Q&A: Querying for COVID-19 POA

Q: We had a patient admitted with a negative COVID-19 test, but after being retested the patient had a positive COVID-19 result. Should we query the provider whether COVID-19 was present on admission (POA)?

The patient was admitted through the emergency department with extreme shortness of breath and acute respiratory distress. The chest x-ray showed bilateral infiltrates. The COVID-19 test on the day of admission was negative. The patient was treated for acute hypoxic respiratory failure and pneumonia.

A second COVID-19 test was performed on hospital day four and the results returned positive. A POA indicator of “no” was assigned to ICD-10-CM code U07.1 (COVID-19) without a query for clarification to the attending physician.

A: Yes, this does warrant a query to the physician. Due to the complexities of the condition and incubation period of COVID-19, it cannot be assumed the infection occurred after admission based simply on the date of the test. It would be appropriate to query the physician for clarification for accurate POA classification.

A good query to the physician is:

Please clarify if COVID-19 was:

• Clinically unable to determine if the condition was present on admission

• Not POA and developed during the inpatient stay

• POA at the time of the order to admit patient to inpatient status

You should also consider the POA indicator of W (clinically undetermined), as it relates to COVID-19. This POA designation should be based on explicit physician documentation in the medical record or in response to a query regarding the POA status for a diagnosis of COVID-19. As you know, a coder cannot decide that the diagnosis was clinically undetermined. 

Editor’s note: Audrey Howard, RHIA, and Susan Belley, RHIA, CPHQ, answered this question. Howard is the senior inpatient consultant with 3M Health Information Systems, and Belley is the manager of compliance/audits and content with 3M Health Information Systems.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.