COVID-19 Coding Guidance

by | May 19, 2020 | COVID- 19

DIAGNOSIS CODING

We have started encountering COVID19 cases in some of the practices.  The information below is to provide coding guidance for this rapidly developing situation.

 

Prior to Confirmed COVID-19

Prior to a confirmed diagnosis of COVID-19 providers should bill patient’s signs and symptoms, for example:

  • R05 – Cough
  • R06.02 – Shortness of breath
  • R50.9 – Fever, unexplained

For Possible Exposure the following diagnosis codes are for possible exposure to Covid-19:

  • Z03.818 – Observation for suspected exposure to biologic agent
  • Z20.828 – Exposure to someone with confirmed

 

Confirmed COVID-19

For Confirmed COVID-19 as of today, the following diagnosis codes are for confirmed Covid-19:

  • B97.29 – Other coronavirus as the cause of diseases classified elsewhere).

Note: B97.29 should not be assigned as Primary diagnosis.

 

For Confirmed COVID-19 as of April 1, 2020, the following diagnosis codes are for confirmed Covid-19:

  • U07.1 – COVID-19

 

Related to confirmed COVID-19 infection

  • J12.89 Pneumonia due to COVID-19
  • J20.8 Acute bronchitis

 

*UPDATE as of 3/18/20: The Centers for Disease Control and Prevention (CDC) announced March 18, 2020 a change in the effective date of new diagnosis code U07.1, COVID-19 from October 1, 2020 to April 1, 2020. The unprecedented off-cycle update is due to the “urgent need to capture the reporting of this condition in our nation’s claims and surveillance data,” according to the CDC’s announcement.

 

NEW PROCEDURE CODES

The Centers for Medicare and Medicaid Services (CMS) developed new Healthcare Common Procedure Coding System (HCPCS) codes for providers and laboratories to bill for COVID-19 diagnostic tests. CMS expects that having specific codes for these tests will encourage testing and improve tracking.

  • 87635 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.
  • U0001 – is used specifically for CDC testing laboratories to test patients for the virus that causes COVID-19.
  • U0002 – allows laboratories to bill for non-CDC laboratory tests for the COVID-19 virus.

 

The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after February 4, 2020.

 

MEDICARE TEST PRICES

U0001 – Medicare Test Price   $35.92

U0002 – Medicare Test Price   $51.33

 

CPT Code Being Fast-Tracked

The American Medical Association also announced plans for fast tracking development of a CPT code for reporting novel coronavirus tests. The CPT Editorial Panel will manage the expedited process, including the creation of a test description to accompany the code and the effective date of the code. If approved, the new CPT code will support the response to the urgent public health need for streamlined reporting of novel coronavirus testing offered by hospitals, health systems, and laboratories in the United States.

 

CMS CALL TO ACTION

CMS issued a call to action to healthcare providers across the country to ensure they are implementing their infection control procedures, which they are required to maintain at all times. Additionally, CMS also announced that, until further notice, State Survey Agencies and Accrediting Organizations will focus their facility inspections exclusively on issues related to infection control and other serious health and safety threats, like allegations of abuse—beginning with nursing homes and hospitals. Critically, this shift in approach will allow inspectors to focus their energies on addressing the spread of COVID-19.

 

Additional Information

To learn more about coronaviruses and specifically about COVID-19, see the CDC and WHO websites:

https://www.cdc.gov/coronavirus/index.html

https://www.who.int/health-topics/coronavirus

 

MedicareCoding.com

No one knows the Florida Medicare system better than MedicareCoding.com.  For 25 years, MedicareCoding.com has helped over 20,000 Florida Practitioners and their staff navigate the complex Medicare System.  We provide a full suite of Preventive, Diagnostic, and Treatment Services to ensure optimal health of their Medicare revenue cycle and maximize the Medicare coverage for your patients.

 

Donna Smith

www.MedicareCoding.com