The new pandemic has had a shocking effect on an entire world. With many businesses ceasing their operations in times of a universal turmoil, healthcare providers have been those suffering the most. Not only do you risk your lives when treating COVID-19-positive patients, but some of you may have also lost yourselves in a plethora of new billing & reimbursement guidelines. Many new procedure & diagnosis codes related to COVID-19 have been introduced by the CMS since early 2020. It is no time to lose your revenue! Let us guide you through all possible ways of how you can report certain health conditions caused by this novel virus.
Physicians may use the ICD-10 code U07.1 to report a COVID-19 infection itself, which stands for nothing else but a confirmed COVID-19. At the same time, J12.82 can be used to indicate a pneumonia directly caused by COVID-19.
When it comes about post-COVID-19 conditions and potential exposures, in 2021 the CMS has introduced a sophisticated batch of new ICD-10 codes that can be used for those purposes in Fiscal Year 2022. Below are the most common conditions that you can indicate on your claims:
1) M35.81 - Multisystem inflammatory syndrome
2) M35.89 - Other specified system involvement of connective tissue
3) Z11.52 - Encounter for screening for COVID-19
4) Z20.822 - Contact with and (suspected) exposure to COVID-19
7) Z86.16 - Personal history of COVID-19
8) U09.9 - Post COVID-19 condition, unspecified
An encounter related to COVID-19 may be reported as an ordinary office visit (codes 99205-99205; 99215 – 99215), while the following HCPCS and CPT procedure codes should be used to report an initial diagnostic test, in accordance with a complexity of service:
1) U0001 - Real-Time RT-PCR Diagnostic Panel
2) U0002 - Any technique, multiple types or subtypes (includes all targets), non-CDC
3) U0003 - Infectious agent detection by nucleic acid (DNA or RNA)
As for the antibody blood tests, below is the most common CPT code that can be used:
• 86769 - Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
During the Public Health Emergency, most insurance payers waive any patient’s responsibility for COVID-19 tests, meaning that healthcare providers shall not collect any copays, deductibles or coinsurances for such visits.
Proper reporting is key to a flawless reimbursement. We would like to remind you that the information indicated on your claims and in patients’ charts should indicate the most precise and factual information on the services and conditions.
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