Positive COVID-19 Test but "resolved" or "shedding"
AHA and CMS have given direction this year on coding positive COVID-19 test results on accounts based on the positive COVID-19 test result and/or provider documentation in the medical record. In August, CMS announced that Medicare would start to reimburse an extra 20% for patients who have a COVID-19 diagnosis code (along with a positive COVID-19 test result in the medical record). This brings up some coding questions that we would appreciate your thoughts on.
Our question stems from the COVID+ patient who enters the hospital for another reason (not COVID) and is no longer showing signs/symptoms but is still testing positive for COVID. Our providers are documenting in the medical record that the patient is shedding the virus, residual positive, or virus resolved. Are you coding the U07.1 (because of the positive test result) and the AHA guidance (stated above) with no provider documentation of active Covid; or, are you coding Personal History of Covid code Z86.16, based on traditional AHA Coding Clinic Guidelines?
Comments
Good Morning, If patient has an active infection we assign U07.1. If patient has viral shedding and history of infection only with NO active infection, we assign Z86.16. We met with the coding team as they were capturing U07.1 when there was a positive result and provider's documentation was not clear. Hope this helps!
I just received a denial for the above scenario. U07.1 was coded as a secondary diagnosis and they want to replace U07.1 with the Z code. Discharge summary states "Covid 19 test was positive however it was thought to be from the patient's prior history of Covid infection 3 months ago. Not thought to be an active infection". I followed up with coding dept. and I was given the coding guideline "Asymptomatic Individual who tests + for Covid 19" as the rationale as to why U07.1 was coded and to use this coding guideline as at he basis for appeal. Any thoughts?
Hopefully future coding clinics will make this scenario a little clearer on what to code.