Frequently Asked Questions Regarding ICD-10-CM Coding for COVID-19

Revised April 21, 2022

The following questions and answers were jointly developed and approved by the American Hospital Association’s Central Office on ICD-10-CM/PCS and the American Health Information Management Association.

  • ICD-10-CM code U07.1, COVID-19, may be used for discharges/date of service on or after April 1, 2020. For more information on this code, click here. The code was developed by the World Health Organization (WHO) and is intended to be sequenced first followed by the appropriate codes for associated manifestations when COVID-19 meets the definition of principal or first-listed diagnosis. Specific guidelines for usage are available here. For guidance prior to April 1, 2020, please refer to the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak.

  • When COVID-19 meets the definition of principal or first-listed diagnosis, code U07.1, COVID-19, should be sequenced first, and followed by the appropriate codes for associated manifestations, except when another guideline requires that certain codes be sequenced first, such as obstetrics, sepsis, or transplant complications. However, if COVID-19 does not meet the definition of principal or first-listed diagnosis (e.g. when it develops after admission), then code U07.1 should be used as a secondary diagnosis.

  • The Centers for Disease Control and Prevention’s National Center for Health Statistics, the US agency responsible for maintaining ICD-10-CM in the US, is implementing several new ICD-10-CM codes pertaining to COVID-19 on January 1, 2021. See ICD-10-CM FAQ #44 for further details.

  • The HIPAA code set standard for diagnosis coding in the US is ICD-10-CM, not ICD-10. As shown in the April 1, 2020 Addenda on the CDC website, the only new code being implemented in the US for COVID-19 is U07.1.

  • Please refer to the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak. After April 1, 2020, refer to the Official Guidelines for Coding and Reporting found here.

  • No, the code is not retroactive. Please refer to the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak for guidance for coding of discharges/services provided before April 1, 2020.

  • No, code B97.29 is not exclusive to the SARS-CoV-2/2019-nCoV virus responsible for the COVID-19 pandemic. The code does not distinguish the more than 30 varieties of coronaviruses, some of which are responsible for the common cold. Due to the heightened need to uniquely identify COVID-19 until the unique ICD-10-CM code is effective April 1, providers are urged to consider developing facility-specific coding guidelines that limit the assignment of code B97.29 to confirmed COVID-19 cases and preclude the assignment of codes for any other coronaviruses.

  • Diagnosis code B34.2, Coronavirus infection, unspecified, would in generally not be appropriate for the COVID-19, because the cases have universally been respiratory in nature, so the site of infection would not be “unspecified.” Code B97.29, Other coronavirus as the cause of diseases classified elsewhere, has been designated as interim code to report confirmed cases of COVID-19. Please refer to the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak for additional information. Because code B97.29 is not exclusive to the SARS-CoV-2/2019-nCoV virus responsible for the COVID-19 pandemic, we are urging providers to consider developing facility-specific coding guidelines that limit the assignment of code B97.29 to confirmed COVID-19 cases and preclude the assignment of codes for any other coronaviruses.

  • Yes, the supplement applies to all patient types. As stated in the supplement guidelines, “If the provider documents “suspected”, “possible” or “probable” COVID-19, do not assign code B97.29. Assign a code(s) explaining the reason for encounter (such as fever, or Z20.828, Contact with and (suspected) exposure to other viral and communicable diseases.”

  • The intent of the guideline is to code only confirmed cases of COVID-19. It is not required that a copy of the confirmatory test be available in the record or documentation of the test result. The provider’s diagnostic statement that the patient has the condition would suffice.

  • Yes, Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or state level, but it has not yet been confirmed by the Centers for Disease Control and Prevention (CDC). CDC confirmation of local and state tests for the COVID-19 virus is no longer required.

  • Due to the heightened need to capture accurate data on positive COVID-19 cases, we recommend that providers consider developing facility-specific coding guidelines to hold back coding of inpatient admissions and outpatient encounters until the test results for COVID-19 testing are available. This advice is limited to cases related to COVID-19.

