by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Apr 29th, 2022
Since the official declaration of the COVID-19 public health emergency (PHE), we have seen a trend in code updates taking place throughout the year, rather than at the regularly scheduled intervals, when yet another round of code changes and additions are taking place. Before reviewing the newest ICD-10-CM code additions, let us take a quick look at how we are doing with documenting and reporting two of the more common ICD-10-CM codes for reporting COVID-19, which include:
COVID-19 Exposure
By now, most facilities and provider organizations have created internal policies defining when it is appropriate to report code Z20.822, as during certain time periods of increased exposure within our communities, it seemed that this code would literally apply to every human being who ever left the comfort of their home. Still, establishing internal policies for reporting this code is important for supporting its use during the onslaught of upcoming OIG audits related to COVID-19 reporting.
COVID-19
Code U07.1 is another common code being reported during the PHE. This code is reported when the documentation supports either a positive COVID-19 test result, or when after examination and evaluation, a qualified provider diagnoses the patient as having COVID-19, even in the face of a negative test result. We have all heard or maybe even experienced a false negative COVID-19 result only to find out later either by examination or another type of COVID-19 test, that the patient was actually positive all along. One of the reasons why having a solid code reporting policy is important is because different facilities (e.g., physicians, emergency departments) have different policies about testing patients for COVID-19. Some require testing of all patients with a fever or any COVID-19 symptoms, while others may see and examine the patient prior to ordering testing. While rapid antigen tests return a result almost instantly, the notorious “brain biopsy” or rather the PCR test, can take up to three days to return a result.
Internal Coding Policies
Does your organization have policies in place for testing and reporting these diagnoses? When testing is ordered and performed but takes a few days for the results to come back, do you hold claims until the test results are received so you can apply the correct diagnosis? Many organizations require claims to be held as different payer policies and public health emergency (PHE) guidelines may affect payment if the right code is not reported. For testing that returns a negative result, the provider obviously “suspected COVID-19” and Z20.822 should be reported. If, however, the result is positive, then U07.1 would be reported instead. If both codes are reported, Z20.822 to justify ordering the test and U07.1 for a positive result, report only U07.1, as it is the diagnosis that was confirmed after testing.
Documentation Must Support the Code Reported
While it is important to report the codes correctly, it is also important to have all of the supporting documentation in the record to support the code reported. This means the subjective portion of the encounter should include a history of possible exposure and the medical decision making portion of the examination should include any orders for testing, the results, or a provider statement that supports COVID-19 in the face of a negative test result. If an audit results in a request for medical records, all these pieces of information should be included to ensure the auditor can verify the diagnosis was supported by the record.
TIP: In the face of a negative COVID-19 test, providers still have the ability to diagnose a patient as COVID-19 positive based on their exposure timeline, active symptoms, and physical examination findings.
NEW COVID-Related ICD-10-CM Codes
- U09.9 Post COVID-19 condition, unspecified
Post-acute sequela of COVID-19 - Z80.0- Immunization not carried out because of
- Z28.1 Immunization not carried out because of patient decision for reasons of belief or group pressure
- Z28.2- Immunization not carried out because of
- Z28.31- Under-immunization status
- Z28.8- Immunization not carried out for other reason
While it is likely that all of these codes will be reported, it is expected that U09.9 will be one of the more frequently reported codes in the aftermath we refer to as "long-COVID". The guidelines that go with this code include reporting it as an underlying cause of the symptom(s) or condition(s) for which the patient is seeking treatment after having already had COVID-19. For example, a patient who presents with loss of taste following COVID-19, would report and sequence the codes as follows:
R43.8 Loss of taste
U09.9 Post COVID-19 condition
If a patient presented with the same conditions and a new (re-infection) diagnosis of COVID-19, sequencing would be:
U07.1 COVID-19
R43.8 Loss of taste
U09.9 Post COVID-19 condition
TIP: Do not report U07.1 with U09.9 except in cases of re-infection
When reporting the vaccinated or unvaccinated codes, it is important to keep in mind these two definitions:
- Unvaccinated: A patient who has not received at least one dose of any COVID-19 vaccine.
- Partially vaccinated: A patient who has had at least one dose of a multi-dose COVID-19 vaccine but not the remaining dose(s)
Documentation is the key to reporting the correct code and for those facilities and organizations that use computer-assisted coding programs, formatting and documenting within the appropriate formatted sections will help the program work best. As we prepare for the end of the PHE, and returning to the previous standard of changes, it is important to prepare for how to keep up with coding changes while verifying those changes that are slated to be permanent.
About Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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.
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