The American Health Information Management Association (AHIMA) and the American Hospital Association (AHA) have been publishing COVID-19 ICD-10-CM/PCS information and guidance since March 20th, 2020, last year. The most recent update occurred on March 1st, 2021 and is worth a detailed review. The COVID-19 coding FAQ (Frequently Asked Questions) covers both “CM” (diagnosis) and “PCS” (procedure) questions and scenarios. There are now a total of 54 questions and answers regarding ICD-10-CM, so a lot to read over and keep up with. Here are a few of the new FAQs, starting with FAQ #45:
Question #45: A patient presents to the emergency department with complaints of throat tingling and chest tightness following administration of the COVID-19 vaccine. The provider documented allergic reaction to COVID-19 vaccine. The current ICD-10-CM indexing for allergy to vaccine points to a code for serum reaction. How should this case be coded? (3/1/21)
Answer: Assign codes T78.49XA, Other allergy, initial encounter; R07.89, Other chest pain; and R09.89, Other specified symptoms and signs involving the circulatory and respiratory systems. The currently approved COVID-19 vaccines in the United States are not serum based, and therefore code T80.62XA-, Other serum reaction due to vaccination, initial encounter is not appropriate.
Question #46: A patient presents to the emergency department with complaint of malaise following administration of the COVID-19 vaccine. The provider documented adverse effect of COVID-19 vaccine. How should this case be coded? (3/1/21)
Answer: Assign codes R53.81, Other malaise; and T50.B95A, Adverse effect of other viral vaccines, initial encounter.
Question #47: A patient presents to the emergency department via ambulance after complaining of hives and swelling, severe breathing problems, and swelling in the throat, following administration of the COVID-19 vaccine. The provider documented anaphylactic reaction to COVID-19 vaccine. The current ICD-10-CM indexing for anaphylactic reaction to immunization points to a code for serum reaction. However, since the COVID-19 vaccine is not serum based, may we use code T80.52? (3/1/21)
Answer: Assign code T80.52XA, Anaphylactic reaction due to vaccination, initial encounter, for documented anaphylactic reaction to the COVID-19 vaccine. Although subcategory T80.5, identifies anaphylactic reaction to serum, it is the closest available code to capture this condition.
According to the newly publishing coding guidance (FAQ #52), when a patient presents with an acute manifestation/condition due to COVID-19 infection, but the COVID-19 test is negative you will still assign the code U07.1 as the principal/first listed diagnosis followed by the code for the acute manifestation/condition, i.e., pneumonia due to COVID-19, J12.82, as a secondary (Other diagnosis) code.
In addition, some prior coding guidance has been revised or updated since the original publication, so again, check the website regularly and also discuss with your coding staff and coding consultants. Follow this link to access the AHIMA/AHA COVID-19 Coding FAQ: [Updated March 1, 2021] AHIMA and AHA FAQ: ICD-10-CM/PCS Coding for COVID-19 | Journal Of AHIMA
No new guidance was published March first regarding PCS codes. There is an updated FY 2021 Code Table, Index, and related Addenda files for the 21 new procedure codes, which is available at: https://www.cms.gov/medicare/icd-10/2021-icd-10-pcs
A best practice is to have ongoing coding education and general awareness regarding the documentation and coding of COVID-19 and related conditions, as this is vital to coding accuracy, compliance, and reimbursement. Due to the several changes to specific COVID-19 coding guidance throughout the past 12 months, having a routine audit process to validate accuracy and integrity is a must. So, your next steps are to read through the complete COVID-19 FAQ, educate your coding staff and others, and have a documentation and coding audit conducted soon.
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