Monday, August 23, 2021

The NeverEnding Story-COVID Coding Updates

If you’re a fan of the film “The NeverEnding Story”, then perhaps you feel that title applies to pandemic coding over the past year. Coding professionals find our COVID-19 coding world is still changing, and truthfully there is no end in sight.  For example, there is consideration for a post-COVID code that could be implemented with our October 1st Official Coding updates. 

If you have ever heard me do a presentation that contained information on COVID coding, you know that I stress how important it is to stay up-to-date with the coding guidance that is being disseminated.  Unfortunately, there has been no rhyme or reason as to when new information is published which makes that a challenging proposition.  In addition to the Official Coding Guidelines and Coding Clinic guidance, we have been getting clarity in the “Frequently Asked Questions Regarding ICD-10-CM/PCS Coding for COVID-19” (FAQs) from the American Hospital Association (AHA) and the American Health Information Management Association (AHIMA).  Updates to the FAQs have most recently been published on 3/1/21, and 3/24/21.  This “In the kNOW” will share a few of these updates related specifically to vaccines.

Vaccine administrations are well under way, and for a small number of patients, reactions are prompting medical care.  Let’s examine the differences to understand the guidance. 

Allergic reaction – this is a hypersensitivity to a substance.  Symptoms could be itching, hives, chest tightness or shortness of breath.  Instinctively, as a coding professional, you may search for this code by going to Allergy, vaccine, which says to see Allergy, serum, and that is where we run into a problem.  In the United States, the vaccines that are being used are not serum based.  That would make this code assignment incorrect.  Therefore, in order to capture, the correct code, we must use the specified NEC designation under Allergy and assign T78.49X-.  The FAQs direct assignment of T78.49X- first, followed by the codes for the specific symptoms, such as R07.89 for other chest pain, or R06.02 for shortness of breath. 

Adverse effect – this would be a harmful or abnormal result of the vaccine and may also be called a side effect.  Malaise, chills, and nausea are examples of adverse effects.  The ICD-10-CM Alphabetic Index for adverse effect directs us to the Table of Drugs and Chemicals.  Finding Vaccines, we can locate viral NEC as the appropriate option with code T50.B95- assigned.  In this circumstance, when coding adverse effects, the adverse effect is sequenced first, say R53.81 for malaise, followed by T50.B95- as a secondary code.  Keep in mind, that if a normal side effect prompts medical attention it should be coded.

Anaphylactic reaction – this is a severe allergic reaction which occurs quickly.  Symptoms include difficulty breathing and/or swallowing, swelling of throat, and drop in blood pressure.  The Alphabetic Index at Anaphylaxis redirects a coding professional to Shock, anaphylactic.  From there the choice becomes serum.  But wait!  Didn’t I say earlier that vaccines in the U.S. are not serum based.  Well, yes, I did.  However, ICD-10-CM does not have a more appropriate choice available at this time.  T80.52X- is the closest code that we can capture for now.  Might we see a specific code developed to capture anaphylaxis related to a COVID vaccination?  Perhaps.  As I mentioned earlier, I don’t think we are done seeing codes specifically related to COVID being rolled out. 

In closing, again, I stress frequent checking of the FAQs to ensure that you have the most current information related to COVID coding.  I suggest at least checking weekly for updates, more often if you can.  This way you can apply the appropriate coding for the COVID cases you are reporting.  It is so vital that all coding professionals are on the same page in this data collection as our work is going to be pivotal in the research that will be ongoing into this disease.

Now you are In the kNOW!!


About the Author 

Dianna Foley, RHIA, CHPS, CCS, CDIP  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.