NEW COVID ICD-10 Coding Updates Effective Jan 1, 2021

QRM’s Clinical Reimbursement Specialist, Megan Ussery, RN, RAC-CT has provided Clarification surrounding CMS’ new additions to COVID ICD-10 Coding that will become effective with dates of stay beginning January 1, 2021.

CDC Announcement

“There is an ongoing and urgent need to capture more information about this condition in our surveillance data and the nation's health care claims. The Centers for Disease Control (CDC), under the National Emergencies Act Section 201 and 301, is announcing further additions to ICD-10-CM Classification related to COVID-19, that will become effective January 1, 2021.”

  • Z11.52 - Encounter for screening for COVID-19

  • Z20.822 – Contact with and (suspected) exposure to COVID-19

  • Z86.16 – Personal history of COVID-19

  • M35.81 – Multisystem inflammatory syndrome (MIS)

  • M35.89 – Other specified systemic involvement of connective tissue

  • J12.82 – Pneumonia due to coronavirus disease 2019

Clarification Scenarios:

Pneumonia confirmed due to COVID-19 for stays prior to January 1, 2021

  • U07.1 COVID-19

  • J12.89 Other viral pneumonia

Pneumonia confirmed due to COVID-19 for stays beginning January 1, 2021 or after

  • U07.1 COVID-19

  • J12.82 Pneumonia due to coronavirus disease 2019

U07.1 is only used to code a “confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider or documentation of a positive COVID-19 test result.”, per the ICD-10-CM official guidelines. Do not use U07.1 if the case is “suspected”, “possible”, “probable”, or “inconclusive”.

Active COVID-19 infection?

  • Code U07.1 and the conditions caused (not symptoms)

COVID-19 infection is no longer active, but patient still has residuals?

  • Code the residual condition and B94.8 (sequelae of other specified infectious and parasitic diseases)

COVID-19 infection is no longer active, and patient has no residual conditions?

  • Code Z86.19-personal history of other infectious and parasitic diseases (prior to January 1, 2021) or Z86.16- personal history of COVID-19 (after January 1, 2021).

Let's Get to the Point:

Ensuring Accuracy in coding is critical for true representation of patient’s conditions as well as reimbursement. Please let us know if we can be of additional help.