Blog, Revenue Integrity, The Hospital Finance Podcast®

Payment and coding guidance for COVID-19 [PODCAST]

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The Hospital Finance Podcast

In this episode, we are joined by Kathy Pride, EVP Coding & Documentation Services at Panacea Healthcare, to review payment and coding updates being implemented during this public health emergency.       

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Highlights of this episode include:

  • General ICD-10-CM Coding Guidance
  • 2019-Novel Coronavirus (COVID-19) Laboratory Test & Payment
  • COVID-19 Emergency-Related Billing Policies and Procedures

To read the full blog article containing specific coding guidelines and the latest updates, go to Panacea Insights.

Mike Passanante: Hi, this is Mike Passanante. And welcome back to the award-winning Hospital Finance Podcast®. With the advent of the COVID-19 pandemic, we’re doing more to try to bring you the latest information regarding hospital reimbursement and coding issues. Today we’re going to be talking about the CMS and AMA payment and coding guidance for COVID-19. And to walk us through that, I’m joined by Kathy Pride who is the executive vice president of coding and documentation services at Panacea Healthcare. Kathy, welcome to the show.

Kathy Pride: Thank you Michael and thank you for having me.

Mike: So Kathy why don’t we start out by talking about some of the general ICD-10 coding guidelines as we know it today, which is March the 19th.

Kathy: Okay. So the CDC has issued instructions in conjunction with the current ICD-10-CM classification and the official guidelines and basically the COVID-19 virus– right now they’re asking us to use the code B97.29 which is other coronavirus, as the cause of disease is classified elsewhere. Along with any comorbidities, those coding guidelines haven’t changed so you use the comorbidities. However, today just hot off the press the World Health Organization has issued what they’re calling an emergency temporary code to use for The COVID-19 virus. Now that code doesn’t take effect until April 1st, so it’s just a little less than two weeks away. So as of today, you want to still continue using that B97.29, but starting April 1st you’re going to use a new code. And the code– it’s a little unusual because we’re using an alphabetical character that we don’t normally see, and that code is U07.1. So that will be the code starting April 1st. Now as I said this was a temporary– what they call emergency code. There will be a COVID-19 permanent code specific to that particular coronavirus, but that won’t be issued until the updates October 1st, 2020. So for now as of today, we’re going to use B97.29. April 1st we’re going to U07.1, and October 1st we’ll have a whole other code. Which that will be– we’ll hear more about that probably in the next couple of months what that new code will be.

Mike: And it looks like there were some updates to the laboratory test and payment codes as well. Can you tell us what’s going on there?

Kathy: Yes. They’ve issued some new HCPCS, or CPT codes to code for the testing of the viruses. So those codes, 87635 and then there’s a couple of U codes, U001 and U002. The description of those and all the details and the estimated payments are on the website with all the details.

Mike: It’s great, and it’s certainly very detailed information there. And there is some COVID-19 emergency-related billing policies and procedures that were issued. What can you tell us about those Kathy?

Kathy: Well, these are coming fast and furiously. Basically, when the President declared an emergency or disaster under the Stafford Act and the National Emergencies Act, it gives a lot of leeway to the Federal, State, and even local governments to waive certain requirements. One of the biggest changes that I’ve seen is that they’re lifting a lot of the restrictions to Telehealth, and they’re allowing patients to call in from home where there were really strict restrictions on that in the past, geographical restriction, you had to live in a rural area, things like that. You had to go into what they call an originating site. So you couldn’t actually do it from your home, you had to go to a real health clinic who would call the distant provider, who is the provider actually providing the service. But now they’re allowing patients to call in from home. They’ve also lifted the restriction on– it had to be audiovisual. Now they can actually just have an audio Telehealth visit, so that doesn’t have to have the visual capabilities. A lot of our elderly folks– I think about my dad, he still has a flip phone. So they don’t have those smartphones that know how to use that visual piece of it. So they’re lifting that. And the other one that I just heard today, as a matter fact, is they’re allowing physicians to work across state lines. Or actually, it said all medical professionals. So they can work in other– as long as they’re licensed in one state they can work in another state. So this is, I think, particularly helpful for a lot of these major cities that are on the border of two states, or multiple states. So that’s another big thing that was lifted. And then the last thing is they’re relaxing, not lifting, but relaxing some of the HIPAA requirements. And that’s really more related to the Telehealth. So, you want to be sure and read those specific guidelines that they’re lifting because it’s not– or not lifting, I’m sorry, relaxing. So you want to read those particularly. It really is more about consent than anything, so we need to still protect our patients’ PHI and things like that.

Mike: Kathy things are certainly changing in the world around us very quickly. We thank you for stopping on the podcast today to bring us the latest, and we’ll certainly look forward to having you back as things evolve. For everyone in our audience, we wish you the best of health and safety. And we look forward to bringing you more important updates as the situation changes. Kathy, thanks again for coming by the show today.

Kathy: Thank you for having me.

COVID-19, better known as Coronavirus has spread throughout the world. Symptoms of this respiratory disease may include fever, cough, and shortness of breath. These symptoms may show up 2 to 14 days after exposure. If you are experiencing these symptoms and have come into contact, or are in an area with an ongoing outbreak, please call a hotline and/or consult with a physician. Clean and disinfect high-touch surfaces. For more information please visit Thank you.

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