At the beginning of the COVID-19 pandemic, ICD-10 coding recommendations for COVID-19 changed during the period of February 20-April 1, 2020. Many regions suspended billing requirements to ease the burden on healthcare workers caring for the surge of people ill with HIV. In using ICD-10 codes for search purposes, we must think carefully about the impacts of changes in coding and relaxed billing requirements (in addition to test availability) on how individuals are classified with COVID-19 using electronic health records. Here is a timeline of events from February 20-April 1:

February 20, 2020: The CDC releases guidelines for coding encounters related to COVID-19 using existing ICD-10 codes; the guidance recommends use of “other” codes for those confirmed with COVID-19 in the categories of pneumonia, acute bronchitis, lower respiratory infections, acute respiratory distress syndrome, “contact with and (suspected) exposure to other viral communicable diseases;” when a definitive diagnosis for COVID-19 has not been established, the routine codes for cough (R04), shortness of breath (R06.02) and fever unspecified (R50.9) should be noted. Suspected cases were not to be reported. It is important to note that this guidance was based on testing, guidelines for which required travel or close contact with someone who had recently traveled to Wuhan, China, in addition to symptoms.

Recommended codes for COVID-19 in the US from Feb 20-April 1, 2020:

  • Pneumonia:
    • J12.89 Other viral pneumonia AND B97.29 Other coronavirus as the cause of diseases classified elsewhere
  • Acute Bronchitis
    • J20.8 Acute bronchitis due to other specified organism AND B97.29 Other coronavirus as the cause of diseases classified elsewhere
    • J40 Bronchitis not specified as acute or chronic AND B97.29 Other coronavirus as the cause of diseases classified elsewhere
  • Lower respiratory infection
    • J22 Unspecified acute lower respiratory infection AND B97.29 Other coronavirus as the cause of diseases classified elsewhere
    • J98.8 Other respiratory disorders AND B97.29 Other coronavirus as the cause of disease and classified elsewhere
  • Acute respiratory distress syndrome (ARDS)
    • J80 Acute respiratory distress syndrome AND B97.29 Other coronavirus as the cause of diseases classified elsewhere
  • Exposure to COVID-19
    • Z03.818 Encounter for observation for suspected exposure to other biological agents ruled out
    • Z20.828 Contact with and (suspected) exposure to other viral communicable Diseases
  • Signs and symptoms
    • R05 Cough
    • R06.02 shortness of breath
    • R50.9 Fever, unspecified
  • INAPPROPRIATE CODES:
    • B34.2 Coronavirus infection unspecified would NOT be appropriate for COVID-19
    • If the person is considered suspected, possible, or probable case of COVID-19 do not assign code B97.29; rather, assign a code that explains the reason for the encounter (e.g. fever or Z20.828)

March 18: The CDC states it will roll out a new diagnosis code (U01.7) for COVID-19 on April 1. (See announcement at https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-3-18-2020.pdf)

April 1: ICD-10 codes (U07) established and available for use specific to COVID-19 (see https://www.cdc.gov/nchs/data/icd/ICD-10-CM-April-1-2020-addenda.pdf)

  • U07.1 COVID-19 virus identified (for those who tests positive for SARS-Cov-2)
  • U07.2 COVID-19 virus not identified

Note that many clinicians reported these codes were not available in their electronic health record systems as of April 1, 2020; length of delays differed by system.

Additional resources for electronic health record-based algorithms for COVID-19: