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

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).

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

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

If patient is a COVID suspect- combine 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) Leave the code in, even if they later come up as a negative.

This should be 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 - of course anybody seeking to do definitive analysis of all COVID-19 cases will need to obtain and use the data on confirmed cases from Cadham.

Is this still how we want to do it with all the changes that have happened to testing?

• SMW

• Cargo

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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
  • Note that this test is done by Cadham Lab and not by the usual DSM lab.

Is that still true?

• SMW

• Cargo

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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.

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

Boarding Loc coding

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

Background

Data about COVID is sent to MCHP so please adhere to the guidelines below closely so our data is well understood.

1 Do we still send it there specially for COVID? IE, are any of our rules for COVID still related to MCHP at all?

• SMW

• Cargo

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