Neurology & Pain Management Coding Alert

Question: Though we are not directly responsible for patients with COVID-19, we do have to keep abreast of the changes in case it might affect some aspect of patient care. Can you give me a rundown of the latest news about COVID-19 as it relates to patient care and coding?

Wisconsin Subscriber

Answer: Here are the most recent guidelines the Centers for Disease Control and Prevention (CDC) and the American Medical Association (AMA) have issued for ICD-10 and CPT^® coding for the emergency. This information was accurate at the time of writing, but information related to COVID-19 is changing rapidly. Please check payer websites, the Centers for Medicare & Medicaid Services (CMS, cms.gov), CDC (cdc.gov), and AAPC’s blog (www.aapc.com/blog) for the most up-to-date information.

CPT® On March 26, the American Medical Association (AMA) provided the following guidance for CPT^® coding:

For patient assessment: Use 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …) for synchronous assessments either face-to-face or via audio/visual telehealth; 99441-99443 (Telephone evaluation and management …) or G2012 (… virtual check-in …) for audio-only telephone services; G2010 (Remote evaluation of recorded video and/or images …), or 99421-99423 (Online digital evaluation and management service …) for asynchronous services such as virtual check-ins.

For swab collection with in-person E/M assessment: Include work in the evaluation and management (E/M) code.

For swab collection without in-person E/M assessment: Use 99211 (Office or other outpatient visit …), appending modifier 25 (Significant, separately identifiable evaluation and management service …) if this occurs in the provider’s office on the same day as a separate assessment that is not done in-person. Use 99000 (Handling and/or conveyance of specimen for transfer from the office to a laboratory) if your office incurs expenses preparing the specimen or is charged for the courier picking up the specimen to be delivered to the lab. For specimen collection at an independent testing site, the AMA recommends coding 99001 (Handling and/or conveyance of specimen for transfer from the patient in other than an office to a laboratory (distance may be indicated).

If the collection is bundled into the lab fee, then you cannot use 99000. Medicare carriers particularly consider collection and handling of specimens as part of an E/M service, and you should not code for it separately.

For lab tests: Use either temporary code U0001 (CDC 2019 Novel Coronavirus (2019-nCoV …) (for CDC laboratories) or U0002 (2019-nCoV Coronavirus…) for dates of service on or after Feb. 4, 2020 until March 13, when you should use 87635 (Infectious agent detection … [COVID-19] …).

(Source: www.ama-assn.org/system/files/2020-03/cpt-reporting-covid-19-testing.pdf.)

ICD-10 These are the current CDC guidelines, effective April 1, 2020 through Sept. 30, 2020.

Do not use B97.29 as a secondary code: When COVID-19 is the cause of another condition, you will no longer code the other condition first with B97.29 (Other coronavirus as the cause of diseases classified elsewhere) as the secondary code. Instead, you will use temporary code U07.1 (COVID-19) as the first listed code, with the other condition sequenced second, such as:

• Acute bronchitis confirmed as due to COVID-19: U07.1 with J20.8 (Acute bronchitis due to other specified organisms).
• Acute respiratory distress syndrome (ARDS) due to COVID-19: U07.1 with J80 (Acute respiratory distress syndrome).
• Bronchitis not otherwise specified (NOS) due to COVID-19: U07.1 with J40 (Bronchitis, not specified as acute or chronic).
• Lower respiratory infection not otherwise specified (NOS) or acute respiratory infection NOS associated with COVID-19: U07.1 with J22 (Unspecified acute lower respiratory infection).
• Pneumonia confirmed as due to COVID-19: U07.1 with J12.89 (Other viral pneumonia).
• Respiratory infection, NOS associated with COVID-19: U07.1 with J98.8 (Other specified respiratory disorders).

Patients presenting during pregnancy, childbirth, or the puerperium because of COVID-19 are an exception to this sequencing guideline. In such cases, you would sequence O98.5- (Other viral diseases complicating pregnancy, childbirth and the puerperium) first, followed by U07.1 and any appropriate codes for associated manifestation(s) per ICD-10 guideline I.C.15.s.

Screenings: Use Z11.59 (Encounter for screening for other viral diseases) for an asymptomatic patient with no known exposure when the test results are either negative or unknown. Use U07.1 for asymptomatic patients who test positive.

Signs and symptoms: Use the appropriate code(s) for each of the presenting signs and symptoms for any patient who presents with signs and symptoms of COVID-19 without a definitive diagnosis. Assign Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases) as an additional code for actual or suspected contact with, or exposure to, someone who has COVID-19.

(Source: www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf.)