COVID-19

Stacie.coy@maryrutan.org

I was presented with some questions from our Chief of Staff this morning and I'm curious how other facilities are handling certain scenarios.  If a patient comes in for lab testing and they have the symptoms listed to code and then after the fact, they have a confirmed positive result, do we go back afterward and get additional documentation to code the COVID-19?  

Thanks,

subherwal31@gmail.com

When we found out about the new COVID-19 code going into effect on April 1st, the Coding manager and I discussed what the physician needs to document if the lab results do come back positive. We have requested the physicians to document "Confirmed COVID-19 case" or something to that effect, so that the coders can capture the code. We have also informed the physicians that we will be sending retroqueries to them if a patient is discharged before the test results are back. According to my Coding Manager, the term "confirmed" is very important, and his coders will not pick up the diagnosis if the physician documents "possible", "probable" or "suspected".

Stacie.coy@maryrutan.org

Thank you for your response.  This is very helpful!

sarah_wicks@urmc.rochester.edu

We have a question about the Z codes for COVID-19. Some of the coders feel the Z03.818 is just for outpatient and the Z20.828 is for inpatient.  If you look at the two descriptions that are much different. 

Exposure to COVID-19 For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, it would be appropriate to assign the code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.
For cases where there is an actual exposure to someone who is confirmed to have COVID-19, it would be appropriate to assign the code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.

Our question is can you or should use Z03.818 for inpatient?

Sarah Wicks

Strong Memorial Hospital

fentona@bronsonhg.org

Updated: AHIMA and AHA FAQ on ICD-10-CM Coding for COVID-19

March 20, 2020 at 3:11 pm19

Question: Does the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak apply to all patient encounter types, i.e., inpatient and outpatient, specifically in relation to the coding of “suspected”, “possible” or “probable” COVID-19?

Answer: Yes, the supplement applies to all patient types. As stated in the supplement guidelines, “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, Contact with and (suspected) exposure to other viral and communicable diseases.”

Question: The supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 pandemic refers to coding confirmed cases in a couple of instances, but it does not specify what “confirmation” means similar to language in guidelines found for reporting of HIV, Zika and H1N1. Can you clarify whether the record needs to have a copy of the lab results or what lab tests are approved for confirmation?

Answer: The intent of the guideline is to code only confirmed cases of COVID-19. It is not required that a copy of the confirmatory test be available in the record or documentation of the test result. The provider’s diagnostic statement that the patient has the condition would suffice.

Question: Should presumptive positive COVID-19 test results be coded as confirmed?

Answer: Yes, Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or state level, but it has not yet been confirmed by the Centers for Disease Control and Prevention (CDC). CDC confirmation of local and state tests for the COVID-19 virus is no longer required.

Question: How should we handle cases related to COVID-19 when the test results aren’t back yet? The supplementary guidance and FAQs are confusing since some times COVID-19 is not “ruled out” during the encounter, since the test results aren’t back yet.

Answer: Due to the heightened need to capture accurate data on positive COVID-19 cases, we recommend that providers consider developing facility-specific coding guidelines to hold back coding of inpatient admissions and outpatient encounters until the test results for COVID-19 testing are available. This advice is limited to cases related to COVID-19.

Hope that helps!

Amy Fenton RN, CDI

nameher

There is no real reason to complete the record prior to results unless, you feel, as in some cases, the test won't be completed.  There has been some incidence of this.  I advise coders to hold the account just as they would for a path report.

jaimeiam

Wanted to share this tool we are using with the latest guidance from AHA

elizabeth.aguirre@bswhealth.org

Question. New guidance states to code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider, documentation of a positive COID-19 test result, or a presumptive positive COVID-19 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 the type of test performed; the provider’s documentation that the individual has COVID-19 is sufficient.

