Updated on: October 20, 2020

Sequela Conditions from COVID-19-The Long Haulers

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Original story posted on: October 12, 2020

There is a term we now use for patients who are suffering from sequela conditions of COVID-19 which is Long Haulers. There are many conditions/signs symptoms and late effects of COVID-19 we are learning about every day and the list keeps growing.  What are post-COVID patients experiencing?  Many of post COVID-19 patients are seeing one or more symptoms conditions including shortness of breath, fatigue, thrombosis, dizziness, neurological, cardiovascular and respiratory conditions as well as hearing loss, difficulty concentrating, memory loss, hearing loss, visual problem, strokes, depression, PTSD and more. What is not known, however, is what symptoms and complications may linger long after an initial COVID-19 infection. Early research shows the disease attacks more than just the respiratory system, affecting multiple organs with blood clots and inflammation.

A study published by the Centers for Disease Control and Prevention (CDC) released July 24, 2020 indicated 35percent of COVID-19 (SARS-CoV-2) outpatients had not returned to usual state of health. As cases grow to over 7 million and quickly climbing in the United States with a significant number of patients recovering we are going to see the next wave of patients who need care for sequela conditions (late effects).  However, a recent study from Indiana University School of Medicine (IUSM) finds that long hauler’s COVID-19 symptoms are more numerous than on the CDC website.  I encourage everyone to read this study as it is enlightening. The study can be found at: https://dig.abclocal.go.com/wls/documents/2020/072720-wls-covid-symptom-study-doc.pdf

In acute cases patients have suffered sopercentme late effect conditions or symptoms according to scientists  These conditions/symptoms may last 6 months to a year and more serious late effects may be permanent. Some of the potential long-term effects can affect patients who are asymptomatic or have mild cases of COVID-19 as well.

What are some of these symptoms?  The most common is fatigue, muscle and body aches, shortness of breath and difficulty breathing, but also these conditions can occur

  • loss of hearing
  • skin changes
  • calf pain
  • dry eyes,
  • rashes
  • confusion, fog brain
  • loss of taste and smell
  • abdominal pain
  • lower back pain
  • muscle pain or weakness
  • tinnitus or humming in ears
  • sharp or sudden chest pain
  • depression and/or PTSD
  • fibrosis or scarring in lungs
  • Cognitive impairment
  • thyroiditis
  • stroke
  • seizures

And the list goes on. Painful symptoms according to the IU survey included symptoms that were painful at 26.5 percent and painless symptoms at 73.5 percent.

As a long hauler myself having survived COVID-19 eight months ago,  I have experienced some of these symptoms.  Some of my symptoms finally went away after a few months, but I am still having some bouts of fatigue and shortness of breath which is being managed medically. Most certainly we may see more sequela conditions emerge as more people recover. Practitioners will probably continue to treat many more patients with specific conditions and/or signs/symptoms post COVID-19.  With so many new cases of COVID-19 on a daily basis, this is only the beginning.  We need to be prepared for the long haul.

How does this affect Coding Sequela to COVID-19?

It is all about the documentation and identifying the condition/symptom sequela to COVID-19. It is important that when coding sequela to COVID-19 any condition/symptoms that is sequela that we list all that are relevant.  Be specific, documentation must include the relationship with COVID-19 in order to code the condition as sequela. Query the practitioner if the documentation is not clear.  Physicians should also document any patient counseling related to prevention measures to reduce the spread of COVID-19.   

Make sure when coding sequela to COVID-19, that the patient had a confirmation of COVID-19 by testing or documentation in the practitioners record. The coding guidelines tell us to code first all the condition(s) being treated  that are sequela to COVID-19 (e.g., shortness of breath, DVT, fatigue, etc.) and use the additional code B94.8-Sequelae to identify the late effect.  When it is unclear if the documented condition/symptoms is related to COVID-19 but there is documented confirmation the patient had COVID-19:

  • Code first the condition/symptoms treated
  • Report Z86.19 (personal history of other infectious and parasitic diseases) as an additional diagnosis.

Lastly keep on top of articles and research to learn about the sequela conditions as we are all in this for the long haul.

Valuable Reading

Indiana University School of Medicine COVID-19 Survey

https://dig.abclocal.go.com/wls/documents/2020/072720-wls-covid-symptom-study-doc.pdf

COVID-19 Sequelae Can Linger for Weeks; https://www.medpagetoday.com/infectiousdisease/covid19/86482

Best Practice Coronavirus disease; https://bestpractice.bmj.com/topics/en-gb/3000168/pdf/3000168/Coronavirus%0disease%202019%20%28COVID-19%29.pdf

Coding encounters related to COVID-19; CDC, https://documentcloud.adobe.com/link/track?uri=urn%3Aaaid%3Ascds%3AUS%3A4a77cfd4-54f4-4548-9c9d-d9498dbb9f2c#pageNum=1

Covid-19 Coding and Guidance, American Medical Association; https://www.ama-assn.org/system/files/2020-05/covid-19-coding-advice.pdf

https://journal.ahima.org/ahima-and-aha-faq-on-icd-10-cm-coding-for-covid-19/
ICD-10-CM Official Guidelines for Coding and Reporting

https://journal.ahima.org/the-legacy-of-covid-19-impact-on-him-now-and-in-the-future/

Complications and Sequela to COVID-19: https://reliefweb.int/report/world/epidemiological-alert-complications-and-sequelae-covid-19

Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified Clinical Documentation Improvement Practitioner

Deborah Grider has 35 years of industry experience and is a recognized national speaker, consultant, and American Medical Association author who has been working with ICD-10 since 1990 and is the author of Preparing for ICD-10, Making the Transition Manageable, Principles of ICD-10, the ICD-10 Workbook, Medical Record Auditor, and Coding with Modifiers for the AMA. She is a senior healthcare consultant with Karen Zupko & Associates. Deborah is also the 2017 American Health Information Management Association (AHIMA) Literacy Legacy Award recipient. She is a member of the ICD10monitor editorial board and a popular panelist on Talk Ten Tuesdays.

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