In response to the global pandemic declared by the World Health Organization (WHO) on March 11, 2020, for COVID-19, and the national emergency declared in the United States on March 13, 2020, the Centers for Disease Control and Prevention (CDC) made an unprecedented update to the ICD-10 coding system. This urgent action led to the early release of the diagnosis code U07.1, specifically for COVID-19. Originally slated for implementation on October 1, 2020, the effective date was accelerated to April 1, 2020, highlighting the critical need for accurate and timely reporting of COVID-19 cases for claims processing and public health surveillance.
For a comprehensive understanding of the CDC’s announcement regarding the ICD-10 code, you can refer to the official CDC document. Further insights into the rationale behind this expedited implementation can be found in our previous article, “Update: New ICD-10 Code For COVID-19 Effective April 1.”
April 1, 2020, ICD-10-CM Addenda Changes: A Closer Look
The CDC/NCHS has published the complete Index Addenda on their website, detailing the changes to both the Tabular List and the Index. These updates provide essential guidance for accurately using the new diagnosis code U07.1.
Notably, the Tabular notes associated with ICD-10 code U07.1 emphasize the necessity of using additional codes to specify manifestations such as pneumonia. These instructions are crucial for proper coding sequence and capturing the full clinical picture of COVID-19 cases.
Official ICD-10-CM Coding and Reporting Guidelines for COVID-19
Prior to the introduction of diagnosis code U07.1, the CDC/NCHS issued a preliminary ICD-10-CM Official Coding Guideline Supplement for the 2019 Novel Coronavirus (COVID-19), effective from February 20, 2020. With the official implementation of U07.1 on April 1, 2020, the agencies released updated Official Coding and Reporting Guidelines to accompany the new code. These guidelines, integrated into Chapter 1 (Infectious Diseases) and Chapter 15 (Pregnancy, Childbirth and the Puerperium), are vital for accurate coding and reporting. The complete Official Coding and Reporting Guidelines were in effect from April 1, 2020, through September 30, 2020.
Chapter 1: Guiding Principles for Coding Coronavirus Infections (A00-B99)
1. COVID-19 Infections (Infections due to SARS-CoV-2)
a) Coding Confirmed COVID-19 Cases with U07.1
The fundamental guideline for using diagnosis code U07.1 is to assign it only for confirmed cases of COVID-19. Confirmation can be documented by the provider, through a positive COVID-19 test result, or a presumptive positive test result. This is a specific exception to the standard hospital inpatient guideline Section II, H, which typically requires definitive diagnoses. For coding purposes related to diagnosis code U07.1, the provider’s statement that the patient has COVID-19 is sufficient, regardless of the test type. Importantly, presumptive positive COVID-19 test results should also be coded as confirmed cases using U07.1.
A presumptive positive test result indicates a positive local or state-level test, even if not yet confirmed by the CDC. The updated guidelines eliminated the previous requirement for CDC confirmation for local and state tests to be considered confirmed for coding with diagnosis code U07.1. Conversely, if the provider uses terms like “suspected,” “possible,” “probable,” or “inconclusive” for COVID-19, diagnosis code U07.1 should not be assigned. In these uncertain cases, coders should use codes that explain the reason for the encounter, such as codes for specific symptoms (like fever) or Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases.”
b) Sequencing U07.1 and Related Codes
When COVID-19 is the principal diagnosis, ICD-10 code U07.1, COVID-19, should be sequenced first. This should be followed by codes that describe associated manifestations, except in obstetrical cases, as detailed in Section I.C.15.s. concerning COVID-19 in pregnancy, childbirth, and the puerperium.
For cases where a COVID-19 infection progresses to sepsis, refer to Section I.C.1.d. Sepsis, Severe Sepsis, and Septic Shock.
For guidelines specific to COVID-19 in pregnancy, childbirth, and the puerperium, see Section I.C.15.s.
c) Coding Acute Respiratory Illnesses Due to COVID-19 with U07.1
(i) Pneumonia Due to COVID-19
When pneumonia is confirmed as being caused by COVID-19, assign both diagnosis code U07.1, COVID-19, and J12.89, Other viral pneumonia.
