Coding Tip: Covid-19 Diagnosis Coding Common Scenarios
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVID-19 Frequently Asked Questions document by the AHA. The links are in the references. The scenarios below are for coding cases as of April 1, 2020 and for the most part applicable for all sites of encounter:
A patient presents for respiratory symptoms of COVID-19 such as SOB, is tested, and tests positive for COVID-19. How is this coded?
Assign code U07.1, Covid-19. Do not assign the symptoms as they are integral to COVID-19
A patient presents for respiratory symptoms of COVID-19. The patient is tested but the test result is negative for COVID-19. The physician states after seeing the test result and given the patient’s symptoms and clinical picture that he still believes the patient has COVID-19 and is treating the patient as if he does have it. How is this coded?
Assign code U07.1, Covid-19. Do not assign the symptoms as they are integral to COVID-19. Per FAQ even though the test results are negative, or if the provider documented disagreement with the test results, assign code U07.1, Covid-19. Also code any related diagnoses such as viral pneumonia as secondary diagnosis.
A patient is admitted with symptoms of COVID-19 and sepsis. The patient test results are positive for COVID-19. Patient is treated for viral sepsis as well. Is U07.1, COVID-19 always sequenced as the principal diagnosis?
The principal diagnosis will depend on the circumstances of admission. Every case can be different so coders must review the clinical presentation of the patient, the documentation and treatment and then make a decision as they would in any case in which two conditions present on admission could potentially be the principal diagnosis. There is no rule that U07.1 must always be principal.
A COVID-19 patient admitted to the hospital with acute hypoxic respiratory failure that progresses to ARDS (acute respiratory distress syndrome). Can I code both J96.01, acute hypoxic respiratory failure and J80, ARDS to show the severity of illness and risk of mortality of this patient?
No, assign code U07.1, COVID-19 as principal diagnosis with secondary diagnosis of J80, ARDS. There is an excludes1 note at J96 that excludes J80. HIA also recently wrote a letter to AHA asking this question and they stated to code J80 only as the ARDS is a life-threatening form of respiratory failure and is not an unrelated condition.. Code J80 would capture both.
When acute hypoxic respiratory failure present on admission progresses to ARDS after admission, would the POA of the J80, ARDs be Yes or No?
We would assign a POA of Yes for J80 because ARDS is a life-threatening form of respiratory failure and is not an unrelated condition. There are Coding Clinics regarding similar situations and AHA states that progressions of a disease process would be considered present on admission if a different code it assigned. See AHA Coding Clinic for ICD-10-CM/PCS, First Quarter 2020: Page 4; Coding Clinic for ICD-10-CM/PCS, Third Quarter 2019: Page 12.
A patient comes in with SOB and chest pain suspicious for COVID-19. COVID-19 test is negative. MD does not document COVID-19 or presumed COVID-19. What is assigned?
Assign the symptoms or assign the condition found to be responsible for the symptoms as the principal diagnosis or primary diagnosis for the encounter. Assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases as a secondary diagnosis. This will show that the patient was tested after suspicion for COVID-19 symptoms, but the result was negative, and that the MD did not think the patient had COVID-19.
A patient is coming to get testing after being exposed to a COVID-19 patient. They want to know if they are positive. The patient has no signs or symptoms. The test is negative. What is assigned? What about if the test result is not known?
Assign Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. This code is assigned because in this instance, the patient was exposed to a COVID-19 patient but has no symptoms whatsoever and the test result was negative. Hospitals and other facilities may want to wait for the test results before coding the claim. Always check with your facility to see if they are holding claims until final testing result is available.
A patient with exposure to a COVID-19 patient without symptoms presents for testing. The COVID-19 test is positive. There is no contrary information from the physician. Must the patient have symptoms to code U07.1 or can U07.1 be assigned when only a positive test result is found?
Assign U07.1, COVID-19 for a patient who’s test results are positive for COVID-19. The patient does not have to have symptoms to code U07.1.
We now have patients coming in strictly for antibody testing outpatient. They simply want to know if they had COVID-19 in the past and did not know it. How would this be coded?
Assign Z01.84, Encounter for antibody response examination for the diagnosis.
We have a patient without symptoms, without exposures to COVID-19 who is very fearful that she has COVID-19. There are no symptoms, signs or anything else found by the physician. The patient does not qualify for testing for COVID-19 per the CDC. How should we code this encounter?
The best code for this situation is Z71.1, Patient with feared complaint in whom no diagnosis is made. See AHA Coding Clinic, Fourth Quarter 2016: Page 4 for a similar situation in which Z71.1 was assigned.
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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