Oncology & Hematology Coding Alert

Find out why you should not use B34.2 as a diagnosis coding option.

As you know, the 2019 novel coronavirus (COVID-19) has been declared a pandemic national emergency in the United States — which means your oncology practice may be adjusting to new coding scenarios. Here’s the latest coding guidance you should be adopting as soon as possible.

Rationale: It is essential healthcare systems begin using these codes to report all COVID-19 testing and confirmed diagnoses. This critical data could potentially help the lives of millions.

Learn This Category I Pathology and Laboratory Code

In the midst of cold and flu season, labs are responding to the need for testing and monitoring COVID-19 cases by sharing knowledge with clinicians, using infection control measures, and implementing appropriate testing.

“Our goal is early detection of new cases and to prevent further spread of the coronavirus,” said Robert R. Redfield, MD, director of the Center for Disease Control and Prevention (CDC) in a press release.

The CPT^® Editorial Panel approved a new Category I Pathology and Laboratory code for novel coronavirus testing: 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 code became effective March 13, 2020.

Heads up: This is an early release, so you will need to manually upload this code descriptor into your electronic health record and billing systems.

More info: A special edition CPT^® Assistant is publicly available, which provides guidance for using this new code. You can also visit the AMA website for more information. https://www.ama-assn.org/system/files/2020-03/cpt-assistant-guide-coronavirus.pdf.

Oncology advice: According to the American Society of Clinical Oncology (ASCO), you won’t find any specific guidance with respect to COVID-19 testing in patients with cancer. You should follow local and state public directives.

You Also Have Two New HCPCS Level II Codes

The Centers for Medicare and Medicaid Services (CMS) created two codes as well, says Suzan Hauptman, MPM, CPC, CEMC, CEDC, director compliance audit at Cancer Treatment Centers of America. They are U0001 (2019 Coronavirus Real Time TR-PCR Diagnostic Test Panel) and U0002 (2019 nCOV Coronavirus, SSARS-CoV-2/2019-nCOV using any technique, multiple types or subtypes).

For Medicare beneficiaries being tested for the coronavirus (COVID-19), CDC laboratories may use temporary HCPCS code U0001 “to bill for tests and track new cases of … SARS-CoV-2,” while non-CDC laboratory tests can use U0002 “to bill for SARS-CoV-2/2019-nCoV (COVID-19).”

“You will use these codes to submit claims to Medicare. Aetna and United Healthcare are among those insurance companies accepting these codes for dates of service February 4 and after. They will be ready to accept these April 1, 2020,” Hauptman says.

Don’t Overlook ICD-10-CM Options

You should also check out the new ICD-10-CM codes to reflect the coronavirus.

1) For confirmed cases of COVID-19:

The Centers for Disease Control (“CDC”) has released a new ICD-10-CM code, U07.1 (2019-nCoV acute respiratory disease). The new code, originally announced earlier this year, was initially to be effective Oct. 1, 2020. However, CDC announced during the Coordination and Maintenance Committee meeting on March 18, 2020 “that due to the ‘urgent need to capture the reporting of [COVID-19] in our nation’s claims and surveillance data,’ the agency has changed the effective date of new diagnosis code U07.1, COVID-19, from Oct. 1, to April 1, 2020.”

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,” and as of April 1, 2020, the new code is more specific to the COVID-19 confirmed illness.

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 a secondary code in addition to the appropriate code for the other condition.

Example 1: A patient diagnosed with acute bronchitis due to a confirmed case of COVID-19. You’ll report codes U07.1, J20.8 (Acute bronchitis due to other specified organisms), and B97.29. For patients with a malignancy being actively treated for the disease and considered at the time of the visit, but not the primary reason for the visit, the cancer diagnosis ICD-10-CM code would be reported in the 4th position. If the malignancy is present in this scenario and the physician does not treat or assess the patient’s cancer, you would use the status code.

Example 2: You’ll use U07.1 and B97.29 as an additional code if the virus is responsible for such diseases as pneumonia, classified as J12.89 (Other viral pneumonia), or sepsis, classified as A41.89 (Other specified sepsis). For oncology patients, the same additional codes described in Example 1 would be applicable in this situation as well.

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.”

Relate The COVID-19 Outbreak to Your Oncology Practice

On the ASCO “Care of Individuals With Cancer During COVID-19” website (URL: www.asco.org/asco-coronavirus-information/care-individuals-cancer-during-covid-19), you’ll find some oncology related issues addressed. Your coding for necessary surgeries and chemotherapy treatment will go on, while you may see a decrease in screening cancer measures for the time being.

Disclaimer: Information related to COVID-19 is changing rapidly. This information was accurate at the time of writing. Be sure to stay tuned to future issues of Oncology Coding Alert for more information. You can also refer to payer websites, CMS (cms.gov), CDC (cdc.gov), and AAPC’s blog (www.aapc.com/blog) for the most up-to-date information.