COVID-19 coding guidance has changed several times since the start of the public health emergency. Coding professionals must review current guidance to report diagnoses correctly and avoid errors.
The American Hospital Association (AHA) Central Office provides official guidance on medical coding for ICD-10-CM/PCS and HCPCS coding for hospital providers. The AHA Coding Clinic on ICD-10-CM/PCS remains an important resource for health information management (HIM), coding, and clinical documentation improvement (CDI) professionals.
AHA Coding Clinic and COVID-19 Coding
The first-quarter 2021 issue of the AHA Coding Clinic included COVID-19 coding FAQs and updated Official Guidelines for Coding and Reporting.
The COVID-19 FAQ was developed through collaboration between the AHA and the American Health Information Management Association (AHIMA).
Coding professionals should monitor AHA and AHIMA updates for revised COVID-19 guidance. The guidance can affect code selection, sequencing, and documentation requirements.
How to Code COVID-19-Associated Pneumonia
One important FAQ addresses patients who have COVID-associated pneumonia but receive a negative COVID-19 test result.
Question: How should an encounter or admission for COVID-associated pneumonia be coded when the patient’s latest COVID-19 test is negative?
Answer: The guidance cited in the 2021 Coding Clinic assigns U07.1, COVID-19, as the principal or first-listed diagnosis. The provider should also report J12.82, Pneumonia due to coronavirus disease 2019, as an additional diagnosis.
The guidance explains that pneumonia represents an acute manifestation of COVID-19. Therefore, coders should report U07.1 first when the documentation establishes COVID-19 as the cause.
The most recent test result does not by itself determine code assignment in this scenario. Coders should follow the applicable Official Guidelines and Coding Clinic guidance.
New COVID-19 ICD-10-CM Codes for 2021
Several new ICD-10-CM codes became effective on January 1, 2021.
These included:
- J12.82 — Pneumonia due to coronavirus disease 2019
- M35.81 — Multisystem inflammatory syndrome
- Z20.822 — Contact with and (suspected) exposure to COVID-19
- Z86.16 — Personal history of COVID-19
New ICD-10-PCS codes also became available for certain procedures related to COVID-19 and other clinical services.
Other Coding Clinic Topics
The Coding Clinic issue also included an “Ask the Editor” section. It addressed several ICD-10-CM coding questions.
Examples included:
- Pseudoseizure and R56.9
- Multiple sclerosis and peripheral neuropathy
- Multiple sclerosis (G35)
- Polyneuropathy in diseases classified elsewhere (G63)
- Chronic hepatic failure (K72.10)
- Toxic metabolic encephalopathy (G92)
The issue also included ICD-10-PCS guidance for several procedures.
Examples included:
- Spacer placement for decompression
- Sentinel embolic protection device placement
- Total proctocolectomy with J-pouch creation
Why Coding Professionals Should Review Coding Clinic
Coding guidelines can change as clinical and reporting requirements evolve. A coding team should therefore review new Coding Clinic issues and applicable official guidance regularly.
Regular review can help organizations:
- Identify coding changes
- Improve coding accuracy
- Reduce inconsistent code assignment
- Support CDI efforts
- Strengthen internal coding education
- Identify potential audit risks
- Improve documentation practices
Coding teams should also distinguish between official guidelines, Coding Clinic advice, payer requirements, and other educational resources.
Recommended Steps for HIM and CDI Teams
Organizations can create a structured process for reviewing new coding guidance.
1. Review the New Coding Clinic Issue
Give coding and CDI professionals enough time to read the relevant sections. A 20- to 30-day review period can help teams complete the process without disrupting daily work.
2. Discuss Important Changes
Schedule a team discussion after the review. Focus on guidance that affects your organization’s coding practices.
3. Submit Unresolved Questions
Discuss unclear scenarios with the coding team. When questions remain, consider submitting appropriate coding questions through the AHA Coding Clinic process.
4. Monitor COVID-19 Updates
Assign staff to monitor AHA and AHIMA updates regularly. COVID-19 guidance has changed over time, so teams should avoid relying on outdated references.
5. Conduct a Coding Audit
Review applicable encounters after implementing new guidance. An internal or external audit can identify coding patterns that need correction.
6. Educate and Reaudit
Use audit findings to educate coding and CDI staff. Then perform a follow-up audit to determine whether the education improved coding accuracy.
7. Prepare for the Next Update
Make Coding Clinic review part of the organization’s regular coding education program.
AHA Coding Clinic as a Coding Resource
The AHA Coding Clinic provides valuable guidance for coding professionals. Its content can help teams understand complex ICD-10-CM and ICD-10-PCS scenarios.
Access to the publication requires a subscription. However, coding professionals can also submit certain coding questions through the AHA’s online process.
Healthcare organizations should always use the most current applicable coding guidelines. They should also verify requirements that apply to their specific healthcare setting and payer.
Conclusion
COVID-19 coding requires careful attention to current ICD-10-CM guidelines and Coding Clinic guidance. The 2021 updates introduced several important codes, including J12.82, M35.81, Z20.822, and Z86.16.
Coding teams should review new guidance, educate staff, audit affected encounters, and monitor future updates. A structured process can help organizations maintain accurate and consistent coding practices.