Pinson & Tang

Coronavirus: Clinical and Coding Considerations

March 15, 2020

Zoonotic diseases can be caused by viruses that infect one species and evolve through genetic mutations allowing them to make the leap to other species, including humans, where they spread.  The Coronavirus is the latest example of a zoonotic disease spreading rapidly through a new host population lacking any immunity to fight back.

This is no new evolutionary phenomenon. The best-known historical case occurred about 20,000 years ago when bovine tuberculosis made the jump to humans when we first turned to agriculture as our food source.  HIV may have done the same in Africa, originating in other primates (simian immunodeficiency virus).

Coronaviruses are a large group of viruses that cause illness ranging from the common cold to more severe diseases. This particular coronavirus is officially called “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2) in contrast to the SARS-CoV-1 that emerged in 2002. The word “corona” means “like a crown.” Under the electron microscope, the spherical coronavirus is lined with small projections resembling a small crown.

The 2019 coronavirus disease (COVID-19) is the collective term for all respiratory infections caused by SARS-CoV-2. Initial symptoms are much like almost any significant respiratory infection such as fever and/or respiratory-like symptoms like cough, sneezing, shortness of breath and difficulty breathing. In more severe cases, infection can cause pneumonia, respiratory failure, acute kidney injury and even death especially among people over age 60 and/or those with significant chronic diseases. The disease appears to be less severe in children and people less than age 60.

When COVID-19 attacks it settles down in the body’s cells where it multiplies exponentially before causing symptomatic infection. This period between invasion and disease is called the “latent” (silent) period lasting 2-14 days during which the host is infectious to others.

The apparently healthy, unsuspecting host goes around as usual all the while shedding viruses that infect others. Just like the flu, transmission occurs via aerosol droplets from coughing and sneezing and also by contact with contaminated surfaces. Hand-to-hand and hand-to-surface are the primary mechanisms of contact transmission, hence the important of frequent hand washing and sanitary gels.

The availability of testing kits is currently limited so CDC has strict testing guidelines. The results usually take 2-3 days. Production of testing kits is beginning to accelerate.

Treatment is primarily supportive focusing on the complications. There are no known effective anti-viral drugs but some are being tested. Prevention is the best defense. The following are recommended by the CDC for everyone:

  • Wash your hands often with soap and water
  • Cover your mouth and nose when you cough or sneeze
  • Stay home when you are sick
  • See your doctor if you think you are ill

Surgical face masks will limit, but not eliminate, the chance of inhaling large infectious particles circulating near the face produced by patients who cough and sneeze, which is the primary way the virus is spread. A face mask should be worn by people who have COVID-19 or are symptomatic to protect others from infection. The CDC recommends that the N95 particulate filtering facepiece respirators be reserved for protecting healthcare workers in the riskiest situations. A vaccine is currently being developed but will take several months for production and testing. It could take a year or more to produce enough doses for every American.

The ICD-10 code for COVID-19 is B97.29 (Other coronavirus as the cause of diseases classified elsewhere). Only cases confirmed as COVID-19 are coded.  According to the new guidelines, do not assign code B97.29 if the provider documents “suspected,” “possible,” or “probable” COVID-19. Instead, assign codes explaining the reason or symptoms for the encounter (such as fever, cough, shortness of breath). The COVID-19 respiratory infections associated with SARS-CoV-2 and the corresponding codes are: For ARDS associated with COVID-19:

  • J80 (Acute respiratory distress syndrome), and
  • B97.29 (Other coronavirus as the cause of diseases classified elsewhere).

For pneumonia associated with COVID-19:

  • J12.89 (Other viral pneumonia) and
  • B97.29 (Other coronavirus as the cause of diseases classified elsewhere).

For acute bronchitis associated with COVID-19:

  • J20.8 (Acute bronchitis due to other specified organisms), and
  • B97.29 (Other coronavirus as the cause of diseases classified elsewhere).

For acute or lower respiratory infections associated with COVID-19:

  • J22 (Unspecified acute lower respiratory infection), and
  • B97.29 (Other coronavirus as the cause of diseases classified elsewhere).

Other ICD-10 codes associated with COVID-19 include:

  • Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out) for possible exposure to COVID-19 subsequently ruled out
  • Z03.828 (Contact with and suspected exposure to other viral communicable diseases) for actual exposure to someone who is confirmed to have a COVID-19 infection

CDC plans to include a new code for COVID-19 (the disease) in the 2021 ICD-10-CM and will probably create a unique B97.2- code for SARS-CoV-2 itself as it did for SARS-CoV-1 coronavirus.

CDC maintains a Coronavirus home page to provide all the information and advice you need to know and do about the coronavirus epidemic.  It includes recommendations for infected persons, healthy people and in all social settings like the workplace, schools and colleges, public events, certain specific communities, travel, and “high-risk” populations. The situation is fluid and CDC recommendations will continue to evolve, so periodically monitor the site to keep up with any changes.


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