Updated on: August 16, 2021

Important News for Coders: Quantifying the Sequelae Following Acute COVID-19

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Original story posted on: August 13, 2021

 Research shows that about 14 percent of adults developed at least one new clinical sequela requiring medical care after recovery from COVID-19, though many specifics have yet to be clarified.

Though still well below the peaks seen in 2020, COVID-19 infections, hospitalizations, and deaths in the U.S. are increasing, according to the Centers for Disease Control and Prevention (CDC).

Also, per the CDC, more than 44,000 Americans are currently hospitalized with COVID-19, which is four times the number reported just two months ago, in June. These numbers are alarming, and prompt an increased focus on the impact the virus has on those suffering after recovery – or the "long-haulers," as they are referenced. The healthcare community is addressing this head-on, analyzing data and implementing a new code to better understand the sequelae after recovery from COVID-19.

A recent study was conducted analyzing three data sources within the UnitedHealth Group Clinical Discovery, with results indicating excess risk of developing new clinical sequelae after the acute phase of SARS-CoV-2 infection, including specific types of sequelae that are less commonly seen in other viral illnesses. Additionally, older individuals who had pre-existing conditions and were admitted to the hospital because of COVID-19 were at the most significant excess risk.

While research reveals that about 14 percent of adults who had been infected with the virus developed at least one new clinical sequela requiring medical attention after recovery from COVID-19, many specifics have yet to be determined. The healthcare community's understanding of post-COVID-19 conditions is progressing and will undoubtedly evolve as people continue to contract the virus. However, collecting accurate data and gauging severity can be challenging, as the data collected must rely on self-reporting in many instances. So the Oct. 1 implementation of a new code for COVID sequelae comes not a moment too soon.

It is of particular importance for the coding community to understand guidelines for the new code, and have a definitive line drawn between sequelae and active COVID as we approach the effective date for U09.9, described as "Post COVID-19 condition, unspecified."

The ICD-10-CM guidelines are clear about sequela, defining them as "the residual effect (condition produced) after the acute phase of an illness or injury has terminated." There is no time limit on when a sequelae code can be used, and the residual effect may be present early or may arise months or years later. The new ICD-10 code, U09.9, created by the World Health Organization (WHO) for sequelae after recovery from COVID-19, should be used if there is a description of a sequela of COVID-19, a residual condition following COVID-19, or a post-COVID-19 condition. This code is not to be used in cases that still are presenting as COVID-19. The new code U09.9 will be specific to post COVID-19 conditions, unspecified, and will be used in place of code B94.8, effective Oct. 1.

Coders have many questions about this topic. For instance, if a patient presents to a facility with symptoms such as generalized weakness, the provider must specifically document that the symptoms result from COVID-19, assign code(s) for the specific symptom(s), and use a code for a personal history of COVID-19 – but in this case, would the new code U09.9 be used? The answer is that documentation of simply "post-COVID-19 syndrome" indicates temporality, but not that the current symptoms or clinical conditions are a residual effect (sequelae) of COVID-19.

The above is just one example, although the important thing for coders to remember is to first assign a code related to the specific condition associated with COVID-19, if known, along with the new code, U09.9. If there is a history of COVID-19 without a current related condition, current or recurrent infection with COVID-19, or lack of clarity in the clinical record, it would not be appropriate to use the new code.

With an effective date (Oct. 1) right around the corner for the new code, it is crucial to have a definitive line drawn between sequelae and active COVID. Resources are available for coders through multiple associations to ensure appropriate coding for ICD-10 code U09.9, such as the CDC website and the ICD-10-CM Official Guidelines for Coding and Reporting.  

COVID-19 sequelae, symptoms, risk levels, and severity are critical to measure, as this information is essential for all healthcare planning. And for the population's health, understanding the long-term effects of COVID-19 is of the utmost importance.

Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer

Susan Gatehouse is the founder and chief executive officer of Axea Solutions. An industry expert in revenue cycle management, Gatehouse established Axea Solutions in 1998, and currently partners with healthcare organizations across the nation, to craft solutions for unique challenges in the dynamic world of healthcare reimbursement and data management.

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