News: FY 2021 ICD-10-CM Official Guidelines released, clarified COVID-19 coding practices

The ICD-10-CM Official Guidelines for Coding and Reporting for fiscal year (FY) 2021 have been released. Notably, the Guidelines clarify earlier guidance related to the COVID-19 pandemic.

According to the guidelines, “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 (guideline I.C.1.g.1.e).”

The Guidelines do not include coding guidance for “presumptive positive” COVID-19 cases because it refers to cases awaiting a second confirmatory CDC laboratory test—a practice that is no longer required. The Guidelines do, however, include the following instructions for reporting code U07.1, 2019-nCoV acute respiratory disease:

• 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.

Among other significant coding change is observation code Z03.818. The new Guidelines state that even though “observation codes are primarily to be used as a principal/first-listed diagnosis, […] An observation code may be assigned as a secondary diagnosis code when the patient is being observed for a condition that is ruled out and is unrelated to the principal/first-listed diagnosis.” The Guidelines use the example of incidental COVID-19 testing for a motor vehicle collision with negative results.

The Official Guidelines state that coding guidance will be updated as new information concerning any changes in the pandemic status becomes available.

Editor’s note: The full ICD-10-CM Official Guidelines for Coding and Reporting fiscal year (FY) 2021 can be found here. To read ACDIS’ complete coverage of the COVID-19 pandemic, click here.