What You Need to Know About COVID-19 and Medical Procedure Codes

March 16, 2020 | Article

By Susan Roehl

Coronavirus (COVID-19) is on the top of many people’s minds, and news feeds. While most are concerned about the disease and it’s symptoms, there is also a significant impact to business. For medical practices and health systems in particular, procedure coding and billing related to coronavirus is top of mind.

COVID-19 is impacting the way we do business. We’ve compiled a list of resources to help.

Original Medicare Beneficiaries Related to COVID-19

Testing Codes

Medicare Part B has developed HCPCS codes to report testing for Coronavirus.

  • Providers using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may report for the test using the newly created HCPCS code U0001.
  • HCPCS code U0002 has been adopted to report the test which generally describes 2019-nCOV Coronavirus, SARS-CoV-2/2019-nCOV (COVID-19) using any technique, multiple types or subtypes (includes all targets).

These codes allow facilities conducting the tests to bill for the specific test performed instead of using an unspecified code. Using the specified codes provides better tracking of the public health response for this strain of the coronavirus, which in turn will help protect people from the spread of this infectious disease.

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.

We recommend facilities communicate with the Laboratory Department and/or test vendor to determine the correct HCPCS code to report for any tests which are performed in the facility.

ICD-10-CM codes

The World Health Organization (WHO) has established a new ICD-10-CM emergency code U07.1 (2019-nCOV acute respiratory disease) to report confirmed cases of COVID-19. There are also specific medical procedure codes associated:

  • When pneumonia has been confirmed due to COVID-19, assign codes J12.89, other viral pneumonia, and B97.29, other coronavirus as the cause of disease(s) elsewhere.
  • If acute bronchitis is confirmed due to COVID-19, assign codes J20.8, acute bronchitis due to other specified organisms, and B97.29.
  • An acute lower respiratory infection, NOS, is assigned J22 and B97.29.
  • If a respiratory infection, not specified as lower, associated with COVID-19 is documented, assign J98.8 unspecified lower respiratory infection, with code B97.29.

If the test is provided for a patient with possible exposure to COVID-19, but is ruled out after evaluation, assign Z30.818, encounter for observation for suspected exposure to other biological agents ruled out.

For cases where there is an actual exposure to someone who is confirmed to have COVID-19, it is appropriate to assign the code Z20.828, contact with and (suspected) exposure to other viral communicable disease.

Guidelines note it would not generally be appropriate to assign code B34.2 (coronavirus infection, unspecified) because the cases have been universally respiratory in nature, so the site would not be unspecified.

Telehealth

Congress has included a provision which will waive some restrictions for Medicare telehealth coverage as part of the new COVID-19 supplemental funding package. Current regulations limit telehealth coverage to specified rural sites only. CMS has not yet defined how they will use the newly granted waiver authority. We recommend facilities monitor their Medicare Administrative Contractor website for updates regarding telehealth and other services which may be impacted by surveillance and treatment of COVID-19.

Emergency Ambulance Transportation

Should a facility which would normally be the nearest appropriate facility be unable to receive a patient, Medicare may pay for transportation to another facility so long as that facility is the nearest facility that is available and equipped to provide the needed care for the illness or injury involved.

Medicare Advantage

CMS has advised Medicare Advantage organizations they may waive or reduce enrollee cost-sharing for COVID-19 laboratory tests effective immediately.

Medicare Advantage plans may provide their enrollees with access to Medicare Part B services via telehealth in any geographic area and from a variety of places, including beneficiaries’ homes.

We recommend the specific Medicare Advantage plan websites be monitored for updates regarding testing and reporting of services related to COVID-19.

Other Updates Related to COVID-19

Other items to note in relation to COVID-19 and medical procedure codes include:

  • The three day inpatient requirement for SNFs is related to relocation of Medicare patients and related to COVID-19.
  • There is a waiver of the 25 bed requirement and the 96 hour stay requirements specifically for Critical Access Hospitals.

Understanding Traditional Medicare Medical Coding and Billing Related to COVID-19
As CMS and other payers are developing policies and guidelines as rapidly as possible, it is essential for facilities and providers to stay informed. The best way to do this is by receiving updates from the Medicare Contractors, CMS, and other payers through newsletters and news alerts that are most appropriate for your type of facility.

Medical coding can be complicated. COVID-19 adds an additional layer of complexity.

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