The Centers for Disease Control and Prevention (CDC) recently released official diagnosis coding guidance for health care encounters and deaths related to the 2019 novel coronavirus (COVID-19), potentially in anticipation of more frequent cases in the United States. The guidance identifies specific ICD-10-CM codes to be used to code encounters.
CDC advises that patients presenting with certain signs and symptoms, but where a definitive diagnosis has not been made, should be coded as follows:
R05 – Cough
R06.02 – Shortness of breath
R50.9 – Fever, unspecified
For pneumonia cases confirmed as due to COVID-19, providers should use J12.89, Other viral pneumonia, and B97.29, Other coronavirus as the cause of diseases classified elsewhere.
For acute bronchitis confirmed as due to COVID-19, CDC advises providers to use J20.8, Acute bronchitis due to other specified organisms, or J40, Bronchitis not otherwise specified. In both instances, the provider should also use B97.29.
For lower respiratory infection or acute respiratory infections not otherwise specified that are documented as being associated with COVID-19, CDC recommends using code J22, Unspecified acute lower respiratory infection. If the COVID-19 is documented as being associated with a respiratory infection not otherwise specified, CDC advises that it would be appropriate to use code J98.8, Other specified respiratory disorders. Acute respiratory distress syndrome should be assigned code J80, Acute respiratory distress syndrome. These codes should also be used with B97.29.
Where a patient is evaluated following concern of possible exposure to COVID-19, but COVID-19 is ruled out, CDC advises using Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. If the patient has actual exposure to COVID-19, the provider should assign Z20.828, Contact with and (suspected) exposure to other viral and communicable diseases. B97.29 should not be used where the provider documents “suspected,” “possible” or “probable” COVID-19.
Additional information can be found here.