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v1.0.0
ICD-10 Guide
ICD-10 CodesU07.1

U07.1

Billable

COVID-19

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 U07.1 is a billable code used to indicate a diagnosis of covid-19.

Key Diagnostic Point:

U07.1 is the ICD-10 code designated for COVID-19, the disease caused by the novel coronavirus SARS-CoV-2. This code is used to classify confirmed cases of COVID-19, which can present with a wide range of symptoms, from mild respiratory issues to severe pneumonia and multi-organ failure. The clinical context for using U07.1 includes patients who have tested positive for the virus, regardless of symptom severity. It is essential for tracking the disease's prevalence, guiding public health responses, and ensuring appropriate resource allocation. The code is also critical for billing and reimbursement purposes, as it allows healthcare providers to document the impact of the pandemic on patient care and healthcare systems. Accurate coding of COVID-19 is vital for epidemiological studies and for understanding the long-term effects of the virus on public health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in symptom presentation and severity
  • Need for confirmation of diagnosis through testing
  • Differentiation from other respiratory illnesses
  • Potential for co-infections or complications

Audit Risk Factors

  • Inaccurate documentation of test results
  • Misclassification of symptoms as unrelated
  • Failure to document co-morbid conditions
  • Inconsistent use of the code across different encounters

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Documentation must include test results confirming COVID-19, clinical symptoms, and any treatment provided.

Common Clinical Scenarios

Patients presenting with respiratory symptoms who test positive for COVID-19, patients with severe illness requiring hospitalization.

Billing Considerations

Consideration of co-morbidities and complications, such as pneumonia or acute respiratory distress syndrome (ARDS).

Public Health

Documentation Requirements

Population-level data collection, including case counts, demographic information, and outcomes.

Common Clinical Scenarios

Surveillance of COVID-19 cases in the community, tracking outbreaks, and vaccination status.

Billing Considerations

Importance of accurate reporting for public health initiatives and resource allocation.

Coding Guidelines

Inclusion Criteria

Use U07.1 When
  • According to the CDC and WHO guidelines, U07
  • 1 should be used for confirmed cases of COVID
  • Documentation must support the diagnosis, including positive test results and clinical symptoms
  • It is important to follow the latest updates from health authorities as guidelines may evolve

Exclusion Criteria

Do NOT use U07.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

87635CPT Code

SARS-CoV-2 RNA, qualitative, real-time RT-PCR

Clinical Scenario

Used for testing patients suspected of having COVID-19.

Documentation Requirements

Documentation of symptoms and reason for testing.

Specialty Considerations

Infectious disease specialists should ensure proper coding for testing.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of COVID-19, facilitating better tracking and management of the disease. U07.1 provides a clear designation for confirmed cases, improving data collection and public health responses.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of COVID-19, facilitating better tracking and management of the disease. U07.1 provides a clear designation for confirmed cases, improving data collection and public health responses.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of COVID-19, facilitating better tracking and management of the disease. U07.1 provides a clear designation for confirmed cases, improving data collection and public health responses.

Resources

Clinical References

  • •
    CDC COVID-19 Coding Guidelines

Coding & Billing References

  • •
    CDC COVID-19 Coding Guidelines

Frequently Asked Questions

When should U07.1 be used?

U07.1 should be used for all confirmed cases of COVID-19, supported by positive test results and clinical documentation.

Can U07.1 be used for patients with suspected COVID-19?

No, U07.1 is only for confirmed cases. Use alternative codes for suspected cases.