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Coding Guidance for COVID-19

ICD-10-CM

The ICD-10-CM Coordination and Maintenance Committee meeting March 17-18, 2020, formally adopted the World Health Organization’s emergency code for the novel coronavirus COVID-19. The new ICD-10-CM diagnosis code for COVID-19 is U07.1, effective April 1, 2020. This new code significantly revises the interim coding guidance published by the Centers for Disease Control and Prevention (CDC) effective February 20, 2020.

The new code U07.1 COVID-19 is added to ICD-10-CM Chapter 22, Provisional assignment of new diseases of uncertain etiology or emergency use. Code U07.1 is always listed as the primary code, except for certain obstetric conditions.  U07.1 specifically excludes using other coronavirus codes B34.2 and B97.2-. Additionally, the new U07.1 code excludes using SARS, unspecified J12.81. While the code is effective April 1, 2020, there is a public comment period for the new code through May 18, 2020. 

General Guidance

Dates of Service April 1 and After:

COVID-19 virus can be diagnosed either by confirmatory testing or by clinical certainty. Code first ICD-10-CM U07.1 COVID-19, followed by the disease, condition or manifestation associated with the COVID-19 virus. For testing and testing-related services, one of the Z codes listed below should be assigned when the COVID-19 test is negative.

Clinical Impression

Code First

Also Code

Other viral pneumonia

U07.1

J12.89

Acute bronchitis due to other specified organisms

U07.1

J20.8

Bronchitis, not specified as acute or chronic

U07.1

J40

Unspecified acute lower respiratory infection

U07.1

J22

Respiratory Infection NOS, Other specified resp. disorders

U07.1

J98.8

Acute Respiratory Distress Syndrome (ARDS)

U07.1

J80

Obstetric patient with COVID-19

O98.5-

U07.1

Suspected possible COVID-19 exposure ruled out

Z03.818

 

Exposure to someone confirmed to have COVID-19

Z20.828

 

Encounter for screening for other viral diseases

Z11.59

 

Pneumonia
For a pneumonia case confirmed as due to the 2019 novel coronavirus (COVID-19), assign primary code U07.1 COVID-19, followed by J12.89 Other viral pneumonia.

Acute Bronchitis
For a patient with acute bronchitis confirmed as due to COVID-19, assign codes U07.1 COVID-19, and J20.8 Acute bronchitis due to other specified organisms. Bronchitis not otherwise specified (NOS) due to the COVID-19 should be coded using code U07.1, followed by J40 Bronchitis, not specified as acute or chronic.

Lower Respiratory Infection
If COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, this should be assigned with primary code U07.1 COVID-19, followed by J22 Unspecified acute lower respiratory infection. If the COVID-19 is documented as being associated with a respiratory infection, NOS, it would be appropriate to assign code U07.81 and J98.8, Other specified respiratory disorders.

ARDS
Cases with ARDS due to COVID-19 should be assigned the primary code U07.1 and J80, Acute respiratory distress syndrome.

Exposure to COVID-19
For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, it would be appropriate to assign the code Z03.818, 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 would be appropriate to assign the code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.

Pregnancy, Childbirth, and the Puerperium
During pregnancy, childbirth or the puerperium, a patient presenting because of COVID-19 should receive a principal diagnosis code of O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, followed by code U07.1, COVID-19, and the appropriate codes for associated manifestation(s). Codes from Chapter 15 always take sequencing priority.

Signs and Symptoms
For patients presenting with any signs/symptoms (such as fever, etc.) and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as:  • R05 Cough • R06.02 Shortness of breath • R50.9 Fever, unspecified.

If the provider documents “suspected”, “possible” or “probable” COVID-19, do not assign code U07.1, B97.29 or B34.2. Assign a code(s) explaining the reason for encounter (such as fever, or Z20.828).

Sources:
https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf
https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-3-18-2020.pdf

Test Results Delayed Until After Patient Discharge
For asymptomatic patients with no known exposure or not in an epidemic area and who wants COVID testing, use code Z11.59 [Encounter for screening for other viral diseases] whether test results are available at the time of the encounter or are to be reported later.

Due to the heightened need to capture accurate data on positive COVID-19 cases, the AHA and AHIMA (Coding Clinic editors) recommend that providers consider developing facility-specific coding guidelines to hold back coding of inpatient admissions and outpatient encounters until the test results for COVID-19 testing are available. This advice is limited to cases related to COVID-19.