  • No, the provider does not need to explicitly link the test result to the respiratory condition, the positive test results can be coded as confirmed COVID-19 cases as long as the test result itself is part of the medical record. As stated in the coding guidelines for COVID-19 infections that went into effect on April 1, code U07.1 may be assigned based on results of a positive test as well as when COVID-19 is documented by the provider. Please note that this advice is limited to cases related to COVID-19 and not the coding of other laboratory tests. Due to the heightened need to uniquely identify COVID-19 patients, we recommend that providers consider developing facility-specific coding guidelines to hold back coding of inpatient admissions and outpatient encounters until the test results for COVID-19 testing are available.

  • Yes, if a test is performed during the visit or hospitalization, but results come back after discharge positive for COVID-19, then it should be coded as confirmed COVID-19.

  • Whether or not sepsis or U07.1 is assigned as the principal diagnosis depends on the circumstances of admission and whether sepsis meets the definition of principal diagnosis. For example, if a patient is admitted with pneumonia due to COVID-19 which then progresses to viral sepsis (not present on admission), the principal diagnosis is U07.1, COVID-19, followed by the codes for the viral sepsis and viral pneumonia. On the other hand, if a patient is admitted with sepsis due to COVID-19 pneumonia and the sepsis meets the definition of principal diagnosis, then the code for viral sepsis (A41.89) should be assigned as principal diagnosis followed by codes U07.1 and the appropriate viral pneumonia code (J12.89, Other viral pneumonia, for discharges/encounters prior to January 1, 2021, or code J12.82, Pneumonia due to coronavirus disease 2019, for discharges/encounters after January 1, 2021) as secondary diagnoses.

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  • Coding professionals should query the provider if the provider documented COVID-19 before the test results were back and the test results come back negative. Providers should be given the opportunity to reconsider the diagnosis based on the new information.

  • If the provider still documents and confirms COVID-19 even though the test results are negative, or if the provider documented disagreement with the test results, assign code U07.1, COVID-19. As stated in the Official Guidelines for Coding and Reporting for COVID-19, “Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider . . . the provider’s documentation that the individual has COVID-19 is sufficient.”

  • Assign codes Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, and the appropriate personal history code (code Z86.19, Personal history of other infectious and parasitic diseases, for encounters prior to January 1, 2021, or code Z86.16, Personal history of COVID-19, for encounters after January 1, 2021).

  • For an encounter for antibody testing that is not being performed to confirm a current COVID-19 infection, nor is being performed as a follow-up test after resolution of COVID-19, assign Z01.84, Encounter for antibody response examination.

  • Yes, both codes may be assigned, as aspiration pneumonia and pneumonia due to COVID-19 are two separate unrelated conditions with different underlying causes. This scenario meets the exception to the Excludes1 guideline as a circumstance when the two conditions are unrelated to each other.

    Note that effective January 1, 2021, there is a new code, J12.82, for pneumonia due to coronavirus disease 2019.

  • Any immunocompromised patient (which would include HIV patients) is at higher risk for becoming infected with COVID-19, but HIV does not cause COVID-19. Code both conditions separately, with sequencing depending on the circumstances of admission – just like a patient suffering from diabetes or any other chronic condition that puts them at higher risk for the COVID-19 infection.

  • There is no specific timeframe for when a personal history code is assigned. If the provider documents that the patient no longer has COVID-19, assign the appropriate personal history code (code Z86.19, Personal history of other infectious and parasitic diseases, for discharges/encounters prior to January 1, 2021, or code Z86.16, Personal history of COVID-19, for discharges/encounters after January 1, 2021).

  • People infected with COVID-19 may vary from being asymptomatic to having a range of symptoms and severity. Therefore, for coding purposes, signs and symptoms associated with COVID-19 may be coded separately, unless the signs or symptoms are routinely associated with a manifestation. For example, cough would not be coded separately if the patient has pneumonia due to COVID-19, as cough is a symptom of pneumonia. The additional coding of signs or symptoms not explained by the manifestations would provide additional information on the severity of the disease. Because COVID-19 is primarily a respiratory condition, any other signs/symptoms would be coded separately unless another definitive diagnosis has been established for the other signs or symptoms. This is supported by Guideline IC.18.b, “Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis.”

