Ever since the outbreak of the coronavirus pandemic, the Centers for Disease Control and Prevention (CDC), the American Medical Association, and other professional medical organizations have been in the forefront with guidance for healthcare providers. With new codes and reporting guidelines developed for COVID-19 over the past month, outsourced medical billing and coding services are a practical option for physicians to submit claims and get paid.

The Centers for Disease Control and Prevention (CDC) announced the implementation of a new specific ICD-10 code for COVID-19: U07.1 effective April 1, 2020, rather than October 1, 2020 as originally planned. The effective date was changed due to the COVID-19 national health emergency and the urgent need to capture the reporting of this condition in the nation’s claims and surveillance data (www.cdc.com). ICD-10 code U07.1, COVID-19 is classified to Chapter 22 – Codes for Special Purposes (U00-U85).

Here are the key points on the use of ICD-10 code U07 and COVID-19 infections:

  • ICD-10 code U07.1 may be used for discharges/date of service on or after April 1, 2020.
  • When COVID-19 meets the definition of principal diagnosis or first-listed diagnosis, code U07.1, COVID-19, should be sequenced first, followed by the appropriate codes for associated manifestations, except in the case of obstetrics patients.
  • Code U07.1 should be used as a secondary diagnosis if COVID-19 does not meet the definition of principal or first-listed diagnosis (e.g., when it develops after admission).
  • Guidelines for reporting acute respiratory illness due to COVID-19:
    • Pneumonia: For a pneumonia case confirmed as due to COVID-19, assign codes U07.1, COVID-19, and J12.89, Other viral pneumonia.
    • Acute bronchitis: For a case of acute bronchitis confirmed as due to COVID-19, assign codes U07.1, and J20.8, Acute bronchitis due to other specified organisms. Use code U07.1 and J40, Bronchitis, not specified as acute or chronic to report Bronchitis not otherwise specified (NOS) due to COVID-19.
    • Lower respiratory infection: Assign codes U07.1 and J22, Unspecified acute lower respiratory infection, if COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS. Assign codes U07.1 and J98.8, Other specified respiratory disorders if COVID-19 is documented as being associated with a respiratory infection, NOS.
    • Acute respiratory distress syndrome: Assign codes U07.1, and J80, Acute respiratory distress syndrome. Ffor a patient with acute respiratory distress syndrome (ARDS) due to COVID-19.
  • Exposure to COVID-19: Assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out, for cases of possible exposure to COVID-19 ruled out after evaluation.

    Assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, in cases where there is an actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown.

  • COVID-19 screening: Use code Z11.59, Encounter for screening for other viral diseases for asymptomatic individuals being screened for COVID-19, have no known exposure to the virus, and test results are either unknown or negative.
  • Assign code U07.1, COVID-19 for asymptomatic individuals who test positive for COVID-19.
  • Signs and symptoms without definitive diagnosis of COVID-19: For patients presenting with COVID-19 associated signs/symptoms (e.g. fever, etc.), but a definitive diagnosis has not been established, assign the appropriate code(s) for the signs/symptoms:
    • R05 Cough
    • R06.02 Shortness of breath
    • R50.9 Fever, unspecified
    • Assign Z20.828 Contact with and (suspected) exposure to other viral communicable diseases as an additional code if the patient with signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to someone who has COVID-19.
  • COVID infection in pregnancy: If a patient is admitted because of COVID-19 infection in pregnancy, childbirth, and the puerperium, assign a principal diagnosis code of O98.5, Other viral diseases complicating pregnancy, childbirth and the puerperium, followed by code U07.1, COVID-19, and the appropriate codes for associated manifestation(s). Pregnancy, Childbirth, and the Puerperium (O00-O9A) should take priority.
  • Sepsis: Code U07.1 should be assigned as the principal diagnosis if the patient is admitted with pneumonia due to COVID-19 which then progresses to viral sepsis (not present on admission). On the other hand, if a patient is admitted with sepsis due to COVID-19 pneumonia and the sepsis meets the definition of principal diagnosis, assign code A41.89, Other specified sepsis, as the principal diagnosis followed by codes U07.1 and J12.89, Other viral pneumonia, as secondary diagnoses (www.aha.com).

On March 13, the American Medical Association (AMA) released a new CPT code 87635 to report laboratory testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus that causes COVID-19. For Medicare claims, the Centers for Medicare & Medicaid Services (CMS) introduced two new HCPCS codes for coronavirus testing. Our medical coding company reported on these developments as well the new guidelines on telemedicine billing during this pandemic. With extensive expertise in the field of medical coding and billing, we can help healthcare providers stay up to date on these changes and ensure accurate and timely claim submission to meet payer guidelines.