Over the past few months, the folks at ICD10monitor have seen an increase in website searches regarding two specific ICD-10-CM codes: U07.1 (COVID-19) and F32.9 (Major depressive disorder, unspecified).
Some say that this is a sign of the times, and that may be absolutely true, considering what has gone on in the past four months in healthcare, across our nation and the world. I know I have read a lot about COVID-19, both clinically and regarding the diagnostic and HCPCS/CPT® coding. The diagnosis and topic of depression has also had seen an uptick in interest during our current public health emergency (PHE) timeframe. So let us take a closer look at both of these codes.
We all are very aware that as of April 1, a new code was initiated to capture and report the coronavirus, or COVID-19: code U07.1 2019, Novel Coronavirus (COVID-19). The Centers for Medicare & Medicaid Services (CMS) released a MLN Matters edition on April 1, which also announced the new code.
The COVID-19 code is in the new Chapter 22 of ICD-10-CM, Codes for special purposes (U00-U85); Provisional assignment of new diseases of uncertain etiology or emergency use (U00-U49). See the Centers for Disease Control and Prevention (CDC) listing of the tabular for Chapter 22 online at: https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-3-18-2020.pdf
The U07.1 tabular indicates the following:
The World Health Organization (WHO) created the code for COVID-19 on Jan. 31, in response to the declaration of a PHE, with international concern. WHO has indicated in ICD-10 classification that categories U00-U49 are set aside for provisional assignment of conditions of an uncertain etiology (see ICD10monitor article: https://www.icd10monitor.com/covid-19-has-new-code-in-april).
Since February, the CDC has published two supplements to the ICD-10-CM Guidelines regarding COVID-19. The date of the encounter is key for which set of guidelines one should adhere to; see https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf.
The second supplemental guideline regarding COVID-19 was released on March 18 and became effective with encounters occurring on and after April 1, so we have guidelines for prior to then and after. The American Hospital Association (AHA) and the American Health Information Management Association (AHIMA) have also published a “Frequently Asked Questions Regarding ICD-10-CM Coding for COVID-19.” This is available on both of their websites and is regularly updated with new information, and it provides coding clarifications in relation to COVID-19 in a variety of scenarios.
With a variation of situations relating to COVID-19 coding, we need to take extra care in the selection of the correct ICD-10-CM code. Is it the primary or principal diagnosi? Is it the secondary code? Was the patient seen for screening? Was COVID-19 ruled out? Is the patient pregnant, or was this a newborn? Many coding situations prompt greater need to confirm verification of the code selection. The importance of accurate ICD-10-CM coding cannot be overstated, especially in this time of a PHE!
With the abundance of COVID-19 (U07.1) cases across the United States, and as testing continues to increase, it is understandable that coding professionals are checking guidelines and resources more often. Certainly, we are all watching closely the statistics associated with COVID-19, especially the number of reported cases and the number of deaths due to COVID-19 in our cities, counties, and states, in our nation and around the world. If you are interested in viewing facts on COVID-19, listed by country and state, visit the following site: https://usafacts.org/visualizations/coronavirus-covid-19-spread-map/.
This PHE is something we will not forget in our lifetime. There is a lot of information surrounding COVID-19, and health information management (HIM) coding professionals in all settings need to stay on top of the guidelines and official coding advice, then drive that valuable data into the hands of decision-makers, researchers, and others.
As noted, the other code that has prompted several ICD10monitor searches is for major depressive disorder. Often we read in the medical record that a patient has a minor depressive disorder, and this may mean that they are experiencing common depression symptoms such as the following (at least two and no more than five of the symptoms below, persisting over a two-week period):
- Feelings of emptiness or sadness
- A sense of hopelessness or pessimism
- Loss of interest in things once enjoyed
- Low energy
- Slow movements
- Inability to think clearly, make decisions, or remember things
- Sleep changes
- Weight changes
- Suicidal thoughts
- Complaints of illness a doctor cannot verify
With major depressive disorder, the individual may experience five or more of the above symptoms that last for more than two weeks. These depressive symptoms certainly have been seen and experienced with the COVID-19 pandemic.
The diagnosis of major depression is found in Chapter 5, Mental, Behavioral and Neurodevelopmental Disorders (F01-F99). There are two categories for “major depression” in the tabular index, F32, Major Depressive disorder, single episode, and F33, Major Depressive disorder, recurrent.
The tabular listing for F32 includes the following:
|F32.0||Major depressive disorder, single episode, mild|
|F32.1||Major depressive disorder, single episode, moderate|
|F32.2||Major depressive disorder, single episode, severe without psychotic features|
|F32.3||Major depressive disorder, single episode, severe with psychotic features|
|F32.4||Major depressive disorder, single episode, in partial remission|
|F32.5||Major depressive disorder, single episode, in full remission|
|F32.8||Other depressive episodes (e.g., a typical depression, post-schizophrenic depression)
F32.81 Premenstrual dysphoric disorder
F32.89 Other specified depressive episodes
|F32.9||Major depressive disorder, single episode, unspecified|
Under the code F32.9, Major depressive disorder, single episode, unspecified, there are additional terms:
- Depression NOS
- Depressive disorder NOS
- Major depression NOS
With the current PHE, yes, we are seeing more depression across our population; added to anxiety of the disease spread itself, and volume of deaths, there is unemployment and being on lock-down for several months. Not only do we have COVID patients who may have depression, but the caregivers also are experiencing signs and symptoms of depression. There is an interesting article in Medical News Today, titled Tips on depression management in lockdown: Coping with COVID-19. The link to this article is listed in the references section below, so you might want to read it.
Clinical coding is the foundation to healthcare data, which is connected to all corners of our healthcare system: data that is driving diseases management and research. Having accurate coding is thus an imperative, today and for the future. Keep informed and keep asking great questions that improve our healthcare data, now and for the future!
Programming Note: Listen to Gloryanne Bryant report this story live today during Talk Ten Tuesdays, 10-10:30 a.m. EST.
References: https://www.icd10monitor.com/covid-19-has-new-code-in-april; https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf; https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html; https://usafacts.org/visualizations/coronavirus-covid-19-spread-map/; https://www.codingclinicadvisor.com/faqs-icd-10-cm-coding-covid-19; https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-04-03-mlnc-se; https://www.cms.gov/files/document/mm11623.pdf; https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-3-18-2020.pdf; https://sunrisehouse.com/depression/major-different-everyday/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882809/; https://www.medicalnewstoday.com/articles/depression-and-covid-19