The following are the guidelines by which we in the medical industry use to report the diagnoses to the insurance companies (and also to entities that are tracking morbidity, such as CDC, WHO & whomever.
There are NO instructions on Covid as an incidental diagnosis or a diagnosis in addition to symptoms. It's all predicated on the ideology that Covid is the presumed cause of the illness, such as pneumonia "due to" Covid. These are the guidelines that medical coders are to use when coding: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2021, published both by the CDC and also by CMS.
You can find it here if you want. ICD-10-CM FY2021 Guidelines
This link will lead you to the Covid-specific diagnosis codes to use. ICD-10-CM Official Coding and Reporting GuidelinesApril 1, 2020 through September 30, 2020
Notice the dates. The information below is what was published and instructed for use AFTER Sept 30, 2020, so it's now what is currently in place.
In short a patient is either presumed to have a manifestation of Covid in another comorbid condition ("due to Covid") OR it's an illness without Covid, period and even if Covid is present, it's not reported as there is no code for Covid incidental. For example: There's no code for a patient having pneumonia caused by or due to strep B and oh, by the way, also has Covid. The pneumonia is presumed to have been caused by the Covid & Strep B be damned. Therefore, the code for Covid would be listed FIRST (as the cause) followed by the manifestation of Covid (Pneumonia) and anything else the patient has (Strep B) - even if Strep B was actually the cause.
The instruction is simply flawed, never mind that we see asymptomatic patients all the time who test positive for Covid.
Make of this what you will. See item (g) below, you'll see what I mean. "Coronavirus infections
1) COVID-19 infection (infection due to SARS-CoV-2)
(a) Code only confirmed cases Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider or documentation of a positive COVID19 test result. For a confirmed diagnosis, assign code U07.1, COVID-19. This is an exception to the hospital inpatient guideline Section II, H. In this context, “confirmation” does not require documentation of a positive test result for COVID-19; the provider’s documentation that the individual has COVID-19 is sufficient.
If the provider documents "suspected," "possible," "probable," or “inconclusive” COVID-19, do not assign code U07.1. Instead, code the signs and symptoms reported. See guideline I.C.1.g.1.g.
(b) Sequencing of codes 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 when another guideline requires that certain codes be sequenced first, such as obstetrics, sepsis, or transplant complications.
For a COVID-19 infection that progresses to sepsis, see Section I.C.1.d. Sepsis, Severe Sepsis, and Septic Shock See Section I.C.15.s. for COVID-19 infection in pregnancy, childbirth, and the puerperium See Section I.C.16.h. for COVID-19 infection in newborn For a COVID-19 infection in a lung transplant patient, see Section I.C.19.g.3.a. Transplant complications other than kidney.
(c) Acute respiratory manifestations of COVID-19 When the reason for the encounter/admission is a respiratory manifestation of COVID-19, assign code U07.1, COVID-19, as the principal/first-listed diagnosis and assign code(s) for the respiratory manifestation(s) as additional diagnoses. The following conditions are examples of common respiratory manifestations of COVID-19.
(i) Pneumonia For a patient with pneumonia confirmed as due to COVID-19, assign codes U07.1, COVID-19, and J12.89, Other viral pneumonia.
(ii) Acute bronchitis
For a patient with acute bronchitis confirmed as due to COVID-19, assign codes U07.1, and J20.8, Acute bronchitis due to other specified organisms. Bronchitis not otherwise specified (NOS) due to COVID-19 should be coded using code U07.1 and J40, Bronchitis, not specified as acute or chronic.
(iii) Lower respiratory infection If the COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, codes U07.1 and J22, Unspecified acute lower respiratory infection, should be assigned. If the COVID-19 is documented as being associated with a respiratory infection, NOS, codes U07.1 and J98.8, Other specified respiratory disorders, should be assigned.
(iv) Acute respiratory distress syndrome For acute respiratory distress syndrome (ARDS) due to COVID-19, assign codes U07.1, and J80, Acute respiratory distress syndrome.
(v) Acute respiratory failure For acute respiratory failure due to COVID-19, assign code U07.1, and code J96.0-, Acute respiratory failure. (d) Non-respiratory manifestations of COVID-19 When the reason for the encounter/admission is a non-respiratory manifestation (e.g., viral enteritis) of COVID-19, assign code U07.1, COVID-19, as the principal/first-listed diagnosis and assign code(s) for the manifestation(s) as additional diagnoses.
(e) Exposure to COVID-19 For asymptomatic individuals with actual or suspected exposure to COVID-19, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. For symptomatic individuals with actual or suspected exposure to COVID-19 and the infection has been ruled out, or test results are inconclusive or unknown, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. See guideline I.C.21.c.1, Contact/Exposure, for additional guidance regarding the use of category Z20 codes.
If COVID-19 is confirmed, see guideline I.C.1.g.1.a.
(f) Screening for COVID-19 During the COVID-19 pandemic, a screening code is generally not appropriate. For encounters for COVID-19 testing, including preoperative testing, code as exposure to COVID-19 (guideline I.C.1.g.1.e).
Coding guidance will be updated as new information concerning any changes in the pandemic status becomes available.
(g) Signs and symptoms without definitive diagnosis of COVID-19 For patients presenting with any signs/symptoms associated with COVID-19 (such as fever, etc.) but a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as: • R05 Cough • R06.02 Shortness of breath • R50.9 Fever, unspecified
If a patient with signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to COVID-19, assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, as an additional code.
(h) Asymptomatic individuals who test positive for COVID-19 For asymptomatic individuals who test positive for COVID-19, see guideline I.C.1.g.1.a. Although the individual is asymptomatic, the individual has tested positive and is considered to have the COVID-19 infection.
(i) Personal history of COVID-19 For patients with a history of COVID-19, assign code Z86.19, Personal history of other infectious and parasitic diseases.
(j) Follow-up visits after COVID-19 infection has resolved For individuals who previously had COVID-19 and are being seen for follow-up evaluation, and COVID-19 test results are negative, assign codes Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, and Z86.19, Personal history of other infectious and parasitic diseases.
(k) Encounter for antibody testing For an encounter for antibody testing that is not being performed to confirm a current COVID-19 infection, nor is a follow-up test after resolution of COVID-19, assign Z01.84, Encounter for antibody response examination.
Follow the applicable guidelines above if the individual is being tested to confirm a current COVID-19 infection.
For follow-up testing after a COVID-19 infection, see guideline I.C.1.g.1.j."
Wow
I figured that was what is going on
Thnx