While hospitals face another surge in COVID-19 cases, the healthcare system is yet again experiencing a significant strain on hospital resources. According to The Covid Tracking Project, as of December 5, there are over 100,000 COVID-19-related hospitalizations in the United States, which is nearly double the amount during the first surge (in March). Although there’s a significant strain on the healthcare system, accurately obtaining data and chronicling COVID-19 cases can help alleviate the pressure put on providers.
COVID-19 coding and billing allow providers to follow the spread of the novel coronavirus and receive reimbursement for testing and treating patients who display COVID-19 symptoms. With proper medical billing and coding, healthcare professionals can effectively communicate patient encounters throughout their health system. Accurate coding not only allows for reduced administrative and rework costs, but it does so at a critical point when resources are exhausted by the pandemic. During this time, providers are seeing the value in providing their employees with proper resources and training, for using codes and new documentation guidelines will be crucial in tackling COVID-19.
The Skinny on COVID-19 Codes
With some help from RevCycleIntelligence, we’ve broken down what providers need to know about COVID-19 coding and billing.
With a pressing need to obtain COVID-19 diagnoses on claims and surveillance data, the CDC announced in March that it added the new International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) emergency code (U07.1, 2019-nCoV acute respiratory disease) created by the World Health Organization, which confirms a COVID-19 diagnosis (a positive COVID-19 test or presumptive positive COVID-19 test), as documented by the provider. This also applies to COVID-19 positive asymptomatic patients.
The CDC emphasizes that suspected, possible, probable, or inconclusive cases of COVID-19 should not be assigned U07.1. Instead, providers should assign codes describing the reason for the encounter, such as a fever or Z20.828, which is Contact with and (suspected) exposure to other viral contagious diseases.
Providers should also code for exposure to COVID-19 with code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out and screening, CDC states.
The American Medical Association (AMA) has been updating its Current Procedural Terminology (CPT) code set to allow providers to code and bill for coronavirus testing. The following is a summary of the SARS-COV-2-related CPT codes:
- AMA announced (on March 13) the addition of CPT code 87635 for novel coronavirus testing through infectious agent detection by nucleic acid. The code should only be used if a provider suspects a patient may have COVID-19.
- AMA unveiled expedited updates to CPT for COVID-19 antibody tests with:
- Codes 86328 and 86769 for COVID-19 antibody tests and the revision for SARS-CoV-2 nucleic acid tests (86318).
- Code 86328 for antibody tests using a single-step method immunoassay. Code 86769 for antibody tests using a multiple-step method, the association reported.
AMA noted that since the CPT codes were released early, providers will need to upload the code descriptors into electronic health record systems manually.
Healthcare Common Procedure Coding System (HCPCS)
CMS has created Healthcare Common Procedure Coding System (HCPCS) codes to secure provider reimbursement when diagnosing COVID-19 patients. CMS announced, earlier in the year, the addition of U0001 and U0002 for COVID-19 testing. U0001 is used for documenting and billing tests performed specifically at CDC testing sites, while U0002 allows non-CDC clinical laboratories to create and bill for their own COVID-19 tests.
Telehealth Coding & Billing
With the sudden ascent of COVID-19 cases, the Department of Health & Human Services (HHS) took significant steps to secure easier access to telehealth services. To many providers, telehealth may be a brand new service. As they learn the ins and outs, the HHS has allowed for numerous flexibilities when it comes to telehealth, particularly in regards to being paid the same amount for virtual visits.
Some of the telehealth services offered include telehealth visits, virtual check-ins, and e-visits. As COVID-19 continues, the HHS will continue adding new services to the list.
To report telehealth services and other virtual visits, CMS has provided a list of HCPCS codes paid for under the Physician Fee Schedule during the public health emergency.
AMA has also provided direction on telehealth coding and billing using CPT codes. The guidance covers coding for telehealth visits, online digital visits, remote patient monitoring, and telephone evaluation and management services.
Next Steps: Be Proactive
During the past 10+ months, a lot has been revealed about COVID-19, including risk factors, treatments, prevention, transportation of the disease, etc. Although many questions have been answered, there are quite a few that have not. As rules, regulations, and policies continue to unfold, healthcare professionals are doing their best to keep up.
Some ways in which you can adapt to the evolving changes is to follow the CDC, CMS, AMA, and other official organizations’ coding and billing guidance, grasp not only the coding guidelines provided by a visit perspective and the telehealth and CPT codes but also those provided by the CDC for coding COVID-19 patients, and assess documentation guidelines in the EHR (to check for accurate documentation).