Wednesday, July 7, 2021

COVID-19 Principal Diagnosis Assignment

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.