Coronavirus: What Every Medical Coder Needs to Know

Coronavirus: What Every Medical Coder Needs to Know

On Dec. 31, 2019, as many of us here in the U.S. were celebrating New Year’s Eve, a pandemic quietly began in the Chinese province of Hubei. First identified in Wuhan, the provincial capital, coronavirus (more accurately known as COVID-19 or 2019-nCoV) has spread rapidly in the two ensuing months, resulting in infections, and even deaths, around the globe.
What do we need to know about the virus, either as individuals or as members of the coding community? And what steps can we take to help prevent a pandemic?
Here are the most current answers we have.

What is COVID-19?

According to the World Health Organization (WHO), COVID-19 is a coronavirus, one of a group of infectious diseases classified as zoonotic, meaning that it can be transmitted from animals to humans. Although it is a part of the Severe Acute Respiratory Syndrome (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV) family of viruses, the COVID-19 strain is regarded as novel, or new.

How Widespread is the COVID-19 Virus?

The latest World Health Organization (WHO) Situation Report (dated Feb. 25, 2020) reports 80,239 cases of COVID-19 have been confirmed worldwide since the beginning of the outbreak. Of those cases, 77,780 have been confirmed in China, resulting in 2,666 deaths. Elsewhere, the virus has been reported in 33 countries, with 34 deaths being recorded in the Republic of Korea (10), Japan (1), Philippines (1), Italy (6), France (1), and Iran (12). Three elderly Japanese passengers on the Diamond Princess cruise ship, which has been quarantined in the Japanese port of Yokohama, have also died from the virus, which infected 621 others on board.
Here in the U.S., just 14 confirmed cases have been reported so far. Almost all the cases have been traced back to exposure in China, with just two occurring as the result of exposure to the COVID-19 virus within this country. To date, no deaths related to the virus have been reported on U.S. soil.

Does COVID-19 Have an ICD-10-CM Code?

Even though the virus is new, there are codes within the current 2020 ICD-10-CM code set that you can use to document COVID-19.
Depending on the circumstances, COVID-19 can be coded with B97.29 Other coronavirus as the cause of diseases classified elsewhere. Only report B97.29 for confirmed cases of COVID-19.
For a patient with a confirmed condition due to COVID-19, also assign the appropriate diagnosis code. For example, per ICD-10-CM guidelines, B97.29 should be used 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.
Should a patient be determined to be infected with coronavirus associated with SARS, use B97.21 SARS-associated coronavirus as the cause of diseases classified elsewhere. And 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.
The CDC explains that B34.2 Coronavirus infection, unspecified is inappropriate because the coronavirus is a respiratory illness and, therefore, the site is not unspecified.
More recently, WHO released emergency use ICD codes for 2019-nCoV.  According to WHO, “The ‘2019-nCoV’ disease outbreak has been declared a public health emergency of international concern.”
Emergency ICD-10 code U07.1 is assigned to the disease diagnosis of 2019-nCoV acute respiratory disease. Note that the disease name 2019-nCoV may change to be independent of date and virus family. The ICD-11 code for the illness is RA01.0. At the time of this post, the Centers for Medicare & Medicaid Services had not released any instructions for the use of these new codes.
UPDATE 2/27/2020
Consistent with this WHO update to the ICD-10, the CDC will implement U07.1 2019-nCoV acute respiratory disease into ICD-10-CM for reporting, effective with the next update, Oct. 1, 2020.
See the announcement and interim coding guidance for more information.

Does COVID-19 Have a Test Code?

According to a Centers for Medicare & Medicaid Services (CMS) press release, “Healthcare providers who need to test patients for Coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001).”
The press release also goes on to state that Medicare claims will be accepted beginning on April 1, 2020, for tests billed with this code from Feb. 4, 2020, onward.

What Should Your Facility Do to Prepare for a Local Outbreak?

Another CMS directive provides guidance on this. Right now, it suggests healthcare facilities should review plans for emergency preparedness, “including reviewing … infection control policies and practices to prevent the spread of infection.” This includes:

  • Adhering to the CDC’s Standard, Contact, and Airborne Precautions, including the use of eye protection;
  • Adhering to CDC recommendations on standard hand hygiene practices, using alcohol-based hand rub/hand sanitizer (ABHR/ABHS);
  • Reviewing … appropriate personal protective equipment (PPE) use and availability, such as gloves, gowns, respirators, and eye protection; and
  • Remembering that the protections of the HIPAA Privacy Rule are not set aside during an emergency.

