021, or code Z86.16, Personal history of COVID-19, for encounters after January 1, 2021.

  If the provider documents symptoms are a residual effect of COVID-19, assign code(s) for specific symptom(s) and code B94.8, Sequelae of other specified infectious and parasitic diseases. According to the ICD-10-CM Official Guidelines for Coding and Reporting, a sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated.

• In response to the declared national emergency concerning the COVID-19 outbreak, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) implemented new ICD-10-CM diagnosis codes, effective January 1, 2021.

  The new ICD-10-CM codes implemented on January 1, 2021, are:

  J12.82 Pneumonia due to coronavirus disease 2019

  M35.81 Multisystem inflammatory syndrome

  Z11.52 Encounter for screening for COVID-19

  Z20.822 Contact with and (suspected) exposure to COVID-19

  Z86.16 Personal history of COVID-19

  The January 2021 ICD-10-CM Addenda and updated ICD-10-CM Official Guidelines for Coding and Reporting are available at: https://www.cdc.gov/nchs/icd/icd10cm.htm.

• Assign codes T78.49XA, Other allergy, initial encounter; R07.89, Other chest pain; and R09.89, Other specified symptoms and signs involving the circulatory and respiratory systems. Currently approved COVID-19 vaccines in the United States are not serum based, thus code T80.62XA-, Other serum reaction due to vaccination, initial encounter is inappropriate.

• Assign codes R53.81, Other malaise; and T50.B95A, Adverse effect of other viral vaccines, initial encounter.

• Assign code T80.52XA, Anaphylactic reaction due to vaccination, initial encounter, for documented anaphylactic reaction to COVID-19 vaccine. Although subcategory T80.5 identifies anaphylactic reaction to serum, it is the closest available code to capture this condition.

• Yes, reporting code(s) for side effects is appropriate when the patient needs additional treatment or medical care, such as monitoring or treatment for side effects. Assign the code for the effect’s nature (e.g., fever) followed by code T50.B95A, Adverse effect of other viral vaccines, initial encounter.

• Query the provider whether “residual respiratory failure” refers to acute on chronic, or chronic respiratory failure. Assign the appropriate respiratory failure code based on the response, followed by code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters before October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as a secondary diagnosis for COVID-19 infection sequelae, since the patient is documented as no longer infectious for COVID-19.

  Although the provider mentioned “history of COVID-19,” a personal history code is inappropriate here. As defined in ICD-10-CM Official Guidelines for Coding and Reporting, Section IB. “A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated.” Section I. C.21,c,( 4) further states “Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring.”

• Assign code J96.10, Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, as the principal diagnosis since ARDS has resolved. Additionally, assign code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters before October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as a secondary diagnosis, since the patient no longer has active COVID-19 infection.

• Assign code U07.1. COVID-19, as the principal diagnosis. Code J12.82, Pneumonia due to coronavirus disease 2019, should be assigned as an additional diagnosis. The Instructional Note under code U07.1 directs to use an additional code to identify pneumonia or other manifestations. Therefore, when a patient presents with an acute COVID-19 manifestation like pneumonia, code U07.1 is sequenced as the principal or first diagnosis, regardless of the most recent COVID-19 test result (positive or negative). Official Guidelines for Coding and Reporting for sequela state, “A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated.”

• Assign code U07.1. COVID-19, as the principal or first-listed diagnosis because pneumonia is an acute manifestation of COVID-19 infection. Assign code J12.82, Pneumonia due to coronavirus disease 2019, as an additional diagnosis. The Instructional Note under code U07.1 directs to use an additional code to identify pneumonia or other manifestations. Therefore, for a patient presenting with an acute COVID-19 manifestation like pneumonia, code U07.1 should be reported as the principal or first diagnosis, regardless of their most recent COVID-19 test result (positive or negative).

• Based on provided documentation, the patient has organizing pneumonia due to previous COVID-19 infection. Assign code J84.89, Other specified interstitial pulmonary diseases, followed by code B94.8. Sequelae of other specified infectious and parasitic diseases, for discharges/encounters before October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, for post COVID-19 organizing pneumonia diagnosis.

