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Health Alerts

Posted on: June 22, 2021

Clinician Advisory: Continuing Education Addressing Evaluation & Management of Post-COVID Conditions

Clinician Advisory

June 22, 2021

Continuing Education Opportunity Addressing 

Evaluation & Management of Post-COVID Conditions

 

Actions Requested

 

 

Key Messages

  • Post-COVID conditions can include but are not limited to persistent fatigue, cough, dyspnea, impaired cognition (“brain fog”), dysautonomia (e.g., postural orthostatic tachycardia syndrome), and neurologic disturbances (e.g., stroke; losses of smell, taste, or hearing; headache; insomnia).
  • Prevalence estimates vary widely from 5-80% depending on the studies’ population, methodology, and case definition.  Although the phenomenon appears to be more common in patients recovering from severe acute COVID and older patients, post-COVID conditions also occur in patients who had mild-to-negligible clinical illness and young, healthy patients.
  • Experts suggest a conservative approach to evaluation during the initial 4-12 weeks after acute COVID, with more extensive evaluation for those with longer post-COVID syndromes.  However, comprehensive work-ups should not be delayed for urgent or potentially life-threatening clinical presentations.
  • Management goals are to optimize quality of life and function through a comprehensive rehabilitation plan involving physical therapy, occupational therapy and other modalities and specialists when indicated.
  • Experts caution against dismissing patient reports that seem out of proportion to objective findings.  Misdiagnosis of such dissociated presentations as a mental health problem is reported as being more common in BIPOC groups.
  • Nevertheless, care coordination often may need to include behavioral health specialists for support and management (e.g., post-traumatic stress disorder, depression, anxiety, adjustment to post-COVID conditions).   
  • Understanding of post-COVID conditions remains incomplete and guidance for healthcare professionals will likely change over time as the evidence evolves.
  • Transparent communication with patients should include acknowledgement that our understanding of post-COVID syndromes is still developing and outcomes are uncertain.
  • Coding for post-COVID-associated visits can utilize ICD-10 code B94.8 (sequelae of other specified infectious and parasitic diseases).  Note: code U09.9 (post COVID-19 condition, unspecified) is currently under review by national ICD-10 authorities and is not available for use yet in the United States.
  • The webinar includes a compelling personal account of the acute and post-COVID experience of an infectious diseases specialist.  

 

Additional Resources

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-resources-future.html 

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