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Update #4 - April 14, 2020

The Rybar Group, Inc. is committed to providing you with timely, ongoing communication regarding reimbursement and payment related regulations and opportunities as they become available. 

Official Coding Guidelines for COVID-19 - April 1, 2020 through September 30, 2020 - for Facility Coding

Accurate code assignment is not only important for reporting, but also reimbursement. It's important to follow these coding rules and conventions in order to ensure optimal revenue for the care you're providing.

Code Assignment

Assignment of new ICD-10-CM diagnosis code U07.1, COVID-19, is as follows:

Code only confirmed cases (this is an exception to the current coding guidelines stating "probable" and "suspected" diagnoses may be coded as confirmed).
  • Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider, documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result. For a confirmed diagnosis, assign code U07.1, COVID-19.
  • Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or state level, but it has not yet been confirmed by the Centers for Disease Control and Prevention (CDC). CDC confirmation of local and state tests for COVID-19 is no longer required.
Exposure to COVID-19
  • For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, assign code Z03.818, encounter for observation for suspected exposure to other biological agents ruled out.
  • For cases where there is an actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.
Screening for COVID-19
  • For asymptomatic individuals who are being screened for COVID-19 and have no known exposure to the virus, and the test results are either unknown or negative, assign code Z11.59, Encounter for screening for other viral diseases.
  • When COVID-19 meets the definition of principal diagnosis, code U07.1, COVID-19, should be sequenced first, followed by the appropriate codes for associated manifestations, except in the case of obstetrics patients.
  • During pregnancy, childbirth or the puerperium, a patient admitted (or presenting for a health care encounter) because of COVID-19 should receive a principal diagnosis code of O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, followed by code U07.1, COVID-19, and the appropriate codes for associated manifestation(s).
For more detailed information, contact Julie Hardy, MSA, RHIA, CCS, Director of Revenue Integrity and Payment at jhardy@therybargroup.com or Anita Patel, RHIA, Revenue Integrity and Payment Consultant, at apatel@therybargroup.com.
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