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.
The number of COVID-19 cases in the United States are changing rapidly. Please see the CDC website for the latest data.
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.
Consistent with this WHO update to the ICD-10, the CDC will implement U07.1 COVID-19 into ICD-10-CM for reporting, effective with the next update, April 1, 2020.
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).” This code is used specifically for CDC testing labs to test patients for SARS-CoV-2.
CMS has developed a second HCPCS Level II code (U0002) for labs to bill for non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVD-19). This code may be used for tests developed by certain laboratories in accordance with a new policy the Food and Drug Administration issued Feb. 29.
Medicare claims will be accepted beginning on April 1, 2020, for tests billed with these codes from Feb. 4, 2020, onward. Local Medicare Administrative Contractors are responsible for developing the payment amount for claims they receive for these newly created codes until CMS established national payment rates.
Medicare Administrative Contractor (MAC) COVID-19 Test Pricing was released March 12, 2020.
The CPT Editorial Panel has approved a new CPT® code for COVID-19 testing.
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.
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