Practice Management Alert

If the disease hasn’t affected your community yet, make your preparations now.

U.S. experts believe that it’s just a matter of time until we are encountering COVID-19 in our own communities. The virus, SARS-CoV-2, emerged in late 2019 in China and is now present on every continent except Antarctica. The United States is reporting more COVID-19 disease infections every day as more testing kits become available and the infection spreads.

Washington, California, and New York were leading the country in confirmed cases at the time of publication, but the disease is confirmed in all 50 states. The death toll in the U.S. and around the world continues to rise.

“It’s not a question of if this will happen anymore but rather a question of exactly when this will happen and how many people in this country will have severe illness,” says Nancy Messonnier, MD, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC) in Atlanta.

Know Which Patients Are Most at Risk

People who are at most at risk of infection have been in prolonged contact with others who are infected and symptomatic the CDC says.

Still, many U.S. schools, universities, and other organizations are canceling or postponing events, instructing students and workers to learn or work from home when possible, and pushing back conventions or other large gatherings. The CDC has recommended canceling or postponing any gatherings of more than 50 people for the next eight weeks.

The virus hits those who are over 60 years old or with compromised immune systems hardest. Children seem spared from the worst effects of the disease, and some children (and even some adults) are silent carriers.

“The confirmed COVID-19 infections can cause a range of illness, from little to no symptoms, to those affected being severely ill and even dying. Symptoms can include fever, cough, and shortness of breath. Symptoms may appear from 2 to 14 days after exposure, based on the incubation period for other coronaviruses, such as the MERS (Middle East Respiratory Syndrome) viruses,” CDC says in a dedicated COVID-19 fact sheet.

“No deaths occurred in the group aged 9 years and younger, but cases in those aged 70 to 79 years had an 8.0% [case-fatality rate] CFR and cases in those aged 80 years and older had a 14.8% CFR,” say Zunyou Wu, MD, PhD, and Jennifer M. McGoogan, PhD, researchers at the Chinese Center for Disease Control and Prevention in Beijing, China, in a late-February Journal of the American Medical Association (JAMA) article.

Check Out These Dedicated ICD-10 Codes

If you do encounter patients with the disease — and experts are still predicting that it, perhaps, is not a matter of if, but when — there are dedicated ICD-10 codes for confirmed diagnosis.

Depending on the circumstances, you can code COVID-19 with B34.2 (Coronavirus infection, unspecified) or, if the coronavirus has been identified as the organism responsible for other conditions, B97.29 (Other coronavirus as the cause of diseases classified elsewhere).

Per ICD-10-CM guidelines, use 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).

If the patient has bronchitis due to COVID-19, use code J40 (Bronchitis, not specified as acute or chronic), along with code B97.29, (Other coronavirus as the cause of diseases classified elsewhere).

Should your provider determine that a patient is infected with coronavirus associated with SARS, use B97.21 (SARS-associated coronavirus as the cause of diseases classified elsewhere).

Patients with COVID-19 may also develop acute respiratory distress syndrome (ARDS), in which case you should choose J80 (Acute respiratory distress syndrome), and B97.29 (Other coronavirus as the cause of diseases classified elsewhere).

Use 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 and Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out) if the patient may have been exposed to COVID-19 but that the provider rules out that possibility after evaluation.

Coding tip: “If the provider documents ‘suspected,’ ‘possible’ or ‘probable’ COVID-19, do not assign code B97.29. Assign a code(s) explaining the reason for encounter (such as fever, or Z20.828),” CDC says.

See This CPT^® Update, too

“A new CPT^® code has been created that streamlines novel coronavirus testing offered by hospitals, health systems and laboratories in the United States,” the American Medical Association (AMA) says in a press release.

The code became effective March 13, 2020, as the industry standard for reporting the novel coronavirus testing, the release says.

“By streamlining the flow of information on novel coronavirus testing, a new CPT® code facilitates the reporting, measuring, analyzing, researching, and benchmarking that is necessary to help guide the nation’s response to the public health emergency,” said Patrice A. Harris, MD, MA, president of AMA, in an AMA press release.

Use CPT^® code 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) when documenting testing.

Remember, the status of COVID-19 disease changes daily, so check the CDC’s website for up-to-date details, here: www.cdc.gov/coronavirus/2019-ncov/index.html.