It remains challenging to code COVID-19 for patients, as there are so many variations seen, especially as time goes on. However, as of January 1, 2021, we have new diagnosis codes that are to be used for COVID-19 patients. They don’t include all of the patient scenarios for the conditions seen after COVID but it is a start. We will also present the new codes that will potentially be added for these long-term conditions.
The new COVID-19 diagnosis code from April 2020, remains U07.1. Under PDGM, the Clinical Group assigned is MMTA- Medication Management, Teaching & Assessment – Respiratory; it is also assigned to the Respiratory-10 comorbidity group.
The new 2021 COVID-19 ICD-10 Codes are:
- Pneumonia due to coronavirus disease 2019 (J12.82)
- Multisystem inflammatory syndrome (MIS) (M35.81)
- Other specified systemic involvement of connective tissue (M35.89)
- Encounter for screening for COVID-19 (Z11.52)
- Contact with and (suspected) exposure to COVID-19 (Z20.822)
- Personal history of COVID-19 (Z86.16)
The new specific respiratory diagnosis:
- J12.82 -Pneumonia due to coronavirus disease 2019 / COVID-19 / SARS-CoV-2 follows U07.1 as primary, as coding guidelines state to code COVID first. J12.82 cannot be a primary diagnosis as it states it is ‘due to’ coronavirus.
- Prior to Jan 1,2021, without this specific code, J12.89 was coded, other viral pneumonia due to COVID-19. Therefore, do not use J12.89 to code PNA due to COVID-19 from Jan 1 forward.
The New Musculoskeletal codes are:
M35.81 Multisystem inflammatory syndrome
- Other terms are MIS-A, MIS-C, Multisystem inflammatory syndrome in adults, Multisystem inflammatory syndrome in children, Pediatric inflammatory multisystem syndrome, and PIMS
Coding guidelines for M35.81 MIS are to Code first, if applicable, COVID-19 (U07.1). In addition, any associated complications are coded, such as: acute hepatic failure (K72.0-), acute kidney failure (N17.-), acute myocarditis (I40.-), acute respiratory distress syndrome (J80), cardiac arrhythmia (I47-I49.-)
- If COVID-19 is not coded as the primary diagnosis, then the applicable codes of exposure to COVID-19 or SARS-CoV-2 infection (Z20.822), personal history of COVID-19 (Z86.16), or sequelae of COVID-19 (B94.8) would be coded.
The second new Musculoskeletal Code is M35.89 – Other specified systemic involvement of connective tissue. Currently, there are no specific guidelines for this diagnosis code. Therefore, the physician documentation will have to state M35.89- Other specified systemic involvement of connective tissue- as the diagnoses and any additional codes will follow the coding guidelines.
New Z Codes
The first new Z Code, Z11.52 – Encounter for screening for COVID-19, as the coding guidelines state not to use in a pandemic. Home health will need additional guidance after the pandemic to know when this would be used. Z11.52 for encounter for screening for COVID-19 is in the PDGM clinical grouping, but there will need to be clarifications to say if this should be used as a primary diagnosis.
The second new Z code is Z20.822 – Contact with and (suspected) exposure to COVID-19 (SARS-CoV-2) Coding guidelines state that 3 categories would be coded Z20.822:
asymptomatic individuals with actual or suspected exposure to COVID-19, or symptomatic individuals where the infection has been ruled out, or test results are inconclusive or unknown.
Note: If an individual with a known or suspected exposure to COVID-19, without current COVID-19 infection or history of COVID-19, develops MIS, assign codes M35.81, Multisystem inflammatory syndrome, and Z20.822, Contact with and (suspected) exposure to COVID-19.
The third new Z code is Z86.16 – Personal history of COVID-19
- There is an Excludes 1 note stating sequelae of infectious and parasitic diseases (B90-B94). Therefore, when there is sequelae of COVID-19, the personal history code would not be coded.
- Note: There are no timeframes stated in the coding guidelines for when to assign Z86.16, personal history of COVID rather than active COVID. In addition, there is no timeframe for when to code Sequelae rather than active COVID. Therefore, it is critical to follow the physician’s documentation and to query the physician if there is no documentation stating this information.
PDGM – Four of the new COVID-19 codes can assigned as a primary diagnosis under home health PDGM:
M35.81- Multisystem inflammatory syndrome – Clinical Group – Musculoskeletal Rehabilitation
M35.89 – Other specified systemic involvement of connective tissue – Clinical Group – Musculoskeletal Rehabilitation
Z11.52 – Encounter for screening for COVID-19 – Clinical Group – MMTA Other (not during the pandemic – see notes above)
Z20.822 – Contact with and (suspected) exposure to COVID-19 – Clinical Group – MMTA Infectious Disease, Neoplasms, and Blood-Forming Diseases
Two of the new codes were not assigned to a clinical group, so they cannot be assigned as a primary diagnosis:
J12.82 Pneumonia due to coronavirus disease 2019
Z86.16 Personal history of COVID-19
J12.82 Pneumonia due to coronavirus disease 2019 is the only new diagnosis that was assigned to a comorbidity group – Respiratory 2. However, to date, the grouper is not assigning this code as a comorbidity adjustment.
October 2021 Code for Post COVID–19 Condition
As you can see, we still require other codes to account for the ‘long hauler’ symptoms from COVID-19, as these may be going on for years. Many of the symptoms and conditions from COVID-19 are not acceptable diagnoses for PDGM primary diagnoses, so this can leave agencies and coders in a bind. But help is on its way, although not until October 1, 2021 when annual coding changes are effective.
These codes were very recently added by The World Health Organization (WHO): U09 (Post COVID-19 condition) and U09.9 (Post COVID-19 condition, unspecified). If approved, the new code is expected to be implemented for use in the U.S.A. on October 1, 2021.
The ICD-10-CM panel is seeking comments on the proposed post COVID-19 code until April 9 at nchsicd10CM@cdc.gov.
So hopefully in October, home health and hospice will have these much-needed codes for post COVID-19 condition!
- COVID-19 Codes which began January 1, 2021 give some more specifics to coders. There are remaining questions, of course, one that will be answered in October if the Post COVID-19 Condition codes are approved.
- There are no timeframes to use from active to history code, and to sequelae codes. The physician documentation is key to which codes you should assign when. In the absence of this documentation, it is vital to Query the physician.
- It is important to stay up to date, to be timely with new and revised COVID codes. Keep in mind that the follow the coding guidelines and the physician documentation/confirmation is the key!
HPS is here to assist, with Coding Education as well as Outsourced Coding Services for both Home Health and Hospice. Contact us today to find out how we can help you succeed.
This article also appeared in Home Health Line. The all-in-one business-building solution for home health agency executives.