CDI Tips: COVID-19

Topic: COVID-19

Definition: Coronavirus disease 2019 (COVID-19) refers to a group of respiratory illnesses caused by infection with the SARS-CoV-2 virus. Since the emergence of the initial Alpha variant, multiple significant variants have been identified.

  • Common clinical manifestations include fever, coughing, sneezing, fatigue, muscle or body aches, shortness of breath, and changes or loss in taste or smell. In more severe cases, the illness can advance to pneumonia, acute respiratory distress, kidney failure, sepsis, or death.
  • Individuals at increased risk for severe illnesses include adults aged 65 years and older, people with obesity, those who are immunocompromised, and individuals with serious preexisting health conditions.
  • The federally declared public health emergency for COVID-19 in the United States concluded on May 11, 2023.

Diagnostic Criteria:

DIAGNOSIS: Positive COVID-19 viral or diagnostic test result, or a definitive documentation of active COVID-19 by a provider. 

Note: *The patient must have an active infection to assign code U07.1, COVID-19, for inpatients.

TREATMENT: Treatment of a COVID infection is primarily focused on symptomatic support of the complications. Specific treatment modalities for severely ill patients include: 

  • High-dose steroids: Dexamethasone
  • Antivirals: Remdesivir. Paxlovid
  • Monoclonal antibodies 
  • Tocilizumab (Interleukin-6 receptor blocker) + Dexamethasone
  • Baricitinib (immunomodulator)

CDI & Coding Considerations:

  • The ICD-10 code for COVID-19 is U07.1, which is an MCC. Only confirmed and active cases of COVID that meet the definition of a secondary (or principal) diagnosis can be assigned code U07.1.
  • Coding Clinic 2021 Fourth Quarter, p. 101, even with a current or recent positive test for COVID, when provider documentation includes that a patient is not actively infectious during the admission, this indicates that the patient no longer has an active COVID infection, and code U07.1 would not be assigned.
  • Do not assign code U07.1, COVID-19, based only on a positive lab result. Official Coding Guidelines (4/1/2025) state: “For asymptomatic individuals who test positive for COVID-19 and there is no provider documentation of a diagnosis of COVID-19, query the provider as to whether or not the individual has COVID-19.” If the provider documentation does not indicate the hospitalized patient has an active infection (or a previous infection has resolved) and the patient is asymptomatic, the patient no longer has a current (active) COVID infection and code U07.1 would not be assigned.
  • Sequencing COVID as principal diagnosis. When COVID is the principal reason for admission focus of treatment and meets the definition of principal diagnosis, code U07.1 is assigned first, associated manifestations should be included as secondary codes—except when coding guidelines indicate certain diagnoses be sequenced first, such as obstetrics or transplant complications.
  • When the reason for the admission is a respiratory manifestation associated with COVID, assign code U07.1 as the principal diagnosis and assign Secondary codes for the respiratory manifestations. Providers do not have to explicitly link the respiratory condition with COVID since COVID is a respiratory disease.
    • Example: Pneumonia associated with COVID, assign U07.1, COVID-19, and J12.82, Pneumonia due to COVID-19. If lower respiratory infection is associated with COVID, assign codes U07.1 and J22. If acute respiratory failure or ARDS, assign U07.1 and J96.00 or J80.
  • When the reason for the admission is a non-respiratory manifestation (e.g., viral enteritis) due to COVID, assign code U07.1, COVID-19, as the principal diagnosis and assign the code(s) for the manifestation(s) as secondary diagnoses. Provider documentation must link the non-respiratory condition with COVID. 
  • If a patient is admitted with a residual effect (sequelae) of COVID and the provider documentation indicates the COVID infection is inactive or the patient is no longer infectious, assign a code for the residual effect as principal diagnosis and code U09.9, Post COVID-19 condition, as a secondary diagnosis. Code U09.9, establishes a link between a prior COVID infection and post-acute sequela. Code U09.9 cannot be assigned as a principal diagnosis.
  • Sepsis and COVID-19. The principal diagnosis for a patient presenting with COVID and sepsis (U07.1 or A41.89) depends on the circumstances of the admission and whether sepsis meets the definition of the principal diagnosis. Note that this differs from the coding guidelines for “sepsis and a localized infection” where sepsis is sequenced first.
  • Pregnancy, childbirth, or puerperium. A patient admitted for COVID during pregnancy, childbirth or the puerperium, assign a code from O98.5-, Other viral diseases complicating pregnancy, childbirth, and the puerperium, as principal diagnosis followed by U07.1 and the appropriate codes for the associated manifestations. However, if the reason for the admission is unrelated to COVID but the patient tests positive for COVID during the admission [and has an active infection], the principal diagnosis is the appropriate codes for the reason for admission, with codes O98.5- and U07.1 assigned as additional diagnoses and the associated COVID manifestations.
  • Uncertain diagnosis. Do not assign code U07.1 for possible, probable, or suspected COVID. Instead, code the signs and symptoms reported.
  • Clinical indicators of active infection include respiratory symptoms, patient placed in isolation, treatment for COVID, e.g., Remdesivir, Dexamethasone, Paxlovid.
  • Indicators of a resolved orinactive infection: no symptoms, greater than 14 days since onset of symptoms or date of positive test, patient not in isolation, lack of COVID treatment (Remdesivir, Decadron, etc.), and provider documentation indicating patient is no longer infectious (“history of COVID”, “non-infectious”, post-COVID condition, etc.).  For patients with a history of COVID-19, assign code Z86.16, Personal history of COVID-19.

Query Opportunity:

  • If the documentation is unclear whether the patient has an active COVID infection, a residual effect from a previous COVID infection, a link is needed for a non-respiratory condition, or a personal history, query the provider for clarification. 
  • 1 does not affect Risk Adjustment/HCC coding, however manifestations of COVID may (such as sepsis, respiratory failure, etc.). Review the chart closely, querying based on clinical indicators, as necessary.

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