Codes for COVID, EVALI Take Effect

COVID cases worldwide approached a million in number as April began.

Two new codes became effective for use on April 1; first, U07.1 (COVID-19) may be used for discharges and outpatient dates of service of April 1 and later.  

This code should be used so that COVID-19 cases can be identified. It is important to identify all such cases, as the federal and state governments are updating waivers for the pandemic. In some cases, co-payments may be waived. Also, remember to capture those cases for which patients are exposed to potential and confirmed cases of COVID-19 by using the coding guidance issued by the Centers for Disease Control and Prevention (CDC).   

The global numbers, as of April 1:

• WorldConfirmed Cases: 932,605
  • Deaths: 46,805
• United StatesConfirmed Cases: 213,372
  • Deaths: 4,757

Another code that became effective April 1 is U07.0 for the e-cigarette/vaping associated lung injury (EVALI). This is the lung condition associated with Vitamin E acetate in vaping products. The coding instructions are to also assign codes for manifestations, such as abdominal pain, acute respiratory distress syndrome (ARDS), or lipoid pneumonia.

The CDC has released the addendum for the Index and Tabular for the two new codes. There has been some discussion about U07.2, which would capture cases for which COVID-19 testing is inconclusive. This code has been presented and adopted by the World Health Organization (WHO) for ICD-10, but it has not been adopted for ICD-10-CM. The release of this code was too close to the Coordination and Maintenance Committee Meeting in March for the CDC to present the code for adoption.  

One question that has been posed is whether COVID-19 will always be the principal diagnosis. The recently released update to the Official Coding and Reporting Guidelines is that when COVID-19 meets the definition of principal diagnosis, then it should be listed as such. The exception to this guideline is for obstetrics cases. Another question that has been posed has to do with presumptive positive cases. This update has documented that presumptive positive cases should be coded as confirmed.

Another topic related to COVID-19 and EVALI is that your facility-specific coding guidelines should be updated to incorporate these two new conditions. Your guidelines should include which documentation is used to support COVID-19 cases, and if you have developed a special field or flag to identify these cases.

Provide education to coders regarding COVID-19 and EVALI coding. It is important to have a discussion with coding and clinical documentation specialists to determine where the documentation or coding gaps may be. It will be important to include the medical staff as you create a query template that can be used for these new diagnoses, based on that discussion.       

Also remember to update your chargemaster for the COVID-19 CPT® and HCPCS codes. Pricing has been published for these items.     

As we start the second quarter of 2020, remember to update all the coding and billing information and tools for COVID-19 and EVALI.

Stay safe!

Programming Note: Listen to Laurie Johnson report this story live today during Talk Ten Tuesdays, 10-10:30 a.m. EST.