We have all been keeping up with COVID-19 and the code and guideline changes that have evolved since original coding advice came out in February of 2020.
The advent of code U07.1 was a “game changer”. This code was created and made effective after April 1, 2020. The coding directive in this code states: Use additional code to identify pneumonia or other manifestations.
What is a manifestation vs. a sign/symptom? Per JAMA (Journal of the American Medical Association):
“A symptom is a manifestation of disease apparent to the patient himself, while a sign is a manifestation of disease that the physician perceives. The sign is objective evidence of disease, a symptom, subjective. Symptoms represent the complaints of the patient, and if severe, they drive him to the doctor’s office. If not severe, they may come to light only after suitable questions. The patient perceives, for example, subjective pains and discomforts [Doctor, I have a bad headache], or disturbances of function [Doctor, I can’t move my arm the way I used to], or some simple appearance [Doctor, I have had this rash for the past ten days and I’m worried about it].”
“Regarding SARS-CoV‑2, in general, these findings are nonspecific, such as dyspnea, fever, cough, and headache. The severity of the infection may vary from asymptomatic patients to severe cases of pneumonia that can lead to death. Initially, the disease was characterized by the triad fever, cough, and shortness of breath. The US Center for Disease Control and Prevention (CDC) subsequently added chills, muscle pain, headache, sore throat, and loss of taste or smell to this list (neurological manifestations).”
The JAMA and NCIB (reference links below) are using the terms “manifestations” and “symptoms” interchangeably. In the absence of specific diagnoses that are manifestations of COVID-19 (such as pneumonia, respiratory failure, multisystem inflammatory syndrome, etc.), the manifestation would be the symptom, such as fever or shortness of breath.
Manifestations in the COVID-19 guidelines say they are “examples” (pneumonia, acute bronchitis, acute respiratory infection, etc.), so not a totally inclusive list. The Coding Guidelines for COVID-19 state that if a patient is given the diagnosis of COVID-19, code also the manifestations of COVID-19. Again, in the absence of a more specific manifestation like pneumonia, respiratory failure, ARDs, multisystem inflammatory syndrome, etc., the symptom would be considered the manifestation. There is also a Coding Guideline regarding the use of symptoms codes, which says, “Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider”.
It is important to follow the coding directive for U07.1 and add the manifestations that are documented by the provider.
In summary, in the absence of a definitive diagnosis such as pneumonia or bronchitis, the use of a sign or symptom code would be used as the manifestation.
Written by Jennifer Jones, RHIT, CCS, CCDS & Mary Chelucci, RHIA, CCS
References: Coding Guideline I.C.1.g.c. (COVID Manifestations); Coding Guideline 1.B.4 (Symptoms); https://www.codingclinicadvisor.com/sites/default/files/Frequently%20Asked%20Questions%20Regarding%20COVID-19_v14C_Secure_0.pdf (FAQ #24, #25, #26); https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689634/; https://jamanetwork.com/journals/jama/article-abstract/341611
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