  • 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. 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.

  • Assign code T86.812, Lung transplant infection, as the principal or first-listed diagnosis, followed by code U07.1, COVID-19. This sequencing is supported by the Tabular List note at code T86.812 to “use additional code to specify infection.” The ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.g.3.a. state that “a transplant complication code is only assigned if the complication affects the function of the transplanted organ.” The COVID-19 infection has affected the function of the transplanted lung.

  • Assign code U07.1, COVID-19, as the principal diagnosis, and code J93.83, Other pneumothorax, as a secondary diagnosis. Since the pneumothorax due to COVID-19 present on the first admission has not resolved, this appears to be ongoing treatment for a COVID-19 manifestation.

    If the documentation is not clear regarding whether the physician considers a condition to be an acute manifestation of a current COVID-19 infection vs. a residual effect from a previous COVID-19 infection, query the provider. As stated in the Official Guidelines for Coding and Reporting, the provider’s documentation that the individual has COVID-19 is sufficient for coding purposes.

  • Assign code J93.83, Other pneumothorax, as the principal diagnosis, followed by code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021. In this case, the patient no longer has COVID-19 and the pneumothorax is a residual effect (sequelae). A personal history code is not appropriate because as stated in guideline I.C.21.c.4), “Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring.” The patient is clearly receiving treatment for the residual effect of COVID-19.

  • Assign code U07.1, COVID-19, as the principal diagnosis, followed by code I26.99, Other pulmonary embolism without acute cor pulmonale, for a patient diagnosed with pulmonary embolism and COVID-19. The pulmonary embolism is a manifestation of the COVID-19 infection. Per the instructional note under code U07.1, COVID-19 should be sequenced as the principal diagnosis and additional codes should be assigned for the manifestations.

  • Assign code I26.99, Other pulmonary embolism without acute cor pulmonale, as the principal diagnosis, followed by code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as a secondary diagnosis.

  • Assign code U07.1, COVID-19, as the patient still has COVID-19. Do not assign a code for the pneumonia as the condition has resolved.

  • Assign code G61.0, Guillain-Barre syndrome, as the principal diagnosis, followed by code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021.

  • Assign code U07.1, COVID-19, as the principal diagnosis, and code J96.01 Acute respiratory failure with hypoxia, as a secondary diagnosis. Per the instructional note under code U07.1, COVID-19 should be sequenced as the principal diagnosis and additional codes should be assigned for the manifestations.

  • Assign codes G72.81, Critical illness myopathy, and G57.31, Lesion of lateral popliteal nerve, right lower limb. Assign code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as a secondary diagnosis for the sequelae of a COVID-19 infection.

  • Assign codes for the specific symptoms (such as generalized weakness, debility, etc.). Assign the appropriate personal history code (code Z86.19, Personal history of other infectious and parasitic diseases, for discharges/encounters prior to January 1, 2021, or code Z86.16, Personal history of COVID-19, for discharges/encounters after January 1, 2021) as a secondary diagnosis.

    Do not assign code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as the debility is due to the prolonged hospitalization rather than being a sequela of the COVID-19 infection.

  • Assign code U07.1, COVID-19, as the principal diagnosis, and code M35.8, Other specified systemic involvement of connective tissue, for discharges prior to January 1, 2021, or code M35.81, Multisystem inflammatory syndrome, for discharges after January 1, 2021, as a secondary diagnosis, for MIS-C due to COVID-19. The MIS-C is a manifestation of the COVID-19 infection. Per the instructional note under code U07.1, COVID-19 should be sequenced as the principal diagnosis and additional codes should be assigned for the manifestations.

    If the documentation is not clear regarding whether the physician considers a condition to be an acute manifestation of a current COVID-19 infection vs. a residual effect from a previous COVID-19 infection, query the provider. As stated in the ICD-10-CM Official Guidelines for Coding and Reporting, the provider’s documentation that the individual has COVID-19 is sufficient for coding purposes.

