CMS has issued new guidelines to account for COVID-19. They were effective upon publication, but with all coding rule changes coming effective October 1st we thought that this was as good a time as any to review them. They can be found on pages 28- 32, and pages 73 and 77 of the 2021 ICD-10-CM Official Guidelines for Coding and Reporting. Essentially:

  1. You code only confirmed cases, but you don’t need a positive lab test to code for a case of COVID. Testing availability is scattershot, and tests are variably reliable. I. C. 1.g. 1) “…For a confirmed diagnosis, assign code U07.1, COVID-19. This is an exception to the hospital inpatient guideline Section II, H. In this context, ‘confirmation’ does not require documentation of a positive test result for COVID-19; the provider’s documentation that the individual has COVID-19 is sufficient.”
  2. Code applicable signs and symptoms as PDX if MD notes “probable, suspected, possible.” See guideline I.C.1.g.1.g.
  3. If COVID meets the criteria for PDX, code it first. The usual exceptions apply (e.g. obstetrics, sepsis, or transplant complications.)
  4. If admission is for acute respiratory manifestations, or pneumonia, bronchitis, ARDS, or respiratory failure, the COVID code is sequenced first.
  5. Asymptomatic patients exposed to COVID: use code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.
  6. For symptomatic individuals with actual or suspected exposure to COVID-19 and the infection has been ruled out, or test results are inconclusive or unknown, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. See guideline I.C.21.c.1, Contact/Exposure, for additional guidance regarding the use of category Z20 codes.
  7. Pregnancy, childbirth or the puerperium: if COVID-19 is the reason for admission , code O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, as PDx, and U07.1, COVID-19, secondary. Codes from Chapter 15 always take sequencing priority. If the reason for admission is unrelated to COVID-19 but the patient tests positive for COVID-19 during the admission, the appropriate code for the reason for admission/encounter should be sequenced as the PDx, and codes O98.5- and U07.1, as well as the appropriate codes for associated COVID-19 manifestations, should be assigned as additional diagnoses.
  8. Newborns: For a newborn that tests positive for COVID-19, assign code U07.1, COVID-19, and the appropriate codes for associated manifestation(s) in neonates/newborns in the absence of documentation indicating a specific type of transmission. For a newborn that tests positive for COVID-19 and the provider documents the condition was contracted in utero or during the birth process, assign codes P35.8, Other congenital viral diseases, and U07.1, COVID-19. When coding the birth episode in a newborn record, the appropriate code from category Z38, Liveborn infants according to place of birth and type of delivery, should be assigned as the principal diagnosis.

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