Coding and Billing for COVID-19

Knowing how to bill for COVID-19 has become a real challenge. This article will explore the latest coding advice as of April 20, 2020. As billers and coders, most of us are aware that the “correct” codes for COVID-19 have been very fluid since the beginning of the year. One week we are told to bill one way and the next the powers that be change the rules. It is my hope that with the information I have gathered, I can help others through this confusing time.

Laboratory Billing

As of April 1, 2020 (retroactive to February 4, 2020) the following HCPCS codes should be used to bill COVID-19 diagnostic tests:

U0001 – CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel
U0002 – Non-CDC tests, can be used by labs and healthcare facilities
U0003 – Infectious agent detection by nucleic acid (DNA/RNA) using high throughput technologies as described by CMS-2020-01-R
U0004 – any technique, non-CDC, using high throughput technologies as described by CMS-2020-01-R

CPT codes used for COVID-19 testing:

87635 – Infectious agent detection by nucleic acid (DNA/RNA) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique (effective 3/13/20)
83628 – Immunoassy for infectious agent antibody(ies), single-step method; severe acute respiratory syndrome coronavirus 2 (effective 4/10/20)
86769 – Antibody; severe acute respiratory syndrome coronavirus 2 (effective 4/10/20)

As of March 1, 2020, HCPCS codes billable to independent clinical diagnostic labs:

G2023 – Specimen collection for severe acute respiratory syndrome coronavirus 2, any specimen source; paid at $23.46
G2024 – Specimen collection for severe acute respiratory syndrome coronavirus 2, from an individual in a skilled nursing facility or by a lab on behalf of a home health agency, any specimen source; paid at $25.46

ICD-10 Diagnosis Codes for COVID-19

In an off-cycle update, which was a totally unprecedented exception to the code set updating process, the WHO released the code U07.1 on April 1, 2020 for COVID-19, virus identified. Patients presenting with symptoms without a definite diagnosis, such symptoms should be coded:

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

Another code, Z20.828, was identified for Contact with and/or [suspected] exposure to other viral communicable diseases, which is to be used with a patient who has signs and symptoms on presentation. Z03.818 Encounter for observation for suspected exposure to other biological agents ruled out would be used if the patient is ruled out for COVID-19. For asymptomatic patients that have no known exposure and the test results are either unknown or negative, Z11.59 would be assigned for Encounter for screening for other viral diseases. Asymptomatic individuals who test positive for COVID-19 use U07.1 as COVID-19, virus identified.

Coding Pneumonia and COVID-19

For date of service (DOS) prior to April 1, 2020 a confirmed pneumonia due to 2019 novel coronavirus you would assign:

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

For DOS on or after April 1, 2020 a confirmed pneumonia due to 2019 novel coronavirus you would assign:

U07.1 – COVID-19, virus identified
J12.89 – Other viral pneumonia

Coding Bronchitis and COVID-19

For DOS prior to April 1, 2020 a confirmed acute bronchitis due to 2019 novel coronavirus you would assign:

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

For DOS prior to April 1, 2020 a not otherwise specified (NOS) bronchitis due to 2019 novel coronavirus you would assign:

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

For DOS on or after April 1, 2020 a confirmed acute bronchitis due to 2019 novel coronavirus you would assign:

U07.1 – COVID-19, virus identified
J20.8 – Acute bronchitis due to other specified organisms

For DOS on or after April 1, 2020 a confirmed NOS bronchitis due to 2019 novel coronavirus you would assign:

U07.1 – COVID-19, virus identified
J40 – Bronchitis, not specified as acute or chronic

Coding Respiratory Infection and COVID-19

For DOS prior to April 1, 2020 if COVID-19 is documented in association with a respiratory infection NOS, you would assign:

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

For DOS prior to April 1, 2020 if COVID-19 is documented in association with a lower respiratory infection NOS or an acute respiratory infection NOS, you would assign:

J22 – Unspecified acute lower respiratory infection
B97.29 – Other coronavirus as the cause of diseases classified elsewhere

For DOS on or after April 1, 2020 if COVID-19 is documented in association with a respiratory infection NOS, you would assign:

U07.1 – COVID-19, virus identified
J98.8 – Other specified respiratory disorders

For DOS on or after April 1, 2020 if COVID-19 is documented in association with a lower respiratory infection NOS or an acute respiratory infection NOS, you would assign:

U07.1 – COVID-19, virus identified
J22 – Unspecified acute lower respiratory infection

Coding Acute Respiratory Distress Syndrome (ARDS) and COVID-19

For DOS prior to April 1, 2020 ARDS due to COVID-19 assigned codes would be:

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

For DOS on or after April 1, 2020 ARDS due to COVID-19 assigned codes would be:

U07.1 – COVID-19, virus identified
J80 – Acute respiratory distress syndrome

Bottom-line on Code Usage

Only confirmed positive or presumed positive cases of COVID-19 should be coded U07.1. It should be used if COVID-19 meets the definition of principal diagnosis, should be sequenced first and followed by appropriate codes for signs and symptoms. The only exception is for obstetrics, in which case you would use O98.5. To document suspected, possible, probable or inconclusive cases you would code the signs and symptoms and Z20.828.

If you have further questions, please do not hesitate to reach out for assistance. I have some great resources available to me.

ALPHA II (2020). COVID-19 Critical Coding and Regulatory Updates [Powerpoint]. Retrieved from https://mcusercontent.com/93c09efb2e5cc9a2b8d1cafbf/files/51a35e49-9bda-4c62-9f5f-996ee69a5fdf/COVID_19_Critical_Coding_and_Regulatory_Updates.02.pdf