Use proper ICD-10 codes for COVID-19 as it affects cost-sharing that is being applied! 

To accurately report visits related to COVID-19, appropriate ICD-10 CM codes must be used. It might affect the cost-sharing, as health insurance carriers are waving cost-sharing for COVID-19 related visits regardless if it was confirmed or suspected.

The Centers for Disease Control (CDC), under the National Emergencies Act Section 201 and 301, is announcing a change in the effective date of new diagnosis code U07.1, COVID-19, from October 1, 2020 to April 1, 2020.

Sourcehttps://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-3-18-2020.pdf


ICD-10-CM Official Coding Guidelines - Supplement Coding encounters related to COVID-19 Coronavirus Outbreak prior to April 1, 2020.

General Guidance

Pneumonia

For a pneumonia case confirmed due to the 2019 novel coronavirus (COVID-19), assign codes J12.89 (Other viral pneumonia) and B97.29 (Other coronavirus as the cause of diseases classified elsewhere).

Acute Bronchitis

For a patient with acute bronchitis confirmed due to COVID-19, assign codes J20.8 (Acute bronchitis due to other specified organisms) and B97.29 (Other coronavirus as the cause of diseases classified elsewhere). Bronchitis not otherwise specified (NOS) due to the COVID-19 should be coded using code J40 (Bronchitis, not specified as acute or chronic); along with code B97.29 (Other coronavirus as the cause of diseases classified elsewhere).

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, this should be assigned with code J22 (Unspecified acute lower respiratory infection) with code B97.29 (Other coronavirus as the cause of diseases classified elsewhere). If the COVID-19 is documented as being associated with a respiratory infection, NOS, it would be appropriate to assign code J98.8 (Other specified respiratory disorders) with code B97.29 (Other coronavirus as the cause of diseases classified elsewhere).

ARDS

Acute respiratory distress syndrome (ARDS) may develop in with the COVID-19, according to the Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (COVID-19) Infection. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html

Cases with ARDS due to COVID-19 should be assigned the codes J80 (Acute respiratory distress syndrome) and B97.29 (Other coronavirus as the cause of diseases classified elsewhere).

Exposure to COVID-19 

For cases where there is concern about possible exposure to COVID-19 but is ruled out after evaluation, it would be appropriate to assign the code Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out).

For cases where there is actual exposure to someone who is confirmed to have COVID-19, it would be appropriate to assign the code Z20.828 ( Contact with and (suspected) exposure to other viral communicable diseases).

Signs and symptoms

For patients presenting with any signs/symptoms (such as fever, etc.) and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as:

  • R05 (Cough)
  • R06.02 (Shortness of breath)
  • R50.9 (Fever, unspecified)

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).

This coding guidance has been developed by CDC and approved by the four organizations that make up the Cooperating Parties: The National Center for Health Statistics, the American Health Information Management Association, the American Hospital Association, and the Centers for Medicare & Medicaid Services. 

Reference: COVID-10 clinical presentation: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

Sourcehttps://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf