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This bulletin is an update to the February 24, 2020, bulletin ICD-10-CA Coding Direction for Confirmed COVID-19 Cases and is intended to

The previous bulletin directed that only a confirmed case of COVID-19 is classified to U07.1 Emergency use of U07.1 (COVID-19, virus identified) and that U07.1 is not assigned when COVID-19 is suspected.

See our April 30, 2020, bulletin ICD-10-CA Coding Direction for COVID-19 in Obstetrics, and Updates on the Use of COVID-19 Laboratory Test Results.

New direction

Effective immediately, the new direction per WHO is that a suspected case of COVID-19 is classified to U07.2 Emergency use of U07.2 (COVID-19, virus not identified).

A suspected COVID-19 case is one that has been diagnosed clinically or epidemiologically but laboratory results are inconclusive or not available, or testing is not performed. When COVID-19 is ruled out by a negative laboratory result, U07.2 is not assigned (see table below).

Note: While prefix Q is used to identify unconfirmed diagnoses, it is not used with U07.1 or U07.2. This is an exception to the coding standard Unconfirmed Diagnosis.

It is recommended that hospitals correct previously submitted abstracts that do not comply with the above direction.

Facilities are encouraged to prioritize coding of COVID-19 cases to expedite timely data capture and reporting.

The following tabular listing changes will be included in the ICD-10-CA v2021 (subject to minor changes prior to release).

U07.1 COVID-19, virus identified

Note: Use this code when COVID-19 has been confirmed by laboratory results, irrespective of severity of clinical signs or symptoms.

Use additional code to identify pneumonia or other manifestations.

Excludes: coronavirus infection, unspecified site (B34.2)

coronavirus as the cause of diseases classified to other chapters (B97.2)
severe acute respiratory syndrome [SARS], unspecified (U04.9-)

U07.2  COVID-19, virus not identified    

Note: Use this code when COVID-19 is diagnosed clinically or epidemiologically but laboratory results are inconclusive, not available or testing is not performed.

Use additional code to identify pneumonia or other manifestations.

Excludes: coronavirus infection, unspecified site (B34.2)

COVID-19:

  • confirmed by laboratory results (U07.1)
  • special screening examination (Z11.5)
  • suspected but ruled out by negative laboratory results (Z03.8)

Note: For clients who have a v2018 Shadow file (.sdw) of ICD-10-CA, it is recommended that a note be added at U07.1 and U07.2 so coders are clear on the meaning of each code.

Diagnosis typing and main problem/other problem assignment for U07.2 (COVID-19, virus not identified) depends on the clinical documentation and circumstances surrounding the episode of care.

  • For acute inpatient cases reported to the Discharge Abstract Database (DAD) with a final diagnosis recorded using terms meaning “suspected COVID-19,” assign U07.2 as the most responsible diagnosis (MRDx). Do not apply prefix Q. Assign, as appropriate for the case, additional codes for any manifestations (e.g., pneumonia) that meet the definition of diagnosis type (1) or (2). 
  • For emergency department cases reported to the National Ambulatory Care Reporting System (NACRS), refer to the table below for direction on code assignment for COVID-19–related documentation.

Table: Main problem (MP) and other problem (OP) code assignment for emergency department COVID-19–related cases

COVID-19–related cases Confirmed COVID-19 — Positive laboratory result Ruled out COVID-19 — Negative laboratory result Suspected COVID-19 — Inconclusive, laboratory results not available or testing not performed

Dx: Suspected COVID-19
       Do not apply prefix (Q)

U07.1 (MP)

Z03.8 (MP)

U07.2 (MP)

Dx: Rule out COVID-19
Do not apply prefix (Q)

U07.1 (MP)

Z03.8 (MP)

U07.2 (MP)

Dx: Influenza-like illness
Rule out COVID-19
Do not apply prefix (Q)

U07.1 (MP)

J11.1 (MP)

J11.1 (MP)
U07.2 (OP)

Dx: Cough
Possible COVID-19 exposure
Do not apply prefix (Q)

U07.1 (MP)

Z03.8 (MP)

R05 (MP)
U07.2 (OP)

Dx: Fever, NYD
R/O COVID-19
Do not apply prefix (Q)

U07.1 (MP)

Z03.8 (MP)

R50.9 (MP)
U07.2 (OP)

Case example: Patient without signs or symptoms who was contacted by Public Health to be screened for COVID-19.

