General Surgery Coding Alert

Distinguish suspected versus positive cases.

Because your surgeons may encounter and treat patients with COVID-19 symptoms or definitive diagnosis, you can’t afford to miss the recently issued diagnosis codes and extensive guidelines that will impact how you report claims.

The Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) issued an unprecedented off-cycle addendum to the ICD-10-CM Tabular List of Diseases and Injuries. They followed up that addendum with an equally important update to the ICD-10-CM Official Coding and Reporting Guidelines.

These sweeping updates allow for coders to begin reporting code U07.1 (COVID-19) for COVID-19 positive cases from a date of service (DOS) of Apr. 1.

Caution: You need to consider plenty of usage guidelines and alternate codes before finalizing your diagnosis code selection. Keep reading for a list of brand-new codes and rules to consider before you report COVID-19 related claims.

Greet a Whole New ICD-10-CM Chapter

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. But before doing so, you’ll want to have a look at 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)

Add These Pertinent Guidelines to Your Knowledge Base

Those new details in the Tabular List are only a tiny subset of coding instruction on how to properly report COVID-19-related, and unrelated, cases. To get the full scoop, you’ll need to look at the updated ICD-10-CM Official Coding and Reporting Guidelines at 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 CDC/NCHS, you may report code U07.1 “as documented by the provider, documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result.” Furthermore, the CDC/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.”

You’ve also got to know what constitutes a “presumptive” positive test result. According to the CDC/NCHS, this 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 CDC. CDC confirmation of local and state tests for COVID-19 is no longer required.”

Similar to your typical outpatient coding guidelines, you should code signs and symptoms for COVID-19 cases that use terminology such as “suspected, possible, probably, or inconclusive.” However, if there is documentation to support that the patient had contact or exposure to an individual with a COVID-19 diagnosis, then you should instead report Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases).

Consider Guidance 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. In the updated version of the ICD-10-CM Official Coding and Reporting Guidelines, you’ve got a set of codes to report as secondary diagnoses when COVID-19 manifests as a respiratory condition.

Example: 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. You can find additional coding instruction in the guidelines on how to report the following three conditions alongside a COVID-19 diagnosis:

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

Food for thought: A COVID-19 diagnosis and (some) manifestations like pneumonia do not currently factor into risk adjustment. “The trick may be to code other elements like respiratory distress or dependence on a ventilator — those diagnoses do risk adjust,” explains Sheri Poe Bernard, CPC, of Poe Bernard Consulting in Salt Lake City.