Wednesday, May 6, 2020

Coding Coronavirus

The coronavirus is in the news every day.  With the World Health Organization (WHO) declaring it a pandemic, in this issue of “In the kNOW” we’ll take a look at the guidance provided to help coding professionals appropriately code for this condition.

First, let’s look at some background on this disease.  This version of the coronavirus appears to have originated in Wuhan, China.  While there are many different strains of the coronavirus, the origin of this one seems to be from bats.  Initial transmission of the disease was animal to human but has since evolved to human to human.  This makes containment of the disease much more difficult in today’s world.  Ease of transportation and length of incubation (14 days) means that there is possibility of exposure without the ability to determine how or when the exposure took place. 

Symptoms of someone infected with the coronavirus vary widely.  The symptoms may be mild to the point of not being noticeable to severe which can lead to death.  They include shortness of breath, fever and cough. 
The WHO developed a temporary ICD-10 emergency code (U07.1) for the new coronavirus which has since been named the 2019 novel coronavirus (COVID-19).  In the United States, the National Center for Health Statistics (NCHS), which is part of the Centers for Disease Control and Prevention (CDC), made an unprecedented decision to implement a new code for COVID-19 effective April 1, 2020. 
U07.1 is the code that has been implemented for ICD-10-CM.  It was felt that there was an immediate need to capture the specificity afforded by initiating the new code now rather than waiting until fall.  It is important to recognize that the new code (U07.1) is NOT retroactive.  It can only be assigned for discharges or dates of service on or after 4/1/2020.  It is also worth noting that this code and the guidance supplied apply to all patient types, inpatient and outpatient.  U07.1 should be assigned for confirmed cases of COVID-19 which means that physician documentation that the patient has COVID-19 is sufficient.  Coding professionals are also instructed that presumptive positive cases should be coded as confirmed.  Presumptive positive is a term that is used when a state or local test has returned positive but it hasn’t been confirmed by the CDC.  Confirmation testing by the CDC is no longer being conducted.
U07.1 will be assigned first with the manifestations listed additionally.  This is a sequencing directive according to the “Use additional code” note in the Tabular List.  This differs from the interim guidance that is listed below when coding for the virus with dates prior to 4/1/2020. 
The primary MS-DRGs that will be obtained when U07.1 is assigned as a principal diagnosis are MS-DRGs 177-179 which are Respiratory infections and inflammations with MCC, CC, or neither. 
The following Official Coding Guidelines supplement was issued providing direction on appropriate coding. 
Exposure to COVID-19
When exposure to COVID-19 is a possibility but is ruled out, assign code Z03.818 Encounter for observation for suspected exposure to other biological agents ruled out.
When exposure to a confirmed case of COVID-19 occurs, assign code Z20.828 Contact with and (suspected) exposure to other viral communicable diseases.
Bear in mind, that the following coding guidance applies to coding cases prior to 4/1/2020.  It is noteworthy that B97.29 is not specific to COVID-19.  There are over 30 different strains of coronavirus, and this code would apply to all.  It has been recommended that facility-specific guidelines be implemented to use B97.29 only for COVID-19 cases so that data can be captured accurately.  
Coding pneumonia due to COVID-19
                J12.89 Other viral pneumonia
                B97.29 Other coronavirus as the cause of diseases classified elsewhere
Acute Bronchitis due to COVID-19
                J20.8 Acute bronchitis due to other specified organisms
                B97.29 Other coronavirus as the cause of diseases classified elsewhere
                                If the bronchitis is not otherwise specified assign J40 with B97.29 when due to COVID-19
Lower respiratory infection due to COVID-19
                J22 Unspecified acute lower respiratory infection
                B97.29 Other coronavirus as the cause of diseases classified elsewhere
If the respiratory infection is not otherwise specified assign J98.8 with B97.29 when due to COVID-19
ARDS due to COVID-19
                J80 Acute respiratory distress syndrome
                B97.29 Other coronavirus as the cause of diseases classified elsewhere
Signs and symptoms
                For the signs and symptoms without a definitive diagnosis of COVID-19, assign the appropriate sign or symptom code only.  For example, R05 for cough.
A few additional points.  First, provider documentation of uncertain terms in conjunction with COVID-19 like “possible”, “suspected”, or “probable”, mean we do not assign B97.29 even for inpatients.  Instead, the signs or symptoms should be coded.  This follows the same advice we have for coding for Zika virus.  Second, when coding for COVID-19, because the site has generally been respiratory, it would not be appropriate to assign code B34.2 Coronavirus infection, unspecified.  Third, in order to capture positive cases, it is recommended that facility-specific guidelines be initiated to hold the coding of cases until the results have been returned with this recommendation specific only to COVID-19 cases.  Be aware that physicians do not have to go back in their documentation to link a respiratory condition and a positive COVID-19 test.  If there is a positive test result, coders may assign U07.1.  This advice is specific to COVID-19 code assignment only and does not apply to the coding of other laboratory tests.
Further, new guidance states that when a patient has signs or symptoms that are indicative of COVID-19 and the provider suspects the patient may have it, then Z20.828 can be assigned even if it not specifically stated that the patient has been exposed.      
There are three codes for laboratory testing for coronavirus:
                CPT Code
-  87635 Infectious agent detection by nucleic acid (DNA or  RNA);severe acute respiratory syndrome coronavirus  2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
HCPCS Level II Codes
-  U0001 Used when billing to CDC testing labs
-  U0002 Used when billing to non-CDC testing labs
Coding professionals can reference the CDC/NCHS and American Hospital Association websites for additional information and to find the Official Coding Guidelines supplement and FAQ that address this topic.  This information was current as of 4/28/2020 with the possibility that future changes or revisions will be made.  Coding professionals are urged to monitor official coding sites for updated information on a regular basis.
Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

No comments:

Post a Comment