  • Assign code M35.8, Other specified systemic involvement of connective tissue, for discharges prior to January 1, 2021, or code M35.81, Multisystem inflammatory syndrome, for discharges after January 1, 2021, as the principal diagnosis, for the MIS-C, and code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as a secondary diagnosis for the sequelae of a COVID-19 infection.

    If the documentation is not clear regarding whether the physician considers a condition to be an acute manifestation of a current COVID-19 infection vs. a residual effect from a previous COVID-19 infection, query the provider. As stated in the ICD-10-CM Official Guidelines for Coding and Reporting, the provider’s documentation that the individual has COVID-19 is sufficient for coding purposes.

  • During the COVID-19 pandemic, a screening code is generally not appropriate. For encounters for COVID-19 testing, including preoperative testing, code as exposure to COVID-19 (code Z20.828 for encounters prior to January 1, 2021, or code Z20.822, Contact with and (suspected) exposure to COVID-19, for encounters after January 1, 2021). The ICD-10-CM Official Guidelines for Coding and Reporting state that codes in category Z20, Contact with and (suspected) exposure to communicable diseases, are for patients who are suspected to have been exposed to a disease by close personal contact with an infected individual or are in an area where a disease is epidemic.

    For an encounter for COVID-19 testing being performed as part of preoperative testing, assign code Z01.812, Encounter for preprocedural laboratory examination, as the first-listed diagnosis and assign code Z20.828 or Z20.822 (depending on the encounter date) as an additional diagnosis.

    Coding guidance will be updated as new information concerning any changes in the pandemic status becomes available.

    Note: This advice is consistent with the updated ICD-10-CM Official Guidelines for Coding and Reporting that become effective October 1, 2020. During these unprecedented times, AHA and AHIMA concluded it was necessary to clarify the appropriate codes for COVID-19 testing in advance of the effective date for the revised official coding guidelines.

  • For asymptomatic individuals with actual or suspected exposure to COVID-19, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, for encounters prior to January 1, 2021, and code Z20.822, Contact with and (suspected) exposure to COVID-19, for encounters after January 1, 2021.

    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 or code Z20.822, Contact with an (suspected) exposure to COVID-19, depending on the encounter date.

    If COVID-19 is confirmed, assign code U07.1 instead of code Z20.828 or Z20.822.

    Note: This advice is consistent with the updated ICD-10-CM Official Guidelines for Coding and Reporting that become effective October 1, 2020. During these unprecedented times, AHA and AHIMA concluded it was necessary to clarify the appropriate codes for COVID-19 testing in advance of the effective date for the revised official coding guidelines.

  • Assign codes U07.1, COVID-19, and D68.8, Other specified coagulation defects.

    If disseminated intravascular coagulation (DIC) is documented, assign code D65, Disseminated intravascular coagulation [defibrination syndrome], instead of code D68.8. Not all COVID-19 associated coagulopathy professes to DIC.

  • Assign codes U07.1, COVID-19, and D68.8, Other specified coagulation defects, and L99, Other disorders of skin and subcutaneous tissue in diseases classified elsewhere.

  • Viral shedding can mean either that the patient has an active (current) COVID-19 infection or a personal history of COVID-19. Therefore, the code assignment depends on the provider documentation.

    For documentation of viral shedding in a patient with an active COVID-19 infection, assign code U07.1, COVID-19.

    For documentation of viral shedding in a patient with a personal history of a COVID-19 infection rather than an active infection, assign code Z86.19, Personal history of other infectious and parasitic diseases, for discharges/encounters prior to January 1, 2021, or code Z86.16, Personal history of COVID-19, for discharges/encounters after January 1, 2021.

    If the documentation is not clear as to whether the patient has an active COVID-19 infection or a personal history, query the provider.

  • [Effective 10/1/21:]

    For discharges/encounters on or after October 1, 2021, assign codes R53.1, Weakness, R63.0, Anorexia, and U09.9, Post COVID-19 condition, unspecified, for a diagnosis of post COVID-19 syndrome with generalized weakness and lack of appetite. This is supported by the instructional note at code U09.9 to “code first the specific condition related to COVID-19 if known.”

