While none of us will ever forget the COVID- 19 pandemic, we are now five years out from its beginnings. We have noted several coding updates that have arisen along the way. For example, we are now able to assign for long COVID: U09.9 assigns for post-COVID-19 condition, unspecified.
At the beginning of the pandemic, no one knew we would need a code for this condition. According to Centers for Disease Control and Prevention (CDC) data from 2022, about 7.5 percent of adults in the United States have had long COVID.
A 2022 press release noted that this works out to 1 out of every 13 adults. The definition for long COVID CDC used for the data collection was when the patient self-reported the presence of symptoms for at least a three-month period after having COVID-19. These were symptoms they did not have prior to contracting the virus, and this was among those who either had a positive COVID test or a diagnosis of COVID-19 from a doctor.
We can also now assign for under-immunization status for COVID-19. We have codes for both unvaccinated and partially vaccinated status. Prior to this, we had one code option for under-immunization status.
According to USAFacts, as of March 2025, about 81 percent of the U.S. population has received at least one dose of COVID vaccine. About 70 percent of the U.S. population is considered to be fully vaccinated.
Our guidelines for coding COVID have changed as well, as this April 1, there was an update. Official Coding Guideline C.1.g.1.h. has now been revised. This revision addresses how we assign for those asymptomatic individuals who test positive for COVID-19.
Previously, the guidance stated “although the individual is asymptomatic, the individual has tested positive and is considered to have the COVID-19 infection.”
The Guideline revision now states, “for asymptomatic individuals who test positive for COVID-19 (when) there is no provider documentation of a diagnosis of COVID-19, query the provider as to whether or not the individual has COVID-19.” The revision goes on to note that “a false positive laboratory test is possible, and it is the provider’s responsibility to confirm the diagnosis and document accordingly.”
This is a significant change, and means that coders cannot assign COVID based on a positive lab result. There must be physician documentation, or a query is required. Make sure your coding team is aware of this Guideline change, and update your coding policies and procedures on COVID accordingly.
An article in Respiratory Therapy Zone in March asked the question, “Is COVID-19 Making a Comeback in 2025?” The article addressed an increase in transmission rates in several U.S. states. Concern was also raised about possible new surges in the winter/summer months.
The aforementioned article further notes that the World Health Organization (WHO) has shifted from an emergency response to COVID to long-term disease management, indicating an endemic shift. While we would like to forget, COVID-19 is still here. Staying current with our classification and guidelines helps ensure we are reporting as accurately and completely as possible.
EDITOR’S NOTE: The narrative in this article reflects the firsthand perspectives and professional experience of Tami McMasters Gomez, curated and prepared for publication by Penny
EDITOR’S NOTE: The author of this article used AI-assisted tools in its composition, but all content, analysis, and conclusions were based on the author’s professional
Please log in to your account to comment on this article.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
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.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
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.
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
