ICD-10 Codes and COVID-19
By Lisa Werner
Because the COVID-19 Public Health Emergency has been underway for more than a year, we have seen numerous new ICD-10 codes released that may be used to capture a patient’s presentation upon admission to the inpatient rehabilitation setting. In the following summation, I will review the new codes and indicate their use and implications for inpatient rehabilitation providers.
U07.1 – COVID-19 was the first diagnosis code released. It was meant to be used for patients diagnosed with the virus. Currently, it is used for patients with active virus. For inpatient rehabilitation providers, this code is used when a patient with active virus is in the hospital/unit. It may also be used as an etiologic diagnosis to explain why a patient was admitted. For example, a patient may present with an Impairment Group Code of 16 and an etiologic diagnosis of U07.1. This code should not be used when the patient has tested negative and no longer has active COVID-19. U07.1 is a Tier 3 condition.
Z86.16 – Personal history of COVID-19. This IDC-10 code indicates that the patient once tested positive for COVID-19 but is now found to be negative. This condition is commonly reported on the IRF-PAI for patients who come to rehab following COVID-19. Their reason for admission may be characterized by the persistent symptoms related to COVID-19 like critical illness myopathy, anoxic brain injury, acute respiratory failure or other like conditions. Z86.16 is not a tiering condition.
J12.82 – Pneumonia due to COVID-19. This diagnosis was released on October 1, 2020 to capture a patient’s pneumonia secondary to COVID-19. Prior to release of this code, inpatient rehabilitation providers may have used J12.89 – Other viral pneumonia to capture the presence of pneumonia following the coronavirus. J12.89 is a Tier 3 condition. J12.82 is not listed as tiering condition for inpatient rehabilitation providers.
M35.81 – Multisystem inflammatory syndrome. This diagnosis was also released on October 1, 2020. This code may be used to characterize a patient’s persistent symptoms in conjunction with or following COVID-19. This may be used as the etiologic diagnosis to indicate the reason for the patient’s admission or an active comorbidity. It is not a tiering comorbidity.
These additional codes that became effective on October 1, 2020, may also be reported on a patient’s IRF-PAI as they apply:
- 52 – Encounter for screening for COVID-19
- 822 – Contact with or (suspected) exposure to COVID-19