Wiki COVID testing for asymptomatic Medicare patients


Fairbanks, Alaska
Best answers
My practice is getting denials from Medicare for patients who are coming in to get tested to abide by travel mandates in our state, wanting to ensure they don't have the virus before visiting a local family member or just want to be tested for peace of mind.
The argument is that the above listed reasons are not enough to support the test being medically necessary (we are billing them out as Z11.59 since these patients are asymptomatic). I reviewed this with the provider who leads the department at our practice that does the most testing and his view on it (paraphrased of course) is that since we live in a state/city where community spread has been identified everyone is considered exposed; due to this the preference would be to document in each person's chart that due to current community spread/PHE status within our state testing is medically necessary.
I see both sides of this, it seems the base of the reasons are more social obligation than health-related, but this is not the only provider within our practice (or community) that has taken this stance. Is it appropriate to give a "go-ahead" to document that community-spread=everyone exposed and bill with coding to show that they're exposed?
Previously we were billing Z11.59 and this is what was causing denials, we would likely be switching to Z03.818 for asymptomatic exposure.
I would also GREATLY appreciate any links/articles on why this isn't ok if so, the more information I can get my hands on before giving a final answer the better.
Thank you
I believe that Z03.818 is the correct ICD-10 code to use for the scenario outlined above. This would only be for asymptomatic patients that test negative. Here is a link to a Coding Clinic Advisor article discussing coding for COVID-19. Question 16 seems pertinent to your scenario. Asked Questions Regarding COVID-19_v8.pdf
Here is another link to a great article I found on the ICD-10 Monitor site:

Hope this helps!
This is interesting, the examples at the bottom of that last article are especially useful.
I'm curious as to if insurance will accept "exposure" when it's not direct or the exact source isn't known but this article supports that same mindset. Our Medicare specialist is putting in a call on this today to be double-sure, if she is told anything else beyond what's listed here I'll update
And remember, when you perform an EM that is related to ordering a COVID-19 test or performing a COVID-19 test, put a CS modifier on the EM claim to medicare part B so that they will pay 100% because the cost share is waived and medicare part B pays for the entire EM.
Update: our local MAC has confirmed that Z11.59 is a non-covered/not medically necessary diagnosis. They also notified us CS will not help with this, they only consider CS on claims with "valid" diagnoses.
We do not bill our own labs, our sister hospital that bills them for us doesn't have the flood of denials that we have yet so I can't speak to labs, only E/M services.