COVID-19 Coding Conundrums

COVID Coding Conundrums

By Kathy Mills Chang, MCS-P, CCPC, CCCA

During this uncertain time, Chiropractors have been called on to care for our communities in ways out of standard methods. This means that some practices may need to know diagnosis codes for the COVID-19 disease itself and for its testing and treatment. While we hope your practice is not on the front lines for testing and treating COVID-19, we do want to arm you with the appropriate codes, should you find yourself treating suspected or confirmed cases.

COVID-19 Diagnosis Coding

Although this virus was not in existence in our reality when the 2020 ICD-10 code set emerged in October last year, there are codes available that allow for you to document the diagnosis of COVID-19. The following options exist:

• For confirmed cases of COVID-19, use code B97.29-Other coronavirus as the cause of diseases classified elsewhere
• If the patient has 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.
• For a patient infected with coronavirus associated with SARS, use B97.21 SARS-associated coronavirus as the cause of diseases classified elsewhere. Don’t forget to add the code 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 American Association for Professional Coders (AAPC) reported that the CDC indicates that B34.2 Coronavirus infection, unspecified is inappropriate because the coronavirus is a respiratory illness and, therefore, the site is not unspecified.

The AAPC goes on to report that more recently, the World Health Organization (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.”

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.

CPT/HCPCS Testing and Procedural Coding

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.

Effective March 13, 2020, the CPT Editorial Panel approved a new Category I Pathology and Laboratory code for novel coronavirus testing.

• 87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19], amplified probe technique

This is an early release code, so you will need to manually upload this code descriptor into your electronic health record system.

• CPT® 87635 will be a child code under parent code 87471 Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, amplified probe technique in the 2021 CPT® code set.

A special edition CPT® Assistant is publicly available, which provides guidance for using this new code.  Visit the AMA website for more information about this new code.

About the Author:

Kathy Mills Chang is a Certified Medical Compliance Specialist (MCS-P), Certified Chiropractic Professional Coder (CCPC), and Certified Clinical Chiropractic Assistant (CCCA). Since 1983, she has been providing chiropractors with reimbursement and compliance training, advice, and tools to improve the financial performance of their practices. Kathy leads a team of 21 at KMC University and is known as one of our profession’s foremost experts on Medicare, documentation and CA development.

ChiroTouch provides this information with the understanding that authors or speakers are not experts in finance, regulatory policy or law. ChiroTouch shares this information to the best of our knowledge and experience. The information is subject to change as the COVID-19 crisis evolves.