Cracking the Code

Correct Sequencing of Acute Manifestations of COVID-19

It is important for medical coders to adhere to all current coding guidelines pertaining to COVID-19 medical scenarios. Please remember that coding guidance for COVID-19 is very fluent. There are specific instructions on how to correctly sequence diagnoses for COVID-19 cases. Currently, when a patient is treated for COVID-19, returns to the hospital for further signs and symptoms (i.e. coughing), and has negative subsequent COVID-19 tests BUT provider documents a final diagnosis of Pneumonia due to COVID-19 virus, it is accurate to code that final diagnosis as it is documented. The coding guidelines state to sequence U07.1, COVID-19 as the principal diagnosis and J12.82, Pneumonia due to coronavirus disease 2019 as a secondary diagnosis. In this scenario, the pneumonia is an acute manifestation of COVID-19. Regardless of the patient’s current COVID-19 test results, U07.1 is sequenced first.

Q: A patient returns to the ED five weeks after previously being admitted for COVID-19. The presenting signs and symptoms are fever, cough, and pleuritic chest pain. The provider tests the patient once more for COVID-19; however, the test results are negative. The patient is discharged home with a final diagnosis of pneumonia due to COVID-19 virus.
A: U07.1, COVID-19
J12.82, Pneumonia due to coronavirus disease 2019
Reference: AHA Coding Clinic First Quarter 2021, pages 46-47: Pneumonia as acute manifestation of COVID-19
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