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Coronavirus Billing and Coding Guidelines from CMS

April 9, 2020

Telemedicine billing-793408-editedAs of April 5th, more than 1.3 million cases of coronavirus have been diagnosed across the world, and more than 61,000 people have died of complications due to the virus since the beginning of this outbreak. The COVID-19 infection may cause a range of illnesses. In some patients, it presents with few or even no symptoms, while others get extremely sick. Some of the common symptoms include cough, shortness of breath, and fever. 

As the entire medical field moves to get a handle on the ever-increasing numbers of coronavirus cases, CMS has been providing guidance on how to code the virus and the surrounding health issues that come with it. Of course, the medical and billing and coding landscape surrounding the pandemic is changing daily, so we’ve put together some of the latest information available from CMS to help your practice continue to code the virus and related issues correctly.  

HCPCS Codes for Laboratory Testing for COVID-19 

Healthcare Common Procedure Coding System (HCPCS) codes have been created to bill the laboratory testing for COVID-19. With the urgent need to bill for testing services, CMS created two different codes for coronavirus laboratory testing: U0001 – for the CDC 2019 nCoV Real-Time RT-PCR Diagnosis Panel; U0002, the 2019 nCoV Coronavirus, SARS-Cov-2/2019 CoV, including any techniques, all subtypes and types, non-CDC. The codes went into effect in February but just became available within the Medicare claims processing system on the first of April. 

Other CPT codes are also available for the billing of laboratory testing for COVID-19. CPT code 87635 has been created by the AMA Current Procedural Terminology Editorial Panel, which is for infection agent detect by nucleic acid (RNA or DNA) or the acute severe respiratory system SARS-CoV2, amplified probe technique. This code was available to be filed as of April 1st and can be done for dates of service of March 13, 2002 or after. 

CPS also notes that if new kinds of COVID-19 tests come out in the future, you’ll need to use HCPCS Code U0002 for those methods not specified by codes 87635 or U0001. Additional coding adjustments may come in the future as different types of testing methods for COVID-19 become available. 

Codes for COVID-19 Related Services 

Other than the new code 87635, there are some other specific codes available for COVID-19 related services. Some of these codes include: 

  • U07.1 – This code is for a patient that has been diagnosed with COVID-19 and went into effect on the first of April 2020. 
  • 99091 – Used for conveyance or handling of specimens for transfer from a patient in other than the office to the laboratory (you can indicate distance involved) 
  • Z20.828 – Patient has been exposed to COVID-19
  • Z03.818 – This is the correct ICD-10 code for a patient that was possibly exposed to COVID-19 

For pneumonia, CPS notes that if it’s confirmed as due to COVID-19, you should assign both B97.29 (other coronavirus as the cause of a disease classified elsewhere) and J12.89 (other viral pneumonia).

If a patient has acute bronchitis and it’s confirmed as a result of COVID-19, you’d assign B97.29 as well as J20.8 (acute bronchitis due to other organisms specified). Bronchitis that’s not otherwise specified and due to COVID-19 needs to be coded with J40 (bronchitis not specified as chronic or acute), with the additional code of B97.29. 

Important Note: Using the B34.2 diagnosis code (coronavirus infection, unspecified) is usually not appropriate when coding for COVID-19. This is because these cases have been respiratory in their nature, so the site of infection is not considered unspecified. 

Additional Codes as You Care for Patients Remotely 

A variety of other CPT and Medicare codes for additional services may come in handy as you’re working to care for patients remotely during the coronavirus pandemic. 

  • G2012 – For the brief communication via tech-based service, such as a virtual check-in by a health care professional or physician who can report E/M services, provided to patients that are established, and not originating from a E/M service that was provided within the last seven days nor leading to a procedure or E/M service that’s to be in the next 24 hours or the appointment soonest available. For 5-10 minutes of discussion. 
  • 99421 – online digital E/M service for established patients up to seven days with the cumulative time during that seven days being 5-10 minutes. 
  • G2010 – The remote evaluation of images and/or recorded video that’s been submitted by an established patient, including the interpretation along with follow-up with a patient within 24 business hours. 
  • 99452 –  Interprofessional electronic, internet, telephone health record referral service that’s provided by a requesting/treating physician (30 minutes)
  • 99422 – Online digital E/M service for establish patients for up to seven days for a total of 11-20 minutes of discussion. 
  • G2061 – Qualified healthcare professional (nonphysician) online assessment service for established patients. Up to seven days with a cumulative time of 5-10 minutes. 
  • 99458 – The remote physiologic monitoring treatment management services, physician/qualified healthcare professional/clinical staff time during one calendar month requiring interactive communication with the caregiver/patient during that month, every additional 20 minutes (listed in addition to the code used for the primary procedure).

It’s important to note that some payers and states are offering reimbursement for telehealth (with some including the use of audio-only phone calls) at the same rates paid for in-person visits. However, while we’re offering the latest in codes and policy changes, it’s essential to keep up with the ever-changing billing and coding landscape as well as policy announcements from your payers and state. 

Keeping up with all the changes happening in billing and coding right now is difficult, particularly for practices across the country trying to do their best to help their patients through this pandemic. That’s where M-Scribe Medical Billing can help. We’re constantly staying on top of the latest changes, and we work to make sure our experienced coders are up-to-date with current billing and coding practices as they continue to change. We’ll be there to help you get through the COVID-19 outbreak. To learn more about how we can help you, contact us at today.

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