ICD10 Guideline COVID

This page contains an ICD10 Coding Guideline for ICD10 collection. See ICD10 coding guidelines for similar pages.

This page is an overarching page regarding how we collect different data related to Coronavirus disease 2019 (COVID-19).

List of all COVID-related dxs:

Diagnosis Coding

Coding symptomatic infection

For COVID positive patients combine COVID-19 (SARS-COV-2) with other appropriate diagnosis such as but not limited to:

• Pneumonia, viral
• ARDS (noncardiogenic pulmonary edema)
• Encephalitis, meningoencephalitis, myelitis, encephalomyelitis, viral
• Gastrointestinal infection (gastroenteritis, colitis), viral

The majority of COVID+ patients have myalgias, fatigue, or malaise. We do not collect this as per Template:ICD10 Guideline Signs Symptoms Test Results not needed when cause known.

Coding asymptomatic infection

• Combine COVID-19 (SARS-COV-2) with Carrier of infectious disease, unspecified
• To code muscle weakness due to an active Covid infection, where this the only evidence of the infection, use codes: Muscle, wasting/atrophy NOS, with COVID-19 (SARS-COV-2), and Carrier of infectious disease, unspecified

changed 2023-02-02

When there are both Asymptomatic and Symptomatic COVID19 in admit diagnosis, the symptomatic covid supercedes the asymptomatic and do not code the asymptomatic COVID19 anymore. When both happens as acquired diagnosis, consider the order of occurrence - if first has asymptomatic COVID19 then after two days has symptomatic COVID19, keep both. If the case is having a Symptomatic COVID19 first then later has Asymptomatic COVID, no need to code the Asymptomatic. If symptomatic COVID19 in admit, and asymptomatic COVID19 in acquired or vice versa, keep both codes.

Suspected infections being confirmed POSITIVE or NEGATIVE

• If a suspected infection becomes confirmed, remove this code and replace it with the relevant infection code
• If a suspected infection test comes back negative, delete the code unless that code was the only reason for admission, in which case leave it in
• ALSO, do NOT use this combination of codes for each COVID swab sent, as this represents a diagnosis, not a procedure.

Coding hospital acquired COVID

Add Nosocomial_infection,_NOS to what you would already code for this infection (ie might be different if symptomatic or not, or suspected etc, use the rules described elsewhere for that part).

Post-COVID

• If there are sequelae, consider coding Post COVID-19 condition
• If the condition is resolved, consider coding Past history of Covid-19 infection

Primary Admit Dx considerations

• Follow the same rules as usual for Primary Admit Diagnosis; that way our long term reporting doesn't get any weird discontinuities and if we need to report something for COVID we can still find that it was associated with the same priority:
  • it's only the primary if it meets the criteria in Primary Admit Diagnosis, e.g. if they also have a stroke or trauma COVID might not be related to primary at all
  • code the infection (e.g. Pneumonia, viral) as primary, not the pathogen
  • For those patients that have an active infection where the ONLY symptom is muscle weakness, ie. no respiratory symptoms code Viral infection, NOS with COVID-19 and Muscle, wasting/atrophy NOS

Coding of Pneumonia, bacterial in the context of COVID

• As of May 2021, it has become clear that many or most COVID pneumonia patients are also being treated with broad spectrum antibiotics. This is despite evidence that few of these patients actually have superimposed bacterial pneumonia. There are ongoing attempts in Manitoba to get physicians to cease doing this, but it continues to occur. THUS, in someone with proven COVID pneumonia, even if the patient has been placed on antibiotics for possible bacterial pneumonia, you should NOT code bacterial pneumonia UNLESS there is clinical evidence it is present.
  • This is different than usual coding of bacterial pneumonia, where a consistent clinical picture + use of antibiotics is sufficient to code it.
  • The kinds of "evidence" you should use comes from airway/sputum cultures --- e.g. is a trach culture has lots of WBCs and grows a single organism, this is reasonable evidence (if the team is providing antibiotics). If on the other hand, the trach culture has few or moderate WBCs and grows "mixed oral flora", then this is evidence against superimposed bacterial pneumonia.
  • This gets even murkier since many patients have long-term lung infiltrates after COVID pneumonia, which is usually NOT infectious but USUALLY represents pneumonitis and/or fibrosis, but CAN represent superimposed secondary infection.
  • Bottom line on all this is you need to use your judgement, but do NOT code a bacterial pneumonia just because the docs are writing "post-COVID" pneumonia. See below for more info about that.

Isolation

Enter CCI Isolation, infectious if isolation is in fact happening.

Uncertain cases

Coding Suspected infection

No special rules apply for coding suspected infections for COVID. Follow the normal Admit Diagnosis and Acquired Diagnosis guidelines, as well as Isolation, infectious if applicable.

changed 2022-09-07

Previously we had coded COVID suspect records by COVID-19 (SARS-COV-2) with Observation for suspected infection NOS linked with the same number (don’t link it with any other infection code if not confirmed), and left the code in, even if they later come up as a negative. This was coded on admission (if applicable) but subsequent swabs sent during the admission should not be coded as acquired diagnosis, unless the Swab is positive, then follow the usual guidelines for coding an acquired infection.

Presumed infections =

If the team believes that this is COVID-19 (even without clear cut lab confirmation), then use COVID-19 (SARS-COV-2) as the organism.

Delayed lab results

• I patient dies or is discharged with their COVID-19 lab test still pending, follow the usual rules i.e: Lab_and_culture_reports#How_long_to_wait_for_a_result or Attribution of infections

When info about COVID status is found out long after locations are entered

No special rules for COVID, just use the normal Admit Diagnosis & Acquired Diagnosis rules.

Boarding Loc coding

See Boarding_Loc#How_to_enter_this for some info about coding COVID designated locations.