Wiki Exposure to COVID-19 Diagnosis

[MagenD]

I think I understand how to code this, but I figured I'd check with some professionals out there to make sure. I have a few nursing home patients who have been in contact with another resident who came back positive for COVID-19. Most of them have no symptoms, but because of the known exposure I would assume that Z20.828 would be the appropriate code for this encounter. My question is whether there should be any additional codes associated with the claim or if I can use Z20.828 as the primary and only diagnosis since most z-codes are not typically covered as a primary diagnosis. Thanks for your help!

 

[thomas7331]

Per the guidance that I've been given and/or have read, Z20.828 would be correct if the patient is asymptomatic and is being tested because of the suspected exposure. This code is valid as a primary/first-listed diagnosis. I am not aware that most Z-codes are not typically covered as a primary diagnosis - I think this may be a misconception, but it should not be the case as long as the guidelines or payer policies do not say that a particular code may not be used as a primary diagnosis and the service is actually covered under the patient's plan for the reasons that it was performed.

 

[patti66]

some of the insurance insist on the Z20.828 to be listed as primary diagnosis even when others (SOB, PNA etc) are available but the test came back negative-- at least this is what we've seen for Humana