Interim Coding Guidance for COVID-19 & More

Thoughtware Alert Mar 20, 2020
Stethoscope on an ipad

Fever, cough and shortness of breath are signs and symptoms of the novel coronavirus disease 2019 (COVID-19)—previously named 2019-nCoV. Symptoms may appear within two to 14 days of suspected exposure. Because these symptoms are similar to influenza, proper coding is imperative for treatment and reporting processes. On February 20, 2020, the Centers for Disease Control and Prevention (CDC) issued interim guidance for the coding of COVID-19 treatment.

Interim Coding Guidance: Effective February 20, 2020

Currently, the reporting of confirmed COVID-19 cases includes reporting the disease process, such as viral pneumonia, bronchitis, lower respiratory infection or acute respiratory distress syndrome (ARDS), along with the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code B97.29, Other coronavirus, as the cause of diseases classified elsewhere. This coding guidance is effective through April 1, 2020.

Also, the ICD-10-CM codes Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out) and Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases) are appropriate to report when supported by documentation. These codes should be used now and going forward, unless directed otherwise.

Effective April 1, 2020 – COVID-19 ICD-10-CM (International Classification of Diseases)

The CDC has issued a new effective date of April 1, 2020, for reporting of COVID-19-specific ICD-10-CM diagnosis codes due to the “urgent need to capture the reporting of this condition in our nation’s claims and surveillance data.” For discharges after April 1, 2020, the ICD-10-CM code U07.1 (2019-nCoV acute respiratory disease) should be used to report COVID-19.

Coding of Signs & Symptoms

If a patient presents with signs/symptoms and no definitive diagnosis can be established, then the appropriate code(s) for the presenting signs and symptoms should be assigned; this is consistent with current coding guidelines.

Laboratory Testing Codes

On March 13, 2020, the American Medical Association added an additional CPT code for tracking COVID-19:

  • 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)

CMS announced the release of two additional laboratory codes specifically for the testing of COVID-19:

  • U0001 (Coronavirus Real Time RT-PCR Diagnostic Test Panel)
  • U0002 (can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests)

Denials Prevention

As we move through the regulatory waivers and state of emergency, continue to be vigilant about obtaining the necessary documentation to support the medical necessity of the treatment as well as the particular waiver you may be following to care for your patients, such as ensuring you have patient consent or capacity and need for beds when required. Keep an eye out for more BKD Thoughtware® alerts covering specific requirements for services you may be providing for COVID-19 patients.

If you have questions, reach out to your BKD Trusted Advisor™ or submit the Contact Us form below.

This alert is current as of the recent regulatory announcement on March 19. We encourage you to check in with your BKD Trusted Advisor frequently for new updates given the rapid pace of change as the CDC, CMS and other governmental officials react and relay information.

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