COVID-19 has been officially declared a pandemic, and school districts, sporting events, and cultural traditions like St. Patrick’s Day parades are being canceled  in order to lower the risk of transmission among large throngs of people. One thing that goes on, however, is the day-to-day operation of the urgent care center—the only difference being that your work is more essential than ever.

Secondary to that, of course, is the need to be properly reimbursed for those essential services. With COVID-19 being uncharted territory, Experity has issued an advisory to guide urgent care operators on how to code for optimal reimbursement.

The document below was crafted by Monte Sandler, executive vice president, revenue cycle management for Experity. He is also a contributing editor for JUCM, authoring the Revenue Cycle Management column that appears in each issue.

Coding

Coding instructions are circulating regarding coding for COVID-19 and even laboratories are giving clinics incorrect coding information. Experity has provided the current coding information for diagnosis coding and laboratory testing below. We will continue to update as changes occur.

Diagnosis Coding

Effective for Date of Service (DOS) April 1, 2020 and After

The Center for Disease Control (CDC) approved the new ICD-10 for COVID-19, U07.1,  to become effective on April 1, 2020 for billing purposes.

Effective for DOS March 31, 2020 and Before

Until this new code becomes effective, follow the interim guidance from the CDC for coding these health care encounters. Multiple codes may be required to accurately report the final diagnosis when confirmed as due to COVID-19.

Diagnosis ICD-10-CM
Pneumonia J12.89 – Other viral pneumonia
B97.29 – Other coronavirus as the cause of diseases classified elsewhere
Acute Bronchitis J20.8 – Acute bronchitis due to other specified organisms
B97.29 – Other coronavirus as the cause of diseases classified elsewhere
Bronchitis, Not Otherwise Specified (NOS) J40 – Bronchitis, not specified as acute or chronic
B97.29 – Other coronavirus as the cause of diseases classified elsewhere
Lower Respiratory Infection, NOS, or

Acute Respiratory Infection, NOS

J22 – Unspecified acute lower respiratory infection
B97.29 – Other coronavirus as the cause of diseases classified elsewhere
Respiratory Infection, NOS J98.8 – Other specified respiratory disorders
B97.29 – Other coronavirus as the cause of diseases classified elsewhere
Acute Respiratory Distress Syndrome (ARDS) J80 – Acute respiratory distress syndrome
B97.29 – Other coronavirus as the cause of diseases classified elsewhere

ICD-10-CM B34.2 (Coronavirus infection, unspecified) would be incorrect for COVID-19 since cases are respiratory and not unspecified. Code B97.29 should not be reported for cases described as “suspected”, “possible”, or “probable”.

The CDC’s complete interim coding guidelines for COVID-19 can be found at ICD-10-CM Official Coding Guidelines – Supplement Coding Encounters related to COVID-19 Coronavirus Outbreak Effective: February 20, 2020.

Symptomatic Patient Without a Diagnosis of COVID-19

Regardless of DOS, signs and symptoms without a definitive diagnosis should be reported with the code for each presenting problem. Examples are:

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

Experity recommends reporting Z03.18 or Z20.828 in addition to the symptoms.

Diagnosis ICD-10-CM
Possible Exposure to COVID-19 Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out
Actual Exposure to Someone Confirmed to Have COVID-19 Z20.828 – Contact with and (suspected) exposure to other viral communicable diseases

Laboratory Testing

Medicare

The Centers for Medicare & Medicaid Services (CMS) created two new HCPCS codes for healthcare providers who need to test patients for COVID-19. These codes became effective on February 4, 2020. Medicare will not be able to adjudicate these claims until April 1, 2020 since their systems need to be updated.

  • Providers using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel should bill for that test using the newly created HCPCS code U0001.
  • Non-CDC laboratory tests should be reported with HCPCS U0002. The description is 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets).

Other Payers

The American Medical Association (AMA) issued a new CPT code for reporting these tests effective March 13, 2020.

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

The AMA’s guidance for reporting this code can be found at AMA Fact Sheet: Reporting Severe Acute Respiratory Syndrome Coronavirus (SARS-Cov-2) Laboratory Testing.

Prior to March 13, 2020, one of the HCPCS listed above, U0001 or U0002, would need to be reported.

Experity recommends reporting CPT 87635 for commercial payers in the scenarios that are outlined below.

 

Updated: Experity Issues Guidance on Optimal Coding for Services Related to COVID-19

Monte Sandler

Executive Vice President, Revenue Cycle Management of Experity (formerly DocuTAP and Practice Velocity ).
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