When to use Z00.6?

 When to use code Z00.6 in coding

MEDICARE ACCOUNTS ONLY: Diagnosis code Z00.6 must be in the 2^nd diagnosis code position

 

• ·         Carotid Artery Stenting/Angioplasty (Gore Grafts Only)

• ·         ICD’s-Implantable Cardioverter Defibrillators

• ·         Impella Heart Assistance Device

• ·         Leaders Free II-Bio Freedom Pivotal Study (Bare Metal Stents)

• ·         Pacemaker, Micra Leadless

• ·         TAVR-Transcatheter Aortic Valve Replacement

• ·         TMVR-Transcatheter Mitral Valve Replacement

• ·         Watchman’s Procedure (LAA) Left Atrial Appendage

• ·         Mitral Clips (Mitral Valve Repairs)

• ·         EP Studies

Query-Unable to determine

 Query response unable to determine

• ·         When querying for greater specificity of a documented diagnosis, a provider’s response of “unable to determine” would not preclude the coding of the documented diagnosis. The “unable to determine” response would just not allow assignment of a more specific code.

Example: a provider query requests clarification of the type and/or severity of documented congestive heart failure (CHF). If the provider responds “unable to determine”, the CHF diagnosis code would be reported, but the additional specificity would not be able to be represented in the reported code.

• ·         When querying for clinical indicators without a definitive relationship to an underlying diagnosis, a provider’s response of “unable to determine” would preclude the coding of any of the proposed definitive diagnosis(s) options included on the query template. The coder would only assign codes for the signs or symptoms (following ICD-10-CM Official Coding Guidelines) which prompted the query.

• ·         When querying for clarification of whether a diagnosis or condition has been ruled in or ruled out, a provider’s response of “unable to determine” would indicate uncertainty. Coding would follow the ICD-10-CM Official Coding Guidelines for coding “Uncertain Diagnosis.”

ICD-10-CM Official Coding Guidelines - H. Uncertain Diagnosis; If the diagnosis documented at the time of discharge is qualified as “probable”, “suspected”, “likely”, “questionable”, “possible”, or “still to be ruled out”, or other similar terms indicating uncertainty, code the condition as if it existed or was established. The bases for these guidelines are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis.

ICD-10-CM Covid 19 FAQs - PART 2

 ICD-10-CM Questions

11. Question: Should presumptive positive COVID-19 test results be coded as confirmed? (3/24/2020)

Answer: Yes, Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or state level, but it has not yet been confirmed by the Centers for Disease Control and Prevention (CDC). CDC confirmation of local and state tests for the COVID-19 virus is no longer required.

 

12. Question: How should we handle cases related to COVID-19 when the test results aren’t back yet? The supplementary guidance and FAQs are confusing since some times COVID-19 is not “ruled out” during the encounter, since the test results aren’t back yet. (3/24/2020)

Answer: Due to the heightened need to capture accurate data on positive COVID-19 cases, we recommend that providers consider developing facility-specific coding guidelines to hold back coding of inpatient admissions and outpatient encounters until the test results for COVID-19 testing are available. This advice is limited to cases related to COVID-19.

 

13. Question: Based on the recently released guidelines for COVID-19 infections, does a provider need to explicitly link the results of the COVID-19 test to the respiratory condition as the cause of the respiratory illness to code it as a confirmed diagnosis of COVID-19? Patients are being seeing in our emergency department and if results are not available at the time of discharge, we are reluctant to query the physicians to go 5 back and document the linkage when the results come back several days later. (4/1/2020)

Answer: No, the provider does not need to explicitly link the test result to the respiratory condition, the positive test results can be coded as confirmed COVID-19 cases as long as the test result itself is part of the medical record. As stated in the coding guidelines for COVID-19 infections that went into effect on April 1, code U07.1 may be assigned based on results of a positive test as well as when COVID[1]19 is documented by the provider. Please note that this advice is limited to cases related to COVID-19 and not the coding of other laboratory tests. Due to the heightened need to uniquely identify COVID-19 patients, we recommend that providers consider developing facility-specific coding guidelines to hold back coding of inpatient admissions and outpatient encounters until the test results for COVID-19 testing are available.

 

14. Question: We are unsure about how to interpret the newly released COVID-19 guidelines in relation to the uncertain diagnosis guideline which refers to diagnoses “documented at the time of discharge” stated as possible, probable, etc. Can we code these cases as confirmed COVID-19 if the test results don’t come back until a few days later and the patient has already been discharged? (4/1/2020)

Answer: Yes, if a test is performed during the visit or hospitalization, but results come back after discharge positive for COVID-19, then it should be coded as confirmed COVID-19.

