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CDC to Hospitals: Classify Deaths As COVID-19 With Or Without Verification

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An email acquired by Top Conservative from the Centers for Disease Control (CDC) instructs hospitals to classify new deaths as caused by COVID-19, even if it is only “assumed” COVID-19 was the cause of death.

“This email is to alert you that a newly-introduced ICD code has been implemented to accuratly capture mortality data for Coronavirus Disease 2019 (COVID-19) on death certificates,” the March 24th email states. However, the instructions laid out in the email do not coinside with the agency’s quest for accuracy and raise questions on whether hospitals will take advantage of new legislation guaranteeing payment for COVID-19 patients.

Last week, the Trump administration guaranteed hospitals will be paid for uninsured coronavirus patients. This led to speculation from many that hospitals will classify diseases with similar symptoms as COVID-19.

The CDC email sent to hospitals specifically states testing is not necessary to declare a cause of death as COVID-19.

“Should COVID-19 be reported on the death certificate only with a confirmed test,” the email asks. Below, the CDC answers their question with, “COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death.” The bold lettering was included in the original email.

This leaves hospitals with wiggle room, as COVID-19 symptoms are similar to other common ailments known to cause death. According to WebMD, symptoms of pneumonia include shortness of breath, coughing, and fever. The online health site says symptoms can mirror the flu. On a separate page, WebMD also lists shortness of breath, coughing, and fever as symptoms of COVID-19. Unlike new coronavirus, the federal government has not extended a guarantee of payment to hospitals for treatment of flu or pneumonia patients.

The email to hospitals also asks, “What happens if the terms reported on the death certificate indicate uncertainty?” Below, they list the answer as, “If the death certificate reports terms such as ‘probable COVID-19’ or ‘likely COVID-19,’ these terms would be assigned the new ICD code.” The email further states, “It is not likely the NCHS will follow up on these cases.”

ICD codes, or International Classification of Diseases codes, are used by doctors, health insurance companies, and public health agencies throughout the world to represent diagnoses of illnesses.

Full text of the CDC email follows:

COVID-19 Alert No. 2
March 24, 2020

New ICD code introduced for COVID-19 deaths

This email is to alert you that a newly-introduced ICD code has been implemented to accurately capture mortality data for Coronavirus Disease 2019 (COVID-19) on death certificates.

Please read carefully and forward this email to the state statistical staff in your office who are involved in the preparation of mortality data, as well as others who may receive questions when the data are released.

What is the new code?

The new ICD code for Coronavirus Disease 2019 (COVID-19) is U07.1, and below is how it will appear in formal tabular list format. U07.1 COVID-19
Excludes: Coronavirus infection, unspecified site (B34.2) Severe acute respiratory syndrome [SARS], unspecified (U04.9)

The WHO has provided a second code, U07.2, for clinical or epidemiological diagnosis of COVID-19 where a laboratory confirmation is inconclusive or not available. Because laboratory test results are not typically reported on death certificates in the U.S., NCHS is not planning to implement U07.2 for mortality statistics.

When will it be implemented?

Immediately.

Will COVID-19 be the underlying cause?

The underlying cause depends upon what and where conditions are reported on the death certificate.  However, the rules for coding and selection of the underlying cause of death are expected to result in COVID19 being the underlying cause more often than not.

What happens if certifiers report terms other than the suggested terms?

If a death certificate reports coronavirus without identifying a specific strain or explicitly specifying that it is not COVID-19, NCHS will ask the states to follow up to verify whether or not the coronavirus was COVID-19.
As long as the phrase used indicates the 2019 coronavirus strain, NCHS expects to assign the new code. However, it is preferable and more straightforward for certifiers to use the standard terminology (COVID-19).

What happens if the terms reported on the death certificate indicate uncertainty?

If the death certificate reports terms such as “probable COVID-19” or “likely COVID-19,” these terms would be assigned the new ICD code. It Is not likely that NCHS will follow up on these cases.  If “pending COVID-19 testing” is reported on the death certificate, this would be considered a pending record.  In this scenario, NCHS would expect to receive an updated record, since the code will likely result in R99. In this case, NCHS will ask the states to follow up to verify if test results confirmed that the decedent had COVID19.

Do I need to make any changes at the jurisdictional level to accommodate the new ICD code?

Not necessarily, but you will want to confirm that your systems and programs do not behave as if U07.1 is an unknown code.

Should “COVID-19” be reported on the death certificate only with a confirmed test?

COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death. Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc. If the decedent had other chronic conditions such as COPD or asthma that may have also contributed, these conditions can be reported in Part II. 

E. Brian Rose is the founder of Top Conservative and host of The EBR Show, a live call-in program syndicated on various sites across the Internet. He is a combat Veteran of the Somalia and Bosnia conflicts, best selling author, and former Republican candidate for U.S Congress.

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