by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
June 7th, 2022
When a discussion about COVID-19 begins, it does not seem to take very long before someone brings up the various sequela of individuals they know who have had the virus. We hear of things like loss of smell or taste, repetitive bouts of walking pneumonia, brain fog, total loss of hair, heart attacks in young adults, skin conditions, reverse circadian rhythms, and the list goes on and on. So how are all these symptoms, signs, and conditions being reported and captured in the data?
A quick search of “COVID-19” in the ICD-10-CM Official Coding Guidelines results in over 100 results referencing COVID-19 coding guidelines related to coding the following scenarios:
- Current COVID-19 Infection
- Confirmed-only cases
- Symptomatic vs asymptomatic
- Signs/Symptoms without COVID-19 diagnosis
- Antibody testing
- Sequencing codes
- in pregnancy, childbirth, & puerperium
- in newborns
- with sepsis or severe sepsis
- with respiratory manifestations
- with non-respiratory manifestations
- Vaping-related disorder and COVID-19
- Multisystem Inflammatory Syndrome (MIS)
- Personal history of COVID-19
- Post-COVID-19 follow-up encounters
- Post COVID-19 condition
On October 1, 2021, a new ICD-10-CM code, U09.9 "Post COVID-19 condition, unspecified” was published as a new diagnosis code. Specific coding guidelines for this code are included in the code description as well as in the Official ICD-10-CM Coding Guidelines. Let’s review a few of the guidelines specific to reporting U09.9:
Do not report U09.9 when there is a current or active COVID-19 infection, unless,
“A patient has a condition(s) associated with a previous COVID-19 infection and develops a new active (current) COVID-19 infection, code U09.9 may be assigned in conjunction with code U07.1, COVID-19, to identify that the patient also has a condition(s) associated with a previous COVID-19 infection.”
Code first the specific condition related to COVID-19 if known, such as:
- Chronic respiratory failure (J96.1-)
- Loss of smell (R43.8)
- Loss of taste (R43.8)
- Multisystem inflammatory syndrome (M35.81)
- Pulmonary embolism (I26.-)
- Pulmonary fibrosis (J84.10)
The purpose of the “Code First Rule” is to sequence first, the condition being evaluated and treated, followed by the underlying cause. For example, a patient presents in February with complaints of loss of smell since having had COVID-19 back in October. The provider evaluates the patient’s complaint and offers treatment recommendations and documents “loss of smell due to prior COVID-19 infection.” This diagnosis would be reported with two codes, sequenced according to specific ICD-10-CM coding guidelines, as follows:
Keep Up on ICD-10-CM Coding Guidelines
No longer are the ICD-10-CM code updates occurring just on October 1st of each year. Since the beginning of COVID-19, updates have occurred at random times and often multiple times during the year. This has been based on the need for new diagnosis codes to report the various symptoms, conditions, and events surrounding COVID-19. It is now important to watch for ICD-10-CM updates and to be proactive in searching them out between the official updates every October 1st.
Organizing Documentation for Improved ICD-10-CM Reporting
Many organizations invest in software that autosuggests ICD-10-CM, CPT, and HCPCS codes based on provider documentation. For the computer to autosuggest codes, the documentation must be organized in such a way that the engine knows where to look for specific words and phrases, and then applies engine-specific rules to that information to allow the engine to suggest the code.
Keeping up to date on code changes and how your coding software, coders, quality assurance personnel, and engine suggested coding programs are performing is going to be vital to successful reporting. Incorporating a physician-advocate for clinical documentation improvement (CDI) trainings for all documenting providers will also go a long way in maintaining good documentation and coding standards.
- ICD-10-CM Official Guidelines for Coding and Reporting FY 2019 (October 1, 2018 - September 30, 2019)
Disclaimer: The above article is the opinion of the author(s) and should not be interpreted by providers/payers as official guidance. For any questions about the content of this article, please contact the author(s).
About the Author: Aimee L. Wilcox is a medical coding, billing, and auditing consultant, author, and educator with more than 30 years of clinical and administrative experience in healthcare, coding, billing, and auditing. Medicine, including coding and billing, is a constantly changing field full of challenges and learning and she loves both. Aimee believes there are talented medical professionals who, with proper training and excellent information, can continue to practice the art of healing while feeling secure in their billing and reimbursement for such care.