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Instructions for coding COVID-19

SIRI

SIR's web form for influenza and viral infection. COVID-19 registration of confirmed cases based on at least one of the following criteria is met:

  • Detection of SARS-CoV-2 Nucleic Acid Detection
  • Insulation of SARS-CoV-2
  • Detection of antigen from SARS-CoV-2 and clinical picture compatible with COVID-19 and/or for household contact to confirmed case

U07.1 and U07.2 are aggregated into SIR code JA36
U08.9, U09.9 and U10.9 are aggregated into SIR code JA37

 

U07.1 COVID-19, virus detected

The code is used when COVID-19 has been confirmed (see description under the heading SIRI above), regardless of the severity of the clinical signs or symptoms.

To be registered in SIRI

Patient with (or without symptoms) and confirmed COVID-19 infection. SARS-CoV-2 virus detected. As a further diagnosis, one can choose manifestation of the infection e.g. J12.8 Virus pneumonia. Current symptoms can also be listed as other diagnoses, such as cough, dyspnea.

Example
Patients with symptoms (e.g. pneumonia) and confirmed COVID-19 infection are encoded with COVID-19 code as the main ICU diagnosis and subsequently with relevant manifestations such as other diagnosis:

  • U07.1 COVID-19 virus detected +
  • J12.8 Other specified virus pneumonia +
  • Possible isolation/cohort care code or measure

Other diagnosis/other symptoms (e.g. R06.0 Dyspnea, R05.9 Cough, R65.1 Sepsis according to the Sepsis-3 criteria, etc.) may of course occur and be listed as other diagnosis.

Patient arrives with abdominal pain and is diagnosed with gallstones with acute cholecystitis. The patient also has mild respiratory symptoms where sampling detects COVID-19. The encoding will be:

  • K80.0 Gallstones with acute cholecystitis (Main ICU diagnosis) +
  • U07.1 COVID-19 virus detected +
  • Possible isolation or action code

 

U07.2 COVID-19, virus not detected

The code is used when COVID-19 is diagnosed clinically or epidemiologically, but laboratory tests are not reliable or available.

Not to be registered in SIRI

Current symptoms are listed as other diagnoses, such as cough, dyspnea.

The WHO defines "suspected" COVID-19 as one of the following A-C:

A. Acute respiratory symptoms (fever and at least one other sign or symptom of respiratory infection such as cough or dyspnea) AND no other condition that can fully explain the clinical picture AND travel or stay in an area where there is reported community spread of COVID-19 within 14 days before onset of symptoms;

OR

B. Acute respiratory infection in patients who have been in contact with a confirmed or probable case of COVID-19 within 14 days before onset of symptoms;

OR

C. Serious acute respiratory infection (fever and at least one other sign of respiratory infection e.g. cough, shortness of breath) AND need for hospitalisation and no other condition that can fully explain the clinical picture;

The WHO defines "probable case" covid-19 as one of the following A-B:

A. Suspected case where virus testing is inconclusive.

OR

B. Suspected case where laboratory tests cannot be carried out for any reason.

Example
Patient with symptoms diagnosed with COVID-19 is clinically diagnosed, without verification with laboratory tests. Symptoms may be indicated as other diagnosis if necessary.

  • U07.2 COVID-19, virus not detected +
  • Possible isolation/cohort care code or other measure (see below)

 

U08.9 COVID-19 in its own medical history, unspecified

New ICD-10-SE code from 2021-01-01

The code can be used to indicate previously confirmed or likely COVID-19, meaning the state of health without the person having COVID-19 anymore. The code should not be used for primary cause of death coding.

Not to be registered in SIRI

Please use the Public Health Agency of Sweden's definition of freedom of infection. The National Board of Health and Welfare's definition that the infection has been detected is interpreted as saying that U07.1 or U07.2 has been met historically. U08.9 should not be selected as the main ICU diagnosis. First encode current symptoms and then U08.9.

 

U09.9 Post-infectious condition after COVID-19, unspecified

Additional code that can be used to describe a condition's association with COVID-19. The code should not be used in case of ongoing COVID-19. U09.9 should not be selected as the main ICU diagnosis.

Not to be registered in SIRI

Example
Patient who five months ago fell ill with COVID-19. Now has residual symptoms in the form of anosmia (lack of sense of smell). Now enters the ICU due to subarachnoid haemorrhage.

