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Medical Coding & Billing Tips for COVID-19

Medical Coding & Billing Tips for COVID-19


With the number of COVID-19 (2019-Novel Coronavirus) cases expected to rise in North America, the Centers for Medicare & Medicaid Services (CMS) has provided information on how to medically code and bill all encounters related to COVID-19 for Medicare beneficiaries (CMS, 2020).

Here are the latest coding and billing updates:

  • The Healthcare Common Procedure Coding System (HCPCS) code U0001 will cover the tests and track emerging cases (CMS, 2020). Providers can start using this code on April 1 for services dated February 4 and later.COVID19
  • The second HCPCS code U0002 includes non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVID-19) (CMS, 2020). Providers can start using this code on April 1 for services dated February 4 and later.
  • The payment amount for U0001 and U0002 claims will be determined by Medicare Administrative Contractors (MAC) for their local jurisdictions until a national rate is established by Medicare (CMS, 2020). Providers can consult their local MAC for payment estimates before submitting a billing claim.
  • If a Medicare beneficiary is placed in quarantine as a medical necessity – but does not require acute inpatient care – Medicare will cover any cost outliers and the provider’s diagnosis-related group rate while the patient remains in the quarantine (The National Law Review, 2020).
  • Providers with private and semiprivate rooms are not permitted to charge a differential for a private room that is deemed a medical necessity (CMS, 2020).
  • There will be no additional deductible if a patient elects to remain in the hospital under quarantine, even if he or she would have otherwise been discharged (CMS, 2020).
  • The American Medical Association (AMA) has released a new CPT code to streamline COVID-19 tests from providers (AMA, 2020). CPT code 87635 has short, medium, and long descriptors that can be found on the AMA website. COVID-19
  • Additional coding guidelines for COVID-19 have been established by the CDC (2020). The effective date of ICD-10-CM code U07.1 for COVID-19-related diagnoses is being fast-tracked to April 1. CDC UPDATE 3/18/2020:New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19), April 1, 2020.” For a more in-depth review of the new ICD-10 code for COVID-19, as well as historical background on the virus, read our latest article, “Coding for Coronavirus Outbreak: Interim Guidance from the CDC.”

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