There is no choice already. ICD10CM Official Coding Guidelines says that presumptive positive COVID-19 test results should be coded as U07.1 what is confirmed COVID by the definition. So it’s already there.
This becomes uncertain when we’re looking into the various definitions of Probable case:
- WHO/ECDC says the following:
Probable case is a suspected case for whom testing for virus causing COVID-19 is inconclusive (according to the test results reported by the laboratory) or for whom testing was positive on a pan-coronavirus assay.
This is still a suspicion according to ICD10CM:
If the provider documents “suspected,” “possible,” “probable,” or “inconclusive” COVID19, do not assign code U07.1. Assign a code(s) explaining the reason for encounter (such as fever) or Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.
- CDC’s definition of Probable case refers to this guide that stands for a COVID, confirmed clinically AND/OR epidemiologically. And this should be mapped to the Condition, I think.
• Meets clinical criteria AND epidemiologic evidence with no confirmatory laboratory testing
performed for COVID-19.
OR
• Meets presumptive laboratory evidence AND either clinical criteria OR epidemiologic
evidence.
OR
• Meets vital records criteria with no confirmatory laboratory testing performed for COVID19.
So the terminology is not just messy but might be controversial and we need to make the different decisions for the various definitions of the same terms.
There might not be a certain borderline. Somebody might want to take just lab-confirmed or also include:
- lab inconclusive (or positive in an unspecific panel) with any of clinical or epidemiological evidence;
- lab non-tested, but with both clinical and epidemiological criteria;
- lab non-tested, but with any of clinical or epidemiological criteria;
- vital records criteria.
Such abstractions should indeed be built on the analytical side, but there is no place to map “Clinically confirmed” or “2 out of 5 criteria confirmed” COVID right now. The main reason - criteria are still not defined and agreed. Also, we cannot split the complex constructions such as OR/AND/OR. And maybe it’s not the best approach to imply the Measurement events from the Disease dianosis criteria.
One of the possible solutions is:
- Explicitly stated Excluded and Suspected Conditions go to Observation Domain and live in respective hierarchies of Clinical finding absent and Disease suspected. They may form subhierarchies. Let’s say, “Probable case” will be a child of “Suspected case”; “COVID excluded using clinical diagnostic criteria” will be a child of “COVID excluded”.
- We draw the borderline a little bit closer to suspected than to confirmed, so that clinically or epidemiologically or somehow else diagnosed COVID becomes Condition. Everybody doing the same now, including SNOMED and ICDs.
- For the data sources where lab/epidemiological/any kind of other useful data is not sufficient, we support the analytics by an introduction of 'Maps to status" relationship. The level of certainty of Diagnosis will be mapped to various Condition Statuses including, but not limited to Probable, Presumptive positive, Disorder confirmed (somehow), Laboratory confirmed, Clinically confirmed, Epidemiologically confirmed, Clinically or epidemiologically confirmed, Vital records confirmed.
