May 07, 2021 Network in the Know

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.  

ScenarioCOVID-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:

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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