  Code J84.89 may be found via the Index entry:

  Pneumonia – organizing J84.89

• Assign code U07.1, COVID-19, as the principal or first-listed diagnosis as pneumonia is an acute manifestation of COVID-19 infection. Assign code J12.82, Pneumonia due to coronavirus disease 2019, and code J80, Acute respiratory distress syndrome, as additional diagnoses for pneumonia and ARDS. Also, assign codes J95.859, Other complication of respirator [ventilator], J95.811, Postprocedural pneumothorax, and J94.8, Other specified pleural conditions, to capture hydropneumothorax barotrauma due to mechanical ventilation. COVID-19 presence does not affect hydropneumothorax barotrauma code assignment.

• Assign code Z86.16, Personal history of COVID-19. While the patient had a positive COVID-19 test, the provider documented that the patient was not actively infectious during this admission. When the provider documents “noninfectious” or “not infectious” COVID-19 status, it indicates the patient no longer has active COVID-19 infection, hence assign code Z86.16 instead of code U07.1, COVID-19.

  Although guideline I.C.1.g.1.a., states: “Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider or documentation of a positive COVID-19 test result,” in this scenario the provider clarified the patient no longer has an active COVID-19 infection. Thus, code U07.1, COVID-19, is not appropriate and Official Coding Guideline I.C.1.g.1.a., regarding a positive COVID-19 test result, does not apply.

  If documentation is unclear about active COVID-19 infection or personal history, query the provider for clarification.

• Although the patient still tests positive for COVID-19, the provider documented the condition as a previous history of COVID-19 infection, not reinfection. Therefore, assigning code Z86.16, Personal history of COVID-19, is appropriate.

• Assign code U07.1, COVID-19. The provider’s assessment stated “COVID-19 virus detected,” and COVID-19 infection can occur despite vaccination. This is consistent with Official Guidelines for Coding and Reporting, Section I.C.1.g.1.a., which states: Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider or documentation of a positive COVID-19 test result.

• Assign code Z20.822, Contact with and (suspected) exposure to COVID-19, as principal diagnosis for a patient admitted and found to have a false positive COVID-19 test. ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.1.g.1.e. states: For asymptomatic individuals with actual or suspected exposure to COVID-19, assign code Z20.822, Contact with and (suspected) exposure to COVID-19.

  Although guideline I.C.1.g.1.a., allows coding confirmed COVID-19 cases based on “documentation of a positive COVID-19 test result,” in this scenario, the provider clarified the COVID-19 test as false positive. Therefore, code U07.1, COVID-19, is inappropriate, and Official Coding Guideline I.C.1.g.1.a. regarding coding based on a positive COVID-19 test result does not apply.

  However, always query the provider for clarification when medical record documentation is unclear about the patient’s COVID-19 status.

• (Question #59 was deleted on April 13, 2022.)

• Yes, underimmunization status codes may be assigned based on nursing or other clinician documentation where patient vaccination status information is found.

  Official Coding Guideline I.B.14, Documentation by Clinicians Other than the Patient’s Provider, will be updated with FY 2023 guideline revisions to include all underimmunization status codes as exceptions for conditions/statuses documentable by clinicians other than the patient’s provider.

• Do not assign code Z20.822, Contact with and (suspected) exposure to COVID-19, since provider documentation does not indicate the infant was affected (e.g., small for gestational age) by the mother’s COVID-19 infection, and secondary diagnosis criteria are unmet. Official Guidelines for Coding and Reporting general perinatal rules (16.a.6.) state, “All clinically significant conditions noted on routine newborn examination should be coded. A condition is clinically significant if it requires: clinical evaluation, or therapeutic treatment, or diagnostic procedures, or extended length of hospital stay, or increased nursing care and/or monitoring, or has implications for future health care needs.”

• Assign the appropriate code from category D57, Sickle-cell disorders, for sickle cell crisis and code U07.1 for COVID-19 infection. Sequencing depends on admission circumstances. While COVID-19 infection triggered acute sickle cell crisis, SCD is not a COVID-19 manifestation.

• Assign code Z20.822, Contact with and (suspected) exposure to COVID-19, to identify that the recipient received a donor organ positive for COVID-19.

• The federal Public Health Emergency (PHE) for COVID-19 will expire on May 11, 2023. Based on ICD-10-CM Official Guidelines for Coding and Reporting, continue assigning code Z20.822, Contact with and (suspected) exposure to COVID-19, for COVID-19 screening performed after May 11, 2023.

  Note: This advice is consistent with current coding guidance.

  Effective October 1, 2023, the ICD-10-CM Official Guidelines for Coding and Reporting on encounters for COVID-19 screening will be revised. For COVID-19 screening encounters on or after October 1, 2023, assign code Z11.52, Encounter for screening for COVID-19.

