Coronavirus Medical Coding

What do we need to know about the coronavirus medical coding as members of the medical billing community?

The ebix team is a trusted business partner with a history of standing strong through challenging times since 1977. Being available for our customers is part of our culture and mission. As the novel coronavirus COVID-19 begins to impact our community and daily lives, we assure you that we are following the Centers for Disease Control (CDC) and World Health Organization (WHO) guidelines, as well as guidance from federal, state and local officials, to make informed decisions. We appreciate everyone’s commitment to the recommended prevention methods. While ebix, Inc. remains open for business, should conditions or restrictions around COVID-19 escalate, ebix will do everything in our power to remain capable of servicing our customers through technology tools and flexible working arrangements with our staff and professional resources. We will keep you informed of any changes or delays that could be beyond our control as we move through this epidemic together.

Other Reading Material: Preventing the Coronavirus from Impacting Providers Revenue Cycle

Does COVID-19 Have an ICD-10-CM Code?

source:  Even though the virus is new, there are codes within the current 2020 ICD-10-CM code set that you can use to document COVID-19.

Depending on the circumstances, COVID-19 can be coded with B97.29 Other coronaviruses as the cause of diseases classified elsewhere. Only report B97.29 for confirmed cases of COVID-19.

For a patient with a confirmed condition due to COVID-19, also assign the appropriate diagnosis code. For example, per ICD-10-CM guidelines, B97.29 should be used as an additional code if the virus is responsible for such diseases as pneumonia, classified as J12.89 Other viral pneumonia, or sepsis, classified as A41.89 Other specified sepsis.

Should a patient be determined to be infected with coronavirus associated with SARS, use B97.21 SARS-associated coronavirus as the cause of diseases classified elsewhere. And use Z20.828 Contact with and (suspected) exposure to other viral communicable diseases to document an encounter with a patient infected with any form of the virus.

The CDC explains that B34.2 Coronavirus infection, unspecified is inappropriate because the coronavirus is a respiratory illness and, therefore, the site is not unspecified.

More recently, WHO released emergency use ICD codes for 2019-nCoV.  According to WHO, “The ‘2019-nCoV’ disease outbreak has been declared a public health emergency of international concern.”

Emergency ICD-10 code U07.1 is assigned to the disease diagnosis of 2019-nCoV acute respiratory disease. Note that the disease name 2019-nCoV may change to be independent of date and virus family. The ICD-11 code for the illness is RA01.0. At the time of this post, the Centers for Medicare & Medicaid Services had not released any instructions for the use of these new codes.

UPDATE 3/27/2020 Consistent with this WHO updates to the ICD-10, the CDC will implement U07.1 COVID-19 into ICD-10-CM for reporting, effective with the next update, April 1, 2020.

DoesCOVID-19 Have a Test Code?

According to a Centers for Medicare & Medicaid Services (CMS) press release, “Healthcare providers who need to test patients for Coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real-Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001).” This code is used specifically for CDC testing labs to test patients for SARS-CoV-2.

UPDATE 3/6/2020

CMS has developed a second HCPCS Level II code (U0002) for labs to bill for non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVD-19). This code may be used for tests developed by certain laboratories under a new policy the Food and Drug Administration issued Feb. 29.

Medicare claims will be accepted beginning on April 1, 2020, for tests billed with these codes from Feb. 4, 2020, onward. Local Medicare Administrative Contractors are responsible for developing the payment amount for claims they receive for these newly created codes until CMS established national payment rates.

Medicare Administrative Contractor (MAC) COVID-19 Test Pricing was released on March 12, 2020.

UPDATE 3/13/2020 The CPT Editorial Panel has approved a new CPT® code for COVID-19 testing.