How Laboratories Can Prepare for Coronavirus Coding and Billing Issues

However you feel about the current response, few people ever really expected to be here. We hold emergency preparedness drills and assign “essential personnel” status, but the scope of what we face seems too inconceivable. So now, we must balance providing the care and testing needed by the community with collecting the revenue required to remain viable going forward.

Preparing for COVID-19 Coding and Billing Issues

Right now, healthcare providers are scrambling to brave the potential onslaught of patients. We’re taking inventory of personal protection equipment (PPE), implementing Universal Precautions in greater breadth, and trying to stay up to date with CDC alerts and updates. Without a doubt, just preparing for the growing number of positive cases while keeping current patients and staff members safe can be overwhelming.

In the turmoil that everyone in healthcare, including laboratories, is experiencing, it will be critical to keep track not only of patients being tested, results, and diagnoses, but also patient demographics and billing information. No one is sure how emergency funding will impact the costs of testing, but we need to keep accurate records as plans come to light.

There has been discussion in Washington and at state levels about who is going to pay for the massive testing costs and patient care that now seems inevitable. Insurance payers are said to have met with the administration to discuss reimbursement at a macro level, but details are still very scarce. Private insurances (with self-insured plans and narrow networks) promise to complicate things exponentially, and individual insurers are currently defining their strategies using a silo approach without a coordinated solution.

Coding and Billing for COVID-19 Testing

Capturing current patient demographic information and billing using valid codes will help in data tracking and revenue payment. The Association for Clinical Documentation Integrity Specialists (ACDIS) just released the CDCs ICD-10-CM coding guidelines, which include:

For confirmed cases of pneumonia due to COVID-19, use codes:

  • J12.89, Other viral pneumonia, and
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

For confirmed cases of acute bronchitis due to COVID-19, use codes:

  • J20.8, Acute bronchitis due to other specified organisms, and
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

For bronchitis not otherwise specified (NOS) due to COVID-19, use codes:

  • J40, Bronchitis, not specified as acute or chronic, along with code
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

For lower respiratory infections, NOS, or an acute respiratory infection, NOS, with associated documented COVID-19, assign codes:

  • J22, Unspecified acute lower respiratory infection, with code
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

For respiratory infections, NOS, with associated documented COVID-19, use codes:

  • J98.8, Other specified respiratory disorders, with
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

For confirmed acute respiratory distress syndrome (ARDS) due to COVID-19, assign codes:

  • J80, Acute respiratory distress syndrome, and
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

To code a concern about COVID-19 exposure that was ruled out after evaluation, use code:

  • Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out

To code actual COVID-19 exposure with a confirmed coronavirus case, assign code:

  • Z20.828, Contact with and (suspected) exposure to other viral communicable diseases

For patients presenting with symptoms where a definitive coronavirus diagnosis is not established, assign the appropriate codes for each presenting symptom, such as:

  • R05, Cough
  • R06.02, Shortness of breath
  • R50.9, Fever, unspecified

In addition, there are the following CPT codes that were additionally expanded to specify reporting of antibody testing with increased specificity and were effective April 10, 2020.

Special Update: On Friday, June 26, 2020, the AMA added a new code to specify billing of antigen tests performed on patients suspected of being infected with coronavirus. The AMA has already developed and approved CPT codes for other serological tests for COVID-19 antibodies, including 86328 and 86769 (below).

CPT/HCPCS Code and Description

  • 87635
    Infectious agent detection by nucleic acid (DNA or RNA), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
  • 86328
    Immunoassay for infectious agent antibody(ies), qualitative or semi-qualitative, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), single step method
  • 86769
    Immunoassay for infectious agent antibody(ies), qualitative or semi-qualitative, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), multiple step method
  • 87426
    Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])
  • U0001
    2019 Novel Coronavirus real time RT-PCR diagnostic test panel at a CDC lab
  • U0002
    2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types of subtypes at a non-CDC lab
  • U0003
    Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R.
  • U0004
    2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.
  • C9803
    Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source, is effective for services provided on or after March 1, 2020
  • G2023
    Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Cororavirus disease [COVID-19]), any specimen source.
  • G2024
    Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Cororavirus disease [COVID-19]), from an individual in an SNF or a laboratory on behalf of an HHA, any specimen source.
  • P9603
    Travel allowance, one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing homebound patient; prorated miles actually traveled.
  • P9604
    Travel allowance, one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing homebound patient; prorated trip charge.

Unfortunately, there is a real possibility that patients will bear the ultimate cost for care with very little real relief from payers, putting laboratories and other care providers in a difficult situation when patients receive surprise billings that they didn’t expect. Having precise, accurately coded bills with corresponding documentation is the best way to situate your organization once the storm blows over. It will be at that point that decisions can be made on collectability as we see what our new normal looks like for the future.

We invite you to contact us to discuss our laboratory coding and billing services to see how we can assist your organization during this global pandemic.

About the Author

Infinx
Infinx Healthcare provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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