CDC Releases Updated Guidelines

The guidelines are effective from Jan. 1, 2021 through Sept. 30, 2021.

On Dec. 16, 2020, the Centers for Disease Control and Prevention (CDC) released updated ICD-10-CM Official Coding and Reporting Guidelines for 2021. The updated document can be found on the CDC website. The changes are focused on COVID-19 (Chapters 1, 15, and 16) and Vaping-Related Disorder (Chapter 10). The guidelines are effective from Jan. 1,2021 through Sept. 30, 2021.

In Chapter 1 (Infectious and Parasitic Diseases), the guidance states that only confirmed COVID-19 cases should be assigned U07.1. The documentation to support the diagnosis is created by the provider. A positive test result is not required. If COVID-19 is possible, probable, or likely, assign codes for the presenting symptoms.

The code sequencing related to COVID should be assigned as the principal diagnosis when the patient’s presentation meets the definition. If another coding guideline or instruction requires different sequencing, then the coder should follow the instruction. If the reason for the encounter is respiratory manifestations, assign U07.1 as the principal diagnosis. Here are some examples:

  • Pneumonia – U07.1 and J12.82
  • Acute bronchitis – U07.1 and J20.8
  • Bronchitis NOS – U07.1 and J40
  • Acute lower respiratory infection – U07.1 and J22
  • Lower respiratory infection – U07.1 and J98.8
  • Acute respiratory distress syndrome – U07.1 and J80
  • Acute respiratory failure – U07.1 and J96.0-

If the patient has non-respiratory manifestations of COVID, then assign U07.1, with codes for those manifestations.

If the patient has had exposure to COVID-19 and is asymptomatic, then assign Z20.822. If the patient is symptomatic, but infection has been ruled out, the same code is assigned. For patients who are screened during the pandemic, it is not appropriate to assign Z11.52 (Screening for COVID-19). The guidelines state that the exposure code for testing should be assigned, Z20.822. The code would be assigned for pre-operative testing. If the patient has signs and symptoms and is without a definitive diagnosis, then assign codes for the presenting signs and symptoms. If the patient has had contact with a suspected or actual COVID case, assign the exposure code. If the patient is asymptomatic and has a positive test, then assign U07.1, as the patient is considered to have COVID-19.

If the patient has a personal history of COVID-19, then assign Z86.16. If the patient presents for a follow-up visit after COVID-19 has resolved, then assign Z09 (encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm) and Z86.16 (Personal history of COVID-19). If the patient presents for antibody testing, then assign Z01.84.

For patients who have been diagnosed with multisystem inflammatory syndrome (MIS), assign U07.1 and M35.81. If MIS develops after the COVID infection, then assign M35.81 and B94.8. If MIS develops with a history of COVID-19 and there is no relationship between the two conditions, then assign M35.81 and Z86.16. If MIS develops after an exposure to COVID-19, then assign M35.81 and Z20.822.

The sequencing is impacted for pregnancies and newborns. For COVID-19 diagnosed during pregnancy, assign O98.5- and U07.1. If the encounter is unrelated to COVID-19, but the patient tests positive during the encounter, assign O98.5- and U07.1 as secondary diagnoses. For newborns diagnosed with COVID-19, the Z38 category code would be assigned as the principal diagnosis and U07.1 would be a secondary diagnosis.  If COVID-19 is documented as contracted in-utero or during the birth process, then assign P35.8 and U07.1.

Another topic that was included in the guideline update was vaping-related disorder. For conditions related to vaping, assign U07.0. Assign codes for additional manifestations, such as acute respiratory failure. Codes for associated respiratory signs and symptoms due to vaping are not separately assigned when a definitive diagnosis has been established. It would be appropriate to code for signs and symptoms of other body systems, such as gastrointestinal.

This guideline update provides needed insight to the new ICD-10-CM codes for COVID-19 and vaping. Happy New Year!

Programming Note: Listen to Laurie Johnson report this story live today during Talk Ten Tuesdays at 10 a.m. Eastern.



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