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.