    [Prior to 10/1/21:]

    For discharges/encounters prior to October 1, 2021, unless the provider specifically documents that the symptoms are the results of COVID-19, assign code(s) for the specific symptom(s) and a code for personal history of COVID-19. "Post COVID-19 syndrome" indicates temporality, but not that the current symptom(s) or clinical condition(s) are a residual effect (sequelae) of COVID-19. As stated in the ICD-10-CM Official Guidelines for Coding and Reporting, in the absence of Alphabetic Index guidance for coding syndromes, assign codes for the documented manifestations of the syndrome.

    The appropriate personal history code is Z86.19, Personal history of other infectious and parasitic diseases, for discharges/encounters prior to January 1, 2021, or code Z86.16, Personal history of COVID-19, for discharges/encounters after January 1, 2021.

    If the provider documents that the symptoms are the result (residual effect) of COVID-19, assign code(s) for the specific symptom(s) and code B94.8, Sequelae of other specified infectious and parasitic diseases. According to the ICD-10-CM Official Guidelines for Coding and Reporting, a sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated.

  • In response to the national emergency that was declared concerning the COVID-19 outbreak, the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) is implementing new ICD-10-CM diagnosis codes, effective January 1, 2021.

    The new ICD-10-CM codes being implemented on January 1, 2021, are:

    J12.82 Pneumonia due to coronavirus disease 2019

    M35.81 Multisystem inflammatory syndrome

    Z11.52 Encounter for screening for COVID-19

    Z20.822 Contact with and (suspected) exposure to COVID-19

    Z86.16 Personal history of COVID-19

    The January 2021 ICD-10-CM Addenda and updated ICD-10-CM Official Guidelines for Coding and Reporting are available at: https://www.cdc.gov/nchs/icd/icd10cm.htm.

  • Assign codes T78.49XA, Other allergy, initial encounter; R07.89, Other chest pain; and R09.89, Other specified symptoms and signs involving the circulatory and respiratory systems. The currently approved COVID-19 vaccines in the United States are not serum based, and therefore code T80.62XA-, Other serum reaction due to vaccination, initial encounter is not appropriate.

  • Assign codes R53.81, Other malaise; and T50.B95A, Adverse effect of other viral vaccines, initial encounter.

  • Assign code T80.52XA, Anaphylactic reaction due to vaccination, initial encounter, for documented anaphylactic reaction to the COVID-19 vaccine. Although subcategory T80.5, identifies anaphylactic reaction to serum, it is the closest available code to capture this condition.

  • Yes, it would be appropriate to report a code(s) for side effects when the patient requires additional treatment or medical care such as monitoring or treatment for the side effects. Assign the code for the nature of the effect (e.g. fever) followed by code T50.B95A, Adverse effect of other viral vaccines, initial encounter.

  • Query the provider whether “residual respiratory failure” refers to acute on chronic, or chronic respiratory failure. Assign the appropriate respiratory failure code based on the response, followed by code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as a secondary diagnosis, for the sequelae of COVID-19 infection, since the patient has been documented as no longer infectious for COVID-19.

    Although the provider referred to "history of COVID-19," a personal history code is inappropriate in this case. As defined in the ICD-10-CM Official Guidelines for Coding and Reporting, Section IB. "A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated." In addition, Section I. C.21,c,( 4) states "Personal history codes explain a patient's past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring."

  • Assign code J96.10, Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, as the principal diagnosis since the ARDS has resolved. In addition, assign code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021. as a secondary diagnosis, since the patient no longer has an active COVID-19 infection.

  • Assign code U07.1. COVID-19, as the principal diagnosis. Code J12.82, Pneumonia due to coronavirus disease 2019, would be assigned as an additional diagnosis. The Instructional Note under code U07.1 directs to use an additional code to identify pneumonia or other manifestations. Therefore, when a patient presents with an acute manifestation of COVID-19, such as pneumonia, code U07.1 is sequenced, as the principal or first diagnosis, regardless of whether the patient's most recent COVID-19 test is positive or negative. The Official Guidelines for Coding and Reporting for sequela state, "A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated."

