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HOW SHOULD MEDICAL DOCTORS RESPOND TO THE CORONAVIRUS DISEASE 2019: COVID-19
- Anton van Schalkwyk (Medical Coding Specialist, SAMA)
The international community is hard at work to curb the spread of the Coronavirus Disease 2019, now officially termed COVID-19 (The CO stands for corona, the VI for virus and the D for disease), with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the causative virus. South Africa, like many other countries around the world, has reported its first case of the virus and it is inevitable that more will be infected as time goes by.
The importance for doctors to become acquainted with all aspects concerning the virus cannot be understated, as it has been declared by World Health Organisation as a Public Health Emergency of International Concern (PHEIC).
For the sake of this article there are four aspects to this illness that must be considered by doctors when confronted by the possibility of this illness:
1. Knowing what questions to ask the person :
• Was the patient in close contact with someone who has contracted the disease or who are suspected to be infected or present in a building where patients with SARS-CoV-2 infections were being treated?
• Did the patient on anyone he or she came into contact with travel during the past 14 days to countries with presumed ongoing transmission of the disease, NB – these are changing on a daily basis – check the updates at http://www.nicd.ac.za/diseases-a-z-index/covid-19/daily-updates-of-countries/
• Is the patient diagnosed with severe pneumonia with unknown aetiology?
2. Knowing what steps to take when testing for accurate diagnosis. Laboratory testing is the only way to confirm that the illness of the patient is that of COVID-19. A nasopharyngeal swab and oropharyngeal swab must be taken. ALL suspected samples are to be sent for testing to the Centre for Respiratory Diseases and Meningitis at the National Institute for Communicable Diseases (NICD).
It is important to note that the NCID should be notified first and therefore plans to collect samples must be discussed with the doctor on call before collecting sample. The Hotlines at the NICD are 0828839920 or 0665624021.
In order to get your practice ready for a possible large scale outbreak of COVID-19 in South Africa, the following links at the NICD are of great importance:
• General Information:
http://www.nicd.ac.za/diseases-a-z-index/covid-19/covid-19-resources/
All necessary information regarding the correct response to COVID-19, including all necessary forms for record keeping is available at this link.
• Guidelines for case-finding, diagnosis, management and public health response in South Africa:
http://www.nicd.ac.za/wp-content/uploads/2020/03/NICD_DoH_COVID-19_Guidelines_8_March_2020_final.pdf
3. Ensuring that the coding data coming from their respective practices are above board for the sake of national and international reporting of the disease.
The question of course is: How do we code for it in order to ensure that the statistical data within our healthcare system, as well as that being recorded internationally as coming out of South Africa is clear.
The World Health Organisation has identified ICD-10 U07.1. The World Health Organisation’s description is: Emergency use of U07.1. For now the understanding for the use in South Africa would, in line with the international community, be “Coronavirus Disease-19”. Please note that the description of the code does not change and it must still be described as Emergency use of U07.1 by all coders.
The Private Healthcare Information Standards Committee (PHISC) has developed a standard for coding the virus and its comorbidities within the parameters of South-Africa’s Master Industry Table (MIT). Because ICD-10 coding for the coronavirus (COVID-19) has now been formalised, it is important that we all try and adhere to it. The PHISC coding standard for the COVID-19 has been formalised at meetings held on 26-27 February 2020.
It is important to note that without formal confirmation via laboratory testing, ICD-10 U07.1 should not be used under any circumstances.
PHISC has put the following examples forward when confronted with COVID-19 related coding:
Example 1: Patient admitted with a fever, coughing and shortness of breath. Pathology confirms the cause is Coronavirus disease
Primary ICD-10 Code: U07.1 Emergency use of U07.1
Example 2: A patient diagnosed with confirmed COVID-19 is presenting with acute respiratory failure.
Primary ICD-10: J96.09 Acute respiratory failure, Type unspecified.
Secondary ICD-10: U07.1 Emergency use of U07.1.
Until such time as pathology confirms the cause of the disease, Z11.5 (Special screening for other viral diseases) should be used instead of U07.1.
Example 3: Patient admitted with shortness of breath and a fever. Coronavirus disease is suspected, bloods have been sent to the laboratory for testing.
Primary ICD-10: R06.0 Dyspnoea
Secondary ICD-10: R50.9 Fever, unspecified
Secondary ICD-10: Z11.5 Special screening examination for other viral diseases
After confirmation by pathology that it is indeed an infection caused by COVID-19, the Z11.5 may be exchanged with U07.1 (Emergency use of U07.1).
4. Provide your patients with the necessary information regarding COVID-19 and how to prevent contracting the disease.
One of the ways to inform your patients about COVID-19, is to make information available to read. Attached to this article is a poster, generously provided by the Western Cape Department of Health that may be put up for information purposes.
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