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How to classify COVID-19

Coronavirus disease 2019 (COVID-19) is a disease caused by a new (or ‘novel’) strain of coronavirus (SARS-CoV-2) not previously identified in humans before the outbreak in Wuhan, Hubei Province, China.

On 13 March 2020, the Commonwealth and all state and territory governments signed the National Partnership on COVID-19 Response, in order to provide financial assistance for the additional costs incurred by health services in responding to the COVID-19 outbreak.

In order to implement the measures under the agreement, IHPA is required to update the national activity based funding (ABF) classifications and data reporting requirements to accommodate the emerging situation with COVID-19. Accurately capturing hospital activity associated with the COVID-19 outbreak will also be critical for other purposes, such as epidemiological studies.

This webpage brings together all advice related to the classification of COVID-19 and provides supplementary guidance and FAQs to assist in the coding of COVID-19. Advice on this page will be updated as necessary to address the evolving nature of the COVID-19 pandemic. Changes will be listed in the List of updates section below.

Keep up to date with information about the classification of COVID-19 by visiting this page regularly.

Rules for coding and reporting

IHPA has issued classification advice that specifies the rules for reporting of COVID-19 in Australian hospitals, including emergency and non-admitted care. The advice can be found in the Rules for coding and reporting COVID-19 episodes of care.

Definitions

The following definitions are a guide for users who are required to classify or report COVID-19 related episodes of care. The definitions are based on those developed by the World Health Organization (WHO) for global surveillance.

Case type Definition
Suspected COVID-19

Individuals are suspected to have COVID-19 if they have one of the criteria described below: 

  • acute respiratory illness (that is, fever and at least one sign or symptom of respiratory disease, for example, cough or shortness of breath) AND no other aetiology that fully explains the clinical presentation AND a history of travel to or residence in a country, area or territory that has reported local transmission of COVID-19 during the 14 days prior to symptom onset.

OR

  • any acute respiratory illness AND has been in contact with a confirmed or probable case of COVID-19 during the 14 days prior to the onset of symptoms.

OR

  • severe acute respiratory infection (that is, fever and at least one sign or symptom of respiratory disease, for example, cough or shortness of breath) AND who requires hospitalisation AND who has no other aetiology that fully explains the clinical presentation.
A suspected case of COVID-19, as defined above, will then either receive a confirmed or probable diagnosis of COVID 19 or COVID-19 will be ruled out:
Laboratory confirmed COVID-19 An individual with a laboratory confirmation of infection with COVID 19, irrespective of clinical signs and symptoms.
Clinical diagnosed or probable COVID-19 An individual who is suspected of having COVID-19 but laboratory testing for COVID-19 is inconclusive or not available but in whom a clinical determination of COVID-19 has been made.
Ruled out COVID-19 An individual suspected of having COVID-19 but COVID-19 has subsequently been excluded on laboratory testing and in whom a clinical diagnosis of COVID-19 has not been made.

Supplementary guidance for classifying admitted care

To classify COVID-19 in episodes of admitted care follow the national Coding Rule - Coronavirus disease 2019 (COVID-19) (Effective 1 January 2020; Updated 27 March 2020) in the first instance.

The following guidance supplements the Coding Rule where suspected COVID-19 is the reason for presentation.

Laboratory confirmed cases (tested positive)

Table last updated: 9 April 2020

Key point:     

  • Use U07.1 Emergency use of U07.1 [COVID-19, virus identified] when COVID-19 has been confirmed by laboratory testing irrespective of severity of clinical signs or symptoms.
Reason for presentation Guidance
Symptoms = YES
Exposure = YES

Principal diagnosis:
Symptom(s) or condition(s) as per ACS 0001 Principal diagnosis

Additional diagnoses:
B97.2    Coronavirus as the cause of diseases classified to other chapters
U07.1    Emergency use of U07.1 [COVID‑19, virus identified]

Symptoms = YES
Exposure = NO

Principal diagnosis: 
Symptom(s) or condition(s) as per ACS 0001 Principal diagnosis

