Coding for pneumonia continues to be problematic for most coders. There are many types of pneumonia and documentation is often insufficient for coding to the level of specificity available in our current ICD-10 structure. Some of the specific types of pneumonia codes available include Aspiration, bacterial, Lobar, pneumonia due to influenza, Ventilator Associated pneumonia, and Viral pneumonia including COVID-19. Pneumonia can also be associated with other pulmonary conditions such as COPD. COVID-19 caused an outbreak of respiratory illness, and was first identified in 2019 in Wuhan, China. The first lab-confirmed case in the U.S. was reported to CDC on January 22, 2020. In February 2020 the CDC announced possible community spread. Since then COVID-19 has spread internationally and was declared a global pandemic by WHO in March 2020. Beginning April 1, 2020 there was a new code implemented for COVID-19 and the AHA published Interim Coding Guidelines. On October 1, 2020 the AHA released the first set of Complete Guidelines related to COVID-19.
Some important guidelines to be aware of:
- Code only confirmed cases as documented by the provider or documentation of a positive COVID-19 test result. "Confirmation" does not require documentation of a positive test result for COVID-19; the provider's documentation that the individual has COVID-19 is sufficient.
- When COVID-19 meets the definition of principal diagnosis, code U07.1, COVID-19, should be sequenced first, followed by the appropriate codes for associated manifestations, except when another guideline requires that certain codes be sequenced first, such as obstetrics, sepsis, or transplant complications.
- When a provider has documented both aspiration pneumonia (J69.0) and pneumonia due to COVID-19 (J12.89), both codes may be assigned. (Assign code U07.1 as Pdx per COVID guidelines). Although there is an excludes 1 note at category J12, Viral pneumonia, not elsewhere classified, that excludes pneumonia not otherwise specified (J69.0), aspiration pneumonia and pneumonia due to COVID-19 are two separate unrelated conditions with different underlying causes which meets the exception to the excludes 1 guideline.
- When a patient is re-admitted for a complication of recent COVID-19 Infection, assign a code for the complication followed by B94.8 Sequelae of other specified infectious and parasitic diseases.
- Screening – Assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. Do NOT assign code Z11.59 screening for other viral diseases. Per 2021 OCG, effective 10/1/20, During the COVID-19 pandemic, a screening code is generally not appropriate. For encounters for COVID-19 testing, including preoperative testing, code as exposure to COVID-19 (guideline I.C.1.g.1.e). Coding guidance will be updated as new information concerning any changes in the pandemic status becomes available.
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