Pandemic Results in Early Implementation of COVID-19 ICD-10-CM Code

In yet another unprecedented move, the Centers for Disease Control and Prevention (CDC) is issuing an off-cycle update to the ICD-10-CM code set to include a new diagnosis code of U07.1, COVID-19, for coronavirus disease 2019. This code was originally slated to go into effect on October 1, 2020, however, it is being implemented early due to the declared pandemic and the urgent need to collect this valuable information. The new effective date is April 1, 2020.

Prior to this move, the CDC had released supplemental ICD-10-CM coding guidance for reporting cases related to COVID-19. Healthcare providers should continue to follow these guidelines until the effective date of the new U07.1 code—again, April 1.

ICD-10-CM Supplemental Coding Guidance related to COVID-19

COVID-19 infections are often associated with symptoms ranging from mild to severe. The three common signs and symptoms most often associated with COVID-19 are:

  • Fever (R50.9)
  • Cough (R05)
  • Shortness of breath (R06.02)

For patients who present with any signs or symptoms where no definitive diagnosis has yet been established, the provider should assign and report the ICD-10-CM code that best accurately describes the presenting signs and symptoms.

If a patient develops other illnesses (such as pneumonia, acute bronchitis, or SARS) due to COVID-19, the following ICD-10-CM coding guidance is provided. In these cases, you would assign the appropriate code to describe the confirmed diagnosis along with B97.29, Other coronavirus, as the causes of diseases classified elsewhere. For example: 

  • Pneumonia—Assign code J12.89, other viral pneumonia, along with B97.29.
  • Acute Bronchitis—Assign codes J20.8, Acute bronchitis due to other specified organisms, along with B97.29.
  • Acute Respiratory Distress (ARDS) —Assign J80, Acute respiratory distress syndrome, along with B97.29.

Note: Do NOT use B97.29 if the provider documents a “suspected,” “possible,” or “probable” case of COVID-19.  In these cases, assign appropriate codes explaining reasons for the encounter (such as fever and cough) or Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.

ICD-10-CM code B34.2, Coronavirus infection, unspecified, would not generally be appropriate to use for COVID-19, since cases of COVID-19 have been universally respiratory in nature, thus the site of the infection would not be considered unspecified.

Finally, for patients who present with possible exposure to COVID-19 and that is later ruled out, the appropriate code to assign is Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. In cases where an actual exposure to someone who is confirmed to have COVID-19 did occur, it would be appropriate to assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.

Providers should stay alert to any updated guidance once the new ICD-10-CM code goes into effect.

Ron Orth

Senior Analyst: SNF Regulations and Clinical Reimbursement

Ron is a registered nurse with over 25 years experience in the healthcare field with 15 of those years in the long term care industry. Ron’s presentations on Medicare regulations, PPS, MDS and other topics of interest to the long-term care industry have been featured throughout the United States and in Canada. In addition, Ron has also completed all requirements with the American Health Information Management Association to qualify as an Approved ICD-10-CM Trainer and Ambassador.

Connect with Us

to find out more about our training and resources