Frequently Asked Questions Regarding ICD-10-CM Coding for COVID-19

Revised May 10, 2023

ICD-10-CM and ICD-10-PCS Questions and Answers

Questions and Answers Provided by the AHA Central Office

The following questions and answers were jointly developed and approved by the American Hospital Association’s Central Office on ICD-10-CM/PCS and the American Health Information Management Association.

1. What is the ICD-10-CM code for COVID-19? (rev. 4/1/2020, 12/11/2020)

ICD-10-CM code U07.1, COVID-19, may be used for discharges/date 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. Specific guidelines for usage are available here. 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. Is the new ICD-10-CM code U07.1, COVID-19 a secondary code? (4/1/2020; revised 12/11/2020)

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. Are there additional new codes to identify other situations specific to COVID-19? 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)

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. 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)

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. 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)

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 Official Guidelines for Coding and Reporting found here.
6. Is the ICD-10-CM code U07.1, COVID-19 retroactive to cases diagnosed before the April 1, 2020 date? (3/20/2020)

No, the code is not retroactive. Please refer to the supplement to the ICD-10-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. Is code B97.29, Other coronavirus as the cause of diseases classified elsewhere, limited to the COVID-19 virus? (3/20/2020)

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. What is the difference between ICD-10-CM codes B34.2 vs. B97.29? (3/20/2020)

Diagnosis code B34.2, Coronavirus infection, unspecified, would in 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. 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)

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. 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)

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.
11. Should presumptive positive COVID-19 test results be coded as confirmed? (3/24/2020)

Yes, Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or state level, but it has not yet been confirmed by the Centers for Disease Control and Prevention (CDC). CDC confirmation of local and state tests for the COVID-19 virus is no longer required.
12. How should we handle cases related to COVID-19 when the test results aren’t back yet? The supplementary guidance and FAQs are confusing since some times COVID-19 is not “ruled out” during the encounter, since the test results aren’t back yet. (3/24/2020)

Due to the heightened need to capture accurate data on positive COVID-19 cases, we recommend that providers consider developing facility-specific coding guidelines to hold back coding of inpatient admissions and outpatient encounters until the test results for COVID-19 testing are available. This advice is limited to cases related to COVID-19.
13. Based on the recently released guidelines for COVID-19 infections, does a provider need to explicitly link the results of the COVID-19 test to the respiratory condition as the cause of the respiratory illness to code it as a confirmed diagnosis of COVID-19? Patients are being seeing in our emergency department and if results are not available at the time of discharge, we are reluctant to query the physicians to go back and document the linkage when the results come back several days later. (4/1/2020)

No, the provider does not need to explicitly link the test result to the respiratory condition, the positive test results can be coded as confirmed COVID-19 cases as long as the test result itself is part of the medical record. As stated in the coding guidelines for COVID-19 infections that went into effect on April 1, code U07.1 may be assigned based on results of a positive test as well as when COVID-19 is documented by the provider. Please note that this advice is limited to cases related to COVID-19 and not the coding of other laboratory tests. Due to the heightened need to uniquely identify COVID-19 patients, we recommend that providers consider developing facility-specific coding guidelines to hold back coding of inpatient admissions and outpatient encounters until the test results for COVID-19 testing are available.
14. We are unsure about how to interpret the newly released COVID-19 guidelines in relation to the uncertain diagnosis guideline which refers to diagnoses “documented at the time of discharge” stated as possible, probable, etc. Can we code these cases as confirmed COVID-19 if the test results don’t come back until a few days later and the patient has already been discharged? (4/1/2020)

Yes, if a test is performed during the visit or hospitalization, but results come back after discharge positive for COVID-19, then it should be coded as confirmed COVID-19.
15. Since the new guidelines for COVID regarding sepsis just say to refer to the sepsis guideline, is that then saying that sepsis would be sequenced first and then U07.1 for a patient presenting with sepsis due to COVID-19? (4/1/2020; revised 12/11/2020)

Whether or not sepsis or U07.1 is assigned as the principal diagnosis depends on the circumstances of admission and whether sepsis meets the definition of principal diagnosis. For example, if a patient is admitted with pneumonia due to COVID-19 which then progresses to viral sepsis (not present on admission), the principal diagnosis is U07.1, COVID-19, followed by the codes for the viral sepsis and viral pneumonia. On the other hand, if a patient is admitted with sepsis due to COVID-19 pneumonia and the sepsis meets the definition of principal diagnosis, then the code for viral sepsis (A41.89) should be assigned as principal diagnosis followed by codes U07.1 and the appropriate viral pneumonia code (J12.89, Other viral pneumonia, for discharges/encounters prior to January 1, 2021, or code J12.82, Pneumonia due to coronavirus disease 2019, for discharges/encounters after January 1, 2021) as secondary diagnoses.
16. (Question #16 was deleted on August 5, 2020. See Questions #38 and #39 for updated advice regarding the coding for encounters for testing for COVID-19 and COVID-19 has not been confirmed.)
17. Please provide guidance on correct coding when the provider has documented COVID-19 as a definitive diagnosis before the test results are available, and the test results come back negative. (4/16/2020)

