Coronavirus - What in the World is it and How is it Coded? 2020-02-20

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Mar 2nd, 2020

On December 31, 2019, we learned of a deadly outbreak of an unknown virus, with an unknown cause. We have since learned the virus was identified in Wuhan, China as a novel coronavirus (2019-n-CoV). Until we have more information on the 2019-nCoV, persons with an underlying medical condition are considered high risk. To learn more information on Coronavirus and how it is spread, we turned to the World Health Organization (WHO). They offer some great information and guidance we thought we would share as well as information from the Centers for Disease Control and Prevention (CDC). The CDC has recently published new ICD-10-CM interim coding guidance and instructions for Coronavirus (COVID-19) we will share here as well. 

What is it?

According to the World Health Organization; Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.  

Coronaviruses are zoonotic, meaning they are transmitted between animals and people.  Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans. 

Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure, and even death. 

Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, and thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing.

Coding the Encounter

Coronavirus codes were released in 2015 such as B97.29 - Other coronavirus as the cause of diseases classified elsewhere. You may see it documented as coronavirus, COVID-19 or 2019-nCoV. If coronavirus (COVID-19) is documented as “suspected”, “possible” or “probable”, do not assign B97.29. Assign a code(s) explaining the reason for the encounter such as fever, or Z20.828. If a patient is seen and there is not a confirmed diagnosis of COVID-19, assign the appropriate diagnosis for the presenting signs and symptoms, such as:

• R05 Cough
• R06.02 Shortness of breath
• R50.9 Fever, unspecified

Exposure

If a patient is seen for an encounter and it is only a concern for possible exposure but has been ruled out after an evaluation assign,

• Z03.818 Encounter for observation for suspected exposure to other biological agents ruled out.

If a patient is seen and had an actual exposure with someone who has been confirmed to have COVID-19 assign,

• Z20.828 Contact with and (suspected) exposure to other viral communicable diseases.

Not Specified

If it is not otherwise specified (NOS) due to the COVID-19, assign code

• J40, Bronchitis, not specified as acute or chronic;
• B97.29, Other coronavirus as the cause of diseases classified elsewhere.

Acute Respiratory Distress

If a patient develops acute respiratory distress (ARDS) with COVID-19 assign

• J80 Acute respiratory distress syndrome
• B97.29 Other coronavirus as the cause of diseases classified elsewhere
• Z16.- code to identify resistance to antimicrobial drugs

Pneumonia

Pneumonia confirmed as due to coronavirus, assign the following codes:

• J12.89, Other viral pneumonia
• B97.29, Other coronavirus as the cause of diseases classified elsewhere
• Z16.- code to identify resistance to antimicrobial drugs

Acute Bronchitis

Acute bronchitis confirmed as due to COVID-19, assign codes

• J20.8, Acute bronchitis due to other specified organisms
• B97.29, Other coronavirus as the cause of diseases classified elsewhere

Lower Respiratory Infection

If the COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, this should be assigned with code

• J22, Unspecified acute lower respiratory infection
• B97.29, Other coronavirus as the cause of diseases classified elsewhere.

If the COVID-19 is documented as being associated with a respiratory infection, NOS, it would be appropriate to assign code

• J98.8, Other specified respiratory disorders
• B97.29, Other coronavirus as the cause of diseases classified elsewhere.

Acute Respiratory Distress

Acute respiratory distress syndrome (ARDS) may develop with the COVID-19, according to the Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (COVID-19) Infection, in this case, code ARDS due to COVID-19. 

• J80, Acute respiratory distress syndrome
• B97.29, Other coronavirus as the cause of diseases classified elsewhere.

In addition, the CDC states, "Diagnosis code B34.2, Coronavirus infection, unspecified, would in general not be appropriate for the COVID-19, because the cases have universally been respiratory in nature, so the site would not be “unspecified.”

For more information on Coronavirus disease (COVID-19), see technical guidance from the World Health Organization for information such as a Lab testing and  Patient Management.