During the COVID-19 Public Health Emergency (PHE), it was important that contact with and exposure to the virus be reported in all cases when appropriate. Now that the PHE has ended and COVID is now in an endemic stage, we can still report exposure, Z20.822, when that is documented or suspected. 

Beginning Oct 1, 2023, the guideline for screening encounters was changed to reflect the end of the PHE. Please note that screening codes are intended for outpatient screening encounters, such as planned preoperative screening. Per the screening guideline in Chapter 21, screening codes are not used in diagnostic settings. They are also not used for people who are sick! If you are not familiar with these guidelines, please refer to Section I.C.21.c.5) Screening: 

“Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease (e.g., screening mammogram).  The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening. In these cases, the sign or symptom is used to explain the reason for the test.  A screening code may be a first-listed code if the reason for the visit is specifically the screening exam. It may also be used as an additional code if the screening is done during an office visit for other health problems. A screening code is not necessary if the screening is inherent to a routine examination, such as a pap smear done during a routine pelvic examination.  Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis.  The Z code indicates that a screening exam is planned. A procedure code is required to confirm that the screening was performed.” 

From the FAQ’s published by the AHA and AHIMA:

65. Once the federal Public Health Emergency (PHE) for COVID-19 expires, what code should be assigned for COVID-19 screening that is performed during preoperative testing? (revised 5/9/23)

Effective October 1, 2023, for an encounter for COVID-19 screening that is performed as part of preoperative testing, assign code Z01.812, Encounter for preprocedural laboratory examination, as the first-listed diagnosis and code Z11.52, Encounter for screening for COVID-19, as an additional diagnosis.

Inpatient coders should generally not be assigning screening codes. A patient being admitted to the hospital for workup of some illness will undergo a host of tests, but these are all diagnostic in nature and not for the purposes of screening. A screening test is for early detection of disease in a seemingly well individual, as in screening mammograms for detection of breast cancer. 

Think about it this way: do you assign screening for neoplasm codes on inpatient encounters where a possible neoplasm is being worked-up? No, you assign the code for either the symptoms or whatever the diagnosis is after study. Inpatient encounters are not encounters for screening. They are diagnostic and/or therapeutic encounters. 

1. Z11.52 is a code intended to report a planned screening encounter, such as preoperative and should not be reported on inpatient accounts.
2. Z20.822 can be reported on inpatient accounts when supported by the documentation since COVID-19 is currently endemic in the US. 

Katherine Isbell, RHIA, CDIP, CCS

AHIMA-Approved ICD-10-CM/PCS Trainer

Education Services Manager