 

15. Question: Since the new guidelines for COVID regarding sepsis just say to refer to the sepsis guideline, is that then saying that sepsis would be sequenced first and then U07.1 for a patient presenting with sepsis due to COVID-19? (4/1/2020; revised 12/11/2020)

Answer: Whether or not sepsis or U07.1 is assigned as the principal diagnosis depends on the circumstances of admission and whether sepsis meets the definition of principal diagnosis. For example, if a patient is admitted with pneumonia due to COVID-19 which then progresses to viral sepsis (not present on admission), the principal diagnosis is U07.1, COVID-19, followed by the codes for the viral sepsis and viral pneumonia. On the other hand, if a patient is admitted with sepsis due to COVID-19 pneumonia and the sepsis meets the definition of principal diagnosis, then the code for viral sepsis (A41.89) should be assigned as principal diagnosis followed by codes U07.1 and the appropriate viral pneumonia code (code J12.89, 6 Other viral pneumonia, for discharges/encounters prior to January 1, 2021 or code J12.82, Pneumonia due to coronavirus disease 2019, for discharges/encounters after January 1, 2021) as secondary diagnoses.

 

16. Question: Please provide guidance on correct coding when the provider has documented COVID-19 as a definitive diagnosis before the test results are available, and the test results come back negative. (4/16/2020)

Answer: Coding professionals should query the provider if the provider documented COVID-19 before the test results were back and the test results come back negative. Providers should be given the opportunity to reconsider the diagnosis based on the new information.

 

17. Question: Please provide guidance on correct coding when the provider has confirmed the documented COVID-19 after the test results come back negative. How should this be coded? (4/16/2020)

Answer: If the provider still documents and confirms COVID-19 even though the test results are negative, or if the provider documented disagreement with the test results, assign code U07.1, COVID-19. As stated in the ICD-10-CM Official Guidelines for Coding and Reporting for COVID-19, “Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider . . . the provider’s documentation that the individual has COVID-19 is sufficient.”

 

18. Question: When a patient who previously had COVID-19 is seen for a follow-up exam and the COVID-19 test is negative, what is the best code(s) to capture this scenario? (4/16/2020; revised 12/11/2020)

Answer: Assign codes Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, and the appropriate personal history code (code Z86.19, Personal history of other infectious and parasitic diseases, for encounters prior to January 1, 2021, or code Z86.16, Personal history of COVID-19, for encounters after January 1, 2021).

 

19. Question: How should an encounter for COVID-19 antibody testing be coded? (4/28/2020)

Answer: For an encounter for antibody testing that is not being performed to confirm a current COVID-19 infection, nor is being performed as a follow-up test after resolution of COVID-19, assign Z01.84, Encounter for antibody response examination.

ICD-10-CM Covid 19 FAQs - PART 1

ICD-10-CM Questions

1. Question: What is the ICD-10-CM code for COVID-19? (revised 4/1/2020, 12/11/2020)

Answer: ICD-10-CM code U07.1, COVID-19, may be used for discharges/dates of

service on or after April 1, 2020. For more information on this code, click here. The

code was developed by the World Health Organization (WHO) and is intended to be

sequenced first followed by the appropriate codes for associated manifestations

when COVID-19 meets the definition of principal or first-listed diagnosis. See the

ICD-10-CM Official Guidelines for Coding and Reporting available on the Centers for

Disease Control and Prevention’s National Center for Health Statistics web site for

specific guidelines on usage of this code. For guidance prior to April 1, 2020, please

refer to the supplement to the ICD-10-CM Official Guidelines for coding encounters

related to the COVID-19 coronavirus outbreak.

 

2. Question: Is the new ICD-10-CM code U07.1, COVID-19, a secondary code?

(4/1/2020; revised 12/11/2020)

Answer: When COVID-19 meets the definition of principal or first-listed diagnosis,

code U07.1, COVID-19, should be sequenced first, and followed by the appropriate

codes for associated manifestations, except when another guideline requires that

certain codes be sequenced first, such as obstetrics, sepsis, or transplant

complications. However, if COVID-19 does not meet the definition of principal or

first-listed diagnosis (e.g. when it develops after admission), then code U07.1 should

be used as a secondary diagnosis.

