The Daily Dose
Coding Tips for Actual or Suspected Exposure to COVID-19: ICD-10 Code Z20.822
Since the COVID-19 public health emergency was declared, diagnosis codes for reporting actual or suspected exposure to COVID-19 have been updated. This article provides coding tips, based on the current official 2021 ICD-10 guidelines, for using the new ICD-10 diagnosis code Z20.822. This diagnosis code can be reported for dates of service on or after January 1, 2021.
| Scenario | COVID-19 Guidelines |
| Patient has no signs/symptoms and has actual or suspected exposure to COVID-19. | Report Z20.822. |
| Patient is symptomatic and has actual or suspected exposure to COVID-19. COVID-19 is ruled out, or tests results are inconclusive or unknown. | Report signs/symptoms diagnosis code(s) and Z20.822. |
| Patient has signs/symptoms normally associated with COVID-19 and has actual or suspected contact with, or exposure to, COVID-19. | Report signs/symptoms diagnosis code(s) and Z20.822. Report U07.1 only for confirmed cases, as documented by the provider or when there is documentation of a positive COVID-19 test. |
| Patient presents with known or suspected exposure to COVID-19, has no current COVID-19 infection or history of having COVID-19, and is diagnosed with multisystem inflammatory syndrome. | Report diagnosis code for multisystem inflammatory diagnosis and Z20.822. |
| Patient presents for COVID-19 testing. | Report Z20.822. |
| Patient presents for COVID-19 testing prior to surgery (preoperative testing). | Report the reason for surgery as the primary diagnosis code and Z20.822 as an additional diagnosis code. |
Members are still responsible for their cost share if they received services unrelated to COVID-19, even if a COVID-19 diagnosis was present on the claim.
For a complete summary of COVID-19 diagnosis coding guidelines in place as of January 1, 2021, please refer to the links provided below:
- https://www.cms.gov/files/document/2021-coding-guidelines-updated-12162020.pdf
- https://www.cdc.gov/nchs/data/icd/ICD-10cmguidelines-FY2021-COVID-update-January-2021-508.pdf
For additional information on CDPHP’s COVID-19 testing policy, please refer to COVID-19 Testing, 1550/20.000219, on the CDPHP Secure Provider Portal.
Should you have any questions, please call the CDPHP provider services department at (518) 641-3500 or 1-800-929-7526.
Karen Faxon About the Author
Karen Faxon is a registered nurse and certified coder who joined the CDPHP® workforce in 1996. Since then, Karen has worn many hats at CDPHP. Currently, she is a Senior Clinical Configuration analysis ensuring integrity of clinical codes and code auditing software. On weekends, you can often find her gardening or walking her two dogs, Tilly and Jazzy.
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