2023 Official Coding and Reporting Guidelines for ICD-10-CM are effective with discharges/visits on Oct. 1, 2022.
The Centers for Medicare and Medicaid Services (CMS) released MLN Connects on July 7, 2022, with an article on long COVID. The article provides coding direction for code assignment for long COVID as well as current COVID infection. The article also cites the Official Coding and Reporting Guidelines for additional information.
Long COVID is coded with ICD-10-CM code U09.9 (Post COVID-19 condition, unspecified). Additional codes may be assigned for associated signs and symptoms of long COVID. This diagnosis code represents that the active COVID infection is completed, and that the patient has sequela. This code should not be confused with Z86.16 (Personal History of COVID-19).
According to the Official Coding and Reporting Guidelines for ICD-10-CM FY23, a patient may have a current infection as well as conditions associated with a previous COVID infection. In this situation, the patient should be assigned U07.1 (COVID-19) and U09.9. For a follow-up examination for a patient who has no signs and symptoms following COVID infection with negative test results should be assigned codes Z09 (Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm) and Z86.16.
Another recent release for coding guidance for COVID is American Hospital Association’s Coding Clinic, Second Quarter 2022, pg. 27 states that patients who seek prophylactic treatment (e.g., long-acting monoclonal antibodies) for COVID should be assigned Z29.8 (Encounter for other specified prophylactic measures). These patients may have severe allergy preventing vaccination against COVID or moderate to severe immunocompromised conditions and have had insufficient response to COVID vaccination.
According to the Official Coding and Reporting Guidelines for ICD-10-CM, the patient who presents for antibody testing that is not associated with confirming current COVID infection should be assigned Z01.84 (Encounter for antibody response examination). The patient who presents for testing to confirm a current COVID infection should be assigned Z20.822 (Contact with and [suspected] exposure to COVID-19). During the pandemic, it is not appropriate to assign Z11.52 (Encounter for screening for COVID-19).
ICD-10-CM codes were added in April 2022 regarding vaccination status. These codes are now included in the Official Coding and Reporting Guidelines for ICD-10-CM. Z38.310 (Unvaccinated for COVID-19) is assigned to the patient who has not had any vaccinations for COVID. Z38.311 (Partially vaccinated for COVID-19) is assigned to patients who have not completed their vaccination process based on the Centers for Disease Control and Prevention (CDC) guidance.
Current COVID infections are assigned diagnosis code U07.1. It is appropriate to code additional signs and symptoms associated with the condition. It may be necessary to query the provider regarding significance of associated conditions or if they are actually due to COVID.
The guidelines also state that only confirmed cases should be coded with U07.1. The guidelines continue by saying that confirmation does not necessarily mean a positive test. The provider’s documentation that the patient has COVID is sufficient to code U07.1.
The coding guidance continues to change. It is important to remain current in the coding of this condition and update your facility specific coding guidelines.
Listen to Laurie Johnson’s live reporting on the new ICD-10-CM Official Coding and Reporting Guidelines for FY 23 during today’s Talk Ten Tuesdays at 10 Eastern.
MLN Connects 07/07/2022: 2022-07-07-MLNC | CMS
Official Coding and Reporting Guidelines ICD-10-CM FY23: ICD-10-CM Guidelines FY 2023 (cms.gov)
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