This blog post will be updated as more additional information becomes available – Updated 3/27/20 (New Codes/Effective Dates)
With the concerns around the Coronavirus (COVID-19), no doubt you are getting requests from patients for testing all the while trying to keep up on the mandated state protocols. The other challenge is how to stay current on the codes being established and the associated ICD 10-CM codes to be used. Keeping your billing team informed on how to bill is essential. In this post, I will provide the latest information along with key resources. I will commit to staying current on the latest coding recommendations and update the blog accordingly.
As always check with the payers as they may have different protocols and of course always be familiar with the terms in your contracts. Also, as payers adjust to the change there may be some confusion resulting in possible denials that may need to be resubmitted via appeal and or reconsideration. It is important to remain vigilant and informed.
The Latest:
In February, the Centers for Medicare and Medicaid Services (CMS) developed a new Healthcare Common Procedure Coding System (HCPCS) code for providers and labs to test patients. The code U0001 (CDC testing labs) will allow labs to bill specifically for the test instead of using an unspecified code which often results in claims appeals and denials. This will also allow for better tracking from a public health response perspective.
Coding for Coronavirus
Healthcare providers testing patients for Coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel should bill for that test using the new HCPCS code U0001. CMS will be able to accept this code April 1, 2020 for dates of service on or after February 4, 2020. CMS stated they will pay $36.00 for this test.
CMS announced a second code to use for billing for tests diagnosing COVID-19. This code is U0002 (non-CDC labs) to be used for laboratories to bill for COVID-19 tests that are not from the CDC. Federal Drug Administration (FDA) is allowing some labs to develop their own COVID-19 tests. CMS anticipates that U0002 will encourage testing and improve tracking. CMS will pay $51.00 for these tests.
Resources:
Information for Healthcare Facilities Concerning 2019 Novel Coronavirus Illness (2019-nCoV)
CDC 2019-Novel Coronavirus Guidance for Authorized Laboratories
Beckers Review: Medicare Pricing for Coronavirus Testing 3 Things to Know
New Code Released: 87635
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARA-CoV-2) (Coronavirus disease (COVID-19), amplified probe technique.
This code should not be used with U0001 or U0002. As always check with your payer to confirm any alternative recommendations. 87635 should be reported once per specimen obtained. It will be listed in the 2021 coding books.
ICD 10-CM Codes for Coronavirus
The World Health Organization (WHO) created an emergency ICD 10 CM code: U07.1, 2019-nCoV acute respiratory disease to be effective April 1, 2020. In the meantime, the National Center for Health Statistics (NCHS) developed interim coding advice effective February 20, 2020.
ICD-10-CM codes for confirmed cases related to COVID-19
- B34.2 Coronavirus infection, unspecified. Report when a provider documents coronavirus without other identifying information.
- Z20.828 report when patients have actual exposure to COVID-19 without development of the disease.
- Z03.818 report when patients were possibly exposed to COVID-19 which has been ruled out.
- A diagnosis os suspected or probable use the code that best supports the encounter.
- Pneumonia due to COVID-19 use J12.89 (other viral pneumonia) and B97.29 (other coronavirus as the cause of diseases classified elsewhere).
- Acute bronchitis due to COVID-19 use J20.8 (acute bronchitis due to other specified organisms) and B97.29 (other coronavirus as the cause of diseases classified elsewhere).
- Bronchitis not otherwise specified use J40 (NOS) due to COVID-19 (bronchitis, not specified as acute or chronic) and B97.29 (other coronavirus as the cause of diseases classified elsewhere).
- Lower respiratory infection NOS or acute respiratory infection NOS due to COVID-19: use J22 (unspecified acute lower respiratory infection) and B97.29 (other coronavirus as the cause of diseases classified elsewhere).
- Respiratory infection NOS due to COVID-19: J98.8 (other specified respiratory disorders) and B97.29 (other coronavirus as the cause of diseases classified elsewhere).
- Acute respiratory distress syndrome (ARDS) due to COVID-19 use J80 (acute respiratory distress syndrome and B97.29 (other coronavirus as the cause of diseases classified elsewhere).
If the patient is examined for concerns about exposure to COVID-19 but it is ruled out after the evaluation use code Z03.818 (encounter for observation for suspected exposure to other biological agents ruled out).
If the patient is exposed to someone with a confirmed case of COVID-19 use code Z20.828 (contact with and (suspected) exposure to other viral communicable diseases).
If a patient has signs or symptoms without a definitive diagnosis, assign codes for each of the presenting signs Ex, Cough (R05), Fever, unspecified (R50.9)
Resources:
Beckers Review: Coding for Cornonavirus: 6 things to know
March 4, 2020 the CDC eliminated guidelines and is now relying on clinicians to use their judgment to determine if the patient is exhibiting symptoms related to COVID-19 and whether the patient should be tested. Priority should be given to patients with respiratory illness and known contacts with those infected.
Another issue providers and patients may be confused on is the misunderstanding of results. COVID-19 has an incubation estimated to be 2-14 days. A negative result does not rule out infections. A positive result for a patient who is mildly ill may not require urgent medical attention but does require isolation.
Resource: