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Analysis

2021 ICD-10-CM Guidelines Clarify Reporting of COVID-19 Manifestations

By Revenue Cycle Advisor  
   July 20, 2020

Coders should note that the temporary guidelines will expire September 30.

A version of this article was first published July 20, 2020, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.

CMS released the 2021 ICD-10-CM Official Guidelines for Coding and Reporting on July 8, several weeks earlier than usual. The coding guidelines, which take effect October 1, include new instructions for reporting manifestations of the novel coronavirus (COVID-19), among other changes.

The guidelines include a new section for COVID-19 that expands on the temporary coding guidelines posted in April by the ICD-10-CM Coordination and Maintenance Committee. Coders should note that the temporary guidelines will expire September 30.

New instructions for reporting ICD-10-CM code U07.1 (2019-nCoV acute respiratory disease) include the following:

  • Acute respiratory manifestations of COVID-19.
    • Code U07.1 should be assigned as the principal diagnosis if the reason for the encounter or visit is a respiratory manifestation of COVID-19. Codes for the respiratory manifestations should be assigned as additional diagnoses.
    • Code J96.0 (acute respiratory failure) was added as another respiratory manifestation that may be coded secondary to U07.1.
  • Non-respiratory manifestation of COVID-19.
    • If the reason for the encounter or admission is a non-respiratory manifestation of COVID-19, code U07.1 should be assigned as the principal diagnosis and codes for the manifestations should be assigned as additional diagnoses.
  • COVID-19 in pregnancy.
    • According to new guidance in Chapter 15: Pregnancy, Childbirth, and the Puerperium, if a patient tests positive for COVID-19 during an encounter that is unrelated to the disease, the reason for the encounter should be coded first, 098.5 (other viral diseases complicating pregnancy, childbirth, and the puerperium). The coder would then report U07.1 and any appropriate COVID-19 manifestation codes.
  • COVID-19 in newborns.
    • If a newborn tests positive for COVID-19 and a specific method of transmission is not documented, U07.1 should be assigned and any appropriate codes for associated manifestations, according to a new section in Certain Conditions Originating in Perinatal Period. If a newborn tests positive for COVID-19 and the provider documents that the newborn contracted the disease in utero or during birth, P35.8 (other congenital viral diseases) should be coded followed by U07.1. The guidance clarifies that Z38 (liveborn infants according to place of birth and type of delivery) is the principal diagnosis when coding the birth episode in a newborn record.

A section on coding “presumptive positive” COVID-19 cases was not included in the 2021 guidelines because it refers to cases awaiting a second, confirmatory CDC laboratory test—a practice that is no longer required.

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