{"id":10115,"date":"2020-05-07T02:23:34","date_gmt":"2020-05-07T07:23:34","guid":{"rendered":"https:\/\/www.billingparadise.com\/blog\/?p=10115"},"modified":"2026-03-11T02:03:20","modified_gmt":"2026-03-11T07:03:20","slug":"covid-19-coding-billing-guidelines-that-providers-must-know","status":"publish","type":"post","link":"https:\/\/www.billingparadise.com\/blog\/covid-19-coding-billing-guidelines-that-providers-must-know\/","title":{"rendered":"COVID-19 Coding & Billing Guidelines That Providers Must Know"},"content":{"rendered":"

An unprecedented crisis is being faced by health organizations, the pandemic has increased the challenges of COVID-19 coding and billing, ensuring the accuracy of documentation and data capture is of prime importance for getting paid for their services.<\/p>\n<\/div><\/div><\/div><\/div><\/section>

Healthcare organizations are going through a difficult phase capturing data and documenting COVID-19 cases, with regulations being changed on a day-to-day basis, the burden on the providers has increased twofold.<\/p>\n

The sudden surge of patients with symptoms of the highly contagious disease, has allowed providers to track the spread of the novel coronavirus, and accordingly get paid for testing and treating the patients. The effectiveness of the processes will help providers overcome the challenges emerging out of COVID-19 now, and will set the road map of similar pandemics happening in the future.<\/p>\n

As Patrice A. Harris, MD, MA,<\/a> president of the American Medical Association (AMA) observed, that at a time when resources are stretched by the COVID-19 pandemic, it is important to equip the healthcare workforce to accurately code medical procedures, streamline communication across the health system, so that the administrative and rework cost can be reduced.<\/p>\n

\"\"<\/p>\n

However, many providers fail to realize the benefits of effective COVID-19 coding and billing because of lack of resources and know-how.<\/p>\n

The prevailing conditions have upset the normal workflow of many healthcare organizations, leading to cancellation or postponement of their normal services in order to prevent the spread of COVID-19, while treating and documenting patients with a completely novel condition. An increased unemployment rate has resulted in a new mix of patients visiting organizations, which is creating more coding and documentation challenges than usual.<\/p>\n

COVID-19 has made the healthcare industry quickly adapt to new coding and documentation guidelines for the novel coronavirus. It is critical that these new guidelines be followed in tackling\u00a0 COVID-19 , and the challenges associated with it.\u00a0<\/span><\/p>\n

The scope of this article is to breakdown the details of the COVID-19 billing and coding best practices that providers can implement in order to lower their burden now, as well as for the future, when things begin to settle down.\u00a0<\/span><\/p>\n<\/div><\/div><\/div><\/div><\/section>

COVID-19 TRACKING AND BILLING PROCESSED WITH NEW CODES<\/h2>\n<\/div><\/div><\/div><\/div><\/section>

Patient encounters are documented and billed by providers using a variety of medical code sets. New codes to capture COVID-19 testing and care have been created recently .<\/p>\n

ICD-10-CM<\/a>
\nThe CD announced in March that it has added new international Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) emergency code created by the World Health Organization earlier this year. This is to accommodate the urgent need to capture COVID-19 diagnosis on claims and surveillance data. The diagnosis of COVID-19 has been designated with a code U07.1, 2019-nCoV acute respiratory disease.<\/p>\n

\"\"<\/p>\n

In view of the spread of the virus, CDC which had originally planned to implement U07.1 on Oct.1, 2020, changed the implementation date to April 1, 2020.<\/p>\n

U07.1, according to official guidance from the CDC, can be used by providers to document a confirmed diagnosis of COVID-19, based on a documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result. Asymptomatic patients that test positive for coronavirus can also be documented with this code.<\/p>\n

This is an exception to the hospital inpatient guideline, as per CDC. Provider documentation is sufficient in this case, as “confirmation” does not require documentation of the type of test performed<\/p>\n

Being a principal or first listed diagnosis code, providers must first sequence the new ICD-10-CM code, followed by using appropriate codes for associated manifestations, except in obstetric patients.<\/p>\n

Effective April 1, 2020, the code for Medicare Severity Diagnosis Related Group (MS-DRG) purposes has been recognised by CMS, likewise the new code has been accomodated in the ICD-10MS-DRG Grouper software package<\/p>\n

\"\"<\/p>\n

U07.1 should not be assigned to suspected, possible, probable, or inconclusive cases of COVID-19, as per guidelines emphasised by CDC. Providers can instead assign codes explaining the reason for encounter, such as fever or Z20,828, contact with and (suspected) exposure to other viral communicable diseases.<\/p>\n

Possibility of exposure to COVID-19 which is ruled out after evaluation, can be designated with code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.<\/p>\n<\/div><\/div><\/div><\/div><\/section>

CPT<\/h2>\n<\/div><\/div><\/div><\/div><\/section>

In order to enable providers to code and bill for coronavirus testing, AMA has been updating its Current Procedural Terminology (CPT) code set.<\/p>\n

On March 13 AMA<\/a> announced the addition of CPT code 87635 for novel coronavirus testing through infectious agent detection by nucleic acid. As an example, this code can be used if a patient’s respiratory swabs are taken by a health professional, and sent to a lab, after a patient suspected with COVID-19 reports to the emergency department with fever, cough, and shortness of breath.<\/p>\n

\"\"<\/p>\n

Addition of codes were unveiled by the association recently, which included codes 86328 and 86769 for COVID-19 antibody tests and the revision for SARS-CoV-2 nucleic acid tests (86318).<\/p>\n