 

3. Question: Are there additional new codes to identify other situations specific to COVID19? For example, codes for exposure to COVID-19, or observation for suspected

COVID-19 but where the tests are negative? (3/20/2020; revised 12/11/2020)

Answer: The Centers for Disease Control and Prevention’s National Center for

Health Statistics, the US agency responsible for maintaining ICD-10-CM in the US,

is implementing several new ICD-10-CM codes pertaining to COVID-19 on January

1, 2021. See ICD-10-CM FAQ #44 for further details.

 

4. Question: We have been told that the World Health Organization (WHO) has approved

an emergency ICD-10 code of “U07.2 COVID-19, virus not identified.” Is code U07.2 to

be implemented in the US too? (3/26/2020)

Answer: The HIPAA code set standard for diagnosis coding in the US is ICD-10-

CM, not ICD-10. As shown in the April 1, 2020 Addenda on the CDC website, the

only new code being implemented in the US for COVID-19 is U07.1.

 

5. Question: How should we code cases related to COVID-19 prior to April 1, 2020, the

effective date of ICD-10-CM code U07.1, COVID-19? (4/1/2020)

Answer: Please refer to the supplement to the ICD-10-CM Official Guidelines for

coding encounters related to the COVID-19 coronavirus outbreak. After April 1,

2020, refer to the ICD-10-CM Official Guidelines for Coding and Reporting available

on the Centers for Disease Control and Prevention’s National Center for Health

Statistics web site.

 

6. Question: Is the ICD-10-CM code U07.1, COVID-19 retroactive to cases diagnosed

before the April 1, 2020 date? (3/20/2020)

Answer: No, the code is not retroactive. Please refer to the supplement to the ICD10-CM Official Guidelines for coding encounters related to the COVID-19

coronavirus outbreak for guidance for coding of discharges/services provided before

April 1, 2020.

 

7. Question: Is code B97.29, Other coronavirus as the cause of diseases classified

elsewhere, limited to the COVID-19 virus? (3/20/2020)

Answer: No, code B97.29 is not exclusive to the SARS-CoV-2/2019-nCoV virus

responsible for the COVID-19 pandemic. The code does not distinguish the more

than 30 varieties of coronaviruses, some of which are responsible for the common

cold. Due to the heightened need to uniquely identify COVID-19 until the

unique ICD-10-CM code is effective April 1, providers are urged to consider

developing facility-specific coding guidelines that limit the assignment of code

B97.29 to confirmed COVID-19 cases and preclude the assignment of codes

for any other coronaviruses.

 

8. Question: What is the difference between ICD-10-CM codes B34.2 vs. B97.29?

(3/20/2020)

Answer: Diagnosis code B34.2, Coronavirus infection, unspecified, would generally

not be appropriate for the COVID-19, because the cases have universally been

respiratory in nature, so the site of infection would not be “unspecified.” Code

B97.29, Other coronavirus as the cause of diseases classified elsewhere, has been

designated as interim code to report confirmed cases of COVID-19. Please refer to

the supplement to the ICD-10-CM Official Guidelines for coding encounters related

to the COVID-19 coronavirus outbreak for additional information. Because code

B97.29 is not exclusive to the SARS-CoV-2/2019-nCoV virus responsible for

the COVID-19 pandemic, we are urging providers to consider developing

facility-specific coding guidelines that limit the assignment of code B97.29 to

confirmed COVID-19 cases and preclude the assignment of codes for any

other coronaviruses.

 

9. Question: Does the supplement to the ICD-10-CM Official Guidelines for coding

encounters related to the COVID-19 coronavirus outbreak apply to all patient encounter

types, i.e., inpatient and outpatient, specifically in relation to the coding of “suspected”,

“possible” or “probable” COVID-19? (3/20/2020)

Answer: Yes, the supplement applies to all patient types. As stated in the

supplement guidelines, “If the provider documents “suspected”, “possible” or

“probable” COVID-19, do not assign code B97.29. Assign a code(s) explaining the

reason for encounter (such as fever, or Z20.828, Contact with and (suspected)

exposure to other viral and communicable diseases).”

 

 

10. Question: The supplement to the ICD-10-CM Official Guidelines for coding encounters

related to the COVID-19 coronavirus outbreak refers to coding confirmed cases in a

couple of instances, but it does not specify what “confirmation” means similar to

language in guidelines found for reporting of HIV, Zika and H1N1. Can you clarify

whether the record needs to have a copy of the lab results or what lab tests are

approved for confirmation? (3/20/2020)

Answer: The intent of the guideline is to code only confirmed cases of COVID-19. It

is not required that a copy of the confirmatory test be available in the record or

documentation of the test result. The provider’s diagnostic statement that the patient

has the condition would suffice.