COVID-19 and ICD-10

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Published: 26 March 2020          Last updated: 24 March 2021

The World Health Organisation (WHO) has declared a COVID-19 pandemic with health and care systems responding to the pandemic across the world.

The WHO International Classification of Diseases (ICD-10) is the foundation for the identification of health trends and statistics globally, and the international standard for reporting diseases and health conditions.  The United Kingdom (UK) has a mandatory obligation to collect and submit ICD-10 data to the WHO for the production of international statistical and epidemiological data.

ICD-10 is a vital component of national data sets, Hospital Episodes Statistics (HES) in England, Hospital In-patient Statistics (HIS) in Northern Ireland, Patient Episode Data for Wales (PEDW), Scottish Morbidity Records (SMR), Cancer Registries and others.

The classification of diagnosis using ICD-10 is a mandatory national requirement for the NHS Admitted Patient Care Commissioning Data Set and has a vital role in UK secondary care reporting of episodes of care.

CoronavirusCDC

Published: 24 March 2021

ICD-10 COVID-19 graphic UK NHS Digital

ICD-10 emergency use codes

In ICD-10 there are categories reserved for emergency use under direction from the WHO. The WHO have confirmed the emergency codes and instructional notes designated for COVID-19 as follows:

U07.1     COVID-19, virus identified

COVID-19 NOS

Use this code when COVID-19 has been confirmed by laboratory testing irrespective of severity of clinical signs or symptoms. Use additional code, if desired, to identify pneumonia or other manifestations.

Excl.: Coronavirus infection, unspecified site (B34.2)

           Coronavirus as the cause of diseases classified to other chapters (B97.2)

                          Severe acute respiratory syndrome [SARS], unspecified (U04.9)

U07.2      COVID-19, virus not identified

Use this code when COVID-19 is diagnosed clinically or epidemiologically but laboratory testing is inconclusive or not available. Use additional code, if desired, to identify pneumonia or other manifestations

Excl.:   Coronavirus infection, unspecified site (B34.2)

      COVID-19:

confirmed by laboratory testing (U07.1)

special screening examination (Z11.5)

suspected but ruled out by negative laboratory results (Z03.8)

U07.3     Personal history of COVID-19

Note:      This optional code is used to record an earlier episode of COVID-19, confirmed or probable that influences the person’s health status, and the person no longer suffers of COVID-19. This code should not be used for primary mortality tabulation

U07.4     Post COVID-19 condition

Note:      This optional code serves to allow the establishment of a link with COVID-19. This code is not to be used in cases that still are presenting COVID-19

U07.5      Multisystem inflammatory syndrome associated with COVID-19

 Screenshot 2020-11-25 103045

U07.6     Need for immunization against COVID-19

Note:       This code should not be used for international comparison or for primary mortality coding. This optional code is intended to be used when a person who may or may not be sick encounters health services for the specific purpose of receiving a COVID-19 vaccine.

               Prophylactic COVID-19 vaccination

               Excl.:      immunization not carried out (Z28.-)

U07.7     COVID-19 vaccines causing adverse effects in therapeutic use

Note:     This code is to be used as an external cause code (i.e. as a sub category under Y59, "Other and unspecified vaccines and biological substances"). In addition to this, a code from another chapter of the classification should be used indicating the nature of the adverse effect.

Correct administration of COVID-19 vaccine in prophylactic therapeutic use as the cause of any adverse effect.

UK use of WHO ICD-10 emergency use codes

Last updated: 01 February 2021

In ICD-10 there are categories reserved for emergency use under direction from the World Health Organisation (WHO) and in anticipation of such circumstances.  The WHO has designated codes for COVID-19 from within category U07 Emergency use of U07. In March 2020, code U07.1 Emergency use of U07.1 was designated for use for COVID-19, virus identified and code U07.2 Emergency use of U07.2 was designated for use for COVID-19, virus not identified in the NHS.

The WHO subsequently released three further emergency codes at categories U08, U09 and U10 in November 2020 and two more at categories U11 and U12 in February 2021, to enable users to identify conditions that occur in the context of COVID-19.