(ii) Acute Bronchitis Due to COVID-19
For patients diagnosed with acute bronchitis confirmed as due to COVID-19, use both diagnosis code U07.1 and J20.8, Acute bronchitis due to other specified organisms.
Bronchitis not otherwise specified (NOS) in the context of COVID-19 should be coded using ICD-10 code U07.1 along with J40, Bronchitis, not specified as acute or chronic.
(iii) Lower Respiratory Infection Due to COVID-19
If documentation indicates COVID-19 associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, assign diagnosis code U07.1 and J22, Unspecified acute lower respiratory infection.
When COVID-19 is documented as being associated with a respiratory infection NOS, use ICD-10 codes U07.1 and J98.8, Other specified respiratory disorders.
(iv) Acute Respiratory Distress Syndrome (ARDS) Due to COVID-19
For cases of acute respiratory distress syndrome (ARDS) directly caused by COVID-19, assign both diagnosis code U07.1 and J80, Acute respiratory distress syndrome.
d) Coding Exposure to COVID-19
For situations involving potential COVID-19 exposure that is subsequently ruled out after evaluation, assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.
In cases of actual exposure to someone confirmed or suspected (but not ruled out) to have COVID-19, and the exposed individual tests negative or test results are unknown, use code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. If the exposed individual tests positive for COVID-19, refer back to guideline a) for confirmed case coding with diagnosis code U07.1.
Guidance on COVID-19 Diagnosis Codes and Reporting
e) Coding Screening for COVID-19
For asymptomatic individuals undergoing COVID-19 screening with no known exposure to the virus, and whose test results are either unknown or negative, assign code Z11.59, Encounter for screening for other viral diseases. For individuals screened due to possible or actual COVID-19 exposure, refer to guideline d) for exposure coding.
If an asymptomatic individual is screened for COVID-19 and tests positive, see guideline g) for coding asymptomatic positive cases with diagnosis code U07.1.
f) Coding Signs and Symptoms Without Definitive COVID-19 Diagnosis
For patients presenting with signs or symptoms associated with COVID-19 (such as fever, cough, shortness of breath), but without a confirmed diagnosis, assign appropriate codes for each presenting symptom. Examples include:
- R05 Cough
- R06.02 Shortness of breath
- R50.9 Fever, unspecified
If a patient with COVID-19-related signs and symptoms also has actual or suspected exposure to someone with COVID-19, additionally assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. This is an exception to guideline I.C.21.c.1, Contact/Exposure.
g) Coding Asymptomatic Individuals Testing Positive for COVID-19
For asymptomatic individuals who test positive for COVID-19, assign ICD-10 code U07.1, COVID-19. Even though the individual shows no symptoms, a positive test result indicates infection and necessitates the use of diagnosis code U07.1.
Chapter 15: COVID-19 in Pregnancy, Childbirth, and the Puerperium (O00-O9A)
s) Coding COVID-19 Infection During Pregnancy, Childbirth, and the Puerperium
For patients admitted or presenting for healthcare encounters during pregnancy, childbirth, or the puerperium specifically due to COVID-19, the principal diagnosis code should be O98.5-, Other viral diseases complicating pregnancy, childbirth, and the puerperium. This should be followed by ICD-10 code U07.1, COVID-19, and codes for any associated manifestations. It’s crucial to note that Chapter 15 codes always take sequencing priority in these cases.
Further Resources on ICD-10 Code U07.1 and COVID-19 Coding
For more detailed information on these ICD-10-CM Official Coding and Reporting Guidelines and diagnosis code U07.1, explore the COVID-19 Training Center on YES HIM Education. This resource includes webinars and scenarios illustrating the practical application of these COVID-19 Coding Guidelines.
Stay updated with the latest CDC code announcements and coding guidelines by regularly visiting the CDC/NCHS website. You may also find our articles “New COVID-19 MS-DRG Assignment, Effective April 1” and “Selecting the Right COVID-19 Code: Should You Use CPT or HCPCS” valuable for additional context.
To further enhance your expertise in applying the 2022 ICD-10 COVID-19 codes, consider enrolling in our COVID-19 ICD-10 Coding Learning Path. This comprehensive course covers coding for Coronavirus infections, symptoms, screening, post-COVID-19 conditions, treatments, and vaccines, providing an update to the FY2022 Official Coding Guidelines for COVID-19.
