At the Margins

How to bill for Covid-19 testing and treatment

by Rachel Matthews

Editor's note: This blog was updated on May 19, 2020.

In a race to support the hospitals testing and treating COVID-19 patients, CMS and the American Medical Association (AMA) have announced new billing codes for COVID-related services. We've compiled the codes below to help providers document and track care delivery in this important time.  

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How to bill for COVID-19 testing

In the past month, CMS and the AMA have created three new CPT and HCPCS codes for COVID-19-related testing. These codes are currently active for all U.S. hospitals, health systems, and laboratories.

 

HCPCS codes announced by CMS:

  • U0001 describes COVID-19 testing using the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel; and

  • U0002 describes validated non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).

Read more about these new HCPCS codes in the CMS fact sheet

CPT codes announced by the AMA:

  • 86328 describes, "Immunoassay for infectious agent antibody(ies), qualitative or semi quantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])"; 

  • 86769 describes, "Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])"; and 
     
  • 87635 describes, "Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique."

Read more about the new CPT code in the AMA fact sheet

How to bill for COVID-19 treatment

As of April 1, hospitals that are paid through Medicare’s Inpatient Prospective Payment System (IPPS) should utilize the new ICD-10 code, U07.1, for all confirmed COVID-19 diagnoses. This marks an unprecedented off-cycle code update in contrast to what was originally announced.

According to CDC guidance, as of April 1, for patients with confirmed COVID-19 status and …

  • Pneumonia confirmed as due to COVID-19: assign codes U07.1, COVID-19, and J12.89, other viral pneumonia.

  • Acute bronchitis confirmed as due to COVID-19: assign codes U07.1, and J20.8, acute bronchitis due to other specified organisms.

  • Bronchitis not otherwise specified (NOS) due to COVID-19: assign codes U07.1 and J40, bronchitis, not specified as acute or chronic.

  • COVID-1-associated lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, not otherwise specified (NOS): assign codes U07.1 and J22, unspecified acute lower respiratory infection.

  • COVID-19-associated respiratory infection, NOS: assign codes U07.1 and J98.8, other specified respiratory disorders

  • Acute respiratory distress syndrome (ARDS) confirmed as due to COVID-19: assign codes U07.1, and J80, acute respiratory distress syndrome.

Additional treatment codes:

  • For patients with possible COVID-19 exposure but no positive COVID-19 status, assign code Z03.818, encounter for observation for suspected exposure to other biological agents ruled out.

  • For patients with actual exposure to confirmed COVID-19 carrier but no positive COVID-19 status, report code Z20.828, contact with and (suspected) exposure to other viral communicable diseases.

  • For patients presenting COVID-19 symptoms but have not yet been tested, assign codes for each of the presenting symptoms such as: cough (R05); shortness of breath (R06.02) or fever unspecified (R50.9). For asymptomatic patients who test positive for COVID-19, assign code U07.1, COVID-19.

Why this matters

With each new case, hospital resources are stretched further. Initial analysis by the Peterson-KFF Health System Tracker estimates the cost of an inpatient COVID-19 admission could range from $9,700-$20,300, depending on patient acuity. The diagnosis and treatment of COVID-19 patients remains the clinical priority. However, understanding how to appropriately document, track, and manage reimbursement for these cases is vital in order for hospitals to remain open and financially solvent.

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