• For preoperative COVID-19 screening encounters after May 11, 2023, continue assigning code Z01.812, Encounter for preprocedural laboratory examination, as the first-listed diagnosis and code Z20.822, Contact with and (suspected) exposure to COVID-19, as an additional diagnosis.

  Note: This advice is consistent with current coding guidance.

  Effective October 1, 2023, for preoperative COVID-19 screening encounters, assign code Z01.812, Encounter for preprocedural laboratory examination, as the first-listed diagnosis and code Z11.52, Encounter for screening for COVID-19, as an additional diagnosis.

• In response to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) implemented 12 new ICD-10-PCS procedure codes to describe the introduction or infusion of therapeutics for COVID-19 treatment, effective for discharges on or after August 1, 2020. Code Tables, Index, and related Addenda files for these 12 new procedure codes are at: https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-PCS.

• Effective for discharges on or after August 1, 2020, new ICD-10-PCS codes are implemented for administering three drugs used to treat COVID-19:

  • XW033E5, Introduction of Remdesivir Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 5
  • XW043E5, Introduction of Remdesivir Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 5
  • XW033G5, Introduction of Sarilumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5
  • XW043G5, Introduction of Sarilumab into Central Vein, Percutaneous Approach, New Technology Group 5
  • XW033H5, Introduction of Tocilizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5
  • XW043H5, Introduction of Tocilizumab into Central Vein, Percutaneous Approach, New Technology Group 5

  These codes should only be assigned when these drugs are administered specifically to treat COVID-19.

• Effective for discharges on or after August 1, 2020, assign ICD-10-PCS code XW13325, Transfusion of Convalescent Plasma (Nonautologous) into Peripheral Vein, Percutaneous Approach, New Technology Group 5, or code XW14325, Transfusion of Convalescent Plasma (Nonautologous) into Central Vein, Percutaneous Approach, New Technology Group 5.

• Effective for discharges on or after August 1, 2020, the following ICD-10-PCS codes should be used for administering a new therapeutic substance to treat COVID-19 when the substance is not classified elsewhere in ICD-10-PCS:

  • XW013F5, Introduction of Other New Technology Therapeutic Substance into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 5
  • XW033F5, Introduction of Other New Technology Therapeutic Substance into Peripheral Vein, Percutaneous Approach, New Technology Group 5
  • XW043F5, Introduction of Other New Technology Therapeutic Substance into Central Vein, Percutaneous Approach, New Technology Group 5
  • XW0DXF5, Introduction of Other New Technology Therapeutic Substance into Mouth and Pharynx, External Approach, New Technology Group 5

  These codes should only be assigned for therapeutic substances used to treat COVID-19. For administration of “other therapeutic substances” for medical conditions other than COVID-19, see ICD-10-PCS table 3E0. For example, code 3E033GC describes “Introduction of Other Therapeutic Substance into Peripheral Vein, Percutaneous Approach.”

• No, the 12 new ICD-10-PCS codes for therapeutic substances to treat COVID-19 do not affect MS-DRG assignment. However, hospitals are encouraged to report these codes when applicable, as they will be useful in evaluating the effectiveness of different therapeutic substances used for COVID-19 treatment and tracking patient outcomes.

• When a more specific ICD-10-PCS code exists, such as for stem cell transfusion, assign that code rather than a less specific new technology code. The new codes for “introduction of other new technology therapeutic substance” are intended only for new substances not classified elsewhere in ICD-10-PCS.

• No, these new codes are only intended for use when these drugs are administered to treat COVID-19.

• Only assign the drug administration code once.

• If your facility wishes to capture this information, you may assign the appropriate code from table 3E0 for anti-inflammatory drug introduction. Do not assign a code from table XW0 for Introduction of Other New Technology Therapeutic Substance.

• In response to the COVID-19 pandemic, CMS is implementing 21 new ICD-10-PCS procedure codes to describe the introduction or infusion of therapeutics, including monoclonal antibodies, for COVID-19 treatment, as well as new codes for COVID-19 vaccines, effective January 1, 2021. An announcement listing these codes and information related to ICD-10 MS-DRGs V38.1 is at: https://www.cms.gov/medicare/icd-10/2021-icd-10-pcs

  For guidance on the appropriate ICD-10-PCS procedure code when a new drug or other therapeutic substance is administered in the inpatient setting to treat COVID-19, and no unique code exists for the specific substance administration, see ICD-10-PCS FAQ #4.