CMS Provides SNFs with New PDPM ICD-10 Diagnosis Codes to Address COVID-19

Thoughtware Alert Published: Apr 21, 2020
Patient and Nurse

On February 11, 2020, the World Health Organization (WHO) announced the official name of the disease caused by the SARS-CoV-2 virus: COVID-19. Consistent with this WHO update, the Centers for Disease Control and Prevention’s National Center for Health Statistics implemented a new diagnosis code into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for reporting, effective March 18, 2020.

CMS in turn updated the FY 2020 PDPM ICD-10 Mappings on March 31, 2020, to reflect the new vaping code (U07.0 – Vaping-related disorder) mapped to the Return to Provider (RTP) category and the new COVID-19 code (U07.1 – 2019-nCoV acute respiratory disease) mapped to the Pulmonary category. These codes are effective as of April 1, 2020.

The ICD-10 official coding and reporting guidelines provide several examples and diagnosis codes to use for various coding scenarios related to COVID-19. Some of the diagnosis codes listed don’t map to a clinical category but to RTP, which isn’t acceptable for use as a primary diagnosis. See the table below for guidance on billing for COVID-19.



Signs & Symptoms Without Definitive Diagnosis of COVID-19


These codes can’t be used on minimum data set (MDS) assessments with an assessment reference date prior to April 1, 2020.

Using the correct ICD-10 codes can be a challenge under normal circumstances. Understanding which ICD-10 codes to use in these trying times is important for MDS accuracy, reimbursement and claim filing.

As with most topics related to COVID-19, changes are being made rapidly. Please note that this information is current as of the date of publication. Visit BKD's COVID-19 Resource Center to learn more. If you have questions, contact your BKD Trusted Advisor™ or use the Contact Us form below.

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