A lot of information is appearing very fast about COVID-19 (coronavirus disease 2019), and medical coders have the extra challenge of sorting through the onslaught to find the bits relevant to coding claims related to testing and treatment. This Q&A brings together the latest authoritative news about coding for COVID-19.
Term tip: COVID-19, a respiratory disease, is caused by a virus named SARS-CoV-2. Be alert for references to both terms in coding news updates.
Will CPT® Create a Code Specific to COVID-19 Testing? (And Other AMA News)
On March 10, 2020, the American Medical Association (AMA), which holds copyright in CPT®, announced that the CPT® Editorial Panel will hold a special meeting to consider a unique CPT® code for reporting novel coronavirus tests. More information should be available from the CPT® Editorial Panel soon.
March 16, 2020, update: The AMA has approved 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). The AMA published the code March 13, 2020, and the code is effective immediately.
March 25, 2020, update: The AMA has posted additional resources, including:
- Coding advice for telemedicine encounters and encounters related to COVID-19
- COVID-19 testing CPT® flowchart
- CMS emergency updates for payment policies and regulations
April 10, 2020, update: Effective April 10, 2020, the CPT® Editorial panel made these lab code changes related to COVID-19:
- Revised code, adding underlined portions: 86318 (Immunoassay for infections agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip);
- New code: #86328 (… severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]))
- Tip: The # means the code is out of numerical order.
- New code: 86769 (Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]))
- Tip: Code 86769 is a child code under parent code 86710 (Antibody; influenza virus).
There are note changes, as well, incorporating these codes, so be sure to review the complete announcement about April 10 COVID-19 CPT® updates, including checking long descriptor changes. For instance, a note with 86328 points you to 86769 for multi-step method testing. The AMA’s COVID-19 coding and guidance page also includes a link to a special edition CPT® Assistant about these April updates.
Is There a HCPCS Level II Code for Testing? (And Other HCPCS News)
There are two HCPCS Level II codes on the way, according to Medicare’s “Current emergencies” page. The Medicare claims processing systems will be able to accept the codes April 1, 2020, but dates of service can go back to Feb. 4, 2020.
Code U0001 (CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel) will be used specifically for Centers for Disease Control & Prevention (CDC) testing laboratories to test patients for SARS-CoV-2.
Code U0002 (2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-CDC) will allow labs to bill for non-CDC lab tests.
March 16, 2020, update: CMS released a document with test pricing for U0001 and U0002.
April 1, 2020, update: Clinical labs should be aware of two new codes to identify and reimburse specimen collection for COVID-19 testing, effective with line item date of service on or after March 1, 2020:
- G2023 (Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source)
- G2024 (Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source)
April 7, 2020, update: Information on proper use of revised modifier CS (Cost-sharing for specified covid-19 testing-related services that result in an order for or administration of a covid-19 test) is now available from the April 7, 2020, MLN Connects. In short, the Families First Coronavirus Response Act waives cost-sharing under Medicare Part B under specified payment systems for COVID-19 testing-related services. These are certain evaluation and management (E/M) visits that involve ordering or administering a COVID-19 lab test. You should not charge Medicare patients co-insurance or deductible amounts for those services from March 18, 2020, through the end of the public health emergency (PHE). For both professional and institutional claims, the announcement states you will need to resubmit applicable claims that did not include modifier CS to get 100% payment. Providers who bill Part B should read the full announcement.
April 14, 2020, update: CMS posted a ruling, CMS-2020-01-R, that included two new codes:
- U0003 (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, making use of high throughput technologies as described by CMS-2020-01-R.)
- U0004 (2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.)
Code U0003 identifies tests otherwise coded using 87635 but performed using high throughput technologies.
Code U0004 identifies tests otherwise coded using U0002 but performed with high throughput technologies.
If you report COVID-19 testing, read the ruling to understand how it defines high throughput technologies. Codes U0003 and U0004 will be paid at the rate of $100. As of April 19, 2020, Medicare has not posted a HCPCS quarterly update file that includes these codes.
Where Can I Learn More About Medicare Coverage and News?
The “Current emergencies” page, linked in the previous question, is a good place to start. For instance, Medicare has posted a COVID-19 FAQs document on that page that answers questions like “Does Medicare pay for a doctor or non-physician practitioner (NPP) to furnish care in a beneficiary’s home?” and “Does Medicare pay for a doctor, NPP, or nurse to call or use other technology to communicate with a patient?” The FAQ also covers issues like hospital services, vaccinations, and ambulance services.
You also should be sure you’re signed up for email notifications from national Medicare and your Medicare Administrative Contractor (as well as other payers) to get alerts about code updates and policy changes.
March 13, 2020, update: Medicaid has posted FAQs, as well, available on the Medicaid COVID-19 page.
March 18, 2020, update: Medicare has expanded access to telehealth services for beneficiaries and posted related FAQs. Medicaid has posted telehealth information, as well.
March 23, 2020, update: CMS has posted a Telehealth Toolkit for General Practitioners and an End-Stage Renal Disease Providers Toolkit.
The MLN Matters Special Edition Article SE20011 on Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) (PDF) was updated to cover the use of modifiers on telehealth claims and to explain that the DR condition code is not needed on telehealth claims under the waiver.
Is There an ICD-10-CM Code for COVID-19?
At a January meeting, the World Health Organization (WHO) established a new ICD-10 code, U07.1 (2019-nCoV acute respiratory disease), with the expectation that the virus name would change.
ICD-10-CM is a clinical modification of ICD-10 used in the U.S., so just because ICD-10 has a code doesn’t mean ICD-10-CM will have an identical code. But in this case, the CDC has announced that there will be a similar new code effective Oct. 1, 2020. The new code, descriptor, and relevant addenda are expected to be presented at the March 2020 ICD-10 Coordination and Maintenance Committee meeting.
In the meantime, the CDC has posted an ICD-10-CM Official Coding Guidelines supplement, “Coding encounters related to COVID-19 Coronavirus Outbreak,” to offer authoritative guidance on reporting signs, symptoms, exposure, and confirmed cases.
For future updates on diagnosis coding, keep tabs on the CDC’s National Center for Health Statistics ICD-10-CM page.
March 20, 2020, update: The CDC has announced a change in the effective date for U07.1 (COVID-19). It will be effective April 1, 2020.
March 26, 2020, update: The CDC has released an updated April 1, 2020, ICD-10-CM addenda, so you can see the official Tabular and Index entries related to COVID-19 code U07.1. Check for notes like “Use additional code to identify pneumonia or other manifestations.”
April 1, 2020, update: The CDC has posted COVID-19 official guidelines for ICD-10-CM for April 1, 2020, to Sept. 30, 2020.
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Originally Published On: TCI Supercoder
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