Jill Young, CPC, CEDC, CIMC
This auditing and compliance “Tip of the Week” was originally published by the National Alliance for Medical Auditing Specialists (NAMAS), a division of DoctorsManagement.

The Centers for Disease Control and Prevention (CDC) released its ICD-10 guidelines for COVID-19, using the newly adopted code U07.1. You can find the CDC’s guidance document here.

The information shows an effective date range from April 1, 2020 through September 30, 2020. This reminds us that “confirmation” does not require the coder personally sees a positive test result or even to know the type of test performed. The provider’s personal documentation that the individual has COVID-19 is sufficient.

Presumptive positive cases of COVID-19 should also be coded as confirmed. This type of positive test is one that was done at the local or state level but has not yet been confirmed by the CDC. The agency no longer requires that it confirm a state or local test in order to assign a definitive diagnosis of COVID-19. Conversely, if the provider’s documentation uses words like “suspected,” “possible,” or “acts like,” do not assign U07.1. Rather, report diagnosis codes corresponding to the signs and symptoms that prompted the patient to present for the visit.

In terms of sequencing, if the new COVID-19 code meets the definition of a principal diagnosis, it should be first-listed, followed by the appropriate codes for associated manifestation(s), except in the case of obstetrical patients. For these cases, see Section I.C.15.s of the ICD-10-CM guidelines for instructions.

The remaining sections of the CDC document have coding instruction that address the proper way to code screening encounters for both patients who have confirmed exposure to COVID-19 (Z20.828) as well as for patients who have a possible exposure to COVID-19 (Z03.818). In such screening cases, these diagnoses should only be coded if the patient tests negative for COVID-19; if they test positive, then U07.1 would be coded instead. Lastly it addresses how patients without a definitive diagnosis of COVID-19 who are seen with signs and symptoms would be coded.
The CDC document presents both the older guidance (effective from Feb. 20, 2020 to March 31, 2020) alongside the most recent guidance superseding it (effective from April 1, 2020 to Sept. 30, 2020).
Good luck!

This Week’s Audit Tip Written By:
Jill Young, CPC, CEDC, CIMC
Jill is owner of Young Medical Consulting, LLC based in Michigan.

What to do next…

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  2. Read more: What can you expect from a coding and compliance review?
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