As coding and billing regulations continuously change, the content of this article may not be the most up-to-date information and is not intended to take the place of either the written policies or regulations. We encourage participants to review the specific regulations and other interpretive materials as necessary.
It seems that everything surrounding the 2019 novel Coronavirus, also known as COVID-19, is evolving at the speed of light. Over the past week, the number of confirmed COVID-19 patients has risen from 214.9k cases to 417.7k cases. The codes and coding guidelines for reporting the virus and its manifestations are also changing rapidly.
In addition to the two new HCPCS codes that are effective February 4, 2020 (U0001 and U0002), the CPT® Editorial Panel of the American Medical Association (AMA)1 released a new CPT® code to capture testing for COVID-19. The new code, 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, is effective as of March 13, 2020, and will be published in the CPT® 2021 book.
There are lots of unanswered questions at this point regarding the use of the CPT® code versus the HCPCS codes and individual payor requirements. Several payers, including United Healthcare and Aetna, have announced that they will accept either the HCPCS codes or the CPT code in order to simplify coding and reimbursement during the crisis. CMS has announced expected reimbursement rates of $35.91 or $35.92 for U0001 and $51.31 or $51.33 for U0002. The reimbursement rate varies depending on region and is subject to the local Medicare Administrative Contractor’s (MAC) approval.
In an unprecedented move, the Centers for Disease Control (CDC) announced a change in the effective date of new diagnosis code U07.1, COVID-19, and the associated addenda from October 1, 2020, to April 1, 2020. Effective for dates of service on or after April 1, healthcare providers should use U07.1 to report confirmed or presumed positive cases of COVID-19 infections.
The American Hospital Association (AHA) also released an FAQ document titled “AHIMA and AHA FAQ on ICD-10-CM Coding for COVID-19”, which was jointly developed and approved by the AHA’s Central Office on ICD-10-CM/PCS and the American Health Information Management Association (AHIMA).
As of April 1, pneumonia that has been confirmed to be due to COVID-19 should be assigned codes U07.1, COVID-19, and J12.89, Other viral pneumonia. Acute bronchitis that has been confirmed to be due to COVID-19 should be coded using U07.1, COVID-19, and J20.8, Acute bronchitis due to other specified organisms. Unspecified bronchitis due to COVID-19 should be assigned codes U07.1, COVID-19, and J40, Bronchitis, not specified as acute or chronic.
Respiratory infections confirmed to be caused by COVID-19 should be assigned code U07.1, COVID-19, in addition to code J22, Unspecified acute lower respiratory infection, NOS, if specified as acute; or code J98.8, Other specified respiratory disorders, if there is no documentation of an acute infection.
Acute respiratory distress syndrome (ARDS) that develops in patients with a confirmed COVID-19 infection should be assigned code U07.1, COVID-19, and J80, Acute respiratory distress syndrome.
There are currently no specific codes to describe patients with a suspected exposure to COVID-19 that is ruled out following evaluation. These patients should continue to be reported using code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. For patients with an actual exposure to someone with a confirmed COVID-19 infection, code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, should be assigned as the ICD-10-CM code set lacks a specific code to describe exposure to the novel coronavirus.
For patients who present with signs and symptoms of the virus, such as fever, cough, or shortness of breath, but without a definitive diagnosis, the appropriate code(s) for the symptoms should be assigned.
However, if a provider documents “suspected”, “possible”, or “probable” COVID-19, DO NOT ASSIGN code U07.1. Rather, assign code(s) for the signs and symptoms the patient is experiencing. An exception to this rule exists for presumptive positive test results, which should be coded as confirmed COVID-19 infections since a presumptive positive result indicates that the patient has tested positive for the virus at the local level and that confirmation from the CDC of the positive result is pending.
The worldwide spread of the Coronavirus is causing rapid change, but rest assured that Vitalware will continue to monitor official sources to keep you informed of the latest updates.
1CPT is a registered trademark of the American Medical Association