On March 6, 2020, Governor Tom Wolf issued a public health emergency declaration in
response to the presence of COVID-19 in Pennsylvania. On March 13, 2020, COVID-19 was
declared a nationwide emergency under the Stafford Act retroactive to March 1, 2020.
Discussion
On February 20, 2020, the Centers of Disease Control and Prevention (CDC) issued official diagnosis coding guidance for health care encounters related to the 2019 novel coronavirus
(COVID-19) previously named 2019-nCoV.
A new ICD-10 emergency code (U07.1, 2019-nCoV acute respiratory disease) has been
established by the World Health Organization (WHO). The new code was scheduled to be
added to the International Classification of Diseases, Tenth Revision, Clinical Modification
(ICD-10-CM) for reporting, effective with the next update, October 1, 2020.
The CDC issued interim coding guidance to be used in conjunction with the current ICD-10-CM
classification and the ICD-10-CM Official Guidelines for Coding and Reporting (effective
October 1, 2020). However, due to the urgent need to capture the reporting of the COVID-19
coronavirus in our nation’s claims and surveillance data, the CDC under the National
Emergencies Act Section 201 and 301, announced a change in the effective date of new
diagnosis code U07.1, COVID-19, from October 1, 2020 to April 1, 2020.
As a result, providers should use the new diagnosis code U07.1, COVID-19, beginning April 1,
2020.
Procedure
Effective with dates of services on and after April 1, 2020, providers should use the new
diagnosis code U07.1, COVID-19.
For dates of service beginning February 20, 2020, providers should refer to the CDC interim guidance as noted below for conditions related to COVID-19.
Pneumonia
For a pneumonia case confirmed as due to COVID-19, assign codes J12.89, Other viral
pneumonia, and B97.29, Other coronavirus as the cause of diseases classified elsewhere.
Acute Bronchitis
For a patient with acute bronchitis confirmed as due to COVID-19, assign codes J20.8, Acute
bronchitis due to other specified organisms, and B97.29, Other coronavirus as the cause of
diseases classified elsewhere. Bronchitis not otherwise specified (NOS) due to COVID-19
should be coded using code J40, Bronchitis, not specified as acute or chronic; along with code
B97.29, Other coronavirus as the cause of diseases classified elsewhere.
Lower Respiratory Infection
If COVID-19 is documented as being associated with a lower respiratory infection NOS, or an
acute respiratory infection, NOS, this should be assigned with code J22, Unspecified acute
lower respiratory infection, with code B97.29, Other coronavirus as the cause of diseases
classified elsewhere. If COVID19 is documented as being associated with a respiratory
infection, NOS, it would be appropriate to assign code J98.8, Other specified respiratory
disorders, with code B97.29, Other coronavirus as the cause of diseases classified elsewhere.
ARDS
Acute respiratory distress syndrome (ARDS) may develop with COVID-19, according to the
Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus(COVID-19) Infection.
Cases with ARDS due to COVID-19 should be assigned the codes J80, Acute respiratory
distress syndrome, and B97.29, Other coronavirus as the cause of diseases classified
elsewhere.
Exposure to COVID-19
For cases where there is a concern about a possible exposure to COVID-19, but this is ruled
out after evaluation, it would be appropriate to assign the code Z03.818, Encounter for
observation for suspected exposure to other biological agents ruled out.
For cases where there is an actual exposure to someone who is confirmed to have COVID-19,
it would be appropriate to assign the code Z20.828, Contact with and (suspected) exposure to
other viral communicable diseases.
Signs and symptoms
For patients presenting with any signs/symptoms (such as fever over 100, cough, shortness of
breath) and where a definitive diagnosis has not been established, assign the appropriate
code(s) for each of the presenting signs and symptoms such as:
- R05 Cough
- R06.02 Shortness of breath
- R50.9 Fever, unspecified
Note: Diagnosis code B34.2, Coronavirus infection, unspecified, would generally not be
appropriate for COVID-19, because the cases have universally been respiratory in nature, so
the cite would not be “unspecified”.
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).
Additional information is also available on the CDC and CMS websites.
Information on MA Program coverage related to COVID-19 can be found on the DHS website here.
The Pennsylvania Department of Health has a dedicated page for COVID-19 that provides
regular updates. Click here for the most up to date information regarding COVID-19.
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