In a time when healthcare providers face heavy financial pressures, ensuring that you’ll get paid for the right work at the right rate is essential. While reimbursement practices may have been hard to keep up with even before the pandemic, the onslaught of COVID-19 testing and treatment services has added new hurdles — and new codes — to a process already fraught with complexity.
For their part, agencies have set out to ease the burden. The Centers for Disease Control and Prevention (CDC) and others have worked to make COVID-19 medical codes readily available while fast-tracking documentation guidance for suspected and confirmed coronavirus cases.
While the reimbursement ecosystem for COVID-19 may continue to evolve in policy and practice, here’s what physicians should know right now.
In alignment with the World Health Organization‘s addition of emergency-use ICD codes for COVID-19, the CDC has implemented new guidelines for infections of SARS-CoV-2. Effective April 1 through Sept. 30, these include:
- Confirmed Cases: “U07.1, COVID-19” should be used for confirmed COVID-19 cases, with or without symptoms. “Confirmed” includes cases that are documented by the provider or documented from a positive/presumptive-positive COVID-19 test.
- Potential Cases: Suspected, possible, probable or inclusive tests should be assigned codes that align with the clinical indication (like a cough). Alternatively, providers could include “Z20.828” if there’s been a suspected exposure to the virus.
- Ruled-Out Cases: Use “Z03.818” for cases where evaluation has ruled out concerns of potential COVID-19 exposure.
- Asymptomatic Screening: Use “Z11.59” for asymptomatic patients who don’t have a suspected exposure to the coronavirus and have either negative or unknown results.
Keep in mind: When a confirmed case of COVID-19 leads to other clinical impressions (like viral pneumonia or acute bronchitis), U07.1 should precede additional diagnosis codes (like J12.89 or J20.8), except in cases of pregnancy or childbirth, which has its own designated coding protocol.
Get the guidelines for more: ICD-10-CM Official Coding and Reporting Guidelines for Coronavirus Infections
Current Procedural Terminology (CPT®) Codes
The American Medical Association (AMA) has codified modifications and new additions to account for coronavirus testing, including assays for active SARS-CoV-2 and antibodies. Important updates include:
- Nucleic Acid Testing: Effective March 13, “87635” can be used for DNA/RNA testing of the novel coronavirus.
- Antibody Testing: Effective April 10, the revised code “86318” can be used along with the new child code “86328” for a single-step immunoassay for SARS-CoV-2 antibodies (as with a point-of-care strip). Another new child code, “86769,” can be assigned for multistep antibody testing under existing parent code “86710.”
Keep in mind: Per AMA, providers need to manually enter these COVID-19 medical codes and descriptions into their EMR, as they were updated outside of an official CPT data release.
Healthcare Common Procedure Coding System (HCPCS) Codes
The Centers for Medicare & Medicaid Services (CMS) has also created new codes for use with coronavirus testing. The new additions include:
- CDC Testing: U0001 can be used for tests performed at CDC labs.
- Other Testing: U0002 can be used for tests performed in non-CDC labs, including private labs that have developed their own tests.
- High-Throughput DNA Testing: U0003 can be used for nucleic acid high-throughput tests.
- High-Throughput Other Testing: U0004 can be used for high-throughput tests of any technique in a non-CDC lab.
Keep in mind: As the CMS relaxes rules to facilitate good-faith telehealth, it’s important to review the applicable codes for virtual encounters. The AMA has compiled a list of CPT and HCPCS codes for telehealth visits, online digital visits, remote patient monitoring and more.
Correct Coding Matters — and Not Just for Reimbursement
Yes, correct coding means faster reimbursement. But it’s about much more than enabling patients to receive covered care and you to be paid for it. Accurate documentation supplies crucial data that helps track the prevalence and spread of the new coronavirus, a metric made all the more vital amid testing shortages.
By assigning the right codes, providers are not just on the frontlines of COVID-19 testing and treatment — they’re also on the frontlines of helping ensure every case gets counted. And that, in addition to providing quality care, is a critical weapon in the fight against the novel coronavirus.