Cardiology Coding Alert

Remember: Take a look at the Z-codes related to COVID-19 cases.

During the recent COVID-19 public health emergency (PHE), CMS added the new ICD-10 code U07.1 (COVID-19) for reporting confirmed cases of COVID-19. Along with this new code, you also received new guidance on how to handle COVID-19 cases, from the new ICD-10 Official Coding and Reporting Guidelines. These guidelines became effective on April 1, 2020.

Read on to keep your COVID-19 claims in tip-top shape.

Discover New Chapter in ICD-10-CM

The Tabular List of Diseases and Injuries now includes the following new chapter, section, and category code:

• 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

For COVID-19 positive patients, you’ll report code U07.1. Make sure you check out the following list of supplemental “Use additional” and Excludes1 notes:

• 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)

Follow New COVID-19 Guidelines

ICD-10 has added some new guidelines regarding COVID-19. You can read the new guidelines in their entirety here: https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf.

Start by reviewing the rules surrounding Section C.1.g.1.a:

• a) Code only confirmed cases

According to the new guidelines, you should “code only a confirmed diagnosis of the 2019 novel coronavirus (COVID-19) as documented by the provider, documentation of a positive COVID-10 19 test result, or a presumptive positive COVID-19 test result.” For a confirmed diagnosis of COVID-19, you should report U07.1 “This is an exception to the hospital inpatient guideline Section II, H, per the guidelines. “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.”

You must also know how to report a presumptive positive COVID-19 test result. Per the guidelines, you should code a presumptive positive result as confirmed. And a presumptive positive test results means that “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 (CDC). CDC confirmation of local and state tests for COVID-19 is no longer required.”

You should not report U07.1 if the physician documents “suspected,” “possible,” “probable,” or inconclusive COVID-19. You would instead report a code explaining the reason for the encounter such as a fever or Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases) or Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out) dependent on test results and specific COVID-19 exposure.

Grasp Rules for Pulmonary Manifestations, Complications

You’ll also have a set of specific rules to follow if and when a patient experiences acute respiratory illness due to COVID-19. Check out these secondary diagnoses when COVID-19 manifests as a respiratory condition.

Coding example 1: For instance, for a COVID-19 patient diagnosed with subsequent pneumonia, the guidelines advise that you report J12.89 (Other viral pneumonia) as a secondary diagnosis code. So, you would report U07.1, J12.89 on your claim.

Coding example 2: For a patient with acute bronchitis confirmed as due to COVID-19, you should report U07.1, J20.8 (Acute bronchitis due to other specified organisms) on your claim. Note: If the patient has bronchitis not otherwise specified (NOS) due to COVID-19, then you would report U07.1, J40 (Bronchitis, not specified as acute or chronic) on your claim.

Coding example 3: If the physician documents the patient’s COVID-19 as being associated with a lower respiratory infection, NOS, or an acute respiratory infection, NOS, you should report U07.1, J22, (Unspecified acute lower respiratory infection) on your claim. Note: If the physician documents the patient’s COVID-19 as being associated with a respiratory infection, NOS, then you would report U07.1, J98.8 (Other specified respiratory disorders) on your claim.

Coding example 4: If the patient has acute respiratory distress syndrome (ARDS) due to COVID-19, then report U07.1, J80 (Acute respiratory distress syndrome) on your claim.