Coding professionals should query the provider if the provider documented COVID-19 before the test results were back and the test results come back negative. Providers should be given the opportunity to reconsider the diagnosis based on the new information.
18. provide guidance on correct coding when the provider has confirmed the documented COVID-19 after the test results come back negative. How should this be coded? (4/16/2020)

If the provider still documents and confirms COVID-19 even though the test results are negative, or if the provider documented disagreement with the test results, assign code U07.1, COVID-19. As stated in the Official Guidelines for Coding and Reporting for COVID-19, “Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider . . . the provider’s documentation that the individual has COVID-19 is sufficient.”
19. When a patient who previously had COVID-19 is seen for a follow-up exam and the COVID-19 test is negative, what is best code(s) to capture this scenario? (4/16/2020; revised 12/11/2020)

Assign codes Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, and the appropriate personal history code (code Z86.19, Personal history of other infectious and parasitic diseases, for encounters prior to January 1, 2021, or code Z86.16, Personal history of COVID-19, for encounters after January 1, 2021).
20. How should an encounter for COVID-19 antibody testing be coded? (4/28/2020)

For an encounter for antibody testing that is not being performed to confirm a current COVID-19 infection, nor is being performed as a follow-up test after resolution of COVID-19, assign Z01.84, Encounter for antibody response examination.
21. If a patient has both aspiration pneumonia and pneumonia due to COVID-19, may code J12.89, Other viral pneumonia, be assigned with code J69.0, Pneumonitis due to inhalation of food and vomit? There is an Excludes1 note at category J12, Viral pneumonia, not elsewhere classified, that excludes pneumonia not otherwise specified (J69.0). (4/28/2020; revised 12/11/2020)

Yes, both codes may be assigned, as aspiration pneumonia and pneumonia due to COVID-19 are two separate unrelated conditions with different underlying causes. This scenario meets the exception to the Excludes1 guideline as a circumstance when the two conditions are unrelated to each other.

Note that effective January 1, 2021, there is a new code, J12.82, for pneumonia due to coronavirus disease 2019.
22. For a patient who has HIV/AIDS and is diagnosed with COVID-19, the guidelines don’t assume a relationship between COVID-19 and HIV, so does the provider need to link the two conditions for coding? (4/28/2020)

Any immunocompromised patient (which would include HIV patients) is at higher risk for becoming infected with COVID-19, but HIV does not cause COVID-19. Code both conditions separately, with sequencing depending on the circumstances of admission – just like a patient suffering from diabetes or any other chronic condition that puts them at higher risk for the COVID-19 infection.
23. Is there a timeframe for considering the COVID-19 as history of, or current? For example, if a patient is documented as having had COVID-19 four weeks ago and during the current encounter the patient is documented to no longer have COVID-19, do we use the personal history code? (4/28/2020; revised 12/11/2020)

There is no specific timeframe for when a personal history code is assigned. If the provider documents that the patient no longer has COVID-19, assign the appropriate personal history code (code Z86.19, Personal history of other infectious and parasitic diseases, for discharges/encounters prior to January 1, 2021, or code Z86.16, Personal history of COVID-19, for discharges/encounters after January 1, 2021).
24. When a patient is diagnosed with COVID-19, we understand that signs and symptoms are not manifestations and would not be separately coded. We also understand that Guideline I.C.18.b. states that “signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.” When a patient diagnosed with COVID-19 presents with both respiratory signs/symptoms (e.g. shortness of breath, cough) and non-respiratory signs/symptoms (e.g. gastrointestinal problems, dermatologic or venous sufficiency issues), may the non-respiratory signs/symptoms/conditions be coded separately since they are not routinely associated with COVID-19? (4/28/2020; revised 8/25/2021)

People infected with COVID-19 may vary from being asymptomatic to having a range of symptoms and severity. Therefore, for coding purposes, signs and symptoms associated with COVID-19 may be coded separately, unless the signs or symptoms are routinely associated with a manifestation. For example, cough would not be coded separately if the patient has pneumonia due to COVID-19, as cough is a symptom of pneumonia. The additional coding of signs or symptoms not explained by the manifestations would provide additional information on the severity of the disease. Because COVID-19 is primarily a respiratory condition, any other signs/symptoms would be coded separately unless another definitive diagnosis has been established for the other signs or symptoms. This is supported by Guideline IC.18.b, “Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis.”
25. How should we code neonates/newborns that test positive for COVID-19? (5/26/2020)

When coding the birth episode in a newborn record, the appropriate code from category Z38, Liveborn infants according to place of birth and type of delivery, should be assigned as the principal diagnosis. For a newborn that tests positive for COVID-19, assign code U07.1, COVID-19, and the appropriate codes for associated manifestation(s) in neonates/newborns in the absence of documentation indicating a specific type of transmission. For a newborn that tests positive for COVID-19 and the provider documents the condition was contracted in utero or during the birth process, assign codes P35.8, Other congenital viral diseases, and U07.1, COVID-19.
26. What is the correct sequencing for a patient who is status post lung transplant admitted for management of respiratory manifestations of COVID-19? (6/4/2020)

Assign code T86.812, Lung transplant infection, as the principal or first-listed diagnosis, followed by code U07.1, COVID-19. This sequencing is supported by the Tabular List note at code T86.812 to “use additional code to specify infection.” The ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.g.3.a. state that “a transplant complication code is only assigned if the complication affects the function of the transplanted organ.” The COVID-19 infection has affected the function of the transplanted lung.
27. A patient was treated for pneumonia and pneumothorax due to COVID-19 and discharged from the hospital. Later the same day, the patient presented to the emergency department with pneumothorax and was readmitted due to increasing shortness of breath and for pneumothorax evacuation. Chest tube was inserted, the patient improved and was discharged. How should the readmission be coded? (7/22/2020)

Assign code U07.1, COVID-19, as the principal diagnosis, and code J93.83, Other pneumothorax, as a secondary diagnosis. Since the pneumothorax due to COVID-19 present on the first admission has not resolved, this appears to be ongoing treatment for a COVID-19 manifestation.

