Wiki Covid-19 Testing

[adenison95]

I have been billing for Covid-19 lab tests with Z03.818 or Z20.828 with mod CR. Today an insurance company told me that in order to have a patient's co-pay waived, I need to use U07.1. I explained I cannot use the U07.1 unless the patient actually has Covid-19. Am I understanding this incorrectly? Other insurances I have billed are waiving copays with Z03.818 or Z20.828.

Thanks!

 

[thomas7331]

You are correct, you cannot use U07.1 if the documentation does not reflect that patient has been diagnosed with the disease. Whether or not a copay should be waived is a matter that is between the patient and their insurance company - it is not up to a provider or coder to report their claim differently to make this happen.

 

[shatfield]

I had the same thing happen to me today. I am in pediatrics and I had a major payer call today stating that we need to use U07.1 so that it's covered at 100%. The only balance the patient had was a copay. I was totally confused b/c I had never used this code unless it was a confirmed diagnosis. We only do the swab in our office and send out the test so we don't get the results back to know if it's confirmed until after we bill the claim. I usually use exposure to, screening for or the signs and symptoms of the patient at the visit.