March 26, 2020
News > COVID-2019: Coding Challenges and Practice Pitfalls

COVID-2019: Coding Challenges and Practice Pitfalls

March 26, 2020


Discovered in December 2019 in Wuhan (Central China), a new сoronavirus infection named COVID-19 has rapidly spread to the rest of the world and become the first global pandemic of the 21st century. On January 30, 2020, the World Health Organization (WHO) declared the 2019 Novel сoronavirus (2019-nCoV) disease outbreak a public health emergency of international concern. The official name of the disease was announced on February 11, 2020.

As we write this article, there are about 500,000 confirmed cases; over 65,000 have occurred in the USA. Fatality rate has already exceeded 7% in Italy, and the situation is provoking worldwide panic and affecting businesses, the consumer goods market, and the healthcare industry.

This time we will try to look at the situation from the medical business point of view and discuss the coding and billing aspects of COVID-19. What are the ICD codes for the coronavirus, are they billable, and how can you improve your coding and billing processes in the current situation?

According to the 10th revision of the International Classification of Diseases (ICD-10), there are two emergency codes for COVID-19: U07.1, which is assigned to a disease diagnosis of COVID-19 confirmed by laboratory testing, and U07.2, assigned to a clinical or epidemiological diagnosis of COVID-19 where laboratory confirmation is inconclusive or not available.

However, in the USA, there are currently no specific ICD-10 codes to use when billing for services related to COVID-19. The U07.1 code will be added to the U.S. ICD-10-CM list effective April 1. Starting on that day, U07.1 should be used to report a patient who has tested positive for COVID-19.

Until then, the CDC is giving the following guidance:

For a diagnosis of COVID-19, report the code for the patient condition that is related to the COVID-19 (e.g., J12.89, “Other viral pneumonia”) and B97.29, “Other coronavirus as the cause of diseases classified elsewhere.”

To make a long story short, U07.1 is considered for confirmed cases only, and is not available to bill until April 2020, while B97.29 is the diagnosis code providers should use for confirmed cases through March 31, 2020. However, healthcare providers who work with Medicaid should refer to the Medicaid billing guidance for COVID-19 Evaluation and Testing.

Please note that if the provider documents “suspected”, “possible” or “probable” COVID-19, you should not assign the B97.29 code.

As for ICD-11, which will come into effect on January 1, 2022, the confirmed diagnosis is coded as RA01.0 and the suspected or probable diagnosis as RA01.2.

The Centers for Medicare & Medicaid Services (CMS) introduced the first HCPCS code, U0001, to bill for tests and track new cases of the virus. Another HCPCS code, U0002, allows laboratories to bill for non-CDC laboratory tests for the coronavirus. CMS experts believe that specific codes will encourage testing and improve tracking. Medicare will be able to accept these codes on April 1 for dates of service starting from February 4.

COVID-19 puts forth organizational and institutional problems and dramatically affects the healthcare industry. Under the current conditions, coding, billing, and medical practice itself become more challenging than ever, but you can get some support from healthcare software. Here is a couple of ideas:

  • Advanced EMR or billing solutions help you populate codes correctly. You can start entering the code or simply a keyword, and the system will give you a hint by displaying a dropdown menu.

You can also automate your claim generation process, which is quite possible with modern medical billing platforms. This can help you overcome the personnel shortage and considerably speed up your revenue cycle management.

  • Telemedicine, including televisits and phone consultations can help you practice social distancing and avoid unnecessary personal contacts.

IT solutions designed for medical businesses can help you focus on the health of your patients, which should be the only challenge nowadays, whatever the situation turns out to be.

It is on you to take care of them, so take care of yourselves, too.