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COVID-19 Reimbursement

ICD-10-CM Coding Guidelines for COVID-19

What are the correct diagnosis codes to use when you encounter a patient with the COVID-19 coronavirus? This author provides the most updated ICD-10-CM coding guidelines.

Information regarding coding, coverage, and payment is provided as a service to our readers. Every effort has been made to ensure accuracy. However, HMP and the author do not represent, guarantee, or warranty that coding, coverage, and payment information is error-free and/or that payment will be received.

Because COVID-19 is a new disease to the world, medical professionals caring for these patients did not have a diagnosis code and coding guidance for reporting their work on medical claims and for surveillance data. Therefore, a significant amount of ever-changing information about diagnosis reporting has been published on the websites of the National Center for Health Statistic (NCHS) and of the Centers for Medicare & Medicaid Services (CMS). Information provided in this article is an aggregation of guidance from these websites. 

Following is a brief synopsis of the diagnosis coding and guidance as of April 1, 2020.

·      On January 30, 2020, the World Health Organization (WHO) declared the 2019 novel coronavirus (2019-nCoV) disease outbreak a public health emergency of international concern. As a result of the declaration, the WHO Family of International Classifications Network Classification and Statistics Advisory Committee convened an emergency meeting on January 31, 2020 to discuss the creation of a specific code for this new coronavirus. A new International Classification of Diseases, Tenth Revision (ICD-10) emergency code (U07.1, 2019-nCoV acute respiratory disease) was established by the WHO.

·      In the U.S. the next update to the ICD-10-CM is not until October 1, 2020.  Therefore, the NCHS published a supplement to the 2020 ICD-10-CM Official Coding Guidelines that provided interim coding guidance on encounters related to the COVID-19 outbreak. This interim guidance was effective on February 20, 2020. The code that was assigned to identify COVID-19 was B97.29, Other coronavirus as the cause of diseases classified elsewhere. The code and guidelines were published for interim use until the new code U07.1 could be formally implemented on October 1, 2020.

·      Because the COVID-19 outbreak was deemed a pandemic and there was an urgent need to capture the diagnosis on claims and surveillance data in the U.S., on April 1, 2020 a new code and new guidelines were published by the Centers for Disease Control (CDC): https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-3-18-2020.pdf . The interim code B97.29 was end dated 3/31/2020.
 
Here is an excerpt from the CDC announcement: “Given these developments, and the urgent need to capture the reporting of this condition in our nation’s claims and surveillance data, the Centers for Disease Control (CDC), under the National Emergencies Act Section 201 and 301, is announcing a change in the effective date of new diagnosis code U07.1, COVID-19, from October 1, 2020 to April 1, 2020. This off-cycle update is unprecedented and is an exception to the code set updating process established under HIPAA.”

·      On April 1, the NCHS released new diagnosis coding guidelines for the new U07.1 COVID-19 diagnosis code https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf

Table 1 (download PDF here) provides an overview of the correct diagnosis codes to use in common COVID-19 situations. This author will update Table 1 if additional diagnosis coding guidance is released. 

Donna Cartwright is senior director of health policy and reimbursement at Integra LifeSciences Corp., Plainsboro, NJ. She is approved as an AHIMA-approved ICD-10-CM/PCS trainer and she has been designated as a fellow of the American Health Information Management Association.

For a related article, see "Telehealth Waivers During COVID-19 Public Health Emergency" at https://www.todayswoundclinic.com/articles/telehealth-waivers-during-covid-19-public-health-emergencyhttps://www.todayswoundclinic.com/articles/telehealth-waivers-during-covid-19-public-health-emergency .

COVID-19 Reimbursement
Topics
Donna J. Cartwright, MPA, RHIA, CCS, RAC, FAHIMA
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