Understanding the diagnosis codes related to COVID-19 is crucial for accurate medical billing, data tracking, and patient care. Specifically, when dealing with patients who have a history of COVID-19, selecting the correct ICD-10-CM code is essential. This guide provides a detailed overview, drawing from official guidelines and expert recommendations to clarify the appropriate diagnosis codes for encounters related to a history of COVID-19.
Navigating ICD-10-CM for Past COVID-19 Infections
The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is the standard for diagnosis coding in the United States. Within this system, several codes are relevant when addressing patients who have recovered from COVID-19 and are being seen for follow-up or for conditions potentially related to their past infection.
Key Codes for History and Post-COVID Conditions
Two primary code categories come into play when discussing the longer-term implications of COVID-19: Personal History of COVID-19 and Post COVID-19 Condition.
1. Z86.16: Personal History of COVID-19
Code Z86.16, Personal history of COVID-19, is designated for patients who have a history of COVID-19 but no longer have an active infection and are not currently receiving treatment for it. This code is crucial for documenting a patient’s past medical history, which can be relevant for future healthcare decisions.
When to Use Z86.16:
- Follow-up after completed treatment: When a patient is seen for a follow-up examination after recovering from COVID-19.
- Past infection with no active treatment: For encounters where the patient’s history of COVID-19 is relevant, even if they are being seen for an unrelated condition.
- “Non-infectious” or “not infectious” status documented: When a provider explicitly documents that the patient is no longer infectious, even if they previously tested positive.
- Viral shedding in patients with a history of COVID-19: If viral shedding is documented in the context of a past infection, Z86.16 is appropriate.
Important Considerations for Z86.16:
- Not for active infection: Z86.16 is not to be used when the patient has a current, active COVID-19 infection. In cases of active infection, code U07.1 should be used.
- No current treatment for COVID-19: This code signifies that the patient is not presently undergoing treatment for COVID-19 itself.
- Potential for recurrence: Personal history codes, like Z86.16, are used for conditions that no longer exist but might have implications for future health and may require monitoring.
2. U09.9: Post COVID-19 condition, unspecified
Code U09.9, Post COVID-19 condition, unspecified, (also known as Long COVID or Post-Acute Sequelae of SARS-CoV-2 infection (PASC)) is used for conditions that are a sequela or residual effect of a previous COVID-19 infection. This code came into effect on October 1, 2021, replacing the use of code B94.8 (Sequelae of other specified infectious and parasitic diseases) for post-COVID conditions.
When to Use U09.9:
- Residual effects after acute COVID-19: When a patient presents with symptoms or conditions that are a direct result of a prior COVID-19 infection, even if the acute phase has passed.
- Ongoing treatment for post-COVID conditions: If a patient is receiving treatment for a condition identified as a sequela of COVID-19.
- “Post COVID-19 syndrome”: For diagnoses of post-COVID-19 syndrome where symptoms are documented as residual effects of the infection.
- Conditions that persist after COVID-19 resolution: Examples include respiratory failure, pneumonia, Guillain-Barre syndrome, and other systemic issues that are determined to be sequelae.
Important Considerations for U09.9:
- Sequelae, not just temporality: The symptoms or conditions must be documented as residual effects or sequelae of COVID-19, not just temporally related.
- Code first: The instructional note at U09.9 directs to “code first the specific condition related to COVID-19 if known.” For instance, for post-COVID-19 syndrome with weakness, code R53.1 (Weakness) first, followed by U09.9.
- Replaced B94.8 for COVID-19 sequelae: For encounters on or after October 1, 2021, U09.9 is the appropriate code for COVID-19 sequelae, replacing B94.8 which was used previously.
Differentiating Between History (Z86.16) and Post-COVID Condition (U09.9)
The key difference lies in the current clinical status and the nature of the encounter.
- Z86.16 (History): Used when the past COVID-19 infection is relevant to the patient’s medical history but is not the reason for the current encounter or treatment. The patient has recovered from COVID-19 and is not currently experiencing related symptoms or being treated for COVID-19 itself.
- U09.9 (Post-COVID Condition): Used when the patient is experiencing ongoing health issues or being treated for conditions that are a direct result of a previous COVID-19 infection. The focus is on the residual effects of the virus.
Example Scenarios:
- Scenario 1: A patient comes in for a routine annual check-up and has a history of COVID-19 six months ago, from which they fully recovered. Code: Z86.16.
- Scenario 2: A patient who had COVID-19 three months ago now presents with persistent shortness of breath and fatigue, diagnosed as post-COVID respiratory issues. Codes: J96.9 (Respiratory failure, unspecified) and U09.9.
- Scenario 3: A patient is admitted for pneumonia due to active COVID-19 infection. Code: U07.1 (COVID-19) and J12.82 (Pneumonia due to coronavirus disease 2019). Z86.16 or U09.9 are not appropriate here as the infection is active.
Addressing Common Questions from Official Guidelines
The original article provides valuable Q&A from the AHA Central Office on ICD-10-CM/PCS. Several of these questions directly relate to the appropriate use of history and sequelae codes:
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Question: When to use personal history code vs. sequelae code?
- Answer: Personal history (Z86.16) is for past conditions no longer requiring treatment but with potential recurrence. Sequelae (U09.9) is for residual effects of a past illness that are being treated.
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Question: Patient has “residual respiratory failure” after COVID-19 but is no longer infectious. History or sequelae code?
- Answer: Sequelae code (U09.9). Even though “history of COVID-19” is mentioned, the ongoing respiratory failure is a residual effect, making U09.9 and the specific respiratory failure code appropriate, not Z86.16.
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Question: Patient has organizing pneumonia due to previous COVID-19 infection.
- Answer: Code J84.89 (Other specified interstitial pulmonary diseases) for organizing pneumonia, and U09.9 for post-COVID condition.
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Question: Patient is documented as “noninfectious” or “not infectious” COVID-19 status.
- Answer: Assign code Z86.16 (Personal history of COVID-19), not U07.1 (COVID-19), as the patient no longer has an active infection.
Conclusion: Accurate Coding for COVID-19 History and Sequelae
Selecting the correct diagnosis code for patients with a history of COVID-19 is vital for accurate healthcare documentation and billing. Understanding the nuances between Z86.16 (Personal history of COVID-19) and U09.9 (Post COVID-19 condition, unspecified), and when to use each, ensures compliance with ICD-10-CM guidelines and provides a clear picture of the patient’s health status. By carefully considering the patient’s current condition, treatment status, and the documentation provided, healthcare professionals can confidently apply the most appropriate diagnosis codes.
References:
- Centers for Disease Control and Prevention. ICD-10-CM Official Guidelines for Coding and Reporting. https://www.cdc.gov/nchs/icd/icd10cm.htm
- American Hospital Association. ICD-10-CM and ICD-10-PCS Questions and Answers. (Source article)