The three-character categories WHO have issued at U08, U09, U10, U11 and U12 are provided for countries that are unable to report codes at four-character level.

U08, U09 U10, U11 and U12 are not currently included as part of the NHS ICD-10 5th Edition data files and we and a number of countries reported that it would be too great a burden on users to issue an update to these files at this time. WHO has therefore agreed that countries which are technically constrained from using the issued three-character categories may utilise available emergency four-character codes already included at U07.

To this end the equivalent UK emergency codes for use from 01 November 2020 are:

UK ICD-10 5th Edition Emergency codes for use from 01 November 2020

WHO additional ICD-10 emergency codes for COVID-19 published September 2020 (not for use in the UK)

U07.3 Personal history of COVID-19

U08 Personal History of COVID-19

U07.4 Post COVID-19 condition

U09 Post COVID-19 condition

U07.5 Multisystem inflammatory syndrome associated with COVID-19

U10 Multisystem inflammatory syndrome associated with COVID-19

 And from 01 February 2021:

UK ICD-10 5th Edition Emergency codes for use from 01 February 2021 WHO additional ICD-10 emergency codes for COVID-19 published January 2021 (not for use in the UK)
U07.6 Need for immunization against COVID-19 U11 Need for immunization against COVID-19
U07.7 COVID-19 vaccines causing adverse effects in therapeutic use U12 COVID-19 vaccines causing adverse effects in therapeutic use

 The emergency codes and descriptions with associated COVID-19 clinical coding standards and guidance are available on the COVID-19 National Clinical Coding Standards and Guidance page. 

ICD-10 data files, Tabular List and eViewer

Last updated: 24 November 2020

The NHS ICD-10 5th Edition data files (implemented across the NHS on 1 April 2016) and NHS eViewer include the ICD-10 emergency use codes in category U07 and will therefore be present in local hospital systems. 

The code descriptions within U07 will remain as ‘Emergency use of’ until further notice to avoid hospitals needing to redeploy data files in local systems.

  • The current WHO ICD-10 Volume 1 Tabular List includes the category U07 and four-character codes
  • The ICD-10 5th Edition Codes and Titles and Metadata file released by NHS Digital for use by the NHS and NHS system suppliers will not change, as the category U07 and four-character codes are already included
  • The ICD-10 eVersion Volume 1 Tabular List includes the category U07 and four-character codes. A set of shared notes reflecting the code descriptions of the codes designated for emergency use for COVID-19 within category U07 that can be imported into the eVersion are available on the Classifications Browser and eVersions page.

COVID-19 background

In January 2020, the WHO declared a new strain of coronavirus (COVID-19) first identified in Wuhan City, China as a public health emergency of international concern.

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERSCoV) and Severe Acute Respiratory Syndrome (SARS-CoV). COVID-19 is a new strain that has not been previously identified in humans.

Coronaviruses are zoonotic, meaning they are transmitted between animals and people. Common symptoms of coronavirus include fever and a cough that may progress to a severe pneumonia causing shortness of breath and breathing difficulties.

The virus causing the disease has also been officially named by the International Committee on Taxonomy of Viruses (ICTV) as ‘severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)’.

COVID-19 WHO case definitions for surveillance

Confirmed cases

A confirmed case is a person with laboratory confirmation of infection with the COVID-19 virus, irrespective of clinical signs and symptoms.

Suspected cases

a) a patient with any acute respiratory illness AND who has been a contact of a confirmed or probable case of COVID-19 disease during the 14 days prior to the onset of symptoms

OR

b) a patient with acute respiratory illness (that is, fever and at least one sign or symptom of respiratory disease, for example, cough or shortness of breath) AND with no other etiology 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 disease during the 14 days prior to symptom onset

OR

c) a patient with severe acute respiratory infection (that is, fever and at least one sign or symptom of respiratory disease, for example, cough or shortness breath) AND who requires hospitalization AND who has no other etiology that fully explains the clinical presentation.

Probable case

A probable case is a suspected case for whom the report from laboratory testing for the COVID-19 virus is inconclusive. 

Further information of case definitions is also published by Public Health England and can be found here.

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