CODING FOR COVID-19 DIAGNOSES

Because diagnosis coding for COVID-19 is complicated, the WHO created two codes- U07.1 (COVID-19 lab-confirmed) and U07.2 (COVID-19 clinically diagnosed). However, the United States only adopted the U07.1 code since U07.2 was released later. This leaves the coding very subjective for clinically diagnosed patients. Properly documenting and coding for a patient who would have fallen under U07.2 is vital for patient pay coverage, inclusion in disease registries, follow-up appointments, and future serologic testing. Since there were not separate codes for lab-confirmed COVID-19 and clinically diagnosed COVID-19, the CDC’s National Center for Health Statistics (NCHS) confirmed that U07.1 can be used for lab-confirmed and clinically diagnosed patients who have died. An algorithm for the diagnosis and coding of COVID-19 has been recommended:

Algorithm

• If the patient presents for COVID-19 evaluation and has had confirmed or suspected exposure (not ruled out), testing should be completed. If the testing results are available and are negative, code Z20.828 + symptom codes if patient is symptomatic, Z20.828 if patient is asymptomatic, and U07.1 + symptom codes if clinical suspicion remains. If the test yields a positive result, U07.1 + symptom codes should be used for symptomatic patients and U07.1 only should be used for asymptomatic patients. If testing has been ordered or results are pending, U07.1 + symptom codes should be used for clinically diagnosed patients and Z20.828 for clinically uncertain cases. If testing is not able to be done and the patient is clinically negative for COVID-19, Z20.828 + symptom codes should be used. If the testing is not done but the patient is clinically COVID-19 positive, use U07.1 + symptom codes.
• If the patient presents for COVID-19 evaluation and has had suspected exposure (ruled out), testing should still be completed. If the testing results are available and negative, Z20.828 + symptom codes should be used for asymptomatic patients, Z03.818 for asymptomatic patients, and U07.1 + symptom codes when clinical suspicion remains. If the test yielded a positive result, U07.1 + symptom codes should be used for symptomatic patients and only U07.1 for asymptomatic patients. If testing has been ordered or results are pending, U07.1 + symptom codes should be used for a clinical diagnosis and Z03.818 should be used when a diagnosis is clinically uncertain. If testing is not available and the patient is clinically COVID-19 positive, U07.1 + symptom codes should be used. If the patient is clinically COVID-19 negative and testing is unavailable, Z03.818 + symptom codes should be used.
• If the patient presents for COVID-19 evaluation and has not had any known exposure, testing should still be completed. If the patient is asymptomatic and testing results are available, Z11.59 screening for asymptomatic code should be used for a negative result and U07.1 should be used for a positive result. If the patient is symptomatic and testing results are available, a U07.1 + symptom codes should be used for a positive result. If the result is negative, just the symptom codes should be entered unless clinical suspicion remains. In that case, U07.1 + symptom codes should be used. If the testing was ordered or the result are pending, U07.1 + symptom codes should be used for clinically diagnosed and just the symptom codes when a diagnosis is clinically uncertain. If testing is unavailable, U07.1 + symptom codes should be used for a clinically positive COVID-19 result and only the symptom codes for a clinically negative COVID-19 result.