If the documentation is not clear regarding whether the physician considers a condition to be an acute manifestation of a current COVID-19 infection vs. a residual effect from a previous COVID-19 infection, query the provider. As stated in the Official Guidelines for Coding and Reporting, the provider’s documentation that the individual has COVID-19 is sufficient for coding purposes.
28. A patient was hospitalized a few weeks ago for pneumonia due to COVID-19. The patient now presents to the emergency department with shortness of breath and is admitted. The discharge diagnosis for this admission is “pneumothorax due to a previous history of COVID-19.” How should this admission be coded? (7/22/2020; revised 8/25/2021)

Assign code J93.83, Other pneumothorax, as the principal diagnosis, followed by code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021. In this case, the patient no longer has COVID-19 and the pneumothorax is a residual effect (sequelae). A personal history code is not appropriate because as stated in guideline I.C.21.c.4), “Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring.” The patient is clearly receiving treatment for the residual effect of COVID-19.
29. A patient was diagnosed with COVID-19 infection a week ago and is admitted after developing acute onset shortness of breath associated with upper back pain as well as dizziness without syncope. The patient continued to experience symptoms of COVID-19 infection. Patient was discharged with the diagnosis of pulmonary embolism (PE) and COVID-19. What are the appropriate codes? (7/22/2020)

Assign code U07.1, COVID-19, as the principal diagnosis, followed by code I26.99, Other pulmonary embolism without acute cor pulmonale, for a patient diagnosed with pulmonary embolism and COVID-19. The pulmonary embolism is a manifestation of the COVID-19 infection. Per the instructional note under code U07.1, COVID-19 should be sequenced as the principal diagnosis and additional codes should be assigned for the manifestations.
30. A patient is readmitted due to shortness of breath following a previous admission for COVID-19 and associated respiratory failure. The patient no longer has COVID-19. The final diagnosis is “pulmonary embolism due to previous COVID-19.” What are the appropriate codes? (7/22/2020; revised 8/25/2021)

Assign code I26.99, Other pulmonary embolism without acute cor pulmonale, as the principal diagnosis, followed by code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as a secondary diagnosis.
31. A nursing home patient was hospitalized for COVID-19 and pneumonia. He has completed treatment, but he cannot go back to the nursing home until he tests negative for COVID-19, so he is admitted to the skilled nursing facility (SNF) unit at the hospital until he tests negative and can return to the nursing home where he resides. What code should be assigned for the hospital SNF unit stay? (7/22/2020)

Assign code U07.1, COVID-19, as the patient still has COVID-19. Do not assign a code for the pneumonia as the condition has resolved.
32. A patient was diagnosed with "Guillian-Barre Syndrome which is likely a parainfectious complication of recent COVID-19 infection." The patient no longer has COVID-19. How should this be coded? (7/22/2020; revised 8/25/2021)

Assign code G61.0, Guillain-Barre syndrome, as the principal diagnosis, followed by code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021.
33. A patient was transferred from a short term acute care hospital to a long term acute care hospital (LTCH) for continued treatment of acute hypoxic respiratory failure due to COVID-19. What are the appropriate codes for the LTCH admission? (7/22/2020)

Assign code U07.1, COVID-19, as the principal diagnosis, and code J96.01 Acute respiratory failure with hypoxia, as a secondary diagnosis. Per the instructional note under code U07.1, COVID-19 should be sequenced as the principal diagnosis and additional codes should be assigned for the manifestations.
34. A patient was transferred from an acute care hospital to a rehab facility due to sequelae of a COVID-19 infection, including critical illness myopathy and peroneal palsy in the right lower extremity. The patient no longer has COVID-19. What codes should be assigned? (7/22/2020; revised 8/25/21)

Assign codes G72.81, Critical illness myopathy, and G57.31, Lesion of lateral popliteal nerve, right lower limb. Assign code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as a secondary diagnosis for the sequelae of a COVID-19 infection.
35. A patient was transferred from an acute care hospital to a rehab facility for deconditioning for generalized debility due to prolonged hospitalization for COVID-19 which has now resolved. What codes should be assigned? (7/22/2020; revised 12/11/2020; revised 8/25/2021)

Assign codes for the specific symptoms (such as generalized weakness, debility, etc.). Assign the appropriate personal history code (code Z86.19, Personal history of other infectious and parasitic diseases, for discharges/encounters prior to January 1, 2021, or code Z86.16, Personal history of COVID-19, for discharges/encounters after January 1, 2021) as a secondary diagnosis.

