CDC Publishes Final COVID-19 ICD-10-CM Guidelines

CDC Publishes Final COVID-19 ICD-10-CM Guidelines

The Centers for Disease Control and Prevention (CDC) published the final guidelines for the new diagnosis code U07.1, COVID-19, effective April 1 to September 30, 2020.

The off-cycle update of ICD-10-CM is an unprecedented exception to the code set updating process established under HIPAA.

The final guidelines are for coding confirmed diagnoses of the novel coronavirus through a positive test result confirmed by the CDC or a presumed positive test result documented at the local or state level, though the latter no longer requires CDC confirmation. Additional guidance for “suspected,” “possible,” “probable,” or “inconclusive” COVID19 is provided in the final guidelines.

During the March 18 ICD-10 Coordination and Maintenance Committee meeting when the new implementation date of April 1 was announced, Sue Bowman, AHIMA’s senior director, coding policy and compliance, thanked the CDC for expediting the implementation of the new code for COVID-19 and acknowledged the work involved in making this change happen.

COVID-19 has swept across the globe, infecting more than 850,000 and resulting in 42,000 deaths in more than 200 countries. The United States, particularly New York City, is the current global epicenter of the pandemic. The virus’ spread had severely impacted the global economy, and in several countries, overwhelmed hospitals and health systems.

Bookmark AHIMA’s COVID-19 Resources
  • Journal of AHIMA—COVID-19. An authoritative source for healthcare-relevant news and perspectives on the global response to the COVID-19 pandemic. Click here.
  • AHIMA.org COVID-19 Index. Continuously updated with resources, AHIMA news, and navigable links to public health and professional organizations. Click here.
  • AHIMA Engage—COVID-19 Community. A digital networking page to exchange ideas, information, and perspectives. Click here.
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6 Comments

  1. If a patient is admitted to the hospital with COVID19 confirmed, and has viral pneumonia documented. There is not correlation that the viral pneumonia is related to the Covid 19 virus.
    Does the physician have to document the correlation between the Covid and the viral pneumonia, or can it be assumed that there is a correlation?

    Does CDI need to query the physician for this documentation?

    Can it be assumed that the viral pneumonia is Covid related?

  2. I have several questions that I would like to see addressed in a CC question update.:

    1. Patient comes to ER with symptoms of COVID-19 – fever, cough, sob. Patient has been exposed to family members who have tested positive for COVID-19. Patient is NOT tested. Would this be a situation that Z20.828 plus symptoms would be coded?

    2. Patient comes to ER with symptoms,gets tested for COVID-19, test is negative, but the physician documents “I am going to treat the patient as though he/she has COVID”. Z20.828 or U07.1?

    3. Physician orders COVID test along with several other diagnostic tests, including a TEE. Diagnosis listed: HTN, DM, CAD. COVID test is performed 07/31, other tests also done 07/31, TEE done on 08/05/20. All are documented in one encounter dated 08/05/20. Would it be appropriate to use Z01.812 and Z20.828? or just use Z20.828 because the TEE could be considered the procedure?

    Thank you!

  3. It appears that the Official Coding Guidelines as published in Coding Clinic for ICD-10-CM/PCS and the AHIMA published Official Coding Guidelines for COVID-19 are in disagreement especially when it comes to coding Pneumonia due to COVID-19. Has there been an update to either advice to correct this conflict.

  4. Requesting guidance on use of COVID codes U07.1 and Z20.828 for ancillary services.

    Our physician performs ancillary services, reading EKGs and echocardiograms, for the ER.

    Our coder went to the AHIMA and CDC websites and pulled out a bunch of info regarding COVID coding. She is a perfectionist and wants to code things by the guidelines.
    From what she understood from the website, she has to sequence COVID even if it is not documented in the echo and EKG reports.

    E.g. Patient comes to the ER with cough, shortness of breath and EKG results conclude “patient in sinus rhythm”. No mention of COVID in documentation.
    She has to find the reason why EKG was ordered. She goes back to the ER physician report, reads through it and if it says there patient was tested for COVID she feels she has to wait for the results to confirm and code U07.1 either as primary or secondary. She does not want to use Z20.828 because she does not see in medical documentation of ER physician that there is contact with and suspected exposure. Frequently patients state ” I don’t know where I got it from”.

    From what i understood from the AHIMA guideline (correct me if I’m wrong), this is for hospitalists or primary care physicians who have a face to face encounter with confirmed COVID cases and are seeing the patients to treat COVID.

    Our physician reading EKGs and echocardiograms truly have no mechanism to document (and code for COVID). I feel she is exerting extra efforts for no gain, for herself, for the patients or for the practice.

    I believe she has taken the guidelines out of context.

    Please enlighten me.

  5. Please provide guidance COVID-19 codes Z20.828 and Z03.818

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