AMA stated in the announcement that Code 86328 was created for antibody tests using a single step method immunoassay. This is appropriate for a point-of-care platform, for testing methods that usually include a strip with all of the critical components for the assay. The association reported that Code 86769 was established for antibody tests using a multiple step method.<\/p>\n

The COVID-19 coding guidance set forth by AMA notes that these CPT codes were released earlier than the standard updates. It factually implies that code descriptors will have to be manually uploaded by providers into the EHR systems. For 2021, the CPT codes shall be a part of the complete code set data file.<\/p>\n

Eleven scenarios were released by the association for providers to determine and use the appropriate CPT code for COVID-19 testing at their office.<\/p>\n<\/div><\/div><\/div><\/div><\/section>

HCPCS<\/h2>\n<\/div><\/div><\/div><\/div><\/section>

In order to facilitate providers getting reimbursed for diagnosing patients and stopping the spread of coronavirus, CMS has created Healthcare Common Procedure Coding System (HCPCS) codes.<\/p>\n

The addition of two codes – U0001 and U0002 – for COVID-19 tests was announced by CMS earlier this year. In the process of documenting and billing for tests done specifically at CDC testing laboratories, the first code can be assigned, the second code would apply to clinical laboratories outside of the CDC for billing their own COVID-19 tests.<\/p>\n

\"\"<\/p>\n

The codes were being accepted by Medicare beginning April 1, 2020, and will apply for billing tests done on or after Feb 4, 2020.<\/p>\n

Based on a pricing list effective from March 12, 2020, providers will receive $35 from Medicare, for claims coded with U0001 and for claims with U0002 they will receive $51 approximately.<\/p>\n<\/div><\/div><\/div><\/div><\/section>

TELEMEDICINE\/TELEHEALTH CODING & BILLING<\/h2>\n<\/div><\/div><\/div><\/div><\/section>

Many providers are following a circumspect approach dealing with in-person COVID-19 patients, and prefer treating them through virtual telehealth platforms.<\/p>\n

Hospitals have integrated telehealth platforms with their EHR software offering telehealth services when possible to triage patients. As elective and non-urgent services decline, ambulatory services too are following suit. Nonetheless, being a new service, telehealth is presenting new coding and billing challenges for health organizations.<\/p>\n

At a time when COVID-19 is casting its shadow across the entire nation, a wide range of rules and regulations have been relaxed by HHS to facilitate providers leverage telehealth during the crisis, and get paid the same amount for virtual visits. As the crises continue, new services are being added, including telehealth visits, virtual check-ins, and e-visits.<\/p>\n

In order to document telehealth services and other virtual visits, a new set of HCPCS codes are being provided by CMS, which will paid under the Physician Fee Schedule.<\/p>\n

Guidance on telehealth coding and billing using CPT codes is being provided by AMA. It covers telehealth visits, online digital visits, remote patient monitoring, and telephone evaluation and management services. Over 11 scenarios for CPT coding have been included, with examples of how to code for telehealth services during the crises.<\/p>\n<\/div><\/div><\/div><\/div><\/section>

COVID-19 CODING AND BILLING BEST PRACTICES<\/h2>\n<\/div><\/div><\/div><\/div><\/section>

As new information on COVID-19 emerges, rules and regulations are being seemingly changed everyday. Providers need to diligently follow the billing and coding guidelines set forth by CDC, CMS, AMA, and other official organizations.<\/p>\n

\"\"<\/p>\n

As Maria Noelle Ward, MEd, RHIA, CCS, CCS-P, director of HIM practice excellence at AHIMA stated \u201cMost importantly, they need to be sure that they’re following the coding guidelines, those provided from a visit perspective and the telehealth and the CPT codes, but also the guidelines that have been provided by the CDC for actually coding patients who have COVID.\u201d<\/p>\n

As hospitals shift services to outpatients in preparation for greater inpatient demand, this is especially important, Ward explained.<\/p>\n

Documentation guidelines have to be assessed by providers in their EHRs, to ensure services are being accurately documented at this time, as Ward suggested, CDI query templates are a key source for providers.<\/p>\n

Ward concluded by saying \u201cAll of the coded data is going to provide information that contributes to patient care, public policy, reimbursement determination, and any of the statistics related to the spread of COVID,\u201d further elaborating, she said, \u201cResearchers looking at how to treat this and future coronavirus outbreaks are going to need this information. So, it has to be correct on the front end.\u201d<\/p>\n

Ward asserted that they need to have complete, precise, accurate documentation that reflects all of the related conditions, which will lead to higher quality data affecting patient outcomes in the future.<\/p>\n<\/div><\/div><\/div><\/div><\/section>\n","protected":false},"excerpt":{"rendered":"An unprecedented crisis is being faced by health organizations, the pandemic has increased the challenges of COVID-19 coding and billing, ensuring the accuracy of documentation and data capture is of prime importance for getting paid for their services. Healthcare organizations are going through a difficult phase capturing data and documenting COVID-19 cases, with regulations being [...]","protected":false},"author":2,"featured_media":10117,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[721,716],"tags":[],"class_list":["post-10115","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-collections","category-most-recent"],"_links":{"self":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/10115","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/comments?post=10115"}],"version-history":[{"count":2,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/10115\/revisions"}],"predecessor-version":[{"id":450154,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/10115\/revisions\/450154"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/media\/10117"}],"wp:attachment":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/media?parent=10115"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/categories?post=10115"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/tags?post=10115"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}