Do not assign code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as the debility is due to the prolonged hospitalization rather than being a sequela of the COVID-19 infection.
36. What is the ICD-10-CM diagnosis code(s) for a child admitted due to documented multisystem inflammatory syndrome in children (MIS-C) due to COVID-19? (7/23/2020; revised 12/11/2020)

Assign code U07.1, COVID-19, as the principal diagnosis, and code M35.8, Other specified systemic involvement of connective tissue, for discharges prior to January 1, 2021, or code M35.81, Multisystem inflammatory syndrome, for discharges after January 1, 2021, as a secondary diagnosis, for MIS-C due to COVID-19. The MIS-C is a manifestation of the COVID-19 infection. Per the instructional note under code U07.1, COVID-19 should be sequenced as the principal diagnosis and additional codes should be assigned for the manifestations.

If the documentation is not clear regarding whether the physician considers a condition to be an acute manifestation of a current COVID-19 infection vs. a residual effect from a previous COVID-19 infection, query the provider. As stated in the ICD-10-CM Official Guidelines for Coding and Reporting, the provider’s documentation that the individual has COVID-19 is sufficient for coding purposes.
37. A child diagnosed with COVID-19 several weeks ago is now admitted with multisystem inflammatory syndrome in children (MIS-C) due to COVID-19. The patient no longer has COVID-19. How should this be coded? (7/23/2020; revised 12/11/2020, revised 8/25/2021)

Assign code M35.8, Other specified systemic involvement of connective tissue, for discharges prior to January 1, 2021, or code M35.81, Multisystem inflammatory syndrome, for discharges after January 1, 2021, as the principal diagnosis, for the MIS-C, and code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as a secondary diagnosis for the sequelae of a COVID-19 infection.

If the documentation is not clear regarding whether the physician considers a condition to be an acute manifestation of a current COVID-19 infection vs. a residual effect from a previous COVID-19 infection, query the provider. As stated in the ICD-10-CM Official Guidelines for Coding and Reporting, the provider’s documentation that the individual has COVID-19 is sufficient for coding purposes.
38. How should an encounter for screening for COVID-19 be coded, such as a patient being tested for COVID-19 as part of preoperative testing? Should code Z11.59, Encounter for screening for other viral diseases, or, for encounters after January 1, 2020, new code Z11.52, Encounter for screening for COVID-19, be assigned? (8/5/2020; revised 12/11/2020)

During the COVID-19 pandemic, a screening code is generally not appropriate. For encounters for COVID-19 testing, including preoperative testing, code as exposure to COVID-19 (code Z20.828 for encounters prior to January 1, 2021, or code Z20.822, Contact with and (suspected) exposure to COVID-19, for encounters after January 1, 2021). The ICD-10-CM Official Guidelines for Coding and Reporting state that codes in category Z20, Contact with and (suspected) exposure to communicable diseases, are for patients who are suspected to have been exposed to a disease by close personal contact with an infected individual or are in an area where a disease is epidemic.

For an encounter for COVID-19 testing being performed as part of preoperative testing, assign code Z01.812, Encounter for preprocedural laboratory examination, as the first-listed diagnosis and assign code Z20.828 or Z20.822 (depending on the encounter date) as an additional diagnosis.

Coding guidance will be updated as new information concerning any changes in the pandemic status becomes available.

Note: This advice is consistent with the updated ICD-10-CM Official Guidelines for Coding and Reporting that become effective October 1, 2020. During these unprecedented times, AHA and AHIMA concluded it was necessary to clarify the appropriate codes for COVID-19 testing in advance of the effective date for the revised official coding guidelines.
39. What ICD-10-CM code should be assigned for an encounter for COVID-19 testing? (8/5/2020; revised 12/11/2020)

For asymptomatic individuals with actual or suspected exposure to COVID-19, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, for encounters prior to January 1, 2021, and code Z20.822, Contact with and (suspected) exposure to COVID-19, for encounters after January 1, 2021.

For symptomatic individuals with actual or suspected exposure to COVID-19 and the infection has been ruled out, or test results are inconclusive or unknown, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases or code Z20.822, Contact with an (suspected) exposure to COVID-19, depending on the encounter date.

If COVID-19 is confirmed, assign code U07.1 instead of code Z20.828 or Z20.822.

Note: This advice is consistent with the updated ICD-10-CM Official Guidelines for Coding and Reporting that become effective October 1, 2020. During these unprecedented times, AHA and AHIMA concluded it was necessary to clarify the appropriate codes for COVID-19 testing in advance of the effective date for the revised official coding guidelines.
40. What are the appropriate ICD-10-CM code(s) for thrombo-inflammation of COVID-19 associated coagulopathy? (12/11/2020)

Assign codes U07.1, COVID-19, and D68.8, Other specified coagulation defects.

