Corona Virus (COVID-19) Coding Guidelines

COVID-19 Medical Coding Guidelines

Centers for Disease Control and Prevention (CDC) has published interim guidance on coding to help the providers prepare for and respond to the community spread of novel coronavirus disease-2019 (COVID-19).

Diagnosis Description ICD 10 Codes
Pneumonia due to COVID-19 J12.89, B97.29
Acute Bronchitis due to COVID-19 J20.8, B97.29
Bronchitis not otherwise specified(NOS) due to Covid -19 J40, B97.29
Lower respiratory infection(NOS) or Acute respiratory infection(NOS) J22, B97.29
Respiratory infection not otherwise specified(NOS) J98.8, B97.29
Acute respiratory distress syndrome (ARDS) J80, B97.29
Suspected COVID-19, not confirmed or not ruled out Code Signs and Symptoms
Contact with and (suspected) exposure to COVID-19 Z20.828
Suspected exposure to COVID-19 that is ruled out after evaluation Z03.818
COVID-19, Identified and Confirmed (Effective from Apr 1, 2020) Code Signs and Symptoms
COVID-19 Identified and Confirmed from Lab Testing U07.1

Note : CDC has approved the code U07.1 (2019-nCoV acute respiratory disease) and added to the international ICD-10 code effective from April 01, 2020.

We recommend you refer to https://www.cdc.gov/nchs/data/icd/ICD-10-CM-April-1-2020-addenda.pdf for more details.

Coding References : https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf

US Health Insurance companies will waive copays for testing and cover the cost of treatment for the novel coronavirus. Medicare and Medicaid will also cover costs without copays.

Reference : https://www.theverge.com/2020/3/10/21173970/insurance-coronavirus-treatment-testing-coverage-cigna-aetna-humana-pence

Get your Telehealth consults reimbursed by following the Billing guidelines:

According to the CMS latest update GT Modifier is no longer valid for Telehealth services. Telehealth services can be billed with 95 Modifier with usual place of service. For example any Office visit rendered via Telehealth can be billed with 95 Modifier and place of service 11. This new update is effective from March 01, 2020.

Guidelines updated after the CMS update of Regulatory Changes to help US Health Care system Address COVID-19 Patient Surge:

  • CMS will now allow for more than 80 additional services to be furnished via telehealth. Refer to the list of services here at https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf
  • During the public health emergencies, individuals can use interactive apps with audio and video capabilities to visit with their clinician for an even broader range of services. Providers also can evaluate beneficiaries who have audio phones only.
  • Providers can bill for telehealth visits at the same rate as in-person visits.

For more information refer the following links