In light of the rapidly evolving nature of the COVID-19 pandemic, we want to ensure you have the latest tools and information you need to properly bill in this environment. As you may begin to provide new services through telehealth, or see patients in-office that may be exhibiting symptoms suggestive of a COVID-19 infection, we want to remind clients that we’re here to guide you through your questions and concerns.
To that end, we’ve produced two sets of guides to help you: this guide is for practices who are providing services directly to patients that may be infected or suspected of being infected with COVID. The second, available here, is geared towards practices utilizing Telehealth services.
When submitting COVID-19 related claims, follow the appropriate CDC guidance on diagnosis coding for the date of service. The World Health Organization (WHO) has already added code U07.1 (2019-nCoV acute respiratory disease) to the international ICD-10, but this is not expected to be added to the U.S. version (ICD-10-CM) until Oct. 1.
In the meantime, a few recommended diagnosis codes that are already available are listed below separated by primary condition:
For a pneumonia case confirmed as due to the 2019 novel coronavirus (COVID-19), assign codes J12.89, Other viral pneumonia, and B97.29, Other coronavirus as the cause of diseases classified elsewhere.
For a patient with acute bronchitis confirmed as due to COVID-19, assign codes J20.8, Acute bronchitis due to other specified organisms, and B97.29, Other coronavirus as the cause of diseases classified elsewhere. Bronchitis not otherwise specified (NOS) due to the COVID-19 should be coded using code J40, Bronchitis, not specified as acute or chronic; along with code B97.29, Other coronavirus as the cause of diseases classified elsewhere.
Lower Respiratory Infection
If COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, this should be assigned with code J22, Unspecified acute lower respiratory infection, with code B97.29, Other coronavirus as the cause of diseases classified elsewhere. If the COVID-19 is documented as being associated with a respiratory infection, NOS, it would be appropriate to assign code J98.8, Other specified respiratory disorders, with code B97.29, Other coronavirus as the cause of diseases classified elsewhere.
CODING FOR COVID SIGNS & SYMPTOMS
For patients presenting with any signs/symptoms (such as fever, etc.) and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as:
- R05 Cough
- R06.02 Shortness of breath
- R50.9 Fever, unspecified
- Note: Diagnosis code B34.2, Coronavirus infection, unspecified, would generally not be appropriate for the COVID-19, because the cases have universally been respiratory in nature, so the site would not be “unspecified.”
COVID-19 TESTING CODES
On February 4, 2020 CMS created two new HCPCS codes for COVID-19 lab testing:
- U0001- Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for this test.
- U0002 – Code can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests.
- Note: The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after February 4, 2020.
CPT- Additionally, on March 13, 2020, the American Medical Association (AMA) released a new CPT code (87635) for novel coronavirus testing. This code describes laboratory testing for the novel coronavirus—SARS-CoV-2—that causes COVID-19. More information is available here.