2021 ICD-10-CM guidelines offer clarity, detail on reporting COVID-19 and manifestations

Wednesday, July 15, 2020

The CDC released the 2021 ICD-10-CM Official Guidelines on Coding Reporting on July 8, several weeks earlier than usual. The guidelines are effective October 1 and highlights include new instructions for reporting manifestations of novel coronavirus (COVID-19), vaping, and social determinants of health among other changes.

The updated guidelines feature a new section for U07.1 (COVID-19) that expands on the temporary coding guidelines released in April. The temporary guidelines will expire September 30. New instructions for U07.1 include the following:

  • Acute respiratory manifestations of COVID-19.
    • U07.1 should be assigned as the principal diagnosis if the reason for the encounter or visit is a respiratory manifestation of COVID-19. Codes for the respiratory manifestations should be assigned as additional diagnoses.
    • J96.0 (acute respiratory failure) was added as another respiratory manifestation that may be coded secondary to U07.1.
  • Non-respiratory manifestation of COVID-19.
    • If the reason for the encounter or admission is a non-respiratory manifestation, such as viral enteritis, of COVID-19, U07.1 is the principal diagnosis and codes for the manifestations should be assigned as additional diagnoses.
  • COVID-19 in pregnancy.
    • According to new guidance in Chapter 15: Pregnancy, Childbirth, and the Puerperium, if a patient tests positive for COVID-19 during an encounter that is unrelated to the disease, the reason for the encounter should be coded first, 098.5 (other viral diseases complicating pregnancy, childbirth, and the puerperium), and U07.1, followed by any appropriate COVID-19 manifestation codes.
  • COVID-19 in newborns.
    • If a newborn tests positive for COVID-19 and a specific method of transmission is not documented, U07.1 should be assigned and any appropriate codes for associated manifestations, according to a new section in Certain Conditions Originating in Perinatal Period. If a newborn tests positive for COVID-19 and the practitioner documents that the newborn contracted the disease in utero or during birth, P35.8 (other congenital viral diseases) should be coded followed by U07.1. The guidance clarifies that Z38 (liveborn infants according to place of birth and type of delivery) is the principal diagnosis when coding the birth episode in a newborn record.


The 2021 guidelines do not include a section on coding presumptive positive COVID-19 cases. Guidelines for coding presumptive positive cases referred to cases waiting for a second, confirmatory COVID-19 lab test, which is no longer required.

The updates also include significant changes to coding guidelines for reporting vaping-related disorders. According to new guidance in Chapter 10: Diseases of the Respiratory System, U07.0 should be coded as the principal diagnosis if the patient presents with conditions related to vaping, including lung injury related to vaping. Additional manifestation codes, including J96.0, should be reported but not other associated respiratory signs and symptoms such as shortness of breath. Gastrointestinal symptoms, such as diarrhea or abdominal pain, can be coded separately.

The guidelines also provide clarity on coding social determinants of health. Social determinants of health that are self-reported by the patient may be coded if the self-reported information is signed off by a clinician or provider and is incorporated into the health record.