Rev Leaders Are Still Eyeing COVID-19 Reporting – HealthLeaders Media

2022 brought many challenges for revenue cycle leaders, and COVID-19 reporting was no exception.

This past year was trying for hospitals for many reasons. From staffing shortages to financial challenges, revenue cycle leaders faced many trials in 2022.

One thing that is still top of mind for leaders though, is COVID-19 reporting. While COVID-19 might seem like old news at this point, its reporting and subsequent reimbursement is still of utmost importance. Because coding occurs mid-cycle, it provides an opportunity to catch errors introduced earlier in the process, as well as preventing similar errors in the future.

Staying abreast of these regulatory coding updates is important for revenue cycle leaders as coding—and its completeness and accuracy—has a profound impact on an organization’s bottom line.

Its importance was proven as our article on COVID-19 reporting hit one of the top spots for 2022. Here’s what you—and your middle revenue cycle—still need to know about reporting COVID-19 ICD-10-CM diagnosis codes.

Thanks to various code updates since the beginning of the pandemic, there is now a long list of COVID-19 diagnosis codes.

Here are the ICD-10-CM codes that specifically represent COVID-19:       

  • J12.82, pneumonia due to coronavirus disease 2019           
  • U07.1, COVID-19
  • U09.9, post COVID-19 condition, unspecified
  • Z11.52, encounter for screening for COVID-19
  • Z20.822, contact with and (suspected) exposure to COVID-19
  • Z28.310, unvaccinated for COVID-19
  • Z28.311, partially vaccinated for COVID-19
  • Z86.16, personal history of COVID-19

Make sure your teams keep in mind that specific documentation isn’t necessarily needed for COVID-19 code assignment.

The 2022 ICD-10-CM Official Guidelines for Coding and Reporting state that physicians do not have to specifically document “COVID-19” for code U07.1 (COVID-19) to be assigned.

Per ICD-10-CM guidelines, code only a confirmed diagnosis of COVID-19 as documented by the provider, or documentation of a positive COVID-19 test result.

This guideline allows U07.1 to be assigned if the documentation includes a positive COVID-19 laboratory result.

Coding Clinic, Second Quarter 2020, provided additional clarification on this, too. It said that the provider does not need to explicitly link the test result to the respiratory condition, the positive test results can be coded as confirmed COVID-19 cases as long as the test result itself is part of the medical record.

“As stated in the coding guidelines for COVID-19 infections that went into effect on April 1, code U07.1 may be assigned based on results of a positive test as well as when COVID-19 is documented by the provider. Please note that this advice is limited to cases related to COVID-19 and not the coding of other laboratory tests,” it said.

Never assume that COVID-19 was present on admission.

If a physician doesn’t specifically state a patient acquired the COVID-19 infection in your hospital, it is still not appropriate for your teams to assume it was present on admission. In fact, per the ICD-10-CM guidelines, a provider should be queried regarding issues related to the linking of signs/symptoms, timing of test results, and the timing of the findings.

There are COVID-19 vaccine codes for all hospital types: both inpatient and outpatient.

ICD-10-CM diagnosis codes for vaccine status are for all patient types. The vaccine CPT® codes are for outpatient reporting. There are also ICD-10-PCS codes for inpatient reporting of COVID-19 vaccines.

Amanda Norris is the Revenue Cycle Editor for HealthLeaders.