Medicare Compliance & Reimbursement

Question: Has the government issued any guidance regarding coding for the current coronavirus outbreak?

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Answer: Yes, the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), and the World Health Organization (WHO) have all issued the following guidance for coding both coronavirus diagnoses and testing.

1) For confirmed cases of COVID-19:

April 1: Use ICD-10 code U07.1 (2019-nCoV acute respiratory disease). The CDC, under the National Emergencies Act, section 201 and 301, announced that its moving the effective date of the new diagnosis code from Oct. 1, 2020 to April 1, 2020.

“This off-cycle update is unprecedented and is an exception to the code set updating process established under HIPAA,” stresses the CDC in a release.

Review the CDC release at www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-3-18-2020.pdf.

But: In the interim, the CDC instructs you not to use B34.2 (Coronavirus infection, unspecified) for confirmed cases of COVID-19, “because the cases have universally been respiratory in nature, so the site would not be ‘unspecified.’”

2) For cases when COVID-19 is confirmed as the cause of, or associated with, diseases classified elsewhere:

Use B97.29 (Other coronavirus as the cause of diseases classified elsewhere) as the secondary code in addition to the appropriate code for the other condition. For example, you would assign a patient diagnosed with acute bronchitis due to a confirmed case of COVID-19 with codes J20.8 (Acute bronchitis due to other specified organisms) and B97.29.

3) For suspected and confirmed exposure to COVID-19:

Use Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out) “for cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation.”

Use Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases) “for cases where there is an actual exposure to someone who is confirmed to have COVID-19.”

4) For COVID-19 testing:

Use two new HCPCS codes created by CMS on Feb. 13 and March 5 for lab tests and tracking the COVID-19 outbreak.

“Starting in April, laboratories performing the test can bill Medicare and other health insurers for services that occurred after February 4, 2020, using the newly created HCPCS code (U0001). This code is only to be used for the tests developed by the Centers for Disease Control and Prevention,” stresses CMS in a fact sheet. “Laboratories performing non-CDC laboratory tests for SARS-CoV-2/2019- nCoV (COVID-19) can bill for them using a different HCPCS code (U0002).”

Plus: The agency fact sheet lists prices for the two HCPCS codes for the 12 different Medicare Administrative Contractor (MAC) jurisdictions. According to the guidance, Medicare will pay a little under $36 for HCPCS code U0001 and about $51 for HCPCS code U0002.

See the CMS pricing sheet at www.cms.gov/files/document/mac-covid-19-test-pricing.pdf.

Resource: Find the CDC ICD-10-CM Official Coding Guidelines — Supplement at www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf.