There is still much to be learned about the COVID-19 associated coagulopathy.
The first and ultimate reason for excellent documentation is improved patient care through clear communication between providers and an accurate picture of the patient’s medical situation and treatment course.
It is essential to capture all the comorbidities conditions seen in patients who are hospitalized with COVID-19. A variety of clinical scenarios appear in our hospitals across the country with symptoms ranging from mild to ventilated patients to death. Since coding advice regarding COVID-19 is frequently updated, it is recommended to check official coding sources to ensure any advice published here is still current. If the provider documents a definitive COVID-19 diagnosis but after discharge, the test results come back negative, it is recommended to query the provider for clarification.
The provider should be allowed to reconsider the diagnosis based on the new information. If the provider confirms of diagnosis of COVID-19 even though the test results are negative, confirmed COVID-19 (U07.1) should be reported.
It is essential to note that the incubation period for COVID-19 falls within 14 days following exposure, with most cases occurring approximately 4 to 5 days after exposure. Per recent studies, common comorbid conditions identified an infected patient with COVID-19 are as follows:
CDI professionals need to review the record for associated conditions/complications of COVID-19 such as the following:
Furthermore, it is essential to review the record carefully for documentation and clinical indicators for all comorbid conditions. CDI professionals need to review the chart thoroughly and remember that each patient should be approached as being unique in their presentation.
Patients being admitted for novel coronavirus (COVID-19) might present with various manifestations and complications. It is important to report all of them because it impacts the severity of illness and risk of mortality. Some COVID-19 patients have been reported to experience coagulopathy and thrombosis, deep vein thrombosis, pulmonary embolism, and even stroke.
Furthermore, suppose there is evidence of both bleeding and clot formation. In that case, the patient may have DIC (disseminated intravascular coagulation), an MCC that will increase the severity of illness (SOI) and risk of mortality (ROM).
COVID-19 associated coagulopathy is reported using codes U07.1, COVID-19, and Other specified coagulation defects (D68.8). If skin failure due to the COVID-19 associated coagulopathy is documented, report COVID-19 (U07.1), Other specified coagulation defects (D68.8), and Other disorders of the skin and subcutaneous tissue in diseases classified elsewhere (L99).
If specified as disseminated intravascular coagulation (DIC) due to COVID-19, assign U07.1 and Disseminated intravascular coagulation (D65). Not all COVID-19 associated coagulopathy progresses to DIC. Up to 70 percent of the most severely ill patients with SARS-CoV2 have features of disseminated intravascular coagulation (DIC).
Unlike sepsis-associated DIC, patients with COVID-19 associated DIC have relatively mild thrombocytopenia (100 × 109/L to 150 × 109/L) and would usually not meet classic ISTH criteria for DIC.
It is now clear that among hospitalized patients with COVID-19, respiratory failure, pneumonia, and sepsis are frequent complications, with some patients developing multiorgan failure and severe systemic disease. The most common end-organ dysfunctions linked with sepsis: Shock, Acute kidney injury, encephalopathy, disseminated intravascular coagulation (DIC), non-diabetic hyperglycemia, liver dysfunction, etc.
Furthermore, patients critically ill with COVID-19 would present with elevated D-dimers’ baseline characteristics and prolonged prothrombin time. The strong association between COVID-19 and vascular coagulopathy may suggest that multiple molecular pathways are dysregulated during the diseases’ clinical progression and thus contribute to the associated thrombosis. The latest data suggest the incidence of thrombotic complications is between 16–49 percent in patients with COVID-19 admitted to intensive care.
Critically ill patients have higher risks of developing thromboembolism because of the combination of platelet activation, immobility, systemic inflammation, and stasis of blood flow.
In some hospitalized patients with COVID-19, as occurs in sepsis more generally, an overproduction of early response proinflammatory cytokines such as interleukin (IL)-6, IL-1, and TNFα, leads to a cytokine storm. This hyperinflammatory state can cause lung injury, including damage to the microvasculature and endothelial dysfunction, which could trigger haemostatic derangements and the generation of pulmonary thrombi.
It is recommended to monitor haemostatic markers such as prothrombin time, platelet count, and D-dimers in all patients presenting with COVID-19. It is important to determine if the hemostatic changes are a consequence of severe inflammation or if they are specific effects mediated by the virus. In hospitalized COVID-19 patients with sepsis, an overproduction of early response proinflammatory cytokines such as IL-6, TNF alpha, and IL-1 leads to a cytokine storm. This hyperinflammatory state can cause lung injury, which could trigger hemostatic derangements and the generation of pulmonary thrombi. On the other hand, the virus can directly or indirectly interfere with coagulation pathways causing systemic thrombosis.
Antiviral treatments are generally effective early in the disease course, while treatment strategies targeting coagulation and inflammation might be more promising for patients with severe COVID-19. Some studies suggest that low molecular weight heparin (LMWH) can improve prognosis in patients with severe COVID-19 meeting SIC criteria or elevated D-dimers. Other anticoagulants are being tested, such as antithrombin three, factor 10 A, and complement inhibitors.
There is still much to be learned about the COVID-19 associated coagulopathy, but the fast and ongoing collaboration worldwide makes for a hopeful outcome.
Programming Note: Listen to Dr. Kuqi report this story live today during Talk Ten Tuesdays, 10-10:30 a.m. Eastern.
I receive a lot of newsletters every morning to help me stay abreast of what is happening in the healthcare industry. A troubling recent trend
EDITOR’S NOTE Day 3 of the federal shutdown continues. This article by Mark Spivey is part of a special section today published by RACmonitor and
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
