There is a lot of confusion about what ICD-10-CM codes to report for services for patients who reside in a nursing facility. The determining factor when selecting an ICD-10-CM code should always be the documentation in the patient’s medical record.
Effective 4/1/2020 the CDC provided clear guidance in the form of the ICD-10-CM Official Coding and Reporting Guidelines April 1, 2020 through September 30, 2020
“For cases where there is an actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.” This would mean that the patient’s medical record would contain specific documentation reporting the patients exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19. It would be reasonable to expect that within the documentation there would be an order for testing and eventual test results.
The guideline also states, ICD-10-CM code would be reported “for cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out”. Again, the patient’s medical record would contain specific documentation reporting the possible exposure scenario and the measures used in ruling out the exposure.
Lastly, the guideline advises, “Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider, documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result”, assign code U70.1.