Focus on ICD-10-CM Guideline Changes for 2021
Review the new and revised guidelines for coding and reporting diseases such as COVID-19.
While the ICD-10-CM code changes for fiscal year 2021 are a lot to digest, this year’s coding and reporting guideline changes are relatively minimal and straightforward. And it’s no surprise that most of the guideline changes address coding and reporting COVID-19.
Review New and Revised COVID-19 Guidelines
Section I.C.1.g in the ICD-10-CM Official Guidelines for Coding and Reporting includes a vast array of new COVID-19 guidelines. The changes complement the initial set of guidelines introduced in April. In fact, there are numerous instances in which the guidelines from April are addended to include some pertinent new information.
For example, Section I.C.G.1.g.1.b states:
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 when another guideline requires that certain codes be sequenced first, such as obstetrics, sepsis, or transplant complications.
The April 1 guidelines instructed you to sequence U07.1 as the first-listed diagnosis, followed by manifestation codes, except in the case of obstetric patients. Effective Oct. 1, this is expanded to include other clinical scenarios that involve existing ICD-10-CM sequencing guidelines such as with sepsis or transplant complication diagnoses.
More Revisions to Section I.C.1.g Guidelines
You’ll also find that COVID-19 guidelines have been slightly modified from their previous versions in these sections:
- Section I.C.1.g.1.e – Exposure to COVID-19
- Section I.C.1.g.1.f – Screening for COVID-19
- Section I.C.1.g.1.g – Signs and symptoms without definitive diagnosis of COVID-19
- Section I.C.1.g.1.h – Asymptomatic individuals who test positive for COVID-19
New COVID-19 Coding Guidance
The following guidelines have been added since the previous April 1 guidelines installment:
- Section I.C.1.g.1.c. – Acute respiratory failure
- Section I.C.1.g.1.d – Non-respiratory manifestations of COVID-19
- Section I.C.1.g.1.i – Personal history of COVID-19
- Section I.C.1.g.1.j – Follow-up visits after COVID-19 infection has resolved
- Section I.C.1.g.1.k – Encounter for antibody testing
Obstetrical Guideline Additions Were Due
You’ll also want to check out some subtle revisions from the April supplemental guidelines to the following two areas:
- Section I.C.15.s – COVID-19 infection in pregnancy, childbirth, and the puerperium
Here, ICD-10-CM adds some additional context to consider:
If the reason for admission/encounter is unrelated to COVID-19 but the patient tests positive for COVID-19 during the admission/encounter, the appropriate code for the reason for admission/encounter should be sequenced as the principal/first-listed diagnosis, and codes O98.5- and U07.1, as well as the appropriate codes for associated COVID-19 manifestations, should be assigned as additional diagnoses.
- Section I.C.16.h – COVID-19 infection in newborn
You’ll find a new set of instructions to consider for COVID-19 infection in newborns:
For a newborn that tests positive for COVID-19, assign code U07.1, COVID-19, and the appropriate codes for associated manifestation(s) in neonates/newborns in the absence of documentation indicating a specific type of transmission. For a newborn that tests positive for COVID-19 and the provider documents the condition was contracted in utero or during the birth process, assign codes P35.8, Other congenital viral diseases, and U07.1, COVID-19. When coding the birth episode in a newborn record, the appropriate code from category Z38, Liveborn infants according to place of birth and type of delivery, should be assigned as the principal diagnosis.
Ensure Correct Coding in 2021
While most of the guideline changes pertain to COVID-19 clinical encounters, make sure to scour the guidelines for any additional bold or underlined content that may not be documented in the Table of Contents. For instance, one new guideline you shouldn’t miss is found in Section I.C.10.e. The guideline breaks down coding for a variety of emerging conditions and symptoms associated with vaping-related disorders.
You can access the 2021 ICD-10-CM Official Guidelines for Coding and Reporting at www.cdc.gov/nchs/data/icd/10cmguidelines-FY2021.pdf.
Note: An updated version of the 2021 ICD-10-CM coding guidelines was released in December 2020. To learn more about these changes, see the article, “2021 ICD-10-CM Coding Guidelines Get a Refresh.”
Be sure to reference this most up-to-date version of the 2021 ICD-10-CM Official Guidelines for Coding and Reporting.