Rates of <i>ICD-10</i> Code U09.9 Documentation and Clinical Characteristics of VA Patients With Post–COVID-19 Condition
Authors: Pandora L. Wander, Aaron Baraff, Alexandra Fox, Kelly Cho, Monika Maripuri, Jacqueline P. Honerlaw, Yuk-Lam Ho, Andrew T. Dey, Ann M. O’Hare, Amy S. B. Bohnert, Edward J. Boyko, Matthew L. Maciejewski, Elizabeth Viglianti, Theodore J. Iwashyna, Denise M. Hynes, Thomas F. Osborne, George N. Ioannou
Journal: JAMA Network Open (2023)

Importance A significant proportion of SARS-CoV-2 infected individuals experience post–COVID-19 condition months after initial infection. Objective To determine the rates, clinical setting, risk factors, and symptoms associated with the documentation of International Statistical Classification of Diseases Tenth Revision ( ICD-10 ), code U09.9 for post–COVID-19 condition after acute infection. Design, Setting, and Participants This retrospective cohort study was performed within the US Department of Veterans Affairs (VA) health care system. Veterans with a positive SARS-CoV-2 test result between October 1, 2021, the date ICD-10 code U09.9 was introduced, and January 31, 2023 (n = 388 980), and a randomly selected subsample of patients with the U09.9 code (n = 350) whose symptom prevalence was assessed by systematic medical record review, were included in the analysis. Exposure Positive SARS-CoV-2 test result. Main Outcomes and Measures Rates, clinical setting, risk factors, and symptoms associated with ICD-10 code U09.9 in the medical record. Results Among the 388 980 persons with a positive SARS-CoV-2 test, the mean (SD) age was 61.4 (16.1) years; 87.3% were men. In terms of race and ethnicity, 0.8% were American Indian or Alaska Native, 1.4% were Asian, 20.7% were Black, 9.3% were Hispanic or Latino, 1.0% were Native Hawaiian or Other Pacific Islander; and 67.8% were White. Cumulative incidence of U09.9 documentation was 4.79% (95% CI, 4.73%-4.87%) at 6 months and 5.28% (95% CI, 5.21%-5.36%) at 12 months after infection. Factors independently associated with U09.9 documentation included older age, female sex, Hispanic or Latino ethnicity, comorbidity burden, and severe acute infection manifesting by symptoms, hospitalization, or ventilation. Primary vaccination (adjusted hazard ratio [AHR], 0.80 [95% CI, 0.78-0.83]) and booster vaccination (AHR, 0.66 [95% CI, 0.64-0.69]) were associated with a lower likelihood of U09.9 documentation. Marked differences by geographic region and facility in U09.9 code documentation may reflect local screening and care practices. Among the 350 patients undergoing systematic medical record review, the most common symptoms documented in the medical records among patients with the U09.9 code were shortness of breath (130 [37.1%]), fatigue or exhaustion (78 [22.3%]), cough (63 [18.0%]), reduced cognitive function or brain fog (22 [6.3%]), and change in smell and/or taste (20 [5.7%]). Conclusions and Relevance In this cohort study of 388 980 veterans, documentation of ICD-10 code U09.9 had marked regional and facility-level variability. Strong risk factors for U09.9 documentation were identified, while vaccination appeared to be protective. Accurate and consistent documentation of U09.9 is needed to maximize its utility in tracking patients for clinical care and research. Future studies should examine the long-term trajectory of individuals with U09.9 documentation.