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How Laboratories Can Prepare for Coronavirus Coding and Billing Issues

  • Vice President, Growth and Strategy , Infinx

Enjoy the following content from our partner, Infinx.

However you feel about the current response to COVID-19, 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 the community needs 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, shown below:

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

  • J12.89, Other viral pneumonia
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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

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 coding and billing services and how we may assist your organization during this global epidemic.

XIFIN is maintaining a COVID-19 resource repository to help diagnostic service providers navigate testing, reporting, and payor billing and reimbursement requirements, as well as learning more about CARES Act loan programs and their impact.
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