  • Assign code U07.1. COVID-19, as the principal or first-listed diagnosis, because the pneumonia is an acute manifestation of the COVID-19 infection. Assign code J12.82, Pneumonia due to coronavirus disease 2019, as an additional diagnosis. The Instructional Note under code U07.1 directs to use an additional code to identify pneumonia or other manifestations. Therefore, when a patient presents with an acute manifestation of COVID-19, such as pneumonia, code U07.1 should be reported as the principal or first diagnosis, regardless of whether the patient's most recent COVID-19 test is positive or negative.

  • Based on the documentation provided, the patient has an organizing pneumonia due to previous COVID-19 infection. Assign code J84.89, Other specified interstitial pulmonary diseases, followed by code B94.8. Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, for a diagnosis of post COVID-19 organizing pneumonia.

    Code J84.89 may be located by the following Index entry:

    Pneumonia
    - organizing J84.89

  • Assign code U07.1, COVID-19, as the principal or first-listed diagnosis, because the pneumonia is an acute manifestation of the COVID-19 infection. Assign code J12.82, Pneumonia due to coronavirus disease 2019, and code J80, Acute respiratory distress syndrome, as additional diagnoses for the pneumonia and ARDS. In addition, assign codes J95.859, Other complication of respirator [ventilator], J95.811, Postprocedural pneumothorax, and J94.8, Other specified pleural conditions, to capture hydropneumothorax barotrauma due to mechanical ventilation. The presence of COVID-19 does not affect code assignment of hydropneumothorax barotrauma.

  • Assign code Z86.16, Personal history of COVID-19. While the patient had a positive COVID-19 test, the provider documented that the patient was not actively infectious during this admission. When the provider documents "noninfectious" or "not infectious" COVID-19 status, this indicates that the patient no longer has an active COVID-19 infection, therefore assign code Z86.16 instead of code U07.1, COVID-19.

    Although guideline I.C.1.g.1.a., states: “Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider or documentation of a positive COVID-19 test result,” in this scenario the provider has clarified the patient no longer has an active COVID-19 infection. Therefore, code U07.1, COVID-19, is not appropriate and the Official Coding Guideline I.C.1.g.1.a., regarding a positive COVID-19 test result would not apply.

    If the documentation is unclear as to whether the patient has an active COVID-19 infection or a personal history, query the provider for clarification.

  • Although the patient is still testing positive for COVID-19, the provider has documented the patient's condition was a previous history of a COVID-19 infection and not a reinfection, therefore it would be appropriate to assign code Z86.16, Personal history of COVID-19.

  • Assign code U07.1, COVID-19. The provider’s assessment stated “COVID-19 virus detected,” and it is possible for a COVID-19 infection to occur despite vaccination. This is consistent with Official Guidelines for Coding and Reporting, Section I.C.1.g.1.a., which states: Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider or documentation of a positive COVID-19 test result.

  • Assign code Z20.822, Contact with and (suspected) exposure to COVID-19, as principal diagnosis, for a patient admitted and found to have a false positive COVID-19 test. ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.1.g.1.e. states: For asymptomatic individuals with actual or suspected exposure to COVID-19, assign code Z20.822, Contact with and (suspected) exposure to COVID-19.

    Although guideline I.C.1.g.1.a., allows coding of confirmed cases of COVID-19 on the basis of “documentation of a positive COVID-19 test result,” in this scenario the provider clarified the COVID-19 test as being a false positive; therefore code U07.1, COVID-19, is not appropriate and the Official Coding Guideline I.C.1.g.1.a. regarding coding on the basis of a positive COVID-19 test result would not apply to this case.

    However, it is always appropriate to query the provider for clarification whenever the coding professional finds the medical record documentation to be unclear regarding the patient's COVID-19 status.

  • (Question #59 was deleted on April 13, 2022.)

  • Yes, underimmunization status codes may be assigned based on nursing or other clinician documentation where information regarding the patient’s vaccination status can be found.

    Official Coding Guideline I.B.14, Documentation by Clinicians Other than the Patient's Provider, will be updated with the FY 2023 guideline revisions to include all underimmunization status codes as one of the exceptions of acceptable conditions/status' documented by a clinician other than the patient's provider.

