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