Rules and regulations are seemingly changing every day as new information emerges regarding COVID-19. That includes shifts in coding and billing policies.
With that in mind, healthcare providers must be up to speed re: the coding and billing guidance from the CDC, CMS, AMA, and other official organizations.
This is especially vital as hospitals shift services to outpatient in preparation for the potential of greater inpatient demand due to COVID-19.
Providers use a variety of medical code sets to document and bill for patient encounters. New codes have recently been created to capture COVID-19 testing and care. They include:
ICD-10-CM
Spurred by the urgent need to capture COVID-19 diagnoses on claims and surveillance data, the CDC announced in March that is has added the new International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) emergency code created by the World Health Organization earlier this year.
The code to document the diagnosis of COVID-19 is U07.1, 2019-nCoV acute respiratory disease. The CDC originally planned to implement U07.1 on October 1, 2020, but moved the implementation date to April 1, 2020, in light of the rapid spread of the virus.
Though more commonly used in outpatient coding, three additional COVID-19 diagnostic codes are also seeing some use for inpatient coding: Z11.59, Z03.818 and Z20.828.
CPT
The AMA has also updated its Current Procedural Terminology (CPT) code set to enable providers to code and bill for coronavirus testing. The AMA has announced the addition of CPT code 87635 for novel coronavirus testing through infectious agent detection by nucleic acid.
The code should be used if a provider or other healthcare professional collects respiratory swabs and sends them to the lab. In addition, the association unveiled the addition of codes 86328 and 86769 for COVID-19 antibody tests and the revision for SARS-CoV-2 nucleic acid tests (86318).
HCPCS
As COVID-19 testing ramps up, the CMS has created the Healthcare Common Procedure Coding System (HCPCS) so providers can get reimbursed for diagnosing patients and stopping the spread of coronavirus.
They have also announced the addition of two codes – U0001 and U0002 – for COVID-19 tests. The first can be used to document, and bill for tests performed specifically at CDC testing laboratories. The second code supports the agency’s efforts to allow clinical laboratories outside of the CDC to create and bill for their own COVID-19 tests.
Medicare started accepting the codes on April 1, 2020, and the codes will be retroactive to account for testing done on or after February. 4, 2020.
Telehealth Coding and Billing
For many providers, telehealth is a new service emerging from the COVID-19 crisis and is presenting fresh coding and billing challenges for organizations.
Fortunately, HHS has relaxed a wide range of rules and regulations to enable providers to leverage telehealth during the crisis and get paid the same amount for treating patients virtually. Some of the services include telehealth visits, virtual check-ins, and e-visits. The department also continues to add new services to the list as the crisis continues.
To document telehealth services and other virtual visits, CMS has provided a list of HCPCS codes that will be paid under the Physician Fee Schedule during the pandemic.
Conclusion
Today’s healthcare system is facing an unprecedented crisis. Accurate COVID-19 coding and billing – including accurately capturing data and documenting cases –can help providers weather the storm and prepare for future outbreaks.
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