If disseminated intravascular coagulation (DIC) is documented, assign code D65, Disseminated intravascular coagulation [defibrination syndrome], instead of code D68.8. Not all COVID-19 associated coagulopathy professes to DIC.
41. What are the appropriate ICD-10-CM code(s) for skin failure due to underlying coagulopathy and microvascular changes due to COVID-19? (12/11/2020)

Assign codes U07.1, COVID-19, and D68.8, Other specified coagulation defects, and L99, Other disorders of skin and subcutaneous tissue in diseases classified elsewhere.
42. What are the appropriate ICD-10-CM code(s) for "COVID-19 viral shedding?" (12/11/2020)

Viral shedding can mean either that the patient has an active (current) COVID-19 infection or a personal history of COVID-19. Therefore, the code assignment depends on the provider documentation.

For documentation of viral shedding in a patient with an active COVID-19 infection, assign code U07.1, COVID-19.

For documentation of viral shedding in a patient with a personal history of a COVID-19 infection rather than an active infection, assign code Z86.19, Personal history of other infectious and parasitic diseases, for discharges/encounters prior to January 1, 2021, or code Z86.16, Personal history of COVID-19, for discharges/encounters after January 1, 2021.

If the documentation is not clear as to whether the patient has an active COVID-19 infection or a personal history, query the provider.
43. The patient presents to the facility with symptoms such as generalized weakness and lack of appetite, and the provide documents a diagnosis of "post COVID-19 syndrome." How should this be coded? (12/11/2020; revised 8/25/2021)

[Effective 10/1/21:]

For discharges/encounters on or after October 1, 2021, assign codes R53.1, Weakness, R63.0, Anorexia, and U09.9, Post COVID-19 condition, unspecified, for a diagnosis of post COVID-19 syndrome with generalized weakness and lack of appetite. This is supported by the instructional note at code U09.9 to “code first the specific condition related to COVID-19 if known.”

[Prior to 10/1/21:]

For discharges/encounters prior to October 1, 2021, unless the provider specifically documents that the symptoms are the results of COVID-19, assign code(s) for the specific symptom(s) and a code for personal history of COVID-19. "Post COVID-19 syndrome" indicates temporality, but not that the current symptom(s) or clinical condition(s) are a residual effect (sequelae) of COVID-19. As stated in the ICD-10-CM Official Guidelines for Coding and Reporting, in the absence of Alphabetic Index guidance for coding syndromes, assign codes for the documented manifestations of the syndrome.

The appropriate personal history code is Z86.19, Personal history of other infectious and parasitic diseases, for discharges/encounters prior to January 1, 2021, or code Z86.16, Personal history of COVID-19, for discharges/encounters after January 1, 2021.

If the provider documents that the symptoms are the result (residual effect) of COVID-19, assign code(s) for the specific symptom(s) and code B94.8, Sequelae of other specified infectious and parasitic diseases. According to the ICD-10-CM Official Guidelines for Coding and Reporting, a sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated.
44. Are new ICD-10-CM codes pertaining to COVID-19 going into effect in January 2021? (12/11/2020)

In response to the national emergency that was declared concerning the COVID-19 outbreak, the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) is implementing new ICD-10-CM diagnosis codes, effective January 1, 2021.

The new ICD-10-CM codes being implemented on January 1, 2021, are:

J12.82 Pneumonia due to coronavirus disease 2019

M35.81 Multisystem inflammatory syndrome

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

The January 2021 ICD-10-CM Addenda and updated ICD-10-CM Official Guidelines for Coding and Reporting are available at: https://www.cdc.gov/nchs/icd/icd10cm.htm.
45. A patient presents to the emergency department with complaints of throat tingling and chest tightness following administration of the COVID-19 vaccine. The provider documented allergic reaction to COVID-19 vaccine. The current ICD-10-CM indexing for allergy to vaccine points to a code for serum reaction. How should this case be coded? (3/1/2021)

Assign codes T78.49XA, Other allergy, initial encounter; R07.89, Other chest pain; and R09.89, Other specified symptoms and signs involving the circulatory and respiratory systems. The currently approved COVID-19 vaccines in the United States are not serum based, and therefore code T80.62XA-, Other serum reaction due to vaccination, initial encounter is not appropriate.
46. A patient presents to the emergency department with complaint of malaise following administration of the COVID-19 vaccine. The provider documented adverse effect of COVID-19 vaccine. How should this case be coded? (3/1/2021)

Assign codes R53.81, Other malaise; and T50.B95A, Adverse effect of other viral vaccines, initial encounter.
47. A patient presents to the emergency department via ambulance after complaining of hives and swelling, severe breathing problems, and swelling in the throat, following administration of the COVID-19 vaccine. The provider documented anaphylactic reaction to COVID-19 vaccine. The current ICD-10-CM indexing for anaphylactic reaction to immunization points to a code for serum reaction. However, since the COVID-19 vaccine is not serum based, may we use code T80.52? (3/1/2021)

Assign code T80.52XA, Anaphylactic reaction due to vaccination, initial encounter, for documented anaphylactic reaction to the COVID-19 vaccine. Although subcategory T80.5, identifies anaphylactic reaction to serum, it is the closest available code to capture this condition.
48. Should normal or expected side effects of the COVID-19 vaccination be coded for patients seeking medical care or for patients in nursing homes, hospitals, etc., when the side effects meet reporting requirements? (3/1/2021)

