FY 2021 Coding Guideline Updates:
The past two weeks we have discussed the ICD-10-CM and ICD-10-PCS coding changes effective
October 1st, 2020. This week we will be reviewing any corresponding FY 2021 Coding
Guideline Updates that are new or revised because of the annual coding updates. The changes
are effective beginning with discharges between October 1, 2020 – September 30, 2021. A vast
majority of the guideline updates are driven by COVID-19 changes this past year. Below, we will
dive into the key guideline updates for each chapter, but coders should read on their own the
Official Coding Guidelines to ensure full understanding.
Chapter Specific Guidelines
• Chapter 1- Certain Infectious and Parasitic Diseases (A00-B99 and U07.1): A new section “g”
has been added for coronavirus infections. The new guidelines address confirmed, suspected
and positive test results. In guidelines g.1.c.i-v, there are new instructions for respiratory and
non-respiratory manifestations when a patient is COVID-19 positive. Physicians must document
“due to,” “with,” or “in” as part of the documentation to show linkage between COVID-19 and
the manifestation. New guidelines in this section also address coding for COVID-19 exposure,
screening for, signs and symptoms without a definitive diagnosis, antibody testing, personal
history of, and follow up visits after COVID-19 infection has resolved.
• Chapter 10- Diseases of the Respiratory System (J00-J99): There is a new section “e” that
provides instruction for coding vaping related illnesses. One important note to point out
specifically is the following, “Associated respiratory signs and symptoms due to vaping, such
as cough, shortness of breath, etc., are not coded separately when a definitive diagnosis has
been established. However, it would be appropriate to code separately any ICD-10-CM
Official Guidelines for Coding and Reporting FY 2021 Page 59 of 126 gastrointestinal
symptoms, such as diarrhea and abdominal pain.”
• Chapter 15- Pregnancy, Childbirth, and the Puerperium (O00-O9A): A new section, 15.s, was
added to the guidelines to provide coders instruction for coding COVID-19 infection in
pregnancy, childbirth, and puerperium. The new guideline states, “During pregnancy,
childbirth or the puerperium, when COVID-19 is the reason for admission/encounter, code
O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, should
be sequenced as the principal/first-listed diagnosis, and code U07.1, COVID-19, and the
appropriate codes for associated manifestation(s) should be assigned as additional diagnoses.
Codes from Chapter 15 always take sequencing priority. If the reason for
admission/encounter is unrelated to COVID-19 but the patient tests positive for COVID-19
during the admission/encounter, the appropriate code for the reason for
admission/encounter should be sequenced as the principal/first listed diagnosis, and codes
O98.5- and U07.1, as well as the appropriate codes for associated COVID-19 manifestations,
should be assigned as additional diagnoses
• Chapter 16- Certain Conditions Originating in the Perinatal Period (P00-P96): There is new
guidance in I.C.16.h that states U07.1 should be coded as a first listed code when a newborn
has tested positive for COVID-19. If the provider documents that the newborn contracted
COVID-19 in utero or during the birthing process, code P35.8 is assigned for other congenital
viruses followed by U07.1. If the type of transmission is not specified, U07.1 is appended.
• Chapter 21- Factors Influencing Health Status and Contact Health Services: In section 6 of this
chapter, under the observation guidelines, additional language was added to address COVID-19.
Now the language has been revised to indicate that observation codes should be primarily be used
principal or first listed; however, an observation code may be assigned as secondary diagnosis
in some circumstances. Examples included are observation for suspected COVID-19
condition or a patient being observed for treatment after a motor vehicle accident.
• Chapter 22- Codes for Special Purposes (U00 – U85): This is a brand-new ICD-10 chapter for
special purposes, codes U00-U85. This chapter only contains two codes- one for vaping related
disorders and one for COVID-19. There are no specific guidelines in the chapter yet. The reader
is referred to see Section I.C.10.e for the guidelines for vaping related illnesses and Section
I.C.1.g.1 for COVID-19 infection guidelines.
General Guideline Changes
• Effective with the October 1st guideline changes, there is language that patient self-reported
documentation may also be used to assign codes for social determinants of health. The range of
codes in Z55 (Problems related to education and literacy) and Z65 (Problems related to other
psychosocial circumstances) are the two areas applicable to this update. This information must
be incorporated into the patient’s medical record and be signed off by the clinician or provider.
Coders should take time to review on a regular basis the Official Coding Guidelines and
familiarize themselves with the changes. Also, organizations should keep in mind the
importance of physician education as it relates to annual coding and guideline changes.
For source information and more regarding FY 2021 Coding Guideline Updates, click here.