Additional diagnoses: 
B97.2    Coronavirus as the cause of diseases classified to other chapters
U07.1    Emergency use of U07.1 [COVID‑19, virus identified]

Symptoms = NO
Exposure = YES

Principal diagnosis:
B34.2   Coronavirus infection, unspecified site

Additional diagnoses:
U07.1   Emergency use of U07.1 [COVID‑19, virus identified]

Self-presenting, non-mandated
Symptoms = NO
Exposure  = NO

Principal diagnosis:
B34.2   Coronavirus infection, unspecified site

Additional diagnoses:
U07.1   Emergency use of U07.1 [COVID‑19, virus identified]

Mandated screening by authority
Symptoms  = NO
Exposure  = NO

Principal diagnosis: 
B34.2   Coronavirus infection, unspecified site

Additional diagnoses:
U07.1   Emergency use of U07.1 [COVID‑19, virus identified]

Pregnancy complicated by COVID-19 or other condition
(as per ACS 1521 Conditions and injuries in pregnancy)

Code first: 
O98.5   Other viral diseases complicating pregnancy, childbirth and the puerperium

Additional diagnoses: 
As per the advice above

Clinically diagnosed or probable cases (testing is inconclusive, unavailable or not specified)

Table last updated: 9 April 2020

Key points:   

  • Use U07.2 Emergency use of U07.2 [COVID-19, virus not identified] when COVID-19 is diagnosed clinically but laboratory testing is inconclusive, not available or unspecified.
  • DO NOT assign U07.2 for individuals transferred with suspected COVID-19 that has not been ruled out.
Reason for presentation Guidance
Symptoms = YES
Exposure = YES

Principal diagnosis:
Symptom(s) or condition(s) as per ACS ​0001 Principal diagnosis

Additional diagnoses:  
B97.2    Coronavirus as the cause of diseases classified to other chapters
U07.2    Emergency use of U07.2 [COVID‑19, virus not identified]

Symptoms = YES
Exposure = NO

Principal diagnosis: 
Symptom(s) or condition(s) as per ACS 0001 Principal diagnosis

Additional diagnoses: 
B97.2    Coronavirus as the cause of diseases classified to other chapters
U07.2    Emergency use of U07.2 [COVID‑19, virus not identified]

Symptoms = NO
Exposure = YES

Principal diagnosis:      
B34.2     Coronavirus infection, unspecified site

Additional diagnoses:   
U07.2     Emergency use of U07.2 [COVID-19, virus not identified]

Self-presenting, non-mandated
Symptoms = NO
Exposure  = NO

Principal diagnosis: 
B34.2     Coronavirus infection, unspecified site

Additional diagnoses: 
U07.2     Emergency use of U07.2 [COVID-19, virus not identified]

Mandated screening by authority
Symptoms  = NO
Exposure  = NO

Principal diagnosis: 
B34.2     Coronavirus infection, unspecified site

Additional diagnoses: 
U07.2     Emergency use of U07.2 [COVID-19, virus not identified]

Pregnancy complicated by COVID-19 or other condition
(as per ACS 1521 Conditions and injuries in pregnancy)

Code first: 
O98.5   Other viral diseases complicating pregnancy, childbirth and the puerperium

Additional diagnoses: 
As per the advice above

Ruled out cases (tested negative)

Table last updated: 9 April 2020

Key points:   

  • From 1 January 2020, an exception has been made to ACS 0012 Suspected conditions with regard to assignment of codes from category Z03.‑ for coding of symptomatic presentations with suspected COVID-19, ruled out.
Reason for presentation Guidance
Symptoms = YES
Exposure = YES

Principal diagnosis:
Symptom(s) or condition(s) as per ACS 0001 Principal diagnosis

Additional diagnoses:
Z20.8     Contact with and exposure to other communicable diseases
Z03.8     Observation for other suspected diseases and conditions
U06.0     Emergency use of U06.0 [COVID‑19, ruled out]