Yes, it would be appropriate to report a code(s) for side effects when the patient requires additional treatment or medical care such as monitoring or treatment for the side effects. Assign the code for the nature of the effect (e.g. fever) followed by code T50.B95A, Adverse effect of other viral vaccines, initial encounter.
49. A patient was COVID-19 positive at a short term acute care hospital where he was being cared for COVID-19 related respiratory problems and completed treatment with Remdesivir and Dexamethasone. After more than a 2 month stay, the patient is now transferred to a long-term care hospital (LTCH) with acute respiratory failure for tracheostomy weaning. At the time of transfer, the patient had been weaned from ventilator to tracheostomy collar at 28%. Diagnosis on admission was history of COVID-19, acute respiratory failure, and tracheostomy dependence. When queried regarding the patient’s COVID-19 status on admission to the LTCH, the provider indicated that the patient was no longer infectious and is being admitted only to treat the residual respiratory failure requiring oxygenation via tracheostomy. May we assign code J96.90 as a principal diagnosis, followed by code Z86.16, Personal history of COVID-19, since the patient no longer has a COVID-19 infection? (3/1/2021; revised 8/25/2021)

Query the provider whether “residual respiratory failure” refers to acute on chronic, or chronic respiratory failure. Assign the appropriate respiratory failure code based on the response, followed by code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, as a secondary diagnosis, for the sequelae of COVID-19 infection, since the patient has been documented as no longer infectious for COVID-19.

Although the provider referred to "history of COVID-19," a personal history code is inappropriate in this case. As defined in the ICD-10-CM Official Guidelines for Coding and Reporting, Section IB. "A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated." In addition, Section I. C.21,c,( 4) states "Personal history codes explain a patient's past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring."
50. Patient has a long history of multiple transfers between short term acute care hospitals (STACH) and long-term care hospitals (LTCH) for nearly 8 months. Patient is status post prolonged hospitalizations for respiratory failure and critical illness secondary to COVID-19 pneumonia. He never fully recovered from a respiratory standpoint. He is now admitted into the LTCH with COVID-19 listed as past history for continued treatment of respiratory failure with prolonged mechanical ventilation for further continuation of vent weaning and rehab services. COVID-19 treatment was completed 8 months ago at the STACH. Provider documentation states chronic respiratory failure secondary to COVID-19 related ARDS, and status post tracheostomy. Patient is currently on prolonged mechanical ventilation most likely from diaphragm weakness and tenacious secretions complicated by pulmonary hypertension with some degree of prominent lung dysfunction. Would the correct coding and sequencing for the above scenario be J96.10, Chronic respiratory failure, followed by Z86.16, for history of COVID, or B94.8 for sequela of COVID? (3/1/2021; revised 8/25/2021)

Assign code J96.10, Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, as the principal diagnosis since the ARDS has resolved. In addition, assign code B94.8, Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021. as a secondary diagnosis, since the patient no longer has an active COVID-19 infection.
51. Three weeks ago, the patient was admitted for COVID-19 related respiratory problems, with a positive COVID-19 test result at that time. She was treated with Remdesivir and Dexamethasone and was discharged with a five-day prednisone pulse. Since being discharged, the patient had not been feeling well, and was readmitted with worsening cough, pleuritic chest pain and dizziness. Subsequent COVID-19 tests were negative; however, the provider's discharge diagnosis listed, "Pneumonia due to COVID-19 virus." Our infectious disease expert believes that the pneumonia should be coded as a sequela rather than as an acute manifestation of COVID-19 infection. Would pneumonia be considered an acute manifestation of COVID-19, a late effect/sequela of COVID-19, or is the COVID-19 coded as a personal history since the most recent COVID test is negative? What is the principal diagnosis, COVID-19 infection or pneumonia? (3/1/2021)

Assign code U07.1. COVID-19, as the principal diagnosis. Code J12.82, Pneumonia due to coronavirus disease 2019, would be assigned as an additional diagnosis. The Instructional Note under code U07.1 directs to use an additional code to identify pneumonia or other manifestations. Therefore, when a patient presents with an acute manifestation of COVID-19, such as pneumonia, code U07.1 is sequenced, as the principal or first diagnosis, regardless of whether the patient's most recent COVID-19 test is positive or negative. The Official Guidelines for Coding and Reporting for sequela state, "A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated."
52. How is an encounter/admission for COVID-associated pneumonia coded, when the patient's latest COVID-19 test results are negative? (3/1/2021)

Assign code U07.1. COVID-19, as the principal or first-listed diagnosis, because the pneumonia is an acute manifestation of the COVID-19 infection. Assign code J12.82, Pneumonia due to coronavirus disease 2019, as an additional diagnosis. The Instructional Note under code U07.1 directs to use an additional code to identify pneumonia or other manifestations. Therefore, when a patient presents with an acute manifestation of COVID-19, such as pneumonia, code U07.1 should be reported as the principal or first diagnosis, regardless of whether the patient's most recent COVID-19 test is positive or negative.
53. A patient who tested negative for COVID-19 several times as an outpatient now presents to the Emergency Department because of worsening symptoms. The patient was admitted for treatment of possible pneumonia. He was retested for COVID-19, and the results were still negative; however, a COVID-19 antibody test was positive. The provider's final diagnostic statement lists, "Post COVID-19 organizing pneumonia." Would pneumonia be considered an acute manifestation of COVID-19, a late effect/sequela of COVID-19, or is the COVID-19 coded as a personal history since the most recent COVID-19 test is negative? What is the principal diagnosis, COVID-19 or pneumonia? (3/1/2021; revised 8/25/2021)

Based on the documentation provided, the patient has an organizing pneumonia due to previous COVID-19 infection. Assign code J84.89, Other specified interstitial pulmonary diseases, followed by code B94.8. Sequelae of other specified infectious and parasitic diseases, for discharges/encounters prior to October 1, 2021, or code U09.9, Post COVID-19 condition, unspecified, for discharges/encounters on or after October 1, 2021, for a diagnosis of post COVID-19 organizing pneumonia.