 Does the last sentence imply that a diagnostic test is not required and that the physician can make a diagnosis based on the clinical evidence alone?

jennifer.cavagnac@baystatehealth.org

We are doing similarly, pending results are updated by providers and if not we are generating a query. 
This is relatively successful with exception to providers who struggle with facility billing vs physician billing rules. Any advice/success tips on that issue is appreciated. 

justamandakay

I am questioning this too: In this context, “confirmation” does not require documentation of the type of test performed;the provider’s documentation that the individual has COVID-19 is sufficient. Does the last sentence imply that a diagnostic test is not required and that the physician can make a diagnosis based on the clinical evidence alone?

 I have the same type of question.  Patient has a misplaced outpatient test and spouse with positive COVID.  Provider is documenting positive COVID based upon clinical evidence. Are we able to capture the UO7.1 or do we need a re-test with positive results in order to capture?

I am also wondering about when the provider disagrees with the negative test.  He acknowledges the negative test; however, feels the clinical presentation is COVDID 19.

From my understanging, we can not capture UO7.1 based on the provider's clinical judgement. Is that correct?

sarah_wicks@urmc.rochester.edu

jaimeiam said:

Wanted to share this tool we are using with the latest guidance from AHA

This is great. Thanks for sharing Jaime!

ccatlett1

justamandakay said:

I am questioning this too: In this context, “confirmation” does not require documentation of the type of test performed;the provider’s documentation that the individual has COVID-19 is sufficient. Does the last sentence imply that a diagnostic test is not required and that the physician can make a diagnosis based on the clinical evidence alone?

 I have the same type of question.  Patient has a misplaced outpatient test and spouse with positive COVID.  Provider is documenting positive COVID based upon clinical evidence. Are we able to capture the UO7.1 or do we need a re-test with positive results in order to capture?

I am also wondering about when the provider disagrees with the negative test.  He acknowledges the negative test; however, feels the clinical presentation is COVDID 19.

From my understanging, we can not capture UO7.1 based on the provider's clinical judgement. Is that correct?

It is my understanding that this statement is about documenting the "type" of test (Presumptive vs CDC confirmed).  The test has to performed and confirmed as positive by the physician.

Cheryl

allenfrx@gmail.com

Regardless of what the discharge summary says…if the results come back positive late U07.1 can still be reported.   Time stamp 19:45: They recommend holding if test is pending just to be safe. (Biggest issue is risk of reporting a false negative on a patient with milder symptoms and missing out on certain waivers and payment considerations)

https://www.codingclinicadvisor.com/webinar/icd-10-cm-coding-covid-19?fbclid=IwAR3jGRA1inrDPbduDwEmM-5Ib_h9jZ2qqphHcJsNtMTdXFyIBo1yDDNdysY

Everyone who tests positive gets the U07.1.   Even those who don't have any symptoms.

Per the AHA

Asymptomatic individuals who test positive for

COVID-19

Asymptomatic individuals who test positive for

COVID-19:  U07.1, COVID-19. 

Although the individual is

asymptomatic, the individual has tested positive and is

considered to have the COVID-19 infection.

allenfrx@gmail.com

And no...you don't HAVE TO HAVE A test.  (Tests still aren't widely available).

Time stamp 12:40:  It can ALSO be reported if:

1. Documentation of its presence by the provider or

2. A positive COVID test or 

3. A presumptive diagnosis

https://www.codingclinicadvisor.com/webinar/icd-10-cm-coding-covid-19?fbclid=IwAR3jGRA1inrDPbduDwEmM-5Ib_h9jZ2qqphHcJsNtMTdXFyIBo1yDDNdysY

hooter1964

Very Timely question and Answer session here as the April 1 2020 GUIDELINE was confusing.
Thanks All.
Hugh

BrandeiskyJohn

Hi.  Just to be clear on this.....I am thinking a different way... We have patients who have all the signs, symptoms, lab results to confirm COVID 19 infection but still have two negative tests on board.  I am instructing we still code for COVID 19 infection causing their other illnesses / organ failure etc based on the clinical findings and diagnosis by the physician.  I understand the false negative percentages are quite high.  Is that right?  Thanks.

Jane.Brown@ensemblehp.com

My understanding is that there are a fair percentage of false negatives. We are basing our code assignment on physician documentation and this is specified by the guidelines.