Tuesday, December 8, 2020

New Year, New ICD-10-CM Codes?

by June Bronnert, MSHI, RHIA, CCS, CCS-P

This year, 2020, provided new and extraordinary situations due to 2019 novel coronavirus or COVID-19.  Healthcare continues to manage surges in demands for certain services while balancing other elective services.  All of this brought many new challenges to the industry ranging rapid establishment of field hospitals to accurate reflection of the pandemic through industry standard code sets. 

Activating COVID-19 related codes occurred internationally and domestically in various unprecedented off-cycle releases.  The codes reflect COVID-19 procedures and diagnoses.  Procedure code systems such as LOINC, CPT, HCPCS, and ICD-10-PCS released codes supporting laboratory tests, treatment, and vaccination codes to keep pace with industry activities.  Diagnostic code systems such as ICD also released codes across the globe.  The World Health Organization (WHO) originally activated two emergency use U codes related to COVID-19. 

Those codes are as follows:

  • U07.1 COVID-19, virus identified
  • U07.2 COVID-19, virus not identified

In the United States, the ICD-10 Coordination and Maintenance Committee implemented U07.1 COVID-19, effective April 1, 2020. The ICD-10-CM Official Coding and Reporting Guidelines were updated to reflect the new U COVID-19 code along with other various clinical COVID-19 related scenarios. 

The medical understanding of COVID-19 continues to advance.  Other associated conditions and long- term effects from COVID continue to manifest, such as multisystem inflammatory syndrome or persistent fatigue and require healthcare services.  The need for ICD codes to reflect the conditions remains a top priority domestically and internationally.  The WHO has activated additional emergency use U codes to capture the different conditions.  The codes are as follows:

  • U08.9 Personal history of COVID-19, unspecified
  • U09.9 Post COVID-19 condition, unspecified
  • U10.9 Multisystem inflammatory syndrome associated with COVID-19

In the United States, the committee, based upon input from the community, proposed new codes during the September 8-9, 2020 meeting to reflect data capture and the evolving clinical picture of COVID-19.  The proposed effective date is January 1, 2021.

The following new codes were proposed:

  • J12.82    Pneumonia due to coronavirus disease 2019
  • M35.81     Multisystem inflammatory syndrome
  • M35.89 Other specified systemic involvement of connective tissue
  • 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 ICD-10 Coordination and Maintenance Committee received multiple requests to create unique codes of screening, exposure, and personal history of COVID-10 due to the significant public health impact from the virus.  The committee announced at the end of November further COVID-19 related additions to ICD-10-CM.

The new codes support ongoing data needs for healthcare due to the pandemic in a variety of fashions.  The codes identify a variety of clinical situations.  As individuals are receiving tests for a variety of reasons the codes distinguish the reasons, such as a suspected exposure versus a screening.  Another scenario is individuals who have had COVID.  A personal history specific to COVID-19 supports identification of individuals who have had COVID-19.  Identifying this patient cohort with a unique code can support ongoing research efforts.  The research will continue to advance the medical understanding of the disease process.  

The two additional requests, M35.81 Multisystem inflammatory syndrome (MIS) and J12.82 Pneumonia due to coronavirus disease 2019 captures associated COVID-19 conditions.  MIS associated with COVID-19 is a new condition, M35.81 uniquely identifies the condition and support ongoing surveillance efforts.  The request for code J12.82 to capture pneumonia due to COVID-2019 was based upon review of Centers for Medicare and Medicaid (CMS) and Centers for Disease Control (CDC) data.  The data suggests under reporting of the two codes identified in the current coding guidelines to report the condition.

The current 1.g.1.c.i guideline for pneumonia directs one to assign U07.1, COVID-19 and J12.89, Other viral pneumonia for confirmed pneumonia due to the 2019 novel coronavirus.  The guidelines will need revised not only indicate the new code (J12.82) but also if U07.1 is still appropriate to report as the code descriptor for J12.82 indicates the connection to the 2019 coronavirus.

The ICD-10-CM Official Coding and Reporting Guidelines were revised to provide coding advice for a variety of clinical situations related to COVID-19.  The guidelines were updated when U07.1, COVID-19 was implemented.  As the new codes are implemented, watch for updates to the coding guidelines to reflect the clinical scenarios to apply the new codes.   

The effective date is January 1, 2021 for the new COVID-19 related codes.  Keep watching the ICD-10-CM Coordination and Maintenance website for additional details regarding guidance and the new codes:  https://www.cdc.gov/nchs/icd/icd10cm.htm

About the Author

June Bronnert, MSHI, RHIA, CCS, CCS-P is the Senior Director of Informatics at Intelligent Medical Objects Inc. (IMO) where she provides health information management subject matter expertise internally and externally for IMO’s terminology solutions.  She serves as a Committee Member on OHIMA’s Blog Committee in FY2020-21.

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