Code J84.89 may be located by the following Index entry:

Pneumonia
- organizing J84.89
54. The patient is diagnosed with acute COVID-19 viral infection with bilateral pneumonia and adult respiratory distress syndrome (ARDS) resulting in acute hypoxic and hypercapnic respiratory failure. The provider documented that the patient developed acute right-sided hydropneumothorax, likely due to barotrauma due to mechanical ventilation. Since the patient had COVID-19 pneumonia, which can weaken the lungs, would this affect code assignment? How should this case be coded? (3/1/2021; revised 3/24/2021)

Assign code U07.1, COVID-19, as the principal or first-listed diagnosis, because the pneumonia is an acute manifestation of the COVID-19 infection. Assign code J12.82, Pneumonia due to coronavirus disease 2019, and code J80, Acute respiratory distress syndrome, as additional diagnoses for the pneumonia and ARDS. In addition, assign codes J95.859, Other complication of respirator [ventilator], J95.811, Postprocedural pneumothorax, and J94.8, Other specified pleural conditions, to capture hydropneumothorax barotrauma due to mechanical ventilation. The presence of COVID-19 does not affect code assignment of hydropneumothorax barotrauma.
55. A patient with a history of COVID-19 infection was admitted for treatment of acute hyperkalemia and acute kidney injury with chronic kidney disease. Follow-up COVID-19 testing was positive. The provider documented, "COVID likely reflective of old noninfectious virus." How is the COVID-19 status captured for this patient? Does the Official Coding and Reporting Guideline I.C.1.g.1.a., “code only confirmed cases” apply when the provider documents the patient as "noninfectious" but has a positive COVID-19 test during the admission? (8/25/2021)

Assign code Z86.16, Personal history of COVID-19. While the patient had a positive COVID-19 test, the provider documented that the patient was not actively infectious during this admission. When the provider documents "noninfectious" or "not infectious" COVID-19 status, this indicates that the patient no longer has an active COVID-19 infection, therefore assign code Z86.16 instead of code U07.1, COVID-19.

Although guideline I.C.1.g.1.a., states: “Code only 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,” in this scenario the provider has clarified the patient no longer has an active COVID-19 infection. Therefore, code U07.1, COVID-19, is not appropriate and the Official Coding Guideline I.C.1.g.1.a., regarding a positive COVID-19 test result would not apply.

If the documentation is unclear as to whether the patient has an active COVID-19 infection or a personal history, query the provider for clarification.
56. A patient presented to the hospital with acute respiratory failure and COPD exacerbation. It was noted that the patient tested positive for COVID-19 approximately 80 days prior to this admission. A repeat COVID-19 test was performed and came back positive but the provider documented she did not consider the patient's status to be a COVID-19 "reinfection." The discharge summary states: "history of COVID infection currently still testing positive for COVID." Is it appropriate to assign code Z86.16, Personal history of COVID-19, or code U07.1, COVID-19 since there is a positive test? (8/25/2021)

Although the patient is still testing positive for COVID-19, the provider has documented the patient's condition was a previous history of a COVID-19 infection and not a reinfection, therefore it would be appropriate to assign code Z86.16, Personal history of COVID-19.
57. A patient presented for treatment of bulbous pemphigoid bulla with surrounding cellulitis. During the admission, the patient was tested for COVID-19. Although the patient was completely vaccinated, the physician documented the COVID-19 test was positive. The patient was subsequently placed in isolation and instructed to complete 10 days of self-isolation following discharge. How is COVID-19 coded in this scenario? (8/25/2021)

Assign code U07.1, COVID-19. The provider’s assessment stated “COVID-19 virus detected,” and it is possible for a COVID-19 infection to occur despite vaccination. This is consistent with Official Guidelines for Coding and Reporting, Section I.C.1.g.1.a., which states: Code only 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.
58. A patient was recently discharged from the hospital, admitted to a nursing home, and subsequently tested positive for COVID-19 via a rapid antigen test. The patient was readmitted to the hospital for COVID-19; however was asymptomatic. Repeat testing x2 including confirmatory testing of COVID PCR was negative. The provider consulted with infectious disease and hematology and it was documented the patient had a false positive that did not represent a true COVID-19 infection. How is COVID-19 coded in this scenario? (8/25/2021)

Assign code Z20.822, Contact with and (suspected) exposure to COVID-19, as principal diagnosis, for a patient admitted and found to have a false positive COVID-19 test. ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.1.g.1.e. states: For asymptomatic individuals with actual or suspected exposure to COVID-19, assign code Z20.822, Contact with and (suspected) exposure to COVID-19.

