If you’ve been keeping up to date on your Coding Clinic subscription and coding guidelines, you know that coding advice for COVID-19 keeps changing.  As coders, we know it’s imperative to keep our eyes peeled for new codes, updated guidance, and evolving disease processes, but COVID-19 has taken this to a new level with changing advice on a bimonthly basis.  And just in case you are about to stop reading here thinking you are current on COVID, beware: the CDC isn’t done messing with codes related to COVID-19.

What’s New for 2021?

The 2021 ICD-10-CM Official Guidelines for Coding and Reporting incorporated the April 1, 2020 guidelines for coding COVID-19 with revisions.  If you haven’t reviewed the new section on COVID-19 codes, stop what you are doing immediately and read them.  Here is a brief bulleted list of the changes from April to the October update:

  • Removal of the statement about coding presumptive positive cases as confirmed: A presumptive positive test meant that the patient tested positive at the local or state level, but the test result had not yet been confirmed by the CDC. Presumptive positive tests no longer need to be sent to the CDC for confirmation, so the April guideline is now invalid.
  • Removal of guidance to use a screening code (Z11.59) for asymptomatic patients. These patients are now reported using the code for exposure (Z20.828) because during the COVID-19 pandemic, a screening code is generally not appropriate and the guidelines include a statement that, “Coding guidance will be updated as new information concerning any changes in the pandemic status becomes available.”  At the September Coordination and Maintenance Meeting, Nelly Leon-Chisen from the American Hospital Association noted that this statement indicates this guideline will change in the future.  Case in point: a specific screening code for COVID-19 could be coming soon.
  • Additional guidelines have been included in the fiscal year 2021 update to give guidance on coding for personal history of COVID-19, follow-up visits after COVID-19 infection has resolved, and encounters for antibody testing.

At Haugen Consulting Group, we’ve taken the guesswork out of the coding changes by updating our COVID-19 Decision Tree and Coding Tip Sheet.

Watch Reference Dates

Per usual, Coding Clinic for ICD-10-CM includes additional coding advice that is not addressed in the guidelines.  It is imperative that you refer to the encounter dates of service and make note of effective dates for your references when applying information.  The April guidelines were obviously effective April 1, 2020 and the 2021 guidelines were effective October 1, 2020.  But Coding Clinic issues from second and third quarters of 2020 include conflicting information with the third quarter issue paving the way for the 2021 guideline changes.  Second quarter Coding Clinic advice on COVID-19 was effective with discharges as of April 1, 2020 while the third quarter issue was effective with discharges on or after September 8, 2020.

What’s Coming?

I mentioned in my opening statement that the CDC isn’t done with the COVID-19 codes.  A series of new codes were proposed at the September 2020 meeting of the Coordination and Maintenance Committee.  The following codes have been proposed for implementation in January 2021 – a timeline that is out of whack with even our emerging conditions and technology updates that may be implemented every year in April, if necessary.

Z11.52 Encounter for screening of COVID-19
Z20.822 Contact with and (suspected) exposure to COVID-19
Z86.16 Personal history of COVID-19
M35.81 Multisystem inflammatory syndrome
M35.89* Other specified systemic involvement of connective tissue
J12.82 Pneumonia due to coronavirus disease 2019
*Note: this code is not COVID-related, but by expanding code M35.8 to specifically break out multisystem inflammatory syndrome, which is associated with COVID-19, an other specified code also was created to describe other systemic involvement of the connective tissue.

Want to Learn More?

Check out the recorded webinar, 2021 ICD-10-CM Updates, where I discussed the new COVID-19 coding guidelines and stay tuned to Haugen Consulting Group for more updates.

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Senior Consultant

Kristi is a senior consultant with more than 20 years of industry experience. She develops and delivers training on ICD-10-CM/PCS and CPT, both virtually and in classroom settings.
Kristi also performs DRG and APC audits and is known for her vast knowledge on coding vascular interventional radiology procedures. Kristi has an extensive background in coding education and consulting and is a national speakers on topics related to ICD-10 and CPT coding as well as code-based reimbursement.


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