From the upsurge in the pandemic COVID-19, government authorities and associations such as American Medical Association, the Centers for Disease Control and Prevention (CDC), and other Medicare professionals are working hand in hand to mitigate the intensity of the outbreak. With the introduction of new codes and reporting guidelines designed for COVID-19 from the past few months, outsourcing medical billing and coding services should be a practical alternative for physicians to submit claims and get reimbursed. Recently, CDC released ICD-10-CM Official Coding and Reporting Guidelines for COVID-19. These reporting guidelines are valid from 1st April 2020 to 30th September 2020.
As part of these guidelines, Medicare professionals are advised to code only for confirmed cases, which suggests that a documented statement of a physician is sufficient for validation and a test result is not required. Moreover, Coder will use U07.1 (2019-nCoV acute respiratory disease) for reported cases. The presumed positive test results of the COVID-19 should be coded as confirmed.
The following are the ICD-10 codes and reporting guidelines:
New ICD-10 CM Code effective from 1St April 2020
U07.1, COVID-19
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- Designed by World Health Organization (WHO)
- On 18th March 2020, at ICD-10-CM Coordination and Maintenance Committee, this code was released
- Can be utilized for discharges/date of service on or after 1st April 2020
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Guidelines for the reporting of acute respiratory illness owing to COVID-19
Acute bronchitis
A case of acute bronchitis is confirmed because of COVID-19, allocate codes J20.8 and U07.1, Acute bronchitis owing to other listed organisms. Use code U07.1 and J40, Bronchitis, not specified as acute or chronic to report Bronchitis not otherwise specified (NOS) due to COVID-19.
Acute respiratory distress syndrome
Allocate codes U07.1, and J80, Acute respiratory distress syndrome, if a patient is diagnosed with acute respiratory distress syndrome (ARDS) because of COVID-19.
Lower respiratory infection
Assign codes U07.1 and J22, Unspecified acute lower respiratory infection, if COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS. Assign codes U07.1 and J98.8, Other specified respiratory disorders if COVID-19 are documented as being associated with a respiratory infection, NOS.
Pneumonia
Assign codes U07.1, COVID-19, and J12.89, Other viral pneumonia, if a case of pneumonia is confirmed because of COVIS-19.
Exposure to COVID-19
Assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out, for cases of possible exposure to COVID-19 ruled out after evaluation.
Assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, in cases where there is an actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown.
Screening for COVID-19
Use code Z11.59, Encounter for screening for other viral diseases for asymptomatic individuals being screened for COVID-19, have no known exposure to the virus, and test results are either unknown or negative.
Assign code U07.1, COVID-19 for asymptomatic individuals who test positive for COVID-19.
Signs and symptoms without a definitive diagnosis of COVID-19
For patients presenting with COVID-19 associated signs/symptoms (e.g. fever, etc.), but a definitive diagnosis has not been established, assign the appropriate code(s) for the signs/symptoms:
- R05 Cough
- R06.02 Shortness of breath
- R50.9 Fever, unspecified
Assign Z20.828 Contact with and (suspected) exposure to other viral communicable diseases as an additional code if the patient with signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to someone who has COVID-19.
COVID infection in pregnancy
If a patient is admitted because of COVID-19 infection in pregnancy, childbirth, and the puerperium, assign a principal diagnosis code of O98.5, Other viral diseases complicating pregnancy, childbirth, and the puerperium, followed by code U07.1, COVID-19, and the appropriate codes for associated manifestation(s). Pregnancy, Childbirth, and the Puerperium (O00-O9A) should take priority.
