Pathology/Lab Coding Alert

Although your lab won’t assign an ICD-10 code based on test results, you need to understand the latest COVID-19 diagnosis coding rules and options that could impact medical necessity for ordered tests.

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. Use the following tips to make sure you understand the changes.

Tip 1: 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, clinicians should report code

U07.1 (COVID-19) from a date of service (DOS) of Apr. 1. But you should also be familiar with 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)

Tip 2: 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, clinicians 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.”

Lab lingo: You need to know what the guidelines mean by a “presumptive” positive test result, because that term has a different meaning than labs are used to in the context of tests such as drug screens and cultures. According to the CDC/NCHS, presumptive positive 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.”

Signs and symptoms: Similar to typical outpatient coding guidelines, you should anticipate that clinicians will request lab tests with signs and symptoms as the ordering diagnosis, using 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 clinicians should instead report Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases).

Tip 3: Consider Guidance for Pulmonary Manifestations, Complications

Your lab might receive ordering diagnoses for tests based on the set of specific coding rules for patients with acute respiratory illness due to COVID-19. In the updated version of the ICD-10-CM Official Coding and Reporting Guidelines, clinicians may use the new 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 clinicians report J12.89 (Other viral pneumonia) as a secondary diagnosis code. You can find additional coding instruction in the guidelines on how clinicians might 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.

Tip 4: Sequence as Primary Dx, With 1 Exception

The final point of order to consider is sequencing. In most cases, U07.1 is the primary diagnosis, but for patients with a positive COVID-19 diagnosis in pregnancy, childbirth, and puerperium, clinicians should report the appropriate code from subcategory O98.5 (Other viral diseases complicating pregnancy, childbirth and the puerperium) as the primary diagnosis. Clinicians should follow that up with U07.1 and the respective codes for any pulmonary manifestations.

Disclaimer: Information related to COVID-19 is changing rapidly. This information was accurate at the time of writing. Be sure to stay tuned to future issues of Pathology/ Lab Coding Alert for more information. You can also refer to payer websites, CMS (cms.gov), CDC (cdc.gov), and AAPC’s blog (www.aapc.com/blog) for the most up-to-date information.