Impact of Covid for Healthcare Providers: HCC Medical Billing and Coding Operations

The situation in the US with COVID-19 has continued to escalate day by day. Healthcare providers are at the front line of this challenging situation that is impacting the healthcare system in unprecedented ways. In these times of uncertainty, healthcare providers have many moving pieces to worry about, today we will focus on the documentation aspects of the novel coronavirus.

Patient safety is without a doubt the priority, but it is also important that healthcare organizations keep up-to-date records and documentation in order to:

*  Continue receiving the appropriate funding and payments to avoid any operational disruptions.

*  Ensure that the new regulations put into place by the government about waiving costs for patients with COVID-19 are applied correctly.

*  Keep accurate records of COVID-19 for data tracking.

Billing and Coding for COVID-19

As challenging as it is, maintaining good procedures in the billing office during the COVID-19 outbreak is key to keeping hospitals and practices running and ready for patients. CMS has made different adjustments to make sure providers are rightfully equipped to handle the billing and coding for COVID-19 testing and treatment. There are a few new codes available for laboratories to bill for specific COVID-19 diagnostics.

According to Revcycle Intelligence, “the first billing code released this year (U0001) was for SARS-CoV-2 diagnostic tests performed specifically for CDC testing laboratories. The second billing code (U0002) released in the beginning of March will expand medical billing and coding for coronavirus lab tests, permitting laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV, otherwise known as the novel coronavirus or COVID-19”.

Additionally, CMS mentions “on March 13, 2020, the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel created CPT code 87635 (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)”.

Besides logging the newly created codes specific to COVID-19, it is also important to track and capture the appropriate codes to accompany evaluations of suspicious COVID-19 cases. The American Academy of Pediatrics provided in the beginning of March 2020, a list of codes related to respiratory conditions that may need to be included as companion codes for COVID-19 cases.

Pneumonia For a pneumonia case confirmed as due to the 2019 novel coronavirus (COVID-19), assign codes J12.89, Other viral pneumonia, and B97.29, Other coronavirus as the cause of diseases classified elsewhere.
Acute bronchitis For a patient with acute bronchitis confirmed as due to COVID-19, assign codes J20.8, Acute bronchitis due to other specified organisms, and B97.29. If the bronchitis is not specified as acute, due to COVID-19, report code J40, Bronchitis, not specified as acute or chronic, along with code B97.29.
Lower respiratory infection If the COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, report with code J22, Unspecified acute lower respiratory infection, with code B97.29. If the COVID-19 is documented as being associated with a respiratory infection, NOS, it would be appropriate to assign code J98.8, Other specified respiratory disorders, with code B97.29.
Acute respiratory distress syndrome (ARDS) ARDS may develop in conjunction with COVID-19. Cases with ARDS due to COVID-19 should be assigned the codes J80, Acute respiratory distress syndrome, and B97.29.
Exposure to COVD-19 For cases where there is possible exposure to COVID-19, but the disease is ruled out, report code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. For cases where there is an actual exposure to someone who is confirmed to have COVID-19, report code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. This code is not necessary if the exposed patient is confirmed to have COVID-19.
Signs and symptons For patients presenting with any signs/symptoms and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as: Cough (R05); Shortness of breath (R06.02) or Fever unspecified (R50.9).


*Information from this table was directly retrieved from

When it comes to billing, it is also important to consider some of the changes that apply to medicare coverage specific to COVID-19. As we know by now, our geriatric population is at greater risk to develop severe complications caused by the novel coronavirus. A big concern for the senior population regarding the coronavirus is Medicare coverage. Following President Trump’s declaration of a national emergency, a lot of changes have been applied to Medicare coverage for COVID-19.

An article by Forbes lists CMS specifics on what every Medicare and Medicare Advantage plan must cover during the coronavirus special regulations. The following specifications apply to coverage for COVID-19 under Original Medicare:

*  Part A will cover inpatient stays in a hospital and skilled nursing facility subject to the cost-sharing. Also, a beneficiary should not pay more for a single room if quarantined.

*  Medicare Part B will cover the test to diagnose Coronavirus with no copayment after February 4, 2020. Medicare will cover outpatient treatment usual to cost-sharing.

*  There are also changes related to telehealth services, as Medicare Part B now also covers services that are not face-to-face with a doctor, using an online patient portal.

The following applies specifically to Medicare Advantage:

*  Waive in full requirements for gatekeeper referrals, where applicable.

*  Cover services that are provided at out-of-network facilities.

*  Provide the same cost-sharing as if the service or benefit had been furnished at in-network facilities.

*  Make changes that benefit enrollees effective immediately, without the 30-day notification requirement.

As we enter this uncharted territory it is important to look out for the changes in rules and regulations. It is also important to be as prepared as possible with all the necessary tools when it comes to billing and documentation. Having technology such as HCC coding and risk adjustment tools in place now is what is going to help providers make sure they don’t miss out on capturing critical billing and diagnosis codes in either in-person or online visits.

If not already in place, this might be a good time for providers to consider adding HCC Coding technology. Although it is challenging to keep up with documentation in the midst of a pandemic crisis, the use of technology can help providers uncover gaps and document more proficiently.

Technology companies like Inferscience offer tools specific for clinicians providing services to Medicare Advantage patients: with the purpose of providing technology that can optimize the HCC documentation process and help increase RAF scores. Inferscience’s HCC Assistant and HCC Validator solutions make prospecting and code validation quick and easy.

At Inferscience, we’d like to extend our appreciation of healthcare providers all over the United States, if you’re a healthcare provider looking for HCC billing and coding technology tools you can visit our website at or contact us at 617 848 9502.

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