Coding professionals are aware that the
selection of the principal diagnosis is key when coding inpatient
accounts. In this edition of “In the kNOW”,
we’ll take a look at how this applies when coding for COVID-19.
The most
straightforward concept is when a patient is admitted and treated specifically
for COVID-19. In these circumstances, it
is clear that the U07.1 code for COVID-19 would be sequenced as the principal
diagnosis. But happens when there is a wrinkle to the situation, for example, a
pregnant patient has COVID-19? Let’s
break that down and see how it should be coded.
First, if the
pregnant patient is admitted for care related to COVID-19, then the Official
Coding Guidelines instruct us to assign O98.5- (Other viral diseases
complicating pregnancy, childbirth, and the puerperium) as the principal
diagnosis. This would be followed with
the U07.1 code for the COVID infection.
Code assignment follows this standard because sequencing priority is
always given to Chapter 15 (Pregnancy, Childbirth, and the Puerperium)
codes.
Next, if the
admission is for delivery – let’s say for a breech presentation that requires a
C-section and the patient has COVID – then the code assignment here should
reflect the breech presentation (O32.1-) as the principal diagnosis, followed
by the codes O98.5-, and U07.1 to identify the COVID infection.
That brings us to
coding for the newborn. When coding for
a newborn birth record, the principal diagnosis code will always be from
category Z38 (Liveborn infants according to place of birth and type of
delivery). If the newborn is determined
to have COVID-19, and documentation states it was contracted in utero or during
the birth process, then P35.8 (Other congenital viral diseases) is also
assigned followed by a secondary code of U07.1.
If the mode of transmission is not identified, then simply assign U07.1.
Another
circumstance where U07.1 is not assigned as the principal diagnosis is when
coding for a lung transplant complicated with a COVID infection. Under Official Coding Guideline I.C.19.g.3.a
(Transplant complications other than kidney), instructions are provided to
sequence T86- (Complications of transplanted organs and tissues) first with a
secondary code assigned to capture the complication, which in our case would be
U07.1 for the COVID-19 infection.
An additional
instance that can impact the assignment of a COVID-19 diagnosis is when it is
present with sepsis. In that scenario,
coding professionals are directed to follow the sepsis coding guidelines at
I.C.1.d.
Finally, remember outside
of the circumstances noted above, coding professionals must still apply the
principal diagnosis definition when determining the principal diagnosis on each
and every account. If the COVID-19
infection meets that definition, then assign U07.1 as the principal diagnosis,
but if not, it should be assigned as a secondary.
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.
