Get the Most Out of New ICD-10-CM Addenda and Guideline Updates

Get the Most Out of New ICD-10-CM Addenda and Guideline Updates

On April 1, 2020, the National Center for Health Statistics (NCHS) formally issued updates to the ICD-10-CM List of Diseases and Injuries and the ICD-10-CM Official Coding and Reporting Guidelines, respectively. These updates will offer some essential collective guidance on COVID-19 coding and reporting for the extent of this public health emergency (PHE).

Take These Supplemental Notes Into Consideration for U07.1 Coding

To start, you can access the April 1, 2020, Addenda to the ICD-10-CM Tabular List of Diseases and Injuries.
These addenda offer an unprecedented off-cycle update to the ICD-10-CM Tabular List of Diseases and Injuries, typically reserved for the month of October. The addenda includes the following new chapter, section, and category code additions to consider within the ICD-10-CM manual:

  • 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

As you may already be aware, the main code you’ll be reporting for confirmed COVID-19 positive patients during this PHE is U07.1 COVID-19. Furthermore, you’ll want to consider the following supplementary notes found underneath U07.1 for further guidance on code reporting:

  • 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)

Note: You’ll find a similar Excludes1 note underneath B34.2 Coronavirus infection, unspecified:

  • Excludes1: COVID-19 (U07.1)

See What’s New in the ICD-10-CM Index

There’s also an array of new terms and sub terms to consider within the ICD-10-CM Alphabetic Index. You can find the complete list of sub terms in the attached addenda, but have a look at some of the new routes you can take to reach a COVID-19 diagnosis:

  • Coronavirus (infection)
    • coronavirus-19 U07.1
    • COVID-19 U07.1
  • Disease, diseased – see also Syndrome
    • COVID-19 U07.1
  • Infection, infected, infective (opportunistic) B99.9
    • coronavirus-2019 U07.1
    • COVID-19 U07.1

Don’t Forget About New Vaping-Related Illness Codes

The April 1 addenda also allows for immediate reporting of code U07.0 Vaping-related disorder for reporting. You can find some brand-new routes of accessing this code by navigating through the following terms and sub terms:

  • Damage
    • Lung
  • Disease, diseased – see also Syndrome
    • Lung
  • Disorder
    • Lung
  • Injury
    • Lung

Get Up to Speed on Extensive Guideline Changes

Now that you’ve got all the coding mechanics down, you’ll want to shift your focus toward the plethora of new information within the ICD-10-CM Official Guidelines for Coding and Reporting.
Under Section C, Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99), the NCHS implemented the following new subsection:

  • Coronavirus Infections
    • 1) COVID-19 Infections (Infections due to SARS-CoV-2)

Here, you’re presented with an array of new guidelines specific to COVID-19 reporting. Have a look at the first point of order to address:

  • a) Code only confirmed cases

There’s a few important details to consider in this guideline. First, you should only code a confirmed COVID-19 diagnosis “as documented by the provider, documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result.” Furthermore, the 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.
A presumptive positive test result, according to the NCHS, “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 COVID-19 is no longer required.”
Finally, know exactly what to do when the provider uses terminology such as “suspected,” “possible,” “probable,” or “inconclusive:”
“If the provider documents ‘suspected,’ ‘possible,’ ‘probable,’ or ‘inconclusive’ COVID19, do not assign code U07.1. Assign a code(s) explaining the reason for encounter (such as fever) or Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.”

Sequence COVID-19-Related Illnesses Accordingly

Make sure to sequence COVID-19 diagnoses according to the instructed guidelines. In all instances other than COVID-19 in pregnancy, childbirth, and puerperium, you should sequence code U07.1 as the primary, or principal, diagnosis.
When a patient experiences acute respiratory illness due to COVID-19, there are guidelines you should follow that are specific to the following four conditions:

  • Pneumonia
  • Acute bronchitis
  • Lower respiratory infection
  • Acute respiratory distress syndrome

For instance, the guidelines state that, “For pneumonia case confirmed as due to the 2019 novel coronavirus (COVID-19), assign codes U07.1, COVID-19, and J12.89, Other viral pneumonia.” The guidelines further detail how to code confirmed related, and nonconfirmed related COVID-19 cases for the remaining three conditions.
Consider a few more scenarios the guidelines cover:

  • Concern about a possible exposure to COVID-19, but this is ruled out after evaluation:
    • 818 Encounter for observation for suspected exposure to other biological agents ruled out
  • Actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown:
    • 828 Contact with and (suspected) exposure to other viral communicable diseases
  • Asymptomatic individuals being screened for COVID-19 without any known exposure to the virus with test results unknown or negative:
    • 59 Encounter for screening for other viral diseases
  • A patient with COVID-19-associated signs and symptoms, but no established definitive diagnosis:
    • Assign the appropriate signs and symptoms code.
  • A patient with COVID-19-associated signs and symptoms with actual or suspected exposure to an individual with COVID-19:
    • 828
  • Asymptomatic patient with a positive COVID-19 test result:
    • 1

Abide by Different Rules for Pregnancy Scenarios

The last point you need to consider is how to code for COVID-19 hospital admissions during pregnancy, childbirth, or puerperium. In this instance, you will sequence the codes differently than the guidelines referenced in Section C.1.g.1.b. First, you will report the respective code from subcategory O98.5 Other viral diseases complicating pregnancy, childbirth and the puerperium. Next, you will report U07.1 “and the appropriate codes for associated manifestation(s).”

About Has 9 Posts

Brett Rosenberg, MA, CPC, COC, CCS-P, serves as the editor of The Coding Institute’s (TCI’s) Radiology, Otolaryngology, and Outpatient Facility Coding Alerts. He earned his bachelor’s degree in psychology from the University of Vermont in 2011 and his master’s degree in psychology from Medaille College in 2016. Rosenberg is affiliated with the Flower City Professional Coders local chapter in Rochester, N.Y.

3 Responses to “Get the Most Out of New ICD-10-CM Addenda and Guideline Updates”

  1. Serena Marshall says:

    Question please. Your article states to use 59 for asymptomatic individual being screened for COVID-19 without any known exposure to the virus with test results unknown or negative. What is the entire ICD-10-CM code. I tried using Z20.59 but that is not a valid ICD-10 code.

  2. Renee Dustman says:

    Sorry about that. The code numbers have been fixed.

  3. Mandi Kjeseth says:

    Is anyone else having issues with denials for Z11.59 as the primary dx code? Our local MACs are denying saying it is not a valid primary dx code. We are doing a lot of screening visits in community living facilities

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