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COVID-19 Diagnosis Coding Surprises Boost Accuracy

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COVID-19 Diagnosis Coding Surprises Boost Accuracy

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ICD-10-CM Code U07.1 COVID

You can use a confirmed COVID-19 diagnosis even when a positive test is not documented. This is one of the many recent surprises in ICD-10-CM COVID-19 related coding guidelines.

With more patients coming into your office for screening, exposure and signs of COVID-19 and tests being in limited supply, you’ve got to nail down your ICD-10-CM coding. Here’s how to ensure your COVID-19 related ICD-10 codes will hold up to future audit scrutiny.

Report ICD-10 Code U.071 Only for Confirmed COVID-19 Cases

The CDC adopted the World Health Organization’s emergency creation of an ICD-10 code for confirmed diagnoses of COVID-19 cases: U07.1 (2019-nCoV acute respiratory disease). This code will be included in ICD-10-CM 2020.

You can make sure your usage holds up to scrutiny by looking for documentation of positive tests or provider confirmed diagnosis. Apply U07.1 when the documentation indicates one of the following confirmed criteria.

  • CDC positive test: When documentation indicates that the CDC confirmed a test as positive, use1. However, you don’t necessarily have to wait for the federal test results to come back days or weeks later to use this code.
  • Local/state test is positive: You should report code 1 for cases that are “presumed positive.” A patient is “presumed positive” when they have tested positive at the local or state levels, but the diagnosis has not yet been confirmed by the CDC.
  • Asymptomatic, positive test: You should include asymptomatic patients who test positive as having a confirmed diagnosis.
  • Provider indicates confirmed: “Confirmed” means that the provider has documented that COVID-19 is the diagnosis. The provider does not have to document the type of test used to reach that diagnosis.

For All Other COVID-19 Test Results, Look to Z Codes

Part of the reason that the CDC created the new COVID-19 codes is so that they can accurately track the virus. Therefore, you should not use U07.1 to report cases that are “suspect,” “possible,” “probable,” or inconclusive—basically anything but confirmed or presumed positive cases. In these situations, first code the signs or symptoms of the encounter (CDC guidelines give “fever” as an example, so R50.9). Other typical signs or symptoms include:

  • R05 (Cough)
  • 02 (Shortness of breath)

After the signs or symptoms diagnosis, use an additional ICD-10-code to describe the health status of the encounter:

  • Exposure: When the provider documents a reason that he believes the patient has been exposed to the coronavirus, and the test results are unknown or negative, use code 828 (Contact with and [suspected] exposure to other viral communicable diseases).
  • No exposure: If the provider has ruled out coronavirus exposure, use code 818 (Encounter for observation for suspected exposure to other biological agents ruled out).

Screening: For an asymptomatic person who has no known exposure to the virus, is being screened for COVID-19, and the test results are unknown or negative, use code Z11.59 (Encounter for screening for infectious and parasitic diseases, unspecified). Since the patient is asymptomatic, you would not have any signs or symptoms to report.

Sequencing: U07.1 Comes First; Pregnant Patients Are the Exception

When you report a COVID-19 confirmed diagnosis (U07.1) in addition to a manifestation, list code U07.1 first, followed by the manifestation ICD-10 codes. For instance, if the patient has confirmed COVID-19 and pneumonia bronchitis, you should report U07.1 as diagnosis 1 and J18.0 (Bronchopneumonia, unspecified organism) as diagnosis 2.

However, in pregnant patients, you’d code it a little differently. In that case, you’d first list a pregnancy complication diagnosis code (O98.5XXX, Other viral diseases complicating pregnancy, childbirth, and the puerperium). Then, you’d report code U07.1, followed by any additional codes for manifestations.

Additional codes for common COVID-19 manifestations include:

  • 89 (Other viral pneumonia)
  • 8 (Acute bronchitis due to other specified organisms)
  • J22 (Unspecified acute lower respiratory infection)
  • J40(Bronchitis, not specified as acute or chronic)
  • J80 (Acute respiratory distress syndrome)
  • 8(Other specified respiratory disorders)

Also, beware of exclusions. Do not report the following codes together with U07.1:

  • B34.2 (Coronavirus infection, unspecified)
  • B97.2 (Coronavirus as the cause of diseases classified elsewhere)
  • J12.81 (Pneumonia due to SARS-associated coronavirus)

If you want more details on documentation requirements, allowed technology, and RHC/FQHC virtual codes that CMS now pays at higher rates through 2020, register for the online trainingGet Paid $23/ea. for New Patient COVID-19 Testing With 99211” from coding and billing expert, Brenda Edwards, CPC, CDEO, CPB, CPMA, CPC-I, CEMC, CRC, CRCS, CMCS.

COVID-19 Resources For Accurate Coding

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Meet Your Writer

Jen Godreau

Content Director

Jennifer Godreau, CPC, CPMA, CPEDC, COPC, has almost 20 years of experience in billing, coding, compliance, and practice management. She develops the content and programs for Healthcare Training Leader, a practice-specific online training company offering step-by-step advice on increasing reimbursement and avoiding compliance violations. Prior to joining Healthcare Training Leader, Jennifer supervised the program delivery for EMRs, practice management systems and compliance and revenue cycle services for more than 6,000 providers. Thousands of software products - encoders, claims management, auditing, and HIPAA compliance, have been created with her teams and helped thousands of practices more easily reduce revenue losses and comply with complex regulations. Her passion for breaking down healthcare rules and requirements in simple steps has provided practical advice, education, and risk reduction strategies to numerous associations, payers and medical specialties especially in primary care, otolaryngology, eye care, and pediatrics. Jennifer’s advocacy resulted in supervision rule revisions, new CPT codes, and CMS compliance contracts. She oversaw the provider auditing and education for one of the major corporate integrity health system settlements. Jennifer has authored and presented on numerous healthcare compliance and payment challenges. Her education guides include the Certified Otolaryngology Coder (CENTC) exam study guide and the AAPC Professional Medical Coding Curriculum. Jennifer has a Bachelor of Arts from Wittenberg University in Springfield, Ohio. She holds certificates in coding, auditing, pediatric coding, and ophthalmology billing and coding, and is AAPC Vice President of the Naples, FL chapter. Please reach out to Jennifer for step-by-step guidance at