​The public health emergency ended on May 11, 2023, and the COVID screening guideline was updated in October, but here we are: still getting questions about coding for COVID testing.

The last three and a half years have been anything but normal and COVID reigned supreme. We saw new codes being released outside of the regular code release schedule and ever-changing guidelines, FAQs, and other advice. So, when the new guideline about coding for screening came out, it generated a lot of questions. But if you dig a little deeper, you can find the answers to all your questions in the guidelines and Coding Clinic.

The biggest change to COVID coding since October 1 is the use of code Z11.52 to report screening. Prior to that time, we were told not to use this code. Here is a side-by-side comparison of the 2023 and 2024 guidelines:

Let’s delve further into that exposure guideline. Why were we coding exposure before October 1 and not after? Guideline I.C.1.g.1.e (Exposure to COVID-19) refers us to guideline I.C.21.c.1. (Contact/Exposure) for additional guidance regarding the use of Z20 codes. And there is a gem of advice here that I never saw before we landed ourselves in a worldwide pandemic: “These codes are for patients who are suspected to have been exposed to a disease by close personal contact with an infected individual or are in an area where a disease is epidemic.”

“An epidemic is an unexpected number of increased cases of a disease in a specific geographical area. A pandemic is an epidemic on steroids! It occurs when a disease’s growth is exponential and it covers a wide area, affecting multiple countries and populations.”

The reason we were using codes for exposure to COVID during the pandemic is because it was assumed that everyone had at least a suspected exposure to COVID-19.

You may be asking yourself about that time period between May 11 and October 1. Technically we were not in an epidemic status during that time, yet the new guidelines were not effective until October 1. Coding Clinic for ICD-10-CM/PCS answered that dilemma by publishing an article in their second quarter publication (page 3). In that article, they stated we should continue to report code Z20.822 for screening of COVID until the fiscal year 2024 guidelines became effective.

Now that the pandemic has been officially deemed over, when it comes to testing, COVID is treated like any other infectious disease. That means that if a patient is presenting with symptoms and is tested for COVID – and the result is negative, we code only the symptoms. And if they present without symptoms for COVID testing (e.g., preoperative testing), screening code Z11.52 is assigned. As always, if the result is positive, code U07.1, COVID-19 is assigned rather than the symptoms. Guideline I.C.21.c.5 (Screening) states: “Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis.” That means that if the patient was asymptomatic and tested positive, code Z11.52 is assigned along with code U07.1. If you are coding or auditing, you will need to pay close attention to the dates of service and ensure that you are applying the correct version of coding guidelines for COVID screening. In our documentation reviews, we have found this is an area of opportunity for provider education to ensure they document the exposure to allow for reporting of this code.

The brain twist here is treating COVID like any other infectious disease when it was anything but since 2020. As a guide, we have updated our COVID tip sheet to help you navigate these changes. View the document below and click here to download –> ED Coding Tip Sheet for COVID_Effective 10.1.23