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Coding Tip: Z Code Reporting for COVID-19

by May 19, 2020Coding Tips, Coronavirus, COVID-19, Education, ICD-10, Patricia Maccariella-Hafey0 comments

Patricia Maccariella-Hafey, RHIA, CDIP, CCS, CCS-P, CIRCC has over 35 years expertise in the areas of ICD-9-CM, CPT, DRG/APC validation Professional Fee E&M coding, Interventional Radiology, and Facility E&M coding. Patricia is currently Director of Education a healthcare consulting firm specializing in coding compliance review, education and contract coding services.

Pat Maccariella‑Hafey
RHIA, CDIP, CCS, CCS‑P, CIRCC

Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador

Just a few reminders on coding for COVID-19 when the test results are NOT positive. Obviously any positive test result documented in the record for COVID-19 would be coded to U07.1, COVID-19.

If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code?

The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing.  For any patient receiving a COVID-19 test, if negative, there MUST be a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).

Three Z codes to choose from:

Z20.828, Contact with and (suspected) exposure to other viral communicable diseases is assigned when a patient exhibits signs and symptoms of COVID-19 and COVID-19 is suspected, and COVID-19 test is negative.  The symptoms or reason for symptoms would be coded followed by the Z20.828 code.

Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out is assigned when there is NO symptoms or signs of COVID-19 however the patient was documented as being exposed to COVID-19.  Examples include the patient coming in contact with another patient with COVID-19 or some other type of exposure.  The key here is that there is exposure or suspected exposure to COVID-19.  When the test is negative assign Z03.818 to show that the patient was exposed to COVID-19, had no symptoms, and the testing was negative.

Z11.59,  Encounter for screening for other viral diseases is used for a patient who presents for COVID-19 testing and has no symptoms and no exposure, and test is negative.  Early on in the pandemic, only patients with symptoms and exposure were being tested for COVID-19.  They had to meet CDC requirements for testing.  As test kits have become more available, many more patients are being tested without symptoms and without known exposure.  We know of one facility that is testing EVERY PATIENT so there would be a Z code on every patient, testing negative, depending on circumstances. If no symptoms with no exposure documented then it would be Z11.59.  These are typically considered screenings for COVID-19. Coders may also see patents screened before outpatient surgeries, or before going to a nursing home.

Where in the record is it?

Coders will need to research their facility’s record on where to find orders for COVID-19 testing, laboratory results for COVID-19 and documentation of results. Usually test results are documented in the progress notes, but not always.  Each facility is unique in where COVID-19 test orders are so be sure you know where they are.  Coders should really be looking for these orders and tests as more and more facilities are testing patients for COVID-19. In some electronic health records, the coder can search by typing in “COV” in the search box and every instance of documentation of it in the record will come up for review.

COVID-19 Code Validation

Some facilities are validating the coding of every COVID-19 patient.  If so, the coder must be sure to follow facility protocols on pending or referring the record for review.

History of COVID-19

If a patient has a history of COVID-19, and has no signs, symptoms and no manifestations of COVID-19 any longer, assign the history code Z86.19, Personal history of other infectious and parasitic diseases.  There is not a timeframe for the history code so coders will need to review documentation carefully.

Antibody Testing for COVID-19 Only

Antibody testing only is coded to Z01.84, Encounter for antibody response examination

Coders should always refer to the below references for official coding guidance on COVID-19.

References
codingclinicadvisor.com/faqs-icd-10-cm-coding-covid-19
cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf

The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.

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