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ICD-10 coding guideline changes for 2021


What physicians need to know about coding in 2021

For 2021, there are 490 new, 47 revised and 58 deleted ICD-10-CM codes. We will cover the ICD-10-CM guidelines in this article and the ICD-10-CM code changes next month. There are several important changes to the guidelines, including those relating to COVID-19 coding. The updates for these were a little late this year due to COVID-19.

The guideline below is important in how we report codes for social determinants of health.

I.B.14 For social determinants of health:Patient self-reported documentation may also be used to assign codes for social determinants of health, as long as the patient self-reported information is signed-off by and incorporated into the health record by either a clinician or provider.

Chapter 1 Guidelines

Under this chapter, there are important updates for the COVID-19 coding, including the following:

I.C.1.g.1.a. Code only confirmed cases: Code only confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider or documentation of a positive COVID-19 test result. If the provider documents “suspected,” “possible,” or “inclusive COVID-19, do not assign code U07.1. Instead code the signs and symptoms reported.

I.C.1.g.1.b. Sequencing of codes: When COVID-19 meets the definition of principal diagnosis, code U07.1, COVID-19, should be sequenced first except when another guideline requires that certain codes be sequenced first, such as obstetrics, sepsis, or transplant complications.

I.C.1.g.1.c Acute respiratory manifestations of COVID-19: When the reason for the encounter/admission is a respiratory manifestation of COVID-19, assign code U07.1, COVID-19, as the principal/first-listed diagnosis and assign code(s) for the respiratory manifestation(s) as additional diagnoses.


  • Pneumonia confirmed due to COVID U07.1, J12.89
  • Acute Bronchitis confirmed as due to COVID U07.1, J40
  • Lower Respiratory Infection COVID documented as being associated with LRI, U07.1, J22
  • COVID documented as associated with respiratory infection, NOS U07.1, J98.8
  • Acute respiratory failure due to COVID, U07.1, J96.0-

I.C.1.G.1.d. Non-respiratory manifestations of COVID-19:When the reason for the encounter/admission is a non-respiratory manifestation (e.g., viral enteritis) of COVID-19, assign U07.1 as the principal diagnosis and the manifestation(s) as additional diagnoses.

I.C.1.g.1.e. Exposure to COVID-19: For asymptomatic individuals with actual or suspected exposure to COVID-19, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.

For symptomatic individuals with actual or suspected exposure to COVID-19 and the infection has been ruled out, or test results are inconclusive or unknown, assign code Z20.828. Contact with and (suspected) exposure to other viral communicable diseases. See guideline I.C.21.c.1. If COVID-19 is confirmed, see guideline I.C.1.g.1.a.

I.C.1.g.1.f. Screening for COVID-19:During the COVID-19 pandemic, a screening code is generally not appropriate. For encounters for COVID-19 testing, including preoperative testing, code as exposure to COVID-19 (guideline I.C.1.g.1.e).

I.C.1.g.1.g. Signs and symptoms without definitive diagnosis of COVID-19: If a patient with any signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to someone who has COVID-19, assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, as an additional code.

If a patient with signs/symptoms associated with COVID-19 (such as fever, etc.) but a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms.

I.C.1.g.1.g.i. Personal history of COVID-19: For patients with a history of COVID-19, assign code Z86.19,

I.C.1.g.1.h. Asymptomatic individuals who test positive for COVID-19:For asymptomatic individuals who test positive for COVID-19, see guideline 1.C.1.g.1.a.Although the individual is asymptomatic, the individual has tested positive and is considered to have the COVID-19 infection.

I.C.1.g.1.k. Encounter for antibody testing:For an encounter for antibody testing that is not being performed to confirm a current COVID-19 infection, nor is a follow-up test after resolution of COVID-19, assign Z01.84, Encounter for antibody response examination.

Follow the applicable guidelines above if the individual is being tested to confirm a current COVID-19 infection.

