How COVID-19 Has Changed Medical Billing
Updated: Dec 16, 2020
While the pandemic has upended life for pretty much everyone in the country, healthcare providers face additional dilemmas never before seen. And perhaps the most confusion comes in a vital area of the medical practice—billing.
While navigating disruptions, social distancing and telecommuting for some employees, providers must stay informed of and meticulous about new billing codes and how to apply them. This post is a beginning primer on some of the details of COVID-19 billing.
Specificity is Key
While treating and dealing with the disease is challenging enough, providers also must be vigilant in keeping up with new billing codes. With so much happening and so much in disarray, confusion and mistakes can creep in. Precision is vital when you are tracking and bill to keep revenue flow as uninterrupted as possible. Staying current on government updates in this rapidly changing environment should be a priority.
The International Classification of Diseases, aka ICD-10 has been updated with a new code. Providers now are to use U07.1, 2019-nCoV acute respiratory disease when diagnosing a patient with COVID-19. Initially, the Centers for Disease Control had planned to roll out this new pandemic-related ICD-10 code this month, but given how quickly the virus is spreading (especially through asymptomatic patients, which further hastens the pandemic), the CDC brought the code online in April. A report from RevCycle Intelligence gives more details. Because of the coding changes and the volatile nature of the pandemic, it is vital to document treatment accurately.
Exposure to COVID-19. For asymptomatic individuals with actual or suspected exposure to COVID-19, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. For symptomatic individuals with actual or suspected exposure to COVID-19 and the infection has been ruled out, or test results are inconclusive or unknown, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.
Signs and symptoms without definitive diagnosis of COVID-19. For patients presenting with any signs/symptoms associated with COVID-19 (such as fever, etc.) but a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as:
R06.02 Shortness of breath
R50.9 Fever, unspecified
If a patient with signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to COVID-19, assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, as an additional code.
Acute respiratory manifestations of COVID-19. When the reason for the encounter/admission is a respiratory manifestation of COVID-19, assign code U07.1, COVID-19, as the principal /first-listed diagnosis and assign code(s) for the respiratory manifestation(s) as additional diagnosis. For a patient with pneumonia confirmed as due to COVID-19, assign codes U07.1, COVID-19, and J12.89, other viral pneumonia.
Acute bronchitis. For a patient with acute bronchitis confirmed as due to COVID-19, assign codes U07.1, and J20.8, Acute bronchitis due to other specified organisms. Bronchitis not otherwise specified (NOS) due to COVID-19 should be coded using code U07.1 and J40, Bronchitis, not specified as acute or chronic.
Lower respiratory infection. If the COVID-19 is documented as being associated with a lower respiratory infection, NOS, or an acute respiratory infection, NOS, codes U07.1 and J22, Unspecified acute lower respiratory infection, should be assigned. If the COVID-19 is documented as being associated with a respiratory infection, NOS, codes U07.1 and J98.8, Other specified respiratory disorders, should be assigned.
Acute respiratory distress syndrome. For acute respiratory distress syndrome (ARDS) due to COVID-19, assign codes U07.1 and J80, Acute respiratory distress syndrome.
Acute respiratory failure. For acute respiratory failure due to COVID-19, assign code U07.1 and code J96.0, Acute respiratory failure.
Non-respiratory manifestations of COVID-19. When the reason for the encounter/admission is a non-respiratory manifestation (e.g., viral enteritis) of COVID-19, assign code U07.1, COVID-19, as the principal/first-listed diagnosis and assign code(s) for the manifestation(s) as additional diagnosis.
Asymptomatic individuals who test positive for COVID-19. For asymptomatic individuals who test positive for COVID-19, Although the individual is asymptomatic, the individual has tested positive and is considered to have the COVID-19 infection.
Personal history of COVID-19. For patients with a history of COVID-19, assign the code Z86.19, Personal history of other infectious and parasitic diseases.
Follow-up visits after COVID-19 infection has resolved. For individuals who previously had COVID-19 and are being seen for follow-up evaluation, and COVID-19 test results are negative, assign codes Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, and Z86.19, Personal history of other infectious and parasitic diseases. An exception to the hospital inpatient guideline Section II, H. In this context, “confirmation” does not require documentation of a positive test result for COVID-19; the provider’s documentation that the individual has COVID-19 is sufficient. If the provider documents “suspected,” “possible,” “probable,” or “inconclusive” COVID-19, do not assign code U07.1. Instead, code the signs and symptoms reported. See guideline I.C.1.g.1.g.
Stay Vigilant to Reduce Denied Claims
With so much uncertainty during the novel coronavirus, providers must take additional steps to help bring down the number of claims denied while providing life-saving healthcare. Before the pandemic, about five to 10 percent of claims were rejected every year. These numbers have only gone up.
As a provider dealing with a large number of denials during the COVID-19 pandemic, you’ll want to be specific, consistent and informed as our stressed healthcare system continues to provide treatment during this once-a-century crisis.
NEXT MONTH: Changes in evaluation and management in an outpatient setting.
Information in this post is created based on Paragon Health Service’s experience on this particular topic. Please refer to your local Medicare/Medicaid Carrier, CMS, OIG and/or insurance payers for all requirements.