Originally posted 11 March 2020
by Richard Pinson, MD, FACP, CCS
Zoonotic diseases can be caused by viruses that infect one species and evolve through genetic mutations allowing them to make the leap to other species, including humans, where they spread. The current coronavirus is the latest example of a zoonotic disease spreading rapidly through a new host population lacking any immunity to fight back.
This is no new evolutionary phenomenon. The best-known historical case occurred about 20,000 years ago when bovine tuberculosis made the jump to humans when we first turned to agriculture as our food source. HIV may have done the same in Africa, originating in other primates (simian immunodeficiency virus).
Coronaviruses are a large group of viruses that cause illness ranging from the common cold to more severe diseases. This particular coronavirus is officially called “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2) in contrast to the SARS-CoV-1 that emerged in 2002. The word “corona” means “like a crown.” Under the electron microscope, the spherical coronavirus is lined with small projections resembling a small crown.
COVID-19 is the collective term for all respiratory infections caused by SARS-CoV-2. Initial symptoms are much like almost any significant respiratory infection, such as fever and/or cough, sneezing, shortness of breath, and difficulty breathing. In more severe cases, infection can cause pneumonia, respiratory failure, acute kidney injury, and even death especially among people over age 60 and/or those with significant chronic diseases. The disease appears to be less severe in children and people less than age 60.
When SARS-CoV-2 attacks it settles down in the body’s cells where it multiplies exponentially before causing symptomatic infection. This period between invasion and disease is called the “latent” (silent) period lasting 2-14 days during which the host is infectious to others.
The apparently healthy, unsuspecting host goes around as usual all the while shedding viruses that infect others. Just like the flu, transmission occurs via aerosol droplets from coughing and sneezing, and also by contact with contaminated surfaces. Hand-to-hand and hand-to-surface are the primary mechanisms of contact transmission, hence the importance of frequent hand washing and sanitary gels.
The availability of testing kits is currently limited so CDC has strict guidelines for who can be tested. The results usually take 2-3 days. Production of kits is expected to accelerate dramatically very soon.
Treatment is primarily supportive focusing on the complications. There are no known effective anti-viral drugs but some are being tested. Prevention is the best defense. The following are recommended by the CDC:
- Wash your hands often with soap and water
- Cover your mouth and nose when you cough or sneeze
- Stay home when you are sick
- See your doctor if you think you are ill
The use of a facemask for protection against respiratory illnesses, including COVID-19 is not effective. A facemask should be used by people who have COVID-19 and are symptomatic to protect others from infection. The CDC recommends that the N95 particulate filtering facepiece respirators be reserved for protecting healthcare workers in the riskiest situations.
A vaccine is currently being developed but will take several months for production and testing. It could take a year or more to produce enough doses for every American.
The ICD-10 code for SARS-CoV-2 is B97.29 (Other coronavirus as the cause of diseases classified elsewhere). Only confirmed cases are coded. The COVID-19 respiratory infections associated with SARS-CoV-2 and the corresponding codes are:
- Pneumonia – J12.89, Other viral pneumonia
- Bronchitis – J20.8, Acute bronchitis due to other specified organisms
- Other lower respiratory infections – J22, Unspecified acute lower respiratory infection
- ARDS – J80, Acute respiratory distress syndrome
The respiratory infection is sequenced first followed by B97.29.
CDC plans to include a new code for COVID-19 (the disease) in 2021 ICD-10-CM and will probably create a unique 97.2- code for SARS-CoV-2 itself as it did for SARS-CoV-1.
Possible exposure to SARS-CoV-2 subsequently ruled out: code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.
Actual exposure to someone who is confirmed to have a SARS-CoV-2 infection is assigned code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.
- www.UpToDate.com: Coronavirus disease 2019 (COVID-19)
- CDC: ICD-10-CM Official Coding Guidelines – Supplement “Coding encounters related to COVID-19 Coronavirus Outbreak” effective: February 20, 2020
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Dr. Richard Pinson, MD, FACP, CCS
Dr. Richard Pinson is a physician, educator, administrator, and healthcare consultant. He practiced Internal Medicine and Emergency Medicine in Tennessee for over 20 years having board certification in both. Dr. Pinson is a Fellow of the American College of Physicians and former Assistant Professor of Clinical Medicine at Vanderbilt, and has assisted hospitals as a physician consultant for the past ten years.
His personal understanding of the mindset of both doctors and managers allows him a unique vantage point from which to promote cooperation between physicians, hospital staff, and administrators toward achieving beneficial and practical changes.