Interim ICD-10-CM Coding Guidance: Recommended Coding for COVID-19 and pregnancy
The Society for Maternal-Fetal Medicine (SMFM) Coding Committee; Trisha Malisch, CCS-P, CPC; Steve Rad, MD; Vanita Jain, MD
The purpose of this document is to provide interim diagnosis coding guidance for encounters related to the 2019 novel coronavirus (COVID-19) for maternal-fetal medicine subspecialists. While the CDC has published coding guidance in the general setting (https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf), codes from ICD-10-CM Chapter 15 (Pregnancy, Childbirth, and Puerperium) should be sequenced first before codes from other ICD-10-CM chapters in the setting of pregnancy. The following code combinations are recommended for coding maternal and fetal encounters.
The SMFM has recently released guidance regarding COVID-19 and antenatal surveillance: “Very little is known about the natural history of pregnancy after a patient recovers from COVID-19. Given how little is known about this infection, a detailed mid-trimester anatomy ultrasound examination may be considered following first-trimester maternal infection. For those experiencing illness later in pregnancy, it is reasonable to consider sonographic assessment of fetal growth in the third trimester” (https://s3.amazonaws.com/cdn.smfm.org/media/2262/COVID19_PDF.pdf). We also provide interim coding guidance for these imaging services.
Recommendations for antenatal surveillance and pregnancy management, and hence coding guidance, may change as new clinical information becomes available about COVID-19 and pregnancy.
Maternal Exposure/Symptoms/Confirmed Cases
COVID-19 infections can cause a range of maternal illness, from no symptoms to severe illness and death. For E/M encounters, the following code combinations are recommended.
- Exposure to someone confirmed to have COVID-19: O99.89, Z20.828
- Possible exposure to COVID-19, ruled out after evaluation: Z03.818, Z3A._ (0-42 weeks)
Signs and Symptoms without definitive diagnosis
- Use O99.89 + appropriate code for each presenting sign and symptom: R05 Cough, R06.02 Shortness of breath, R50.9 Fever
Confirmed COVID-19 infection
- Confirmed COVID-19 without symptoms: O98.51_, B97.29 (*Last character _ denotes trimester)
- Lower respiratory infection: O99.51_, J22, O98.51_, B97.29
- Acute bronchitis: O99.51_, J20.8, O98.51_, B97.29
- Bronchitis not otherwise specified (as acute or chronic): O99.51_, J40, O98.51_, B97.29
- Viral Pneumonia: O99.51_, J12.89, O98.51_, B97.29
- Respiratory failure with hypoxia: O99.51_, J96.01, O98.51_, B97.29
- ARDS: O99.51_, J80, O98.51_, B97.29
- Respiratory infection, not otherwise specified (other respiratory disorders): O99.51_, J98.8, O98.51_, B97.29
To code for fetal ultrasound procedures in cases of confirmed COVID-19 infection as indicated in accordance with current SMFM recommendations, we recommend utilizing the following coding sequence:
- Detailed mid-trimester anatomy ultrasound: 035.3XX#, O98.51_, B97.29
- Third trimester fetal growth ultrasound: O36.59_#, O98.51_, B97.29
- 13 weeks, singleton, confirmed COVID-19 infection with pneumonia. Seen for inpatient E/M visit. Recommended coding: 099.511, J12.89, O98.511, B97.29, Z3A.13
- Same patient is seen at 20 weeks for detailed ultrasound. Recommended coding: O35.3XX0, O98.512, B97.29, Z3A.20
- 32 weeks, singleton, confirmed COVID-19 infection with respiratory failure. Seen for inpatient E/M visit. Recommend coding: O99.513, J96.01, O98.513, B97.29, Z3A.32
- Same patient is seen for fetal growth ultrasound at 35 weeks. Recommended coding: O36.5930, O98.513, B97.29, Z3A.35
- O99.89 Other specified diseases and conditions complicating pregnancy, childbirth, and the puerperium
- O99.51 Diseases of the respiratory system complicating pregnancy
- O98.51 Other viral disease complicating pregnancy
- O35.3 Maternal care for (suspected) damage to fetus from viral disease in mother
- O36.59 Maternal care for other known or suspected poor fetal growth