Source:  https://journal.ahima.org/ahima-and-aha-faq-on-icd-10-cm-coding-for-covid-19/

 

Dates of Service through March 31, 2020:
Must follow the guidelines published February 20, 2020

Clinical Impression

Code First

Also Code

Other viral pneumonia

J12.89

B97.29

Acute bronchitis due to other specified organisms

J20.8

B97.29

Bronchitis, not specified as acute or chronic

J40

B97.29

Unspecified acute lower respiratory infection

J22

B97.29

Respiratory Infection NOS, Other specified resp. disorders

J98.8

B97.29

Acute Respiratory Distress Syndrome (ARDS)

J80

B97.29

Suspected possible COVID-19 exposure ruled out

Z03.818

 

Exposure to someone confirmed to have COVID-19

Z20.828

 

Encounter for screening for other viral diseases

Z11.59

 

Supplement: Coding encounters related to COVID-19 Coronavirus Outbreak Effective: February 20, 2020

 

New information from the Health Resources and Services Administration (HRSA), which is charged with administering the HHS payment program for uninsured patients during the public health emergency.

HRSA has provided coding guidance for claims for uninsured patients with COVID-19 related presentations. HRSA coding guidance lists categories for Testing, Antibody Testing and Treatment codes:

Under Testing, they list three codes, one of which must be on a claim to be eligible for reimbursement:

- Z03.818 - Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure to COVID-19)

- Z20.828 - Contact with and (suspected) exposure to other viral communicable (confirmed exposure to COVID-19)

- Z11.59 - Encounter for screening for other viral diseases (asymptomatic)

 

Under Treatment, eligible claims must meet the following criteria:

The COVID-19 diagnosis code must be the primary diagnosis code submitted. The only exception is for pregnancy (O98.5-), when the COVID-19 code may be listed as secondary.

- Code for dates of service or dates of discharge through March 31, 2020: B97.29 - Other coronavirus as the cause of diseases classified elsewhere COVID-19 diagnosis codes.

- Code for dates of service or dates of discharge through March 31, 2020: U07.1 - 2019-nCoV acute respiratory disease.

 

Consider this FAQ from HRSA:
https://www.hrsa.gov/coviduninsuredclaim/frequently-asked-questions

Q - What services are eligible for reimbursement?

A - Reimbursement will be made for qualifying testing for COVID-19 and treatment services with a primary COVID-19 diagnosis, including the following:

  • Specimen collection, diagnostic and antibody testing.
  • Testing-related visits including in the following settings: office, urgent care or emergency room or via telehealth.
  • Treatment, including office visit (including via telehealth), emergency room, inpatient, outpatient/observation, skilled nursing facility, long-term acute care (LTAC), acute inpatient rehab, home health, DME (e.g., oxygen, ventilator), emergency ground ambulance transportation, non-emergent patient transfers via ground ambulance, and FDA-approved drugs as they become available for COVID-19 treatment and administered as part of an inpatient stay.
  • FDA-approved vaccine, when available.
  • For inpatient claims, date of admittance must be on or after February 4, 2020.

 

Additional Resources

The links below are to new information from the Health Resources and Services Administration (HRSA), which is charged with administering the HHS payment program for uninsured patients during the public health emergency.

This first link takes you to the HRSA website where you can find links to the COVID-19 Uninsured Portal and FAQ set:

https://www.hrsa.gov/coviduninsuredclaim

This second link takes you to a page with COVID19 advice for both ICD-10 and CPT:

https://coviduninsuredclaim.linkhealth.com/billing-codes.html

 

CPT Code for SARS-CoV-2/2019-nCoV Test

Due to the emergent nature of the public health concern surrounding novel coronavirus testing, the American Medical Association (AMA) Current Procedural Terminology (CPT®) Editorial Panel convened a special meeting and approved a new, specific CPT code to describe laboratory testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

This code is effective immediately for use in reporting this testing service as of March 13, 2020. Note that code 87635 is not in the CPT 2020 publication; however, it will be included in the CPT 2021 code set in the Microbiology subsection of the Pathology and Laboratory section. Contact your third-party payer to determine their guidelines regarding applicability for retroactive billing and reimbursement.

The AMA has released this information:

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)

Clinical Example (87635) A 47-year-old male presents to the emergency department with fever, cough, and shortness of breath. The physician or other qualified health care professional (QHP) suspects the patient may have coronavirus (COVID-19). Respiratory swabs are collected and sent to the laboratory.

Description of Procedure (87635) Place specimens (eg, nasopharyngeal or oropharyngeal swab, sputum, lower respiratory tract aspirate, bronchoalveolar lavage, and nasopharyngeal wash or aspirate or nasal aspirate) into specimen-transport containers. Use oligonucleotide primers and probes for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (formally known as 2019-nCoV), and any pan-coronavirus types or subtypes if included, to identify viral gene target(s). Isolate and purify ribonucleic acid (RNA) from the specimens, followed by molecular amplification and analysis. Send the test result (positive, negative, inconclusive) to the patient’s physician or other QHP and report or refer to the appropriate public health official as indicated.

 

HCPCS codes for CDC RT-PCR Diagnostic Test Panel and Private Lab SARS-CoV-2/2019-nCoV Test

Medicare

There are two new HCPCS codes for healthcare providers who need to test patients for Coronavirus. Providers 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). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV

Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). 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.

 

Source: https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests

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