ED Coding and Reimbursement Alert

Question: We saw a patient for a cough, and the ED physician wanted the patient to get tested for COVID-19. The notes said, “Patient is at high risk due to history of asthma, hypertension, palpitations and obesity.” Which ICD-10 code should we report to reflect the patient’s high-risk nature? The only high-risk diagnosis code I can find in ICD-10 is Z91.89 (Other specified personal risk factors, not elsewhere classified).

South Carolina Subscriber

Answer: When a patient presents with any signs/symptoms associated with COVID-19 such as fever or cough, assign the appropriate code(s) for each of the presenting signs and symptoms such as R05 (Cough) when a definitive diagnosis has not been established.

There is no appropriate ICD-10 code for a high-risk patient, so you won’t need to append another diagnosis beyond the cough. If the patient is definitively diagnosed with COVID-19, you will then assign U07.1 (COVID-19) followed by R05.