Coding Guidelines for Coronavirus

Betsy Nicoletti, MS

Disclosures

March 04, 2020

Editor's Note: Since the publication of this article, the CDC has reversed its previous guidance and provided a dedicated ICD-10 code for COVID-19. Click here for details.

Given the continuing spread of the novel coronavirus disease called COVID-19, there have been a lot of questions about how to address this from a coding perspective should you have a patient who presents with the virus.

On February 20, the Centers for Disease Control and Prevention (CDC) issued guidance on diagnosis coding for reporting COVID-19. This disease and related conditions may be coded with existing ICD-10-DM codes, following the general guidelines that are currently in place.

The code for the coronavirus is B97.29 (other coronavirus as the cause of diseases classified elsewhere). Experienced coders know that the definition's inclusion of the words "diseases classified elsewhere" means the other disease is used in the first position on the claim form. The CDC specifically says not to use B34.2 (coronavirus infection unspecified) because the known cases have all been respiratory in nature and B34.2 is unspecified.

The CDC guidance provides specific examples for patients with conditions caused by the coronavirus. Notice that all of these examples are for conditions confirmed as due to COVID-19.

  • Pneumonia, confirmed as due to COVID-19
    J12.89: other viral pneumonia
    B97.29: other coronavirus as the cause of diseases classified elsewhere

  • Acute bronchitis, confirmed as due to COVID-19
    J20.8: acute bronchitis due to other specified organisms
    B97.29: other coronavirus as the cause of diseases classified elsewhere

  • Bronchitis, not specified as chronic or acute, confirmed as due to COVID-19
    J40: bronchitis, not specified as acute or chronic
    B97.29: other coronavirus as the cause of diseases classified elsewhere

  • Lower respiratory infection, confirmed as due to COVID-19
    J22: unspecified acute lower respiratory infection
    B97.29: other coronavirus as the cause of diseases classified elsewhere
    or
    J98.8: other specified respiratory infection
    B97.29: other coronavirus as the cause of diseases classified elsewhere

  • Cases with acute respiratory distress syndrome (ARDS), confirmed as due to COVID-19
    J80: acute respiratory distress syndrome
    B97.29: other coronavirus as the cause of diseases classified elsewhere

The availability of testing for COVID-19 is currently limited. If the physician has not confirmed the condition as being due to this new coronavirus, do not use B97.29. Use the condition (pneumonia, bronchitis, or symptom or symptoms such as cough, fever, shortness of breath) in the first position.

If the patient has been exposed to someone who is confirmed to have had COVID-19, use Z20.828: contact with and (suspected) exposure to other viral communicable diseases.

If the COVID-19 virus is suspected but testing does not confirm that the patient has the disease, use the confirmed diagnosis such as bronchitis or assignment symptom such as cough, and add Z03.818: encounter for observation for suspected exposure to other biological agents ruled out.

Coding for the new coronavirus doesn't involve new codes or require learning new coding conventions. Follow these current guidelines: Code for confirmed conditions, use the presenting coding in the first position on the claim form (pneumonia, bronchitis, etc.), and use the code for coronavirus in the second position.

Here's the full citation from the ICD-10-CM general guidelines (page 11):

Etiology/manifestation convention ("code first," "use additional code," and "in diseases classified elsewhere" notes) Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD10-CM has a coding convention that requires the underlying condition be sequenced first, if applicable, followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.

In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere." Codes with this title are a component of the etiology/ manifestation convention. The code title indicates that it is a manifestation code. "In diseases classified elsewhere" codes are never permitted to be used as first-listed or principal diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition. See category F02, Dementia in other diseases classified elsewhere, for an example of this convention.

Betsy Nicoletti, MS, is a consultant, author, and speaker as well as the founder of Codapedia.com, a wiki for physician reimbursement.

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