COVID-19 is the collective term for all respiratory infections caused by SARS-CoV-2. The diagnostic criterion is a positive COVID-19 test result or a definitive clinical diagnosis of COVID-19 by a clinician even in the absence of a positive test. In the latter case, the clinician should explain her clinical reasoning for the diagnosis.
The coding of COVID-19 is a bit complicated. The ICD-10-CM code for diseases caused by SARS-CoV-2 2019 is U07.1 (COVID-19). Only confirmed cases of COVID-19, as defined above, are coded U07.1, so this code is never used when the diagnosis is qualified with terms of uncertainty like “suspected,” “probable,” “likely,” etc. (A “presumptive positive test” does not represent such uncertainty, since it refers to a test that has been reported positive by a local or state laboratory but not confirmed by the CDC. Since confirmation by the CDC is no longer required, however, the term is already outdated and unnecessary for documentation.)
When COVID-19 is definitively diagnosed before test results are available and the test result subsequently comes back negative, a coder should query for clarification to allow the clinician to reconsider and reaffirm the diagnosis or document disagreement with a negative test result. For correct coding, it is recommended that claims not be submitted until a patient's COVID-19 test results are available.
When COVID-19 meets the definition of principal diagnosis, code U07.1 is assigned first, followed by the appropriate codes for the associated manifestations (see Table). The only exception is when COVID-19 causes sepsis, in which case viral sepsis (A41.89) is sequenced first.
Cytokine release syndrome (CRS), also known as cytokine storm, is an acute systemic inflammatory syndrome characterized by fever and multiple-organ dysfunction, and it is often fatal. It is a complication that has historically had a well-known association with chimeric antigen receptor T-cell therapy, certain therapeutic antibodies, and haploidentical allogeneic transplantation. CRS is now recognized as a not uncommon complication of COVID-19, with onset ranging from early in the COVID-19 disease course to several weeks after COVID-19 symptoms have resolved.
When possible COVID-19 exposure is a concern but ruled out after evaluation, assign code Z03.818, encounter for observation for suspected exposure to other biological agents ruled out. For cases of actual exposure to someone who is confirmed or suspected to have COVID-19 when the exposed person has tested negative or test results are unknown, assign code Z20.828, contact with and (suspected) exposure to other communicable disease. If the exposed individual tests positive for SARS-CoV-2, COVID-19 (U07.1) is confirmed.
If an asymptomatic individual with no known exposure to the virus is screened for COVID-19 and the test result is negative or unknown, assign code Z11.59, encounter for screening for other viral diseases. For asymptomatic persons who test positive for the virus, assign U07.1 (COVID-19).
For COVID-19 infections presenting during pregnancy, childbirth, or the puerperium, assign a code from O98.5, other viral diseases complicating pregnancy, childbirth, and the puerperium, followed by U07.1 and the pertinent code for the associated infection.