  • In response to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) implemented 12 new ICD-10-PCS procedure codes to describe the introduction or infusion of therapeutics for the treatment of COVID-19, effective with discharges on or after August 1, 2020. The Code Tables, Index and related Addenda files for the 12 new procedure codes are available at: https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-PCS.

  • Effective with discharges on or after August 1, 2020, new ICD-10-PCS codes have been implemented for the administration of three different drugs when used to treat COVID-19:

    • XW033E5, Introduction of Remdesivir Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 5
    • XW043E5, Introduction of Remdesivir Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 5
    • XW033G5, Introduction of Sarilumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5
    • XW043G5, Introduction of Sarilumab into Central Vein, Percutaneous Approach, New Technology Group 5
    • XW033H5, Introduction of Tocilizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5
    • XW043H5, Introduction of Tocilizumab into Central Vein, Percutaneous Approach, New Technology Group 5

    These codes should only be assigned when these drugs are administered to treat COVID-19.

  • Effective with discharges on or after August 1, 2020, assign ICD-10-PCS code XW13325, Transfusion of Convalescent Plasma (Nonautologous) into Peripheral Vein, Percutaneous Approach, New Technology Group 5, or code XW14325, Transfusion of Convalescent Plasma (Nonautologous) into Central Vein, Percutaneous Approach, New Technology Group 5.

  • Effective with discharges on or after August 1, 2020, the following ICD-10-PCS codes should be used for administration of a new therapeutic substance to treat COVID-19 when the substance is not classified elsewhere in ICD-10-PCS:

    • XW013F5, Introduction of Other New Technology Therapeutic Substance into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 5
    • XW033F5, Introduction of Other New Technology Therapeutic Substance into Peripheral Vein, Percutaneous Approach, New Technology Group 5
    • XW043F5, Introduction of Other New Technology Therapeutic Substance into Central Vein, Percutaneous Approach, New Technology Group 5
    • XW0DXF5, Introduction of Other New Technology Therapeutic Substance into Mouth and Pharynx, External Approach, New Technology Group 5

    These codes should only be assigned for therapeutic substances being used to treat COVID-19. For administration of “other therapeutic substances” that are being used to treat medical conditions other than COVID-19, see ICD-10-PCS table 3E0. For example, code 3E033GC describes “Introduction of Other Therapeutic Substance into Peripheral Vein, Percutaneous Approach.”

  • No, the 12 new ICD-10-PCS codes describing the use of therapeutic substances to treat COVID-19 do not impact MS-DRG assignment. However, hospitals are encouraged to report these codes when applicable, as they will be useful in evaluating the effectiveness of different therapeutic substances used to treat COVID-19 and for tracking patient outcomes.

  • When a more specific ICD-10-PCS code exists, such as stem cell transfusion, assign that code rather than one of the less specific new technology codes. The new codes for “introduction of other new technology therapeutic substance” are only intended for new substances that are not classified elsewhere in ICD-10-PCS.

  • No, these new codes are only intended for use when these drugs are being administered to treat COVID-19.

  • Only assign the drug administration code once.

  • If your facility wishes to capture this information, you may assign the appropriate code from table 3E0 for introduction of an anti-inflammatory drug. Do not assign a code from table XW0 for Introduction of Other New Technology Therapeutic Substance.

  • In response to the COVID-19 pandemic, CMS is implementing 21 new ICD-10-PCS procedure codes to describe the introduction or infusion of therapeutics, including monoclonal antibodies, for the treatment of COVID-19, as well as new codes for COVID-19 vaccines, effective January 1, 2021. An announcement listing these codes and information related to the ICD-10 MS-DRGs V38.1 is available at: https://www.cms.gov/medicare/icd-10/2021-icd-10-pcs

    For guidance regarding the appropriate ICD-10-PCS procedure code to assign when a new drug or other therapeutic substance is administered in the hospital inpatient setting to treat COVID-19 and there is no unique code for the administration of the specific substance, see ICD-10-PCS FAQ #4.

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For additional coding guidance for ICD-10-CM for COVID-19 and beyond go to the AHA Coding Clinic Advisor website to see the latest updates.

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