News of the COVID-19 outbreak changes daily, so continue to check reliable media outlets and the CDC website to stay on top of the situation.

Bruce Pegg

17 Responses to “Coronavirus: What Every Medical Coder Needs to Know”

  1. Michelle La Vine says:

    Advice from an elderly Aunt: Refrain at all cost touching your face, eyes, mouth & nose with your hands. Never place your hands on your face. When I applied this advice to my daily life, I have not gotten sick. Not one cold or flu. My child also used this advice and his complexion became clear and stopped using any “miracle” cleanser from that time forward. Just keep your hands off your face.

  2. Carol J. Self, CPPM, CPC, EMT says:

    As there will now be 3 codes for SARS-CoV 2 testing, you should contact your contracted payors to determine which code set will be utilized for proper payment.

  3. Alex says:

    What should be the fee for U0001 and U0002 for providers?

  4. Sheena Washington says:

    It would be awesome to get some direction on the billing CPT codes for Medicare and Medicaid. I have info on DX and the new Lab Code. However, it is hard to locate what is acceptable for Medicare and Medicare. Q3014; T1014 modifiers GT, U1-UD. Are they both payable by Medicare and Medicaid. Are these only if the patient is in a Health Professional Shortage Area (HPSA?. Just need some clarity.

  5. Kate says:

    What would an ICD -10 code be (not the B97.29) if a patient came in and just wants to be tested for the virus and just has a cough, ect. but never exposed to someone with the virus either. Is there one just for checking if they have this virus?

  6. Serena Marshall says:

    Hey Kate, this is what I was able to find for your inquiry.
    Signs and 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)
    Aetna has some really great guidelines for providers. Here is the link:
    https://www.aetna.com/health-care-professionals/provider-education-manuals/covid-faq.html#acc_link_content_section_responsivegrid_copy__responsivegrid_accordion_9

  7. julian says:

    Hi, Lets say one of the biggest problems we are facing today is a way how to collect specimens from these suspected infected individuals, now you see drive thru collection and testing being done. What billable codes can be assigned to a site that only collects the specimens then sends it off to a lab say labcorp for testing services? What codes can allow for ensuring the collection site be paid for services rendered pertaining to covid 19 collection, that are billed to insurances? It would be great if you can shine light on this issue.

  8. Laurel Bennett says:

    For our clinic we are doing the Covid swabs but we are sending them off to actually get tested. So would we bill the 87635?

  9. Victoria K Goldman says:

    please clarify tele med for video conferencing, I have a psychiatrist that is now treating patients thur video zoom. Medicare is allowing this for 90 days but not sure if we use regular code 90837 with modifier 95 with place of service 02, or if we need to use 98972?

  10. Dacia Ossick says:

    Can an Emergency Department bill an E/M if the MSE was completed by an RN for COVID-19?

  11. Kourtney Christiansen says:

    Sheena Washington did you find anything out about Q3014? My company is wanting us to use it but I don’t think it is necessary. Anyone else know more?

  12. Susan Heiss says:

    I need assistance in regards to whom I should talk about reimbursement for coronavirus Panel.
    If I run this covid panel’s what are we looking for reimbursement? Does it meet medical necessity to run this with our plans.
    CORONAVIRUS PANEL
    coronavirus 229E
    coronavirus HKU1
    coronavirus NL63
    coronavirus OC43
    coronavirus COVID-19
    *Endogenous Control
    Thanks

  13. Melissa Short says:

    Based on the updated guidelines by the WHO, there should be 2 codes for COVID-19 and they provided some guidelines for coding the diagnoses. I haven’t seen anything presented by CMS with this update. Has anyone else? Is anyone else able to code using U07.2? https://www.who.int/classifications/icd/COVID-19-coding-icd10.pdf?ua=1

  14. maria says:

    how much does the clinic can charge to the insurance to do a telehealth encounter?

  15. Renee Dustman says:

    Maria, You’ll need to check your fee schedule for that information.

  16. Renee Dustman says:

    Melissa: U07.02 is not for use in the US

  17. Renee Dustman says:

    Susan: If the payer cannot provide an answer, I recommend you use AAPC’s Ask an Expert service. https://www.aapc.com/resources/ask-an-expert/ask-an-expert-purchase.aspx

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