Q&A: Sequencing sepsis and COVID-19

Q: According to the American Hospital Association’s (AHA) Coding Clinic for ICD-10-CM/PCS, first quarter 2020, “when COVID-19 meets the definition of principal or first-listed diagnosis, code U07.1, COVID-19, should be sequenced first, and followed by the appropriate codes for associated manifestations, except in the case of newborns and obstetrics patients.”

However, I’m not clear if we still follow sequencing direction included in the Official Guidelines for Coding and Reporting which states that we should code first for sepsis followed by infection. This would make more sense to me as well from a DRG mapping perspective to capture the patients on mechanical ventilation greater than 96 hours.

A: The Centers for Disease Control and Prevention (CDC) recently released updates to the Official Guidelines for Coding and Reporting related to COVID-19 which includes the following:

Sequencing of codes

When COVID-19 meets the definition of principal diagnosis, code U07.1, COVID-19, should be sequenced first, followed by the appropriate codes for associated manifestations, except in the case of obstetrics patients as indicated in Section I.C.15.s. for COVID-19 in pregnancy, childbirth, and the puerperium.

For a COVID-19 infection that progresses to sepsis, see Section I.C.1.d. Sepsis, Severe Sepsis, and Septic Shock.

Editor’s Note: This question and answer was generated by the ACDIS Leadership Exchange community. For information about ACDIS’ Leadership Exchanges contact ACDIS Associate Editorial Director Melissa Varnavas at mvarnavas@acdis.org.