Q&A: COVID-19 vaccine reactions

Q: Are there are any documentation or coding guidelines for when a patient is admitted for various reactions to the COVID-19 vaccine?

A: Yes, there are a few scenarios out there. The Journal of AHIMA published an article titled, “AHIMA and AHA FAQ: ICD-10-CM/PCS Coding for COVID-19,” which advises coding the principal diagnoses as the reason for admission as normal along with an adverse reaction code that describes the scenario for which the patient was admitted. If the patient is COVID positive and COVID-19 is documented, then U07.1 is coded as the principal diagnosis (for acute care inpatient cases), unless there is another diagnosis that meets the definition of a principal diagnosis with sequencing guidelines (such as sepsis). The article linked above includes three Q&A scenarios for this situation, which are questions 45, 46, and 47.

The Coding Clinic Advisor website also includes a variety of COVID-19 coding updates and covers a host of questions with all kinds of scenarios and answers.

Editor’s Note: Dawn Valdez, RN, LNC, CDIP, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at dvaldez@hcpro.com. For information regarding CDI Boot Camps, click here.