Coding COVID-19 Infection in Newborns

Coding COVID-19 Infection in Newborns

C. Matheson, RHIA, CCS MRA 2 Comments

Coding COVID-19 Infection in Newborns

Coding COVID-19 Infection in Newborns

With the 2021 updates to the ICD-10-CM code classification came 14 new chapter specific guidelines. All but one of these guidelines is related to the coding of COVID-19 infection. Needless to say, COVID-19 is a big deal, and getting the coding for this condition correct has implications for both payment considerations and statistical data collection.

However, even when everyone is focused on getting it right, because of the sheer number of new guidelines, it’s easy to see how a coding professional could get confused or overlook some of the important details. In fact there is one new guideline and a related guideline revision in ICD-10-CM Chapter 16 Certain Conditions Originating in the Perinatal Period that could easily cause confusion if the details of the guidelines are not studied carefully. Let’s take a look at both guidelines and consider what impact they have on coding practices.

The Revision

The revised guideline is I.C.16.a.5 Birth Process or Community Acquired Conditions, and the revision states:

“For COVID-19 infection in a newborn, see guideline I.C.16.h.”

This revision is an addition to the guideline directing whether a condition that presents in a newborn is reported as a perinatal condition (due to the birth process), which would be reported with a code from Chapter 16, or as a community acquired condition, which would be reported with a code from another chapter of ICD-10-CM.

This guideline states that if a newborn has a condition that may be either due to the birth process or community acquired and the documentation does not indicate which it is, the default is due to the birth process and the code from Chapter 16 should be used.

The 2021 revision to guideline I.C.16.a.5, is an indication that when choosing between reporting a condition in a newborn as due to the birth process or as community acquired, the official guidance is different for COVID-19 infection than for other conditions. This addition to the current guideline redirects coders to the new guideline which outlines how this decision should be made for newborns with COVID-19 infection.

The New Guideline

The new guideline is I.C.16.h COVID-19 Infection in Newborn, which states:

“For a newborn that tests positive for COVID-19, assign code U07.1, COVID-19, and the appropriate codes for associated manifestation(s) in neonates/newborns in the absence of documentation indicating a specific type of transmission. For a newborn that tests positive for COVID-19 and the provider documents the condition was contracted in utero or during the birth process, assign codes P35.8, Other congenital viral diseases, and U07.1, COVID-19. When coding the birth episode in a newborn record, the appropriate code from category Z38,

Liveborn infants according to place of birth and type of delivery, should be assigned as the principal diagnosis.”

Key Points from the New Guideline:

· In the absence of documentation indicating a specific type of transmission, a newborn that tests positive for COVID-19 should be assigned code U07.1 COVID-19 infection.

· Assign also the appropriate codes for any associated manifestation(s).

· A positive COVID-19 test in a newborn is only coded as a congenital infection if the physician specifically documents the infection was contracted in utero or during the birth process.

o If the documentation does not indicate whether COVID-19 was contracted due to the birth process or community acquired, the default is community acquired.

· When coding for the birth episode a code from category Z78 Liveborn infants according to the place of birth and type of delivery should be assigned as the principal diagnosis.

A comparison of the guidelines reveals that the coding direction for reporting COVID-19 infections in newborns with no documentation as to type of transmission is the exact opposite of the guidance in the general newborn guideline concerning birth process vs. community-acquired conditions. This opposing guidance means that coding professionals need to pay careful attention when coding COVID-19 infection in newborns so that they do not code according to the wrong guideline out of habit.

On a final note, the direction in the new guideline is based on information from the CDC regarding how the virus is transmitted in newborns based on the most current data available.

The CDC information states “Transmission of SARS-CoV-2, the virus that causes COVID-19, to neonates, is thought to occur primarily through respiratory droplets during the postnatal period when neonates are exposed to mothers, other caregivers, visitors, or healthcare personnel with COVID-19.”

Additional details can be found on the CDC website here.

Other COVID coding resources can be found on the MRA blog page here.

Comments 2

  1. Good Evening,

    I have a question concerning exposure for newborns and the coding guidelines associated for newborn coding only.

    If the mother is Covid Positive, and delivers the Newborn and the newborn either has not been tested because they were asymptomatic, or the newborn has tested negative for COVID 19 what are the coding guideline for exposure only?
    Some references state to code Z05.1 when the newborn is either negative or has not been tested but has a potential for exposure.

    Other references are stating the newborn accounts should be coded like the exposure cases for adults with the Z20.828 and Z05.1.

    However, Z20.828 causes an increase in DRG unnecessarily so we wanted to see if you could possibly help clarify this situation..

    Thank you

    1. The answer to the question of which code to assign for maternal exposure of a newborn to COVID-19 is, it depends.. AHA Coding Clinic 2nd quarter 2020, pages 8-9 indicates that code Z03.818, which comes from a code category that is a counterpart to Z05, but for non newborn patients, indicates that code Z03.818 is assigned for asymptomatic patients and Z20.828 is only assigned if the patient is exhibiting signs/symptoms associated with COVID-19. If an asymptomatic newborn is tested for COVID-19 and the results are negative, I would recommend assignment of Z05.1. If a symptomatic newborn is tested and the results are negative, assignment of code Z20.828 may be warranted. However, assignment of this code changes the grouping from normal newborn to neonate with other significant problems and increases the relative weight of the DRG by 7.5 times. If code Z20.828 is assigned and results in the higher weighted DRG there must be documentation in the record to support the higher weighted DRG to avoid issues if audited.

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