Term

Definition

Confirmed COVID-19 Diagnosis

An ICD-10 diagnosis code U07.1 in any position on the claim.

Probable COVID-19 Diagnosis

An ICD-10 diagnosis code B97.29 or J12.82 in any position on the claim.

Initial COVID-19 Diagnosis Date

The discharge date of the initial visit/stay with a COVID-19 diagnosis.

COVID-19 Diagnosis Related Health Care Utilization

An ICD-10 diagnosis code U07.1, B97.29, J12.82, B94.8, M35.89, M35.8, or M35.81 in any position on the claim. For codes M35.8 and M35.81, B94.8 needs to be on the same claim line to be considered COVID-19 related. Each follow-up time period does not include the initial visit/stay with a COVID-19 diagnosis. Patients can have a health care claim in each of the follow-up time periods. Utilization that crosses time periods will only be counted in one time period (based on the start date of the visit/stay).

The initial visit/stay is assigned hierarchical in the following order: inpatient stay, ER visit (if occurred prior to or on day 1 of SNF/other facility visit), other facility visit, then physician visit.

Utilization definitions based on claims: 1) If an ER visit occurs during another facility visit, then both an ER and other facility visit are counted. ER visits are not counted if they occur during an inpatient stay. 2) Physical therapy and rehabilitation visits are counted a maximum of 1 per 30-day period. 3) Chiropractor visits are not counted towards a medical visit. 4) Any visits that were solely for the purpose of COVID-19 testing (to ensure patient no longer has COVID-19), are not counted towards a medical visit. 5) Home enteral nutrition therapy is not counted towards a medical visit.

COVID-19 reinfection

A COVID-19 test or exposure 91 - 360 days post initial COVID-19 diagnosis (ICD-10 diagnosis codes: Z11.52, Z11.59, Z03.818, Z20.828, or Z20.822 in the primary position on the claim) followed by a COVID-19 diagnosis (ICD-10 diagnosis codes: U07.1, B97.29, or J12.82 in the primary position on the claim) within 7 days.