Coronavirus (COVID-19): Coding, Billing, and Coverage

By Colleen O. Hall, CPC, CIRCC, CPMA, and Joanne Spethman, RHIA, CDIP, CCS
| 4/14/2020
Coronavirus (COVID-19): Coding, Billing, and Coverage

The coronavirus (COVID-19) outbreak has produced large volumes of information from a variety of sources. Credible online resources and current coding, billing, and coverage guidance are listed here.

General online resources

ICD-10-CM coding guidance

CDC: ICD-10-CM official coding guidelines

The CDC originally announced diagnosis guidance for ICD-10-CM coding for encounters related to the coronavirus, effective Feb. 20, 2020.

More recently, the CDC implemented a new ICD-10-CM diagnosis code, U07.1, COVID-19, which is effective as of April 1, 2020. The new code also is considered a major complication or comorbidity (MCC).

Note: For dates of service prior to April 1, 2020, the coding guidelines and instructions are different for reporting COVID-19. Therefore, prior to implementation, it is important to scrutinize all dates of service to comply with corresponding time frames stipulated.

The CDC’s National Center for Health Statistics has released information about the ICD-10 MS-DRGs Version 37.1 R1, effective April 1, 2020.

AHA Coding Clinic Advisor

The American Hospital Association (AHA) Coding Clinic has provided a list of frequently asked questions about ICD-10-CM coding of COVID-19.

CDC: COVID-19 testing

The CDC has published frequently asked questions related to COVID-19 testing at laboratories.

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CMS: New HCPCS billing codes for coronavirus tests

The CMS has released new billing codes for lab tests pertaining to the coronavirus. This will enable clinical labs and providers to receive reimbursement and increase testing and tracking of new cases.

The billing codes are part of the Healthcare Common Procedure Coding System (HCPCS) that Medicare and other insurance carriers can use to process provider claims. The billing codes include the following:

  • U0001, SARS-CoV-2 diagnostic tests performed specifically by CDC testing laboratories
  • U0002, SARS-CoV-2 diagnostic tests performed by non-CDC labs

The new codes align with recent Food and Drug Administration policy that allows certain laboratories to develop their own validated COVID-19 diagnostic tests. The second billing code from the CMS (U0002) can be used to bill Medicare and other payers for these tests developed by non-CDC laboratories.

According to the CMS, it expects the new billing codes to “encourage testing and improve tracking.”

The codes are accepted beginning April 1, 2020, and will cover coronavirus lab tests performed on or after Feb. 4, 2020. Local Medicare Administrative Contractors (MACs) will be responsible for establishing payment amounts for these codes.

AMA: New CPT code

The American Medical Association (AMA) announced a new Current Procedural Terminology (CPT) code for reporting tests for COVID-19, effective immediately. The code and descriptor are:

  • 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

CMS: Medicaid and Medicare coverage

Medicaid

The CMS released four tools to “permit states to access emergency administrative relief, make temporary modifications to Medicaid eligibility and benefit requirements, relax rules to ensure that individuals with disabilities and the elderly can be effectively served in their homes, and modify payment rules to support health care providers impacted by the outbreak.”

Medicare Part A: Inpatient hospitalization

According to a CMS fact sheet on COVID-19 Medicare coverage, when Medicare beneficiaries with COVID-19 no longer require acute inpatient care but remain quarantined in a hospital room to avoid infecting others, Medicare will pay the diagnosis-related group (DRG) rate and any cost outliers until the patient is discharged. In addition, patients will not have to pay an additional deductible for quarantine in a hospital if they otherwise would have been discharged.

Medicare Part B: Outpatient visits

According to the CMS, Part B will cover medically necessary care provided in outpatient quarantine settings, along with clinical lab and medical imaging tests that are medically necessary. 

Inpatient and outpatient quality reporting

The CMS announced exceptions from and extensions to reporting requirements for clinicians, providers, hospitals, and facilities participating in quality reporting programs.

Emergency declaration fact sheet

To help clarify its response to the Trump administration’s COVID-19 emergency declaration, CMS has published a fact sheet for healthcare providers.

Telehealth services

The Trump administration announced on March 17, 2020, expanded coverage for Medicare to pay temporarily for a wider range of telehealth services during the COVID-19 crisis. The CMS, the Department of Health and Human Services (HHS), and the AMA have published related information:

Want more insights on addressing coronavirus-related challenges?
Go to the Crowe COVID-19 resource center for more analysis and updates.

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