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"Best Reimbursement Practices for COVID-19 Coding" Webinar Q&A Responses

Posted By Kara Carlisle

Medical coding has always been a fast-paced ever-changing environment. That statement has never been truer with what we have all seen and experienced over the last few months. Personally, we are all going though things (I am sure) we never thought we would experience. Professionally, we are learning and adapting to coding a new disease process that medically still has many unknowns. Is there a tried and true treatment for COVID-19? Why are some patient’s getting sicker than others? Are there long-term issues for the patient’s after the initial acute illness has passed? For this article, we will focus on what we do know, the coding.

ICD-10-CM Official Coding Guidelines - Supplement Coding encounters related to COVID-19 Coronavirus Outbreak Effective: February 20, 2020

  • Coding Confirmed Covid-19

U07.1- COVID-19

Use additional code to identify pneumonia (J12.89) or other manifestations (acute bronchitis (J20.8), bronchitis NOS (J40), lower respiratory infection (J22), respiratory infection NOS (J98.8), acute respiratory distress syndrome (J80).

Excludes 1:

B34.2 coronavirus infection, unspecified site

B97.2- coronavirus as the cause of diseases classified to other chapters

J12.81- pneumonia due to SARS (severe acute respiratory syndrome)-associated coronavirus

 

  • Possible Exposure, Negative Covid-19

The patient has been exposed to a person who is confirmed to have COVID-19 or is suspected to have COVID-19 and has not yet been ruled out AND the exposed patient either tests negative or the test results are unknown, patient is symptomatic

Z20.828 Contact with and (suspected) exposure to other viral communicable diseases. 

If the exposed person tests positive for COVID-19, then U07.1 is appropriate

 

  • Possible exposure to COVID-19, asymptomatic, negative test result

Z03.818   Encounter for observation for suspected exposure to other biological agents, ruled out

This code is intended to be a PDX/first listed only code.

  • Asymptomatic, screened for Covid-19, no exposure, test negative

         Z11.59   Screening for other viral diseases

                             This code is appropriate as a secondary diagnosis.

 

LIVE Webinar Audience Questions and Answers

ECLAT Health Solutions recently provided a free educational webinar entitled "Best Reimbursement Practices for COVID-19 Coding". The questions below address the LIVE audience questions we received during the webinar, to which we are providing answers. A few of the questions that are similar, have been grouped together in one answer.

 

LIVE AUDIENCE QUESTIONS:

  1. "If we are in a pandemic wouldn't Z20828 apply to anyone with a negative test?"
  2. "Did you say we can code Z20.828 when test was negative even when pt was not exposed or suspected exposure?"

faviconOUR RESPONSE:

To answer this, here is an excerpt from the document: AHA FAQ Regarding COVID-19, Revised 4.16.2020:

Question: What is the difference between code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out, and code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, in relation to COVID-19? Can you provide examples on how to apply the codes? (4/16/2020)

Answer:

According to guideline I.C.21.c.1 Contact/Exposure, Z20 codes may be used for patients who are in an area where a disease is epidemic. Therefore, due to the current COVID-19 pandemic, when a patient presents with signs/symptoms associated with COVID-19 and is tested for the virus because the provider suspects the patient may have COVID-19, code Z20.828 may be assigned without explicit documentation of exposure or suspected exposure to COVID-19. An example of the application of code Z20.828 is a patient with respiratory signs or symptoms, testing for COVID-19 is negative and the patient is determined to have another condition (e.g. flu, pneumonia). Codes should be assigned for the condition (e.g., flu, pneumonia) and code Z20.828 should be assigned as an additional diagnosis.

 

LIVE AUDIENCE QUESTION 2:

  1. "In case #1 did you use both U07.1 and Z20.828?  if so, why?"

faviconOUR RESPONSE:

To answer this, here is an excerpt from the document: AHA FAQ Regarding COVID-19, Revised 4.16.2020:

Question: What is the difference between code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out, and code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, in relation to COVID-19? Can you provide examples on how to apply the codes? (4/16/2020)

Answer:

"If the test results are positive, code U07.1 should be assigned instead of either code Z03.818 or Z20.828"

 

LIVE AUDIENCE QUESTION 3:

  1. "Can we code U071, if doctor overrides the negative COVID test and says the test was false negative, and he thinks they have COVID-19".

faviconOUR RESPONSE:

To answer this, here is an excerpt from the document: AHA FAQ Regarding COVID-19, Revised 4.16.2020:

Question: Please provide guidance on correct coding when the provider has confirmed the documented COVID-19 after the test results come back negative. How should this be coded? (4/16/2020)

Answer:

"If the provider still documents and confirms COVID-19 even though the test results are negative, or if the provider documented disagreement with the test results, assign code U07.1, COVID-19. As stated in the Official Guidelines for Coding and Reporting for COVID-19, “Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider . . . the provider’s documentation that the individual has COVID-19 is sufficient.”