Chapter 4 Guidelines

I.C.4.a.3. Diabetes mellitus and the use of insulin, oral hypoglycemic, and injectable non-insulin drugs:If the patient is treated with both insulin and an injectable non-insulin antidiabetic drug, assign codes Z79.4, Long-term (current) use of insulin, and Z79.899, Other long term (current) drug therapy.

If the patient is treated with both oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, assign codes Z79.84, Long-term (current) use of oral hypoglycemic drugs, and Z79.899, Other long-term (current) drug therapy.

(NOTE: This guideline terminology is also utilized in I.C.4.a.6 Secondary diabetes mellitus.)

Chapter 9 Guidelines

Clarification for I.C.9.a.3 Hypertensive CKD and acute renal failure: For patients with both acute renal failure and chronic kidney disease, the acute renal failure should also be coded. Sequence according to the circumstances of the admission/encounter.

Chapter 10 Guidelines

I.C.10.e. Vaping-related disorders: For patients presenting with condition(s) related to vaping, assign code U07.0, Vaping-related disorder, as the principal diagnosis. For lung injury due to vaping, assign only code U07.0. Assign additional codes for other manifestations, such as acute respiratory failure (subcategory J96.0-) or pneumonitis (code J68.0).

Associated respiratory signs and symptoms due to vaping, such as cough, shortness of breath, etc., are not coded separately, when a definitive diagnosis has been established. However, it would be appropriate to code separately any gastrointestinal symptoms, such as diarrhea and abdominal pain.

Chapter 15 Guidelines

I.C.15.k. Puerperal sepsis: Code O85 should not be assigned for sepsis following an obstetrical procedure (See section 1.C.1.d.5.b., Sepsis due to a postprocedural infection).

I.C.15.s. COVID-19 infection in pregnancy, childbirth, and the puerperium: During pregnancy, childbirth or the puerperium, when COVID-19 is the reason for admission/encounter, O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, should be sequenced as the principal/first-listed diagnosis followed by and code U07.1, COVID-19, and the appropriate codes for associated manifestation(s) should be assigned as additional diagnoses. Codes from Chapter 15 always take sequencing priority.

If the reason for admission/encounter is unrelated to COVID-19 but the patient tests positive for COVID-19 during the admission/encounter, the appropriate code for the reason for admission/encounter should be sequenced as the principal/first-listed diagnosis, and codes O98.5- and U07.1, as well as the appropriate codes for associated COVID-19 manifestations, should be assigned as additional diagnoses.

Chapter 16 Guidelines

I.C.16.h. COVID-19 Infection in newborn:For a newborn that tests positive for COVID-19, assign code U07.1, COVID19, and the appropriate codes for associated manifestation(s) in neonates/newborns in the absence of documentation indicating a specific type of transmission. For a newborn that tests positive for COVID-19 and the provider documents the condition was contracted in utero or during the birth process, assign codes P35.8, Other congenital viral diseases, and U07.1, COVID-19. When coding the birth episode in a newborn record, the appropriate code from category Z38, Liveborn infants according to place of birth and type of delivery, should be assigned as the principal diagnosis.

Chapter 21 Guidelines

I.C.21.c.6 Observation: The observation codes are primarily to be used as principal/first-listed diagnosis only. An observation code may be assigned as a secondary diagnosis code when the patient is being observed for a condition that is ruled out and is unrelated to the principal/first-listed diagnosis (e.g., patient presents for treatment following injuries sustained in a motor vehicle accident and is also observed for suspected COVID-19 infection that is subsequently ruled out). Also when the principal diagnosis is required to be a code from category Z38, Liveborn infants according to place of birth and type of delivery, then a code from category Z05, Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out, is sequenced after the Z38 code. Additional codes may be used in addition to the observation code, but only if they are unrelated to the suspected condition being observed.

Renee Dowling is a billing and coding consultant with VEI Consulting in Indianapolis, Indiana.

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