  • I60.9 Subarachnoid haemorrhage, unspecified (Main ICU diagnosis) +
  • R43.0 Anosmi +
  • U09.9 Post-infectious condition after COVID-19, unspecified

 

U10.9 Multisystemic Inflammatory Syndrome Associated With COVID-19, unspecified

Not to be registered in SIRI if U10.9 and U07.1
Not to be registered in SIRI if only U10.9

State of time associated with COVID-19:

  • Cytokinstorm
  • Kawasaki-like syndrome
  • Multisystem Inflammatory Syndrome in Children [MIS-C]
  • Paediatric Inflammatory Multisystem Syndrome [PIMS]

Excludes: Mucocutaneous Lymph node Syndrome [Kawasaki] (M30.3)

Example
Timely in connection with covid infection

  • U07.1 COVID-19, virus identified (main ICU diagnosis) +

  • U10.9 Multisystemic inflammatory syndrome associated with COVID-19.

The code should be supplemented with U07.1 alternatively U07.2 in cases where MIS-C appears early in the course, (in connection with ongoing infection).

All pediatric cases with suspected or confirmed covid-associated hyperinflammation should be recorded in the Barnreumaregistret. Check with patient manager doctor that this is done.

Assessed COVID-19 The infection is not relevant, but there is still inflammatory syndrome, U10.9 can be used as a stand-alone diagnosis and then also selected as the main ICU diagnosis if relevant.

 

Diagnosis COVID-19 is depreciated

If the diagnosis is not set COVID-19, the symptoms of the patient have (or possibly. Other diagnosis set) U code is not used.

 

ARDS - Coding

Incoming questions:

  1. We have had a number of COVID-19 patients who have not been eligible for invasive ventilation but who have had all the criteria otherwise (except an endotrachealtub) for severe ARDS. How should these be coded? Not reasonable to put "Light ARDS". Should it be J80.9X?
    Answer: According to the Berlin definition, the invasive ventilation referred to is that the patient needs to be intubated or have a track in order to use the coding for moderate and severe ARDS. The studies that form the basis are invasive. If the NIV is to be included, the definition needs to be changed and we have not received any information about this yet. However, have seen studies regarding ARDS that have included NIV. But for the time being, sir is in the original definition. If you do not think you can classify them easily ARDS then you have to choose J80.9X. For more information, see the ARDS section of the Diagnostic Guideline.

  2. Invasively ventilated COVID-19 patients with different degrees of ARDS during the care course: Shall the high degree of difficulty (or more?) Is stated in the coding?
    Answer: Does the patient have an ARDS changed during the time of care should always choose a code and it is the highest severity.

 

Action registration

Isolation in hospital

When we care for patients with suspected or confirmed COVID-19, there is a need to prevent further spread of infection. We can do this through infection isolation or cohort care. Isolation shall not be recorded as a measure in the case of social or humanitarian isolation.

Isolation means a closed-door patient's care room and consistent application of basic hygiene routines. Use action code DV091 Infection isolation - (Isolation of patient due to their infection). Cohort care means that once you have confirmed COVID-19 infection in several patients, a cohort is created. This means that several patients with the same disease can share care rooms, hygiene space and staff. That is, isolating the cohort in relation to other patients. Use action code ZV048 Cohort Care - (The patient is cared for by assigned staff who care for several patients with the same disease/symptoms) as an additional code to DV091 (Infection Isolation)

Registration of measures related to COVID-19

ZV100 Action related to COVID-19 may, where relevant, be used as an additional code to other action performed to clarify that the action is related to COVID-19 but where the patient has not been diagnosed with COVID-19.

To code other possible measures, such as counselling, using a ventilator or ECMO, the relevant action code from KVÅ is used.

In case of investigation:

  • AW999 Other detailed investigation +
  • ZV100 Action related to COVID-19

It is not forbidden to use the additional code even in cases where the patient has diagnosed COVID-19, however, it may be unnecessary as the information is already included as a diagnosis.

