Master the upcoming ICD-10 code and IPPS changes! Prepare your team for the upcoming changes taking effect on October 1. Discover the benefits of IPPSPalooza and how it can drive your success. Click here >
2023 Official Coding and Reporting Guidelines for ICD-10-CM are effective with discharges/visits on Oct. 1, 2022.
The Centers for Medicare and Medicaid Services (CMS) released MLN Connects on July 7, 2022, with an article on long COVID. The article provides coding direction for code assignment for long COVID as well as current COVID infection. The article also cites the Official Coding and Reporting Guidelines for additional information.
Long COVID is coded with ICD-10-CM code U09.9 (Post COVID-19 condition, unspecified). Additional codes may be assigned for associated signs and symptoms of long COVID. This diagnosis code represents that the active COVID infection is completed, and that the patient has sequela. This code should not be confused with Z86.16 (Personal History of COVID-19).
According to the Official Coding and Reporting Guidelines for ICD-10-CM FY23, a patient may have a current infection as well as conditions associated with a previous COVID infection. In this situation, the patient should be assigned U07.1 (COVID-19) and U09.9. For a follow-up examination for a patient who has no signs and symptoms following COVID infection with negative test results should be assigned codes Z09 (Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm) and Z86.16.
Another recent release for coding guidance for COVID is American Hospital Association’s Coding Clinic, Second Quarter 2022, pg. 27 states that patients who seek prophylactic treatment (e.g., long-acting monoclonal antibodies) for COVID should be assigned Z29.8 (Encounter for other specified prophylactic measures). These patients may have severe allergy preventing vaccination against COVID or moderate to severe immunocompromised conditions and have had insufficient response to COVID vaccination.
According to the Official Coding and Reporting Guidelines for ICD-10-CM, the patient who presents for antibody testing that is not associated with confirming current COVID infection should be assigned Z01.84 (Encounter for antibody response examination). The patient who presents for testing to confirm a current COVID infection should be assigned Z20.822 (Contact with and [suspected] exposure to COVID-19). During the pandemic, it is not appropriate to assign Z11.52 (Encounter for screening for COVID-19).
ICD-10-CM codes were added in April 2022 regarding vaccination status. These codes are now included in the Official Coding and Reporting Guidelines for ICD-10-CM. Z38.310 (Unvaccinated for COVID-19) is assigned to the patient who has not had any vaccinations for COVID. Z38.311 (Partially vaccinated for COVID-19) is assigned to patients who have not completed their vaccination process based on the Centers for Disease Control and Prevention (CDC) guidance.
Current COVID infections are assigned diagnosis code U07.1. It is appropriate to code additional signs and symptoms associated with the condition. It may be necessary to query the provider regarding significance of associated conditions or if they are actually due to COVID.
The guidelines also state that only confirmed cases should be coded with U07.1. The guidelines continue by saying that confirmation does not necessarily mean a positive test. The provider’s documentation that the patient has COVID is sufficient to code U07.1.
The coding guidance continues to change. It is important to remain current in the coding of this condition and update your facility specific coding guidelines.
Programming Note:
Listen to Laurie Johnson’s live reporting on the new ICD-10-CM Official Coding and Reporting Guidelines for FY 23 during today’s Talk Ten Tuesdays at 10 Eastern.
Resources:
MLN Connects 07/07/2022: 2022-07-07-MLNC | CMS
Official Coding and Reporting Guidelines ICD-10-CM FY23: ICD-10-CM Guidelines FY 2023 (cms.gov)
The new federal fiscal year (FY) begins on Oct. 1, this coming Sunday. In preparation, I thought that I would review my top 10 activities
CMS is requiring states to pause disenrollments as greater scrutiny is placed on the health insurance programs that cover the nation’s most vulnerable populations. Citing
Please log in to your account to comment on this article.
The CMS Two-Midnight Rule and short-stay audits are here to stay, impacting inpatient and outpatient admissions, ASC procedures, and Medicare Parts C & D. New for 2024, the Two-Midnight Rule applies to Medicare Advantage patients, requiring differentiation between Medicare plans affecting Case Managers, Utilization Review, and operational processes and knowledge of a vital distinction between these patients that influences post-discharge medical reviews and compliance risk. Join Michael G. Calahan for a comprehensive webcast covering federal laws for all admission processes. Gain the knowledge needed to navigate audits effectively and optimize patient access points, personnel, and compliance strategies. Learn Two-Midnight Rule essentials, Medicare Advantage implications, and compliance best practices. Discover operational insights for short-stay admissions, outpatient observation, and the ever-changing Inpatient-Only Listing.
A massive task lies ahead! Now’s the time to start preparing your case management and utilization review teams for successful implementation of changes contained in the 2024 IPPS, OPPS and MPFS rules.
Gain clarity on billing, patient notifications, and discharge appeal rights in social admissions. Join our webcast for essential insights and strategies to navigate this complex landscape, ensuring financial stability and optimal patient care.
Dr. Ronald Hirsch provides tried-and-true strategies and insight into outpatient in hospital bed stays including determining the applicable definition, who uses it, and when and how to bill for this circumstance, solidified with concrete case examples and expert insight.
Explore comprehensive guidelines and best practices for secondary diagnosis coding in our illuminating webcast. Delve into the intricacies of accurately assigning secondary diagnosis codes to ensure precise medical documentation. Learn how to navigate complex scenarios and adhere to coding regulations while enhancing coding proficiency. Our expert-led webcast covers essential insights, including documentation requirements, sequencing strategies, and industry updates. Elevate your coding skills and stay current with the latest coding advancements so you can determine the correct DRG assignment to optimize reimbursement, support medical decision-making, and maintain compliance.
Enhance your inpatient coding precision and revenue with Principal Diagnosis Coding: Mastering Selection and Sequencing. Join our expert-led webcast to conquer the challenges of principal diagnosis selection and sequencing. We’ll decode the intricacies of ICD-10-CM guidelines, equipping you with a clear grasp of the rules and the official UHDDS principal diagnosis definition. Uncover the crucial role of coding conventions, master the sequencing of related conditions, and confidently tackle cases with equally valid principal diagnoses.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY24 Inpatient Prospective Payment System (IPPS) Final Rule, including new ICD-10-CM/PCS codes, plus insights, analysis and answers to questions from the country’s most respected subject matter experts.
This third session in our 2024 IPPS Summit will feature a review of FY24 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by senior healthcare consultant Laurie Johnson, with bonus insights and analysis from two acclaimed subject matter experts
Copyright © 2023 ICD10monitor. Powered by MedLearn Media.
