ICD-10-CM Code for COVID-19

Co-authored by Gina Hobert

Consistent with the World Health Organization (WHO) update to ICD-10, the Centers for Disease Control and Infection (CDC) will implement U07.1 COVID-19 for reporting effective April 1, 2020.

FAQ for ICD-10-CM Coding for COVID-19

1. What is the ICD-10-CM code for COVID-19?

Answer: U07.1 COVID-19 should be used for discharges/dates of service on or after April 1, 2020. Developed by the WHO, the COVID-19 is intended to be sequenced first (except in the case of newborns and obstetric patients) when it meets the definition of principal diagnosis, followed by codes for any associated manifestations. For guidance prior to April 1, 2020, please refer to BNN’s previously published release, or click here for the supplement published by the CDC.

2. Can U07.1 be a secondary diagnosis?

Answer: If it doesn’t meet the definition of principal diagnosis, it should be coded as secondary. An example would be a patient admitted for a hip fracture, and following admission while in the hospital, is determined to have COVID-19.

3. The supplement to the ICD-10-CM Official Coding Guidelines as it relates to coding COVID-19 cases refers to coding “confirmed” cases. What does confirmation mean?  Is the provider required to have a copy of the lab results to support confirmation?

Answer: The provider’s diagnostic statement that the patient has the condition would suffice. The guideline is intended to code only confirmed cases. It is not required that a copy of the lab test or documentation of the test result be available.

4. What does presumptive positive mean, from a coding perspective?

Answer: Presumptive positive means a positive test for the virus at the local or state level, but it has not been confirmed by the CDC. Local and state tests no longer have to be confirmed by the CDC. Presumptive positive test should be coded as confirmed COVID-19.

5. How should cases related to COVID-19 be coded when the results aren’t back from the lab?

Answer: Due to the heightened need to capture accurate data on COVID-19 cases, the American Health Information Management Association (AHIMA) is recommending providers develop facility-specific coding guidelines. Providers are encouraged to delay coding for inpatient admissions and outpatient encounters until the test results are available.

The April 1, 2020 ICD-10-CM Addenda in detail can be found here.

FOR MORE INFORMATION, PLEASE CONTACT THE FOLLOWING MEMBERS OF OUR HEALTHCARE ADVISORY GROUP:

Eric Wetherell, CPA: Principal and Healthcare Advisory Group Lead

Dianne Rodrigue, PA, MHP, CCDS, CRC, CPC: Senior Manager

Gina Hobert, MBA, CHC, CPC-I, CEMC, CRC, CPMA:  Senior Manager

 

Disclaimer of Liability: This publication is intended to provide general information to our clients and friends. It does not constitute accounting, tax, investment, or legal advice; nor is it intended to convey a thorough treatment of the subject matter.

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