 

Additional examples

Ex 1. Patient treated in ICU with confirmed COVID-19. Prints to IMA with residual track. Deemed according to the hospital's guidelines to be free of infection, dv.s. no ongoing COVID-19. On IMA increasing respiratory failure deemed to be related to the patient's Critical Illness Neuropathy. Returns to ICU for respiratory support.
When diagnosing, code for respiratory failure is used as the main diagnosis e.g. J96.0 Acute respiratory insufficiency and as a second diagnosis we choose U08.9 COVID-19 in our own medical history as well as other current codes e.g. Critical Illness Neuropathy for which we choose ICD-10-SE code G62.8 Other specified polyneuropathy.

Ex 2. Patient admitted due to impaired heart failure. The patient also has mild respiratory symptoms where sampling detects COVID-19.
Main ICU diagnosis becomes I50.9 Heart failure Other diagnosis: U07.1 COVID-19, virus identified

Ex 4. Patient treated at ICU (hospital 1) with confirmed COVID-19. Cared for for five weeks in the ICU with Covidpneumoni, the last time as a disease-free person. To be discharged to the intensive care unit at hospital 2.
When diagnosing in hospital 1, the code U07.1 COVID-19 is used, viruses identified + J12.8 Other specified virus pneumonia + other current codes. Do not forget about any code for isolation or cohort care. In Hospital 2, code describing the main diagnosis e.g. J96.0 Acute respiratory insufficiency and U08.9 COVID-19 are used in their own medical history as other diagnosis as well as other current codes (i.e. in hospital 2 not U07.1 and thus no SIRI registration.)

Ex 4. Patient vårdad på IVA (sjukhus 1) med bekräftad COVID-19. Vårdas i fem veckor på IVA med Covidpneumoni varav den sista tiden som smittfriförklarad. Ska skrivas ut till intensivvårdsavdelning på sjukhus 2. 
Vid diagnossättning på sjukhus 1 används koden U07.1 COVID-19, virus identifierat + J12.8 Annan specificerad viruspneumoni + övriga aktuella koder. Glöm inte eventuell kod för isolering eller kohortvård. På sjukhus 2 används kod som beskriver huvuddiagnos t.ex. J96.0 Akut respiratorisk insufficiens och U08.9 COVID-19 i den egna sjukhistorien som övrig diagnos samt övriga aktuella koder (D.v.s. på sjukhus 2 inte U07.1 och därmed ingen SIRI-registrering.)

Ex 5. Patient treated at ICU (hospital 1) with confirmed COVID-19. Cared for for a week in the ICU with Covidpneumoni. To be transferred to intensive care unit at hospital 2.
When diagnosing in hospital 1, the code U07.1 COVID-19 is used, viruses identified + J12.8 Other specified virus pneumonia + other current codes. Do not forget about any code for isolation or cohort care. In Hospital 2, the same codes are used to describe Covid disease (still ongoing do not forget about SIRI registration in hospital 2).

Ex 6. Patient previously cared for in ICU with confirmed COVID-19. Now been in the ward for 2 weeks. Coming back to ICU due to GI bleeding and need for dialysis due to worsening of chronic renal failure. In case of contact with the infection hotline, it is decided that the patient should be assessed as free of infection (this decision can be considered to apply retroactively before arrival in the ICU.
When diagnosing, we use as main ICU diagnosis a code that describes the GI bleeding e.g.K25.0 Ulcers in the stomach – Acute with bleeding. Other diagnoses N18.9 Chronic renal failure and U08.9 COVID-19 in their own medical history, unspecified. No registration in SIRI.

Ex 7. Pregnant woman being treated in intensive care unit with pneumonia and diagnosed with COVID-19.
When diagnosing, the code U07.1 COVID-19 is used, viruses identified + J12.8 Other specified virus pneumonia + Z33.9 Pregnancy UNS and other current codes. Do not forget about code for possible isolation or cohort care.

Ex 8. Pregnant woman admitted to be redeemed has positive sample for SARS-CoV2. Care at the ICU short-term caused by complications of childbirth.
As the main ICU diagnosis use the relevant O-code. Like other diagnoses: U07.1

Ex 9. Patient where COVID-19 is suspected, which is however written off after sampling/investigation. No other diagnosis is made. No symptoms are documented.
As the main diagnosis, you can choose Z03.8B Observation/investigation for suspected infectious disease (bacteria, viruses) and measure registration with e.g. sampling AV061 + ZV100 Action related to COVID-19.