COVID-19: Factual Clinical & Coding Information

March 11, 2020

The data provided below is accurate as of March 11, 2020, and is subject to change. 

While the globe is abuzz with concerns related to COVID-19, now is an important time to get up to speed on the facts of COVID-19 and how to code the condition. The facts listed below are based solely on the Center for Disease Control’s (CDC’s) Coronavirus Disease 2019 website and the CDC’s ICD-10-CM Official Coding Guidelines – Supplement regarding Coding encounters related to COVID-19 Coronavirus Outbreak, Effective: February 20, 2020. All referenced material can be found on those sites by following the links provided below. Additional information can be found on the Intellis IQ Center, our HIM education portal.

The Clinical Facts

Coronaviruses impact humans, other mammals, and birds. They are identified in the lab based on the spike-like protrusions on the surface of the virus. In humans, this family of viruses manifests as respiratory tract infections while the symptoms present differently in other species. In humans, we have seen several other coronaviruses impact the globe, including SARS (sudden acute respiratory syndrome) and MERS (Middle East Respiratory Syndrome). COVID-19 is a new or “novel” strain which means that what we know and understand about this virus is ever-changing as testing increases and research paints a clearer picture of transmission and at-risk populations. Currently, we know that the presenting symptoms of COVID-19 consist of fever, cough, and shortness of breath. Quarantines are typically 14 days because the virus itself takes anywhere between 2-14 days to show symptoms.

Medicine’s current understanding of transmission is that, like most viruses, COVID-19 spreads through close contact and droplet exposure. Close contact is defined by the Center for Disease Control (CDC) as within 6 feet. Since you cannot often visualize your exposure to droplets, following strict precautionary activities is essential to protect yourself and your family from the spread of the virus. According to the CDC, “COVID-19 seems to be spreading easily and sustainably in the community.” 

Prevention consists of:

  • Frequent handwashing for a minimum of 20 seconds or use of a hand sanitizer solution with a minimum of 60% ethyl alcohol.  
  • Cleaning frequently touched surfaces (tables, office or kitchen chairs, light switches) or items (keyboards, pens) with CDC-recommended chemicals or make your own virus-fighting solutions of 4 teaspoons household bleach with 1 quart of water.
  • Avoiding people and pets when you have any symptoms of any infection. There is no current evidence to suggest that animals can spread COVID-19 but infected persons should limit interactions until more research is available. 
  • Cover your mouth and nose when you sneeze…even if you feel sure it’s “just allergies.”  
  • For the sake of completeness, it’s important to reiterate, wash your hands for a minimum of 20 seconds with soap and dry completely. 

The CDC does not recommend the use of facemasks to prevent the spread of COVID-19. Facemasks should be utilized under the direction of a healthcare provider for those with the virus, healthcare workers, and caregivers in close proximity to an infected patient. 

Not everyone who contracts COVID-19 will show extreme symptoms. This virus can produce a range of symptoms from very mild to severe and life-threatening. Those at higher risk of severe illness include the elderly and those with serious chronic medical conditions. If you experience symptoms of COVID-19, contact your healthcare provider to advise whether you should present for evaluation or remain at home. 

As of March 10, 2020, the CDC has released that the U.S. has 647 total cases of COVID-19 with 25 deaths. Individuals can stay updated on current rates by visiting https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html where rates are updated daily at noon Monday through Friday. As of late February, state public health labs have begun performing the bulk of the COVID-19 testing. This was previously done exclusively by the CDC. 

Coding COVID-19

Since coronaviruses have existed in other iterations, ICD-10-CM was prepared with a code for “other coronavirus as the cause of diseases classified elsewhere” (B97.29). The CDC guidance provided on February 20, 2020, recommends that the coder first code the disease complication caused by COVID-19 (examples in their advice include conditions such as pneumonia or acute bronchitis) followed by the code for the virus. Much like coding of other specific viruses (Zika, H1N1, or HIV), the CDC guidance specifies, “if the provider documents ‘suspected’, ‘possible’ or ‘probable’ COVID-19, do not assign code B97.29. Assign a code(s) explaining the reason for encounter (such as fever, or Z20.828)” (Retrieved from https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf). Codes are also advised by the CDC for possible or confirmed exposure to COVID-19.

The CDC responded promptly regarding appropriate coding of the virus which may reinforce the value of accurately reporting clinical data. Currently, tracking of this virus by the CDC has been based on the confirmation of laboratory testing at U.S. public health labs.   

References: 

Coronavirus Disease 2019 (COVID-19). Retrieved on March 10, 2020, from https://www.cdc.gov/coronavirus/2019-nCoV/index.html

ICD-10-CM Official Coding Guidelines- Supplement. “Coding Encounters related to COVID-19 Coronavirus Outbreak, Effective February 20, 2020.” Retrieved on March 10, 2020, from https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf

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