Symptoms = YES
Exposure = NO

Principal diagnosis:
Symptom(s) or condition(s) as per ACS 0001 Principal diagnosis

Additional diagnoses:
Z03.8      Observation for other suspected diseases and conditions
U06.0      Emergency use of U06.0 [COVID‑19, ruled out]

Symptoms = NO
Exposure = YES

Principal diagnosis:
Z20.8     Contact with and exposure to other communicable diseases

Additional diagnoses: 
U06.0     Emergency use of U06.0 [COVID‑19, ruled out]

Self-presenting, non-mandated
Symptoms = NO
Exposure  = NO

Principal diagnosis:
Z71.1      Person with feared complaint in whom no diagnosis is made

Additional diagnoses:
U06.0     Emergency use of U06.0 [COVID‑19, ruled out]

Mandated screening by authority
Symptoms  = NO
Exposure  = NO

Principal diagnosis:
Z11.5      Special screening examination for other viral diseases

Additional diagnoses:
U06.0     Emergency use of U06.0 [COVID‑19, ruled out]

Additional notes for all admitted care cases

  • Note 1: Exposure is determined and documented by a clinician, as opposed to patient-reported exposure to COVID-19 alone.
  • Note 2: Where isolation (as opposed to quarantined) is documented, assign Z29.0 Isolation as an additional diagnosis.
  • Note 3: For Australian admitted care/multiple condition coding purposes: The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) 2019 has new instructional notes at U07.1 Emergency use of U07.1 [COVID-19, virus identified] and U07.2 Emergency use of U07.2 [COVID-19, virus not identified]. However, as ICD-10-AM Eleventh Edition is based on (ICD-10) 2016 the above advice is consistent with the Australian Coding Standards.

Frequently Asked Questions – Admitted care

IHPA will be publishing FAQs as necessary. Keep up to date with information about classification of COVID-19 by visiting this page regularly.

To submit a coding query about COVID-19, please follow the process outlined at the Australian Classification Exchange (ACE) website.

Frequently Asked Questions – Emergency department care

IHPA will be publishing FAQs as necessary. Keep up to date with information about classification of COVID-19 by visiting this page regularly.

Queries about classifying COVID-19 in emergency department care should be followed up with jurisdictional health authorities.

Frequently Asked Questions – Non-admitted care

IHPA will be publishing FAQs as necessary. Keep up to date with information about classification of COVID-19 by visiting this page regularly.

Queries about classifying COVID-19 in non-admitted care should be followed up with jurisdictional health authorities.

List of updates

The following list summarises updates to the guidance provided on this page.

Update Section(s) Description
25 May 2020 Frequently Asked Questions – Admitted care Publishing of Admitted care FAQs – Part 2 (Published 25 May 2020)
25 May 2020 Frequently Asked Questions –  Emergency department care Publishing of Emergency department care FAQs (Published 25 May 2020)
1 May 2020 Frequently Asked Questions – Admitted care Publishing of Admitted care FAQs – Part 1 (Published 1 May 2020)
1 May 2020   Publishing of Rules for coding and reporting COVID-19 episodes of care (Version 1.1)
9 April 2020 Additional notes for all cases
 
Updated Note 3 for new instructional notes included in ICD-10 2019 for U07.2 Emergency use of U07.2 [COVID-19, virus not identified]
9 April 2020 Supplementary guidance/Rules out cases Removed redundant category ‘Pregnancy complicated by COVID-19 or other condition’ in Ruled out cases
Adapted wording under Key points related to ACS 0012 Suspected conditions
9 April 2020 Supplementary guidance/Laboratory confirmed cases
Supplementary guidance/Clinically diagnosed or probable cases
Supplementary guidance/Ruled out cases
Wording added “as per ACS 0001 Principal diagnosis” to align with text in Coding Rule
3 April 2020   Publishing of Rules for coding and reporting COVID-19 episodes of care (Version 1.0)