December 5, 2016

Zika: Nine Rules: Coding Clinic Publishes Coding Guidance for Zika Patients

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The subject of the Zika virus continues to be in the news, particularly with the Nov. 9 announcement by the Centers for Medicare & Medicaid Services (CMS) that $66.1 million have been dedicated to Zika prevention and treatment.

The American Hospital Association (AHA), through the Coding Clinic edition published for the fourth quarter of 2016, provides coding guidance for various coding scenarios with regards to this disease.

The first rule in Zika virus coding is that only confirmed cases are coded. This rule creates an exception to the inpatient coding guidelines of assigning diagnosis codes for “possible,” “probable,” “suspected,” etc. conditions at the time of discharge. The confirmed diagnosis rule applies to all healthcare settings. If the provider documents an unconfirmed Zika diagnosis, then the coder should assign the reason for the encounter.

The second rule is that the code for the Zika virus has changed with the update for the 2017 fiscal year. The initial code, A92.8, should only be assigned for dates of service/discharges of Oct. 1, 2015 through Sept. 30, 2016. Beginning Oct. 1, 2016, confirmed Zika virus cases should be assigned code A92.5.

The third rule is that a patient with a past history of the Zika virus would be assigned Z86.1 (Personal history of infectious and parasitic diseases).

The fourth rule is for pregnant women who have a confirmed Zika diagnosis.

  • If there is unknown status of fetal abnormalities and positive testing, assign O28.3 (Abnormal ultrasound findings, antenatal screening of mother); O98.51- (Other viral disease complicating pregnancy); A92.5 (Zika virus); and Z3A.- (Weeks of gestation).
  • If there is unknown status of fetal abnormalities and negative testing, assign Z03.73 (Encounter for suspected fetal anomaly ruled out), O98.51- (Other viral disease complicating pregnancy); A92.5 (Zika virus); and Z3A.- (Weeks of gestation).
  • For prenatal care of fetal abnormalities, assign O35.3XX- (Maternal care for suspected damage to fetus from viral disease in mother); O98.51- (Other viral disease complicating pregnancy); A92.5 (Zika virus); and Z3A.- (Weeks of gestation).
  • For prenatal care without fetal abnormalities, assign O98.51- (Other viral disease complicating pregnancy); A92.5 (Zika virus); and Z3A.- (Weeks of gestation).
The fifth rule is for pregnant women without signs or symptoms of the Zika virus, but those at risk (travel in high-risk areas, having a sexual partner who has Zika, etc.) and presenting for testing. For these cases, assign Z34.- (Encounter for normal supervision of pregnancy); and Z20.828 (Contact with and suspected exposure to other viral communicable diseases).

The sixth rule is for pregnant women who are seeing a physician for results of Zika testing. If the results are negative, assign Z03.79 (Encounter for other specified maternal and fetal conditions ruled out). If the results are positive, assign O35.3XX- (Maternal care for suspected damage to fetus from viral disease in mother).

The seventh rule is for newborns (at the time of birth) with a mother who has confirmed Zika virus and diagnosed anomalies. Assign the code Z38.- (newborn); P35.8 (Other congenital viral diseases); A92.5 (Zika virus), and additional codes for the specified congenital anomalies.

The eighth rule is for non-pregnant, at-risk patients who present prior to a confirmed Zika diagnosis; for these patients assign Z20.828 (Contact with and suspected other viral communicable diseases) whether they are exhibiting symptoms or not.

The ninth rule is for patients presenting for Zika virus testing out of personal concern; for these patients assign Z71.1 (Person with feared complaint in whom no diagnosis is made).

In conclusion, review the information in the latest Coding Clinic on the coding of the Zika virus.

Remember the first rule, which is to only code confirmed Zika diagnoses.
Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.