Pivot Point Perspective: New COVID-19 codes to improve data capture for tracking and payment.

COVID-19 Coding

How to Code Cases of COVID-19 Effective April 1, 2020

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As a result of the pandemic, a new emergency ICD-10 diagnosis code of U07.1 2019-nCoV acute respiratory disease is going into effect April 1, 2020 and is intended to be used as a principal or first-listed diagnosis. Specific guidelines for usage will be released shortly. This code should be followed by the appropriate codes for associated manifestations, except in the case of newborns and obstetric patients. This code along with its name are temporary and may be changed at a later date. In addition to the code update the ICD-10 MS-DRGs Version 37.1 R1 will also go into effect on April 1, 2020. During the emergency period, a 20% add-on payment will be added to the DRG rate for patients with COVID-19.

Need to Know.

  • All cases prior to April 1, 2020 should be coded following the supplement to the ICD-10-CM Official Coding Guidelines Coding Guidelines and assign code B97.29, (other coronavirus as the cause of diseases classified elsewhere) for those patients definitively diagnosed with COVID-19.
  • IF the provider documents “suspected”, “possible”, or “probable”, COVID-19, do not assign code B97.29. Assign codes explaining the reason for encounter or use ICD-10 code Z20.828 (contact with and (suspected) exposure to other viral communicable diseases) to document an encounter with a patient infected with any form of the virus.
  • Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or state level, but it has not yet been confirmed by the Centers for Disease Control and Prevention (CDC). CDC confirmation of local and state tests for the COVID-19 virus is no longer required.

Due to the heightened need to capture accurate data on positive COVID-19 cases, we 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.

CMS has created two codes in response to the urgent need to bill for COVID-19 laboratory services.

Effective March 13, 2020 a new procedure code has been added 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. CMS has created two codes in response to the urgent need to bill for COVID-19 laboratory services. The codes are: U0001, (CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel) and U0002, (2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC). Both codes are effective 2/4/2020 and will be available in the Medicare claims processing system on April 1, 2020.

In order to ensure appropriate flagging of COVID-19 related care, institutional claims for COVID-19 diagnosis or treatment should include condition code DR, which is used to identify claims that are or may be impacted by specific policies related to a national disaster.

 In order to meet patient needs, many hospitals and health systems have moved testing locations from hospitals to off-campus facilities (e.g. parking lots, parks, football stadiums). In such cases, the NUBC recommends usage of the Hospital Outpatient Type of Bill (013x), the main hospital address and National Provider Identifier (NPI).

The information provided here is current as of 3/31/20. Please contact our Coding and HIM specialists at 800-318-9681 or letschat@pivotpointconsulting.com for updates or questions.

See more of our Rapid Response COVID-19 resources and solutions.

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