COVID-19 coding for outpatient and physician services

April 20, 2020 / By Colleen Deighan, RHIA

As we work to slow the spread of COVID-19, we have learned that many people may be sick with the virus for 1-2 weeks prior to developing symptoms. The most common symptoms are fever, dry cough and shortness of breath. According to the Centers for Disease Control and Prevention (CDC) 80 percent of people recover from the disease without needing any special treatment. The CDC also indicated that up to 25 percent of people infected with COVID-19 may have no symptoms but can unknowingly transmit the disease to others.

As a coding professional focused on outpatient and physician services, I want to share some information about ICD-10-CM coding for patients presenting with symptoms, exposure and a need for screening for COVID-19. 

First, if the patient presents with symptoms and no confirmed diagnosis of COVID-19 at the time of encounter, assign code(s) for each presenting symptom.
Next, if there is a concern that the patient has been exposed to COVID-19 but signs or symptoms and a negative COVID-19 test, assign code Z03.818, Encounter for observation for suspected exposure to other biological agents, ruled out.
Third, if the patient has had actual exposure to someone who is confirmed or suspected to have COVID-19 and their test result is negative or unknown, there are two possible coding scenarios to be considered:

If the patient is symptomatic: assign a code for each symptom as well as code Z20.828, Contact with and (suspected) exposure to other virial communicable disease.
If the patient is asymptomatic, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable disease.

Lastly, if the patient is asymptomatic and has no known exposure to COVID-19, assign code Z11.59, Encounter for screening for other viral diseases.

On March 31, 2020, the National Center for Health Statistics (NCHS) posted updated ICD-10-CM Official Coding Guidelines for COVID-19 April 1, 2020 through September 30, 2020. Based on these new coding guidelines, the slide from my presentation during the “3M Special Webinar Series COVID-19: Implications for HIM and CDI” has been updated to reflect the new guidance:

Stay tuned for more information on COVID-19 as updates become available.

Colleen Deighan, RHIA, CCS, CCDS-O, is a consultant with 3M Health Information Systems.

During a pandemic, healthcare information is gathered, studied, and published rapidly by scientists, epidemiologists and public health experts without the usual processes of review. Our understanding is rapidly evolving and what we understand today will change over time. Definitive studies will be published long after the fact. 3M Inside Angle bloggers share our thoughts and expertise based on currently available information.