 

LIVE AUDIENCE QUESTION 4:

  1. For Case 6, why was Z11.59 not coded? Thank you.

Below is the Case Study 6 as presented in the Webinar:

1-day-old term female delivered via c section.  Gestational age 38 weeks 6 days.  Infant born to COVID-19 positive Mom.  BW 3500 grams Education and counseling was given to Mother prior to deliver regarding precautions and isolation status on the baby to limit exposure to the virus.  Mom chose to room in with the baby. Strict hand hygiene, contact and droplet precautions explained as well as social distancing as possible. At 24 hours of life the baby was tested. COVID-19 negative.

Code Assignment

Z38.01    single newborn via c section

Z20.828 exposure to COVID-19 (impacts DRG)

DRG  794   Rel. Wt. 1.3838

faviconOUR RESPONSE:

We would code Z20.828 over Z11.59 as this infant was born to a COVID-19 positive mother, therefore was known to have exposure.

 

LIVE AUDIENCE QUESTION 5:

  1. I think there is a code for isolation. Should we code this?

faviconOUR RESPONSE:

If an inpatient is being held in quarantine for COVID-19, assign the PCS code for Isolation 8E0ZXY6.

To explain this answer further, here is an answer according to CMS:

Question: Will Medicare provide additional payment if a patient needs to be isolated or quarantined in a private room?

CMS Answer:

"If a Medicare beneficiary is a hospital inpatient for medically necessary care and needs to be isolated or quarantined in a private room, Medicare will pay the Diagnostic Related Group (DRG) rate and any outlier costs for the entire stay until the Medicare patient is discharged. The DRG rate (and outlier payments as applicable) includes payment for when a patient needs to be isolated or quarantined in a private room.

There also may be times when beneficiaries may need to be isolated or quarantined in a hospital private room to avoid infecting other individuals. These patients may not meet the need for acute inpatient care any longer but may remain in the hospital for public health reasons.

Hospitals having both private and semiprivate accommodations may not charge the patient a differential for a private room if the private room is medically necessary. Patients who would have been otherwise discharged from the hospital after an inpatient stay, but are instead remaining in the hospital under quarantine, would not have to pay an additional deductible for quarantine in a hospital."

 

* Additional Note: It should be a facility-specific guideline whether to code isolation as PCS.


 

LIVE AUDIENCE QUESTION 6:

  1. How will you code for Pneumonia in a patient tested positive for Covid-19? U07.1 and (J12.89 or J12.81)?

faviconOUR RESPONSE:

You would code U07.1 for the COVID-19 along with J12.89 is appropriate per COVID-19 guidelines. U07.1 does have an Excludes 1 for J12.81.

 

LIVE AUDIENCE QUESTIONS 7:

  1. Sepsis due to Pneumonia in a patient above? Isn't PDX Sepsis?
  2. Other sepsis A41.89?
  3. Sometimes patient has all the indicators for Sepsis, but documentation and diagnosis may suggest Covid-19.  With mechanical ventilation >24 hrs. Sepsis with vent. pays higher than COVID-19 with vent.  What should we do?

faviconOUR RESPONSE:

In a case in which a patient has both COVID-19 and sepsis, the pdx will be determined by the circumstances of admission.

Here is an excerpt from the document: AHA FAQ Regarding COVID-19, Revised 4.16.2020:

Question: Since the new guidelines for COVID regarding sepsis just say to refer to the sepsis guideline, is that then saying that sepsis would be sequenced first and then U07.1 for a patient presenting with sepsis due to COVID-19? (4/1/2020)
 
Answer: Whether or not sepsis or U07.1 is assigned as the principal diagnosis depends on the circumstances of admission and whether sepsis meets the definition of principal diagnosis. For example, if a patient is admitted with pneumonia due to COVID-19 which then progresses to viral sepsis (not present on admission), the principal diagnosis is U07.1, COVID-19, followed by the codes for the viral sepsis and viral pneumonia. On the other hand, if a patient is admitted with sepsis due to COVID-19 pneumonia and the sepsis meets the definition of principal diagnosis, then the code for viral sepsis (A41.89) should be assigned as principal diagnosis followed by codes U07.1 and J12.89, as secondary diagnoses.
 


References:

American Health Information Management Association (AHIMA) . (2020, March 31). Journal of AHIMA. CDC Publishes Final COVID-19 ICD-10-CM Guidelines. Retrieved from: https://journal.ahima.org/cdc-publishes-final-covid-19-icd-10-cm-guidelines/

American Health Information Management Association (AHIMA) . (2020, March 20). Journal of AHIMA. [Updated April 28] AHIMA and AHA FAQ: ICD-10-CM Coding for COVID-19. Retrieved from: https://journal.ahima.org/ahima-and-aha-faq-on-icd-10-cm-coding-for-covid-19/ 

American Hospital Association (AHA). (2020). ICD-10-CM Coding for COVID-19 (2020, April 1). Retrieved from: https://www.aha.org/system/files/media/file/2020/04/ICD10CMCodingforCOVID19FINALHandoutsandCE_1.pdf

American Medical Association (AMA) Website. (2020, April 10). COVID-19 coding and guidance. Retrieved from: https://www.ama-assn.org/practice-management/cpt/covid-19-coding-and-guidance

Centers For Disease Control and Prevention (CDC) . (2020). ICD-10-CM Official Coding and Reporting Guidelines April 1, 2020 through September 30, 2020. Retrieved from: https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf 

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