Although guideline I.C.1.g.1.a., allows coding of confirmed cases of COVID-19 on the basis of “documentation of a positive COVID-19 test result,” in this scenario the provider clarified the COVID-19 test as being a false positive; therefore code U07.1, COVID-19, is not appropriate and the Official Coding Guideline I.C.1.g.1.a. regarding coding on the basis of a positive COVID-19 test result would not apply to this case.

However, it is always appropriate to query the provider for clarification whenever the coding professional finds the medical record documentation to be unclear regarding the patient's COVID-19 status.
~~59. Is it appropriate to report code Z28.3, Underimmunization status, for encounters where the provider documents the patient has not been immunized against COVID-19? (8/27/2021).~~

(Question #59 was deleted on April 13, 2022.)
60. Would it be appropriate to utilize documentation from clinicians (e.g. nurse) other than the patient’s provider to determine a patients underimmunization status to report the new underimmunization for COVID-19 codes starting April 1st? (revised 4/21/22)

Yes, underimmunization status codes may be assigned based on nursing or other clinician documentation where information regarding the patient’s vaccination status can be found.

Official Coding Guideline I.B.14, Documentation by Clinicians Other than the Patient's Provider, will be updated with the FY 2023 guideline revisions to include all underimmunization status codes as one of the exceptions of acceptable conditions/status' documented by a clinician other than the patient's provider.
61. A patient who had contracted COVID-19 infection during the second trimester of pregnancy delivered a healthy newborn at term. Would code Z20.822, Contact with and (suspected) exposure to COVID-19, be assigned to identify the newborn's exposure to COVID-19? (5/22/22)

Do not assign code Z20.822, Contact with and (suspected) exposure to COVID-19, since the provider’s documentation does not indicate the infant was affected (e.g., small for gestational age) by the mother’s COVID-19 infection and the criteria for secondary diagnosis has not been met. The Official Guidelines for Coding and Reporting general perinatal rules (16.a.6.) state, “All clinically significant conditions noted on routine newborn examination should be coded. A condition is clinically significant if it requires: clinical evaluation, or therapeutic treatment, or diagnostic procedures, or extended length of hospital stay, or increased nursing care and/or monitoring, or has implications for future health care needs.”
62. What is the correct coding and sequencing for an immunocompromised patient with sickle cell disease (SCD) who presents in sickle cell crisis (SCC) triggered by a COVID-19 infection? The sickle cell disease is not a manifestation of COVID-19 infection, but the acute sickle cell pain crisis is directly linked to a COVID-19 infection. (5/22/22)

Assign the appropriate code from category D57, Sickle-cell disorders, for the sickle cell crisis and code U07.1 for the COVID-19 infection. Sequencing would depend on the circumstances of the admission. While the COVID-19 infection triggered an acute sickle cell crisis, SCD is not a manifestation of COVID-19.
63. A patient with end-stage liver disease is admitted for an orthotopic liver transplant. The donor organ came from a brain dead patient who was also COVID-19 positive. The recipient was contacted regarding the COVID-19 positive status of the donor prior to admission and elected to proceed with the liver transplant procedure.
Since the donor was COVID-19 positive, it was decided that anticoagulation was needed due to likely COVID-19 viremia and the patient was started on subcutaneous heparin. The donor organ was successfully transplanted and the patient was started on a daily dose of aspirin for a 3 month duration as well due to the COVID-19 positive organ donation. Is there an ICD-10-CM diagnosis code to capture that the recipient received a donor organ that was positive for COVID-19 at the time of donation? (5/22/22)

Assign code Z20.822, Contact with and (suspected) exposure to COVID-19, to identify that the recipient received a donor organ that was positive for COVID-19.
64. What code will be assigned for COVID-19 screening once the federal Public Health Emergency (PHE) for COVID-19 expires? (revised 5/9/23)

The federal Public Health Emergency (PHE) for COVID-19 will expire on May 11, 2023. Based on the ICD-10-CM Official Guidelines for Coding and Reporting, continue to assign code Z20.822, Contact with and (suspected) exposure to COVID-19, for COVID-19 screening that is performed after May 11, 2023.>/p>

Note: This advice is consistent with current coding guidance.

Effective October 1, 2023, the ICD-10-CM Official Guidelines for Coding and Reporting on encounters for COVID-19 screening will be revised. For encounters for COVID-19 screening on or after October 1, 2023, assign code Z11.52, Encounter for screening for COVID-19.
65. Once the federal Public Health Emergency (PHE) for COVID-19 expires, what code should be assigned for COVID-19 screening that is performed during preoperative testing? (revised 5/9/23)

For an encounter for COVID-19 screening that is performed as part of preoperative testing after May 11, 2023, continue to assign code Z01.812, Encounter for preprocedural laboratory examination, as the first-listed diagnosis and code Z20.822, Contact with and (suspected) exposure to COVID-19, as an additional diagnosis.

Note: This advice is consistent with current coding guidance.

Effective October 1, 2023, for an encounter for COVID-19 screening that is performed as part of preoperative testing, assign code Z01.812, Encounter for preprocedural laboratory examination, as the first-listed diagnosis and code Z11.52, Encounter for screening for COVID-19, as an additional diagnosis.