How can you stay current with the rapidly evolving medical billing codes related to COVID-19? While coding processes are continually evolving, here are a few recent changes you should be aware of to stay in-the-know:
Effective January 1, 2021, further additions to the ICD-10-CM Classification related to COVID-19 were implemented by the CDC. The additional codes are:
- Z11.52 Encounter for screening for COVID-19*
- *From the ICD-10-CM Official Guidelines for Coding and Reporting FY 2021: “During the COVID-19 pandemic, a screening code is generally not appropriate. Do not assign code Z11.52. For encounters for COVID-19 testing, including preoperative testing, code as exposure to COVID-19 (guideline I.C.1.g.1.e).
- Guideline I.C.1.g.1.e: Exposure to COVID-19 - For asymptomatic individuals with actual or suspected exposure to COVID-19, assign code 822. For symptomatic individuals with actual or suspected exposure to COVID-19 and the infection has been ruled out, or test results are inconclusive or unknown, assign code Z20.822.
- Coding guidance will be updated by the CDC as new information concerning any changes in the pandemic status becomes available.”
- Z20.822 Contact with and (suspected) exposure to COVID-19
- Z86.16 Personal history of COVID-10
- M35.81 Multisystem inflammatory syndrome
- M35.89 Other specified systemic involvement of connective tissue
- J12.82 Pneumonia due to coronavirus disease 2019
These codes are in addition to previously added code, U07.1 (COVID-19). Additional guidelines from the CDC include:
- Code only confirmed cases
- Code only a confirmed diagnosis of COVID-19 as documented by the provider, documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result.
- If the documentation states “suspected,” “possible,” “probable,” or “inconclusive,” do not assign code U07.1
- Sequencing of codes
- When COVID-19 meets the definition of principal diagnosis, code U07.1, COVID-19, should be sequenced first, followed by the appropriate codes for associated manifestations, except in the case of obstetrics patients.
For additional information go to the CDC website (link provided). ICD - ICD-10-CM - International Classification of Diseases, Tenth Revision, Clinical Modification (cdc.gov)
For the complete FY 2021 guidelines refer to this CDC link: ICD-10-CM FY 2021-COVID- updated Jan-Guidelines (cdc.gov)
The American Medical Association provided an update late December 2020 related to COVID-19 CPT® coding and guidance. Those updates can be found here: https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-coding-and-guidance.
There is additional CPT® coding guidance for Category I vaccine descriptors, vaccine resources (Appendix Q), https://www.ama-assn.org/system/files/2020-11/covid-19-immunizations-appendix-q-table.pdf; and the special edition of the CPT® Assistant guide https://www.ama-assn.org/system/files/2020-11/cpt-assistant-guide-covid-vaccine-coding-2020.pdf.
NHA is here to help our CBCS certificate holders stay informed and navigate the rapidly changing codes and coding guidelines related to COVID-19. For information on other issues pertaining to billing and coding, such as the 3 Essential Soft Skills for Billing and Coding Specialists, please subscribe to our blog.
Other great websites to help you stay updated:
American Medical Association (AMA): https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-vaccine-and-immunization-codes
Centers for Disease Control and Prevention (CDC): ICD - ICD-10-CM - International Classification of Diseases, Tenth Revision, Clinical Modification (cdc.gov)