Dx: Potential exposure to COVID-19
Do not apply prefix (Q)

U07.1 (MP)
Z11.5 (OP)

Z11.5 (MP)

U07.2 (MP)
Z11.5 (OP)

Case example: Patient concerned about having COVID-19. No sign or symptoms or history of exposure. After assessment, no confirmed diagnosis. COVID-19 testing not ordered.

Dx: Non-medical issue

n/a

n/a

Z71.1 (MP)

Notes

J11.1 Influenza with other respiratory manifestations, virus not identified.
R05 Cough.
R50.9 Fever, unspecified.
U07.1 Emergency use of U07.1 (COVID-19, virus identified).
U07.2 Emergency use of U07.2 (COVID-19, virus not identified).
Z03.8 Observation for other suspected diseases and conditions.
Z11.5 Special screening examination for other viral diseases.
Z71.1 Person with feared complaint in whom no diagnosis is made.
NYD: Not yet diagnosed.
R/O: Rule out.
Dx: Diagnosis (meaning diagnosis at the time of discharge).
n/a: Not applicable.

Use of laboratory test results for coding

When COVID-19 testing is performed, NACRS coders should code an encounter once the COVID-19 laboratory test result is available to ensure that the code assignment reflects the greatest degree of specificity known from the COVID-19–related documentation. If coding is completed prior to availability of the laboratory result, it is recommended that coders flag these charts so that code assignment can be updated accordingly once the laboratory results become available.

Important: The direction for coders to use COVID-19 laboratory test results for code assignment is currently applicable only for data collection specific to the COVID-19 pandemic. This is an exception to the direction provided in the coding standard Using Diagnostic Test Results in Coding, which excludes the use of laboratory reports in coding. 

Documentation by infection control staff indicating that a patient has tested positive for COVID-19 may be used to meet the requirement to assign U07.1 (COVID-19, virus identified).

eQuery

Coding questions #75507 Suspected COVID-19 (Coronavirus Disease — 2019) and #75508 COVID-19 suspecté (maladie à coronavirus 2019) have been posted in eQuery to highlight the direction in this bulletin. Also, coding questions #75153 Confirmed COVID-19 (Coronavirus Disease — 2019) and #75154 COVID-19 confirmé (maladie à coronavirus 2019) have been updated to clarify that these previous coding questions are for direction specific to confirmed cases of COVID-19.

Clients can find answers to COVID-19–related questions submitted to eQuery by searching eQuery on key words “U07.1,” “U07.2” or “COVID-19.” If you require assistance with coding a specific case, submit your question and pertinent clinical documentation via eQuery.

Data capture of COVID-19–related documentation using CED-DxS

2 codes and accompanying common terms will be added to the Canadian Emergency Department Diagnosis Shortlist (CED-DxS) v7.0:

  • U07.1 COVID-19, virus identified
  • U07.2 Suspected COVID-19

U07.1 is to be used for confirmed cases of COVID-19 and U07.2 is to be used for suspected cases of COVID-19, as outlined in this bulletin.

The CED-DxS is used to capture ED Discharge Diagnoses (NACRS data element 137). CED-DxS v7.0 will be released to clients in early April 2020.  

Send your questions about the CED-DxS to NACRSPicklists@cihi.ca.

It is recommended that hospitals correct previously submitted abstracts that do not comply with the above direction.

For further clinical information, visit the Public Health Agency of Canada and WHO websites.

Explore CIHI’s COVID-19 resources web page, with key reports and resources on the coronavirus disease (COVID-19) pandemic.