In this episode, we are joined by Sandy Brewton, Senior Healthcare Consultant for Panacea Healthcare Solutions, to discuss CMS’ new procedure and diagnosis codes for COVID-19.
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Highlights of this episode include:
- Details on CMS’s announcement of new diagnosis and procedure codes for COVID-19.
- What types of procedures are included in the new procedure codes?
- a review of the six new diagnosis codes that were effective January 1st, 2021.
- What impacts the new codes will have on coding and reporting in 2021.
- And more…
Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance Podcast®. As of January 1st, several new ICD-10 codes for Medicare related to COVID are effective. To tell us more about these new codes and their impact, I’m joined by Sandy Brewton, Senior Healthcare Consultant with Panacea Healthcare Solutions. Sandy, welcome to the show.
Sandy: Thanks, Mike. Thanks for having me.
Mike: So Sandy, as I mentioned, CMS recently announced new diagnosis and procedure codes for COVID-19. They are now effective. How many new codes have been created?
Sandy: So in the ever-changing world of COVID-19 and ICD-9 and ICD-10 coding– ICD 10-PCS coding, I should say, CMS has released an additional 21 new PCS procedure codes. And those are going to apply to treatments for COVID-19 and vaccination for COVID-19. In addition to those 21 new PCS procedure codes, there are 6 additional ICD 10-CM diagnosis codes, and some of those will identify conditions resulting from COVID-19. And as you said, all of these codes were effective as of January 1st of 2021.
Mike: So 21 new procedure codes sounds like quite a bit. What type of procedures are included in the new procedure codes?
Sandy: With these procedure codes, we’ll be able to capture the vaccination for COVID-19. And I won’t take the time to list each and every code during our session today, but there are six new vaccine procedure codes. There are so many of those different codes because the differing vaccines are actually administered differently. So, for example, certain vaccines are delivered subcutaneously. Some of the other vaccines are delivered into the muscle. And then the remainder of those vaccine codes actually capture the number of doses with codes for the first dose and then a separate code for the second dose if applicable because some of those vaccines need two doses. Then some only need one to be administered. And then, out of those 21 codes, the remaining 15 new procedure codes will allow us to capture therapeutic treatments for COVID-19. There are 6 COVID treatments that we’ll be able to capture now when performed on patients in the hospital that are being treated for COVID-19. And so, some of those medications are actually in clinical trials at this time as well. One of the medications -and I don’t know if I will pronounce these all correctly, but I’m going to tell you about the 6 new treatments that we’ll be able to capture now. Leronlimab – it’s a monoclonal antibody, And it’s actually used to treat HIV as well. That particular medication is currently in clinical trials for treatment of COVID-19. And what the drug does is it protects healthy T cells from viral infection. So that’s one of the new treatments that we’ll be able to capture now. Etesevimab – it’s very hard to say; I’m not sure how to pronounce that one completely – but it is a recombinant fully human monoclonal neutralizing antibody. And that binds specifically to the SARS COVID virus, which is the COVID-19 virus it attaches to that surface like protein receptor and binds that virus. Another treatment will be able to capture is Bamlanivimab. And it’s a neutralizing immunoglobulin monoclonal antibody and it targets also this like protein of the SARS virus and neutralizes the virus by blocking the virus and keeping it from attaching and entering into the actual human cells. There is an antiviral antibody cocktail and it’s REGN-COV2 and that’s been tested on rhesus macaques and golden hamsters. So I don’t know if that one’s actually being used on humans yet but we do have a code for that now that we can capture that when it is. Then there’s another treatment, SACCOVID, and that’s an immunomodulator and it’s basically a fusion protein and reduces the incidence of the viral pneumonia to promote faster recovery and to prevent patients from getting the viral pneumonia or COVID-19 from progressing to a viral pneumonia and then the last one it’s a drug that’s used in combination with remdesivir and it actually has been approved by the FDA for treatment of COVID-19 when used with remdesivir and its Baricitinib. And that drug in combination with remdesivir is actually used to treat patients who require supplemental oxygen, invasive mechanical ventilation and that’s for the more severe cases of COVID-19. And what this particular drug does is it blocks the activity of one or more of a specific family of enzymes and interferes with the pathway to inflammation. So helps calm that down in their lungs. So that’s kind of an overview of some of the new procedure codes and why we have those, why they’re being released now to aid in the capture of how we’re treating these COVID-19 patients in the hospital.
Mike: You did a great job with those drug names, Sandy, and it sounds incredibly complex. I can’t see where this is going to be very easy to master. So yeah definitely getting a window into that. You also mentioned that CMS released some new diagnosis codes. Are these diagnosis codes for COVID-19 or are they for other conditions?
Sandy: So there are six new diagnosis codes that were effective as of January 1st. Three of those new codes are to capture COVID-19 exposure, COVID-19 history, and COVID-19 screening. So specifically, diagnosis codes Z1152 will be used to capture patients that are screened for COVID-19. So this would typically be assigned for patients who show no symptoms and they’re just having a COVID-19 tests say pre-surgery or for another reason that they may be meeting to be screened for COVID-19. Another one of those diagnosis codes Z20.822 that will be used to capture patients who’ve come into contact with someone who’s known to have COVID-19. So it’s really an exposure to COVID-19 code and this code will be used to report that the patient has been exposed to COVID but these patients won’t have symptoms and they won’t have contracted the illness at this point. The third code of the sixth is diagnosis code Z8616 and that’s for a personal history of COVID-19. So that code will be used for patients who have personally had COVID-19 infection and have recovered from that infection. There are three additional code to round out six new code. These codes will allow us to capture COVID-related conditions. After implementation of these three new diagnostic codes, we’re now able to specifically capture pneumonia due to COVID-19 with a diagnosis code J 12 82. COVID-19 related connective tissue disorders, we can capture with M 35 89, and multi-system inflammatory syndrome from COVID-19 with M 35 81. Now, there’s a caveat though with these three new codes because these three codes can only be assigned COVID-19 infection code is assigned first which, of course, must be assigned based on the official coding guidelines concerning the sequencing directives for COVID-19 and its manifestations. So no doubt, there is going be more guidelines, clarification of coding guidance to come with the implementation of these new codes.
Mike: And Sandy, what impact if any will all of this have on coding and reporting in 2021?
Sandy: Well, and that’s a good question. So what the addition of these codes does is it gives the facilities a way to capture more specific information and more specific data concerning COVID-19, its manifestations, the treatments rendered, and vaccination procedures. As far as the procedure codes go, as with all procedure codes that are assigned specifically for hospital inpatient claims, the facilities themselves are going to need to decide whether or not they’ll be having their coding staff assign these procedure codes or if the data will simply be gleaned from that charge capture details because it can be taken from there. But the new diