COVID-19 ICD-10 coding for confirmed cases
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Guidance for correct ICD-10-CM coding of COVID-19 (U07.1) and related respiratory conditions for Simply Healthcare Plans, Clear Health Alliance, Florida Healthy Kids, and Simply Medicare Advantage providers.
No material clinical or coverage changes in this revision.
Coding and Sequencing Criteria
Coding and sequencing criteria for COVID-19 and related conditions
Assign codes based on provider documentation, test results, exposure status, and clinical presentation as follows:
ALL of the following
- Provider documents a confirmed diagnosis of COVID-19, documents a positive COVID-19 test result, or documents a presumptive positive test result → assign U07.1 (COVID-19).
Presumptive positive (local/state positive not yet CDC-confirmed) should be coded as U07.1; provider documentation alone is sufficient — test type need not be documented.
ALL of the following
- If provider documents suspected, possible, probable, or inconclusive COVID-19 → do not assign U07.1; instead assign appropriate symptom/encounter codes or Z20.828 as applicable.
ALL of the following
- When COVID-19 meets the definition of principal diagnosis → sequence U07.1 first, followed by codes for associated manifestations (exception: obstetrics where Chapter 15 codes take priority).
ALL of the following
- For pneumonia confirmed due to COVID-19 → assign U07.1 and J12.89.
ALL of the following
- For acute bronchitis confirmed due to COVID-19 → assign U07.1 and J20.8.
- For bronchitis NOS due to COVID-19 → assign U07.1 and J40.
ALL of the following
- If associated with lower respiratory infection (unspecified) → assign U07.1 and J22.
- If documented as respiratory infection NOS → assign U07.1 and J98.8.
ALL of the following
- For ARDS due to COVID-19 → assign U07.1 and J80.
Exposure and screening scenarios
- Exposure evaluated and ruled out → assign Z03.818.
- Actual exposure (confirmed or suspected) where exposed individual tests negative or results unknown → assign Z20.828.
- Exposed individual who tests positive → assign U07.1.
- Asymptomatic individual who tests positive → assign U07.1.
- Asymptomatic screening with no known exposure and negative/unknown result → assign Z11.59.
ALL of the following
- When signs/symptoms associated with COVID-19 are present but definitive diagnosis not established → assign appropriate symptom codes (e.g., R05, R06.02, R50.9).
- If such a patient also has actual or suspected contact/exposure → add Z20.828 as an additional code.
ALL of the following
- For COVID-19 in pregnancy, childbirth, or the puerperium when the patient is admitted/presenting because of COVID-19 → assign principal diagnosis code O98.5- (other viral diseases complicating pregnancy, childbirth and the puerperium) followed by U07.1 and appropriate manifestation codes; Chapter 15 codes take sequencing priority.
ICD-10 Code Guidance and Tables
| U07.1 | COVID-19 (confirmed) |
| J12.89 | Other viral pneumonia (due to COVID-19) |
| J20.8 | Acute bronchitis due to other specified organisms (due to COVID-19) |
| J40 | Bronchitis, not specified as acute or chronic (bronchitis NOS due to COVID-19) |
| J22 | Unspecified acute lower respiratory infection (with U07.1) |
| J98.8 | Other specified respiratory disorders (with U07.1) |
| J80 | Acute respiratory distress syndrome (with U07.1) |
| Z03.818 | Encounter for observation for suspected exposure to other biological agents ruled out |
| Z20.828 | Contact with and (suspected) exposure to other viral communicable diseases |
| Z11.59 | Encounter for screening for other viral diseases (asymptomatic, no known exposure; test negative/unknown) |
| U07.1 | Asymptomatic individual who tests positive |
| R05 | Cough |
| R06.02 | Shortness of breath |
| R50.9 | Fever, unspecified |
| O98.5- | Other viral diseases complicating pregnancy, childbirth and the puerperium (principal diagnosis), followed by U07.1 |
Required Actions for Claims and Documentation
Use CDC ICD-10-CM COVID-19 coding guidelines for claims
Follow the CDC ICD-10-CM official coding and reporting guidelines (April 1, 2020 through September 30, 2020) when assigning COVID-19 related diagnosis codes on claims to ensure proper coding and sequencing per Simply Healthcare Plans guidance.
- Use the CDC guidance as the authoritative source for coding COVID-19 (U07.1) and related conditions.
- Apply the CDC sequencing rules (e.g., sequence U07.1 first when COVID-19 is the principal diagnosis, except where Chapter 15 obstetric codes take precedence).
Key Definitions
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