Tag: Coding
ICD-10-CM Official Coding Guidelines – Coding Encounters Related to CoVID-19 Coronavirus Outbreak, Effective 2/20/2020
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CPT, HCPCS, IDC-10 and other codes you should be aware of related to COVID-19?
Aetna is complying with the CMS coding guidelines for COVID-19 lab testing.
From MGMA online community
Sharing for those that may not have seen this on Aetna’s website
What Common Procedural Technology (CPT) codes should be used for COVID-19 testing?
Aetna is complying with the CMS coding guidelines for COVID-19 lab testing. CMS adopted two CPT codes, (U0001) and (U0002), for COVID-19 testing.
- U0001 – 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel should be used when specimens are sent to the CDC and CDC-approved local/state health department laboratories.
- U0002 – 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC should be used when specimens are sent to commercial laboratories, e.g. Quest or LabCorp, and not to the CDC or CDC-approved local/state health department laboratories.
For more information and future updates, visit the CMS website and its recently issued FAQs. CMS has not set pricing for COVID-19 testing, but they are expected to soon.
What CPT, HCPCS, IDC-10 and other codes should I be aware of related to COVID-19?
Reporting codes related to COVID-19 include:
ICD-10 Reporting Codes
- An emergency ICD-10 code has been created by WHO.
- Code U07.1, 2019-nCoV acute respiratory disease, will be implemented into ICD-10-CM with the update effective October 1, 2020. Until then, providers must use available ICD-10 codes and guidance.
Exposure to COVID-19
- Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out). Used for cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation.
- Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases). Used for cases where there is an actual exposure to someone who is confirmed to have COVID-19.
Signs and Symptoms
- For patients presenting with any signs/symptoms (such as fever, etc.) and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as:
-
- R05 (Cough)
- R06.02 (Shortness of breath)
- R50.9 (Fever, unspecified)
SARS-CoV-2/2019 Lab Testing
CMS develops the First HCPCS Code for testing for Coronavirus
From MGMA GovChat 3/6/2020, Drew Voytal
Last month, CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers. CMS expects that having specific codes for these tests will encourage testing and improve tracking.
The Medicare claims processing systems will be able to accept these codes starting on April 1, 2020, for dates of service on or after February 4, 2020. Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates. Laboratories may seek guidance from their MAC on payment for these tests prior to billing for them. As with other laboratory tests, there is generally no beneficiary cost sharing under Original Medicare.
Update 3/10/2020: To follow up to the previous post, I am sharing new CMS FAQs for Medicare providers regarding Medicare payment for lab tests, drugs/vaccines, and physician and hospital services. As new Medicare COVID-19 resources become available I will be sure to post them here, and as always please feel free to reach out with any questions.
Thank you,
Drew
Inportant Information from Aetna OfficeLink Updates 3/1/2020
Changes and Updates include:
- Aetna’s National Pre-certification List, effective 7/1/2020
- Updates to Aetna’s Commercial Drug List, effective 7/1/2020
- Availity the will be Aetna’s sole Provider Portal, effective 4/30/2020
- Individual Service Codes and Service Grouping Updates, effective 6/1/2020
- Updates for In-Office Surgical Pathology Codes, effective 6/1/2020
- Updates to Drug test Thresholds, Billable Service, Notification for Acute Rehabilitation and Skilled Nursing Facilities and New Claim Edits, etc.
Aetna OfficeLink Updates, Published 03/01/2020
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Acronym Guide for Coding by Just Coding
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New File Folder added to POET INK
Billing/Coding
We have added a new Sub-Folder under the Parent Folder called “The Business End“.
The new Sub-Folder is called “Billing/Coding”
There Sir Seymore will add articles to help with your Billing and Coding needs.
Such as the file added today that will help make sense of some Coding Acronyms.
Example: “MUE”, “Medically Unlikely Edit”
The article doesn’t just tell you what “MUE” stands for, it also explains what a “MUE” is, how it effects your coding and where to find the quarterly updates.
This article even explains what to do if you HIT AN EDIT.
Click here to view that article.
Acronym Guide by Just Coding 01/16/2019
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