Lisa Selman-Holman, JD, BSN, RN
President, Selman-Holman & Associates
In an unprecedented move, the CDC has approved new codes for COVID-19 effective with dates of stay January 1, 2021 or later. Code changes are reserved for October 1 each year with April 1 as a date for emergency changes. April 1, 2020 was the effective date for the U07.1 code for COVID-19.
New codes effective January 1 include J12.82, Pneumonia due to COVID-19, which will replace the use of J12.89 the code for pneumonia due to other viral pneumonia. The rule will be the same. If the patient is admitted for COVID-19 related illness, then the U07.1 is coded as primary and then the COVID related illness.
Pneumonia confirmed as due to COVID-19
- U07.1 COVID-19
- J12.89, Other viral pneumonia [replaced by J12.82, as of Jan 1]
The code that has been used (M35.8) for Multisystem Inflammatory Syndrome in Children (MIS-C) has been expanded to M35.81. Another code was added to M35.8 for other specified systemic involvement of connective tissue, M35.89.
Two new Z codes were added specific to COVID-19. Z20.822 is the new code for contact with, exposure to, COVID-19 and Z86.16 has been added for personal history of COVID-19. Those codes are replacing Z20.828 for contact with, exposure to, and Z86.19 for personal history.
One other new code for screening will also have an effective date of January 1, however it is not to be used until the pandemic is over. That code is Z11.52 for screening for COVID-19. (Screening is not the same as testing.)
If the COVID-19 is still an active infection, code U07.1 and then the conditions caused (not respiratory symptoms). If the patient does not have an active infection and still has residuals, code the residual and then B94.8, sequelae of other specified infectious and parasitic diseases.
Patient has critical illness myopathy because of COVID-19. He is now testing negative for COVID.
- G72.81 Critical illness myopathy
- B94.8 Sequelae of other specified infectious and parasitic diseases
If the patient no longer has COVID-19 or residuals from the infection, then the personal history code is used.
These new codes are effective for dates of service January 1 or later meaning if the claim includes dates January 1 or later, the new codes will need to be used.
The CDC has not issued new guidelines as of this date. CMS has not issued any information related to payment for the new codes, but it is suspected that J12.82 will have the same effect as J12.89 and the M35.81 and G35.89 codes will have the same effect as G35.8. There is no payment attached to the Z codes.