The coronavirus outbreak continues to sweep across the world. It is estimated to have caused more than 88000 infections globally as of March 2. In China, where the virus originated, the number of confirmed infections was more than 80,000, with the number of deaths from the virus exceeding 3000 at the time of this writing. In the U.S., a single hospital in Washington State reported two deaths and the total number of cases nation wide spiked 35 percent, to 88 on March 2. The CDC has released diagnosis coding guidance for health care encounters and deaths related to COVID-19. It is expected that there will be a new ICD-10 code for COVID-19 in the October 1, 2020 ICD-10 revision. Medical billing service providers can help physicians report coronavirus cases based on the latest guidelines.

The CDC’s latest guidance is to be used in conjunction with the ICD-10-CM Official Guidelines for Coding and Reporting (effective October 1, 2019). The key points of the CDC’s latest guidance on coding encounters related to the 2019 coronavirus outbreak are as follows:

  • Only cases with confirmed symptoms of COVID-19 should be reported with codes explaining the reason for the encounter. Symptoms can include fever, cough, and shortness of breath and may appear from 2 to 14 days after exposure.
  • Confirmed COVID-19 infections can cause a range of illnesses, with few or no symptoms. Symptoms can range from mild to severe, and the virus can even cause death.
  • The guidance also explains that diagnosis code B34.2, Coronavirus infection, unspecified, would in generally not be suitable for the COVID-19, as all cases have been respiratory in nature, and so the site would not be “unspecified”.
  • The guidelines also distinguish between ‘possible’ and ‘actual’ exposure to COVID-19: “For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, it would be appropriate to assign the code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out… for an actual exposure to someone who is confirmed to have COVID-19, it would be appropriate to assign the code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases”.

Coding conditions due to COVID-19

The CDC’s document provides several examples of coding of encounters related to coronavirus, but notes that other codes for conditions unrelated to coronavirus may be required to fully code these scenarios per ICD-10 rules.

  • Pneumonia: Two ICD 10 codes can be used report a case of pneumonia confirmed as due to COVID-19:
    • J12.89, Other viral pneumonia
    • B97.29, Other coronavirus as the cause of diseases classified elsewhere
  • Acute Bronchitis: For a case of acute bronchitis confirmed as due to COVID-19, assign the following codes:
    • J20.8 Acute bronchitis due to other specified organisms
    • B97.29 Other coronavirus as the cause of diseases classified elsewhere
    • To code Bronchitis not otherwise specified (NOS) due to the COVID-1, use:

    • J40, Bronchitis, not specified as acute or chronic along with B97.29, Other coronavirus as the cause of diseases classified elsewhere
  • Lower Respiratory Infection: For COVID-19 documented as due to a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, use:
    • J22, Unspecified acute lower respiratory infection, with code B97.29, Other coronavirus as the cause of diseases classified elsewhere

    Assign the following codes if the COVID-19 is documented as being associated with a respiratory infection, NOS:

    • J98.8, Other specified respiratory disorders, and code B97.29, Other coronavirus as the cause of diseases classified elsewhere
  • ARDS Acute respiratory distress syndrome (ARDS) – For cases with ARDS due to COVID-19 should be assign:
    • J80, Acute respiratory distress syndrome, and B97.29, Other coronavirus as the cause of diseases classified elsewhere
  • Code signs and symptoms: If signs and symptoms of COVID-19 are present, but a definitive diagnosis cannot be established, the appropriate codes for the signs and symptoms should be assigned. For example:
    • R05 Cough
    • R06.02 Shortness of breath
    • R50.9 Fever, unspecified
  • “Suspected”, “possible” or “probable” COVID-19: If the provider documents the condition as “Suspected”, “possible” or “probable” COVID-19, assign a code(s) explaining the reason for encounter (such as fever, or Z20.828).

“More can and should be done to minimize the risk of coronavirus in the United States,” William Jaquis, M.D., ACEP president, said in a statement. “It is critical that we empower our nation’s emergency care teams and public health experts to protect millions of people and respond quickly and effectively to this virus”.

(www.emergencyphysicians.org/press-releases/2020).

Physicians need to stay updated on the evolution of this emerging infection. As they go all-out to provide the best possible care to patients, coding support and physician billing services are available to help them report COVID-19.