COVID Coding Updates Every CBCS Should Know

How can you stay current with the rapidly evolving medical billing codes related to COVID-19? While coding processes are continually evolving, here are a few recent changes you should be aware of to stay in-the-know:

ICD-10-CM

Effective January 1, 2021, further additions to the ICD-10-CM Classification related to COVID-19 were implemented by the CDC. The additional codes are:

• Z11.52   Encounter for screening for COVID-19*
  • *From the ICD-10-CM Official Guidelines for Coding and Reporting FY 2021: “During the COVID-19 pandemic, a screening code is generally not appropriate. Do not assign code Z11.52. For encounters for COVID-19 testing, including preoperative testing, code as exposure to COVID-19 (guideline I.C.1.g.1.e).
  • Guideline I.C.1.g.1.e: Exposure to COVID-19 - For asymptomatic individuals with actual or suspected exposure to COVID-19, assign code 822. 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 Z20.822.
  • Coding guidance will be updated by the CDC as new information concerning any changes in the pandemic status becomes available.”
• Z20.822  Contact with and (suspected) exposure to COVID-19
• Z86.16  Personal history of COVID-10
• M35.81  Multisystem inflammatory syndrome
• M35.89  Other specified systemic involvement of connective tissue
• J12.82  Pneumonia due to coronavirus disease 2019

These codes are in addition to previously added code, U07.1 (COVID-19). Additional guidelines from the CDC include:    

• Code only confirmed cases
  • Code only a confirmed diagnosis of COVID-19 as documented by the provider, documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result.
  • If the documentation states “suspected,” “possible,” “probable,” or “inconclusive,” do not assign code U07.1
• Sequencing of codes
  • When COVID-19 meets the definition of principal diagnosis, code U07.1, COVID-19, should be sequenced first, followed by the appropriate codes for associated manifestations, except in the case of obstetrics patients.

  For additional information go to the CDC website (link provided). ICD - ICD-10-CM - International Classification of Diseases, Tenth Revision, Clinical Modification (cdc.gov)

  For the complete FY 2021 guidelines refer to this CDC link: ICD-10-CM FY 2021-COVID- updated Jan-Guidelines (cdc.gov)

  CPT®

  The American Medical Association provided an update late December 2020 related to COVID-19 CPT® coding and guidance. Those updates can be found here: https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-coding-and-guidance.

  There is additional CPT® coding guidance for Category I vaccine descriptors, vaccine resources (Appendix Q), https://www.ama-assn.org/system/files/2020-11/covid-19-immunizations-appendix-q-table.pdf; and the special edition of the CPT® Assistant guide https://www.ama-assn.org/system/files/2020-11/cpt-assistant-guide-covid-vaccine-coding-2020.pdf.

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• Additional Resources

  NHA is here to help our CBCS certificate holders stay informed and navigate the rapidly changing codes and coding guidelines related to COVID-19. For information on other issues pertaining to billing and coding, such as the 3 Essential Soft Skills for Billing and Coding Specialists, please subscribe to our blog. 

  Other great websites to help you stay updated:

  American Medical Association (AMA): https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-vaccine-and-immunization-codes

  Centers for Disease Control and Prevention (CDC): ICD - ICD-10-CM - International Classification of Diseases, Tenth Revision, Clinical Modification (cdc.gov)