New Official Guidelines for Coding COVID-19 Diagnoses

On October 1, 2020, the annual update to ICD-10 codes goes into effect. The ICD-10-CM Official Guidelines for coding and Reporting FY 2021 (October 1, 2020 – September 30, 2021) have also been updated. These guidelines are provided by the Centers for Medicare and Medicaid Services (CMS) with the National Center for Health Statistics (NCHS).

Coding guidelines regarding the COVID-19 infection have been added to the official guidance and take the place of the interim rules that were released earlier this year. How you code COVID-19 is a factor in determine whether these claims process correctly to avoid balances the patient should not be required to pay.

Only confirmed cases as documented by the provider or confirmed by test results should be coded with ICD U07.1, COVID-19. This code should be the primary diagnosis on the claim. Codes for any acute respiratory manifestations due to COVID-19 should be additional diagnoses (e.g., pneumonia). This is also the case for non-respiratory manifestations caused by COVID-19.

Suspected cases of COVID-19 should be coded with signs and symptoms (e.g., fever or cough).

Asymptomatic patients with actual or suspected exposure should be coded with ICD Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. This is a change from prior guidance which said to code ICD Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out, for possible exposure. ICD Z03.818 no longer appears in the official guidelines.

Another ICD code in the interim guidelines that has been removed is ICD Z11.59, Encounter for screening for other viral diseases. Per the official guidelines, during the COVID-19 pandemic, a screening code is “generally not appropriate”. Even COVID-19 testing for preoperative testing should be coded as exposure, ICD Z20.828.

Diagnoses added to this guidance are:

  • History of COVID-19: 19, Personal history of other infectious and parasitic diseases.
  • Follow-up visits after COVID-19 has resolved: Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, and 19.
  • Encounter for antibody testing: 84, Encounter for antibody response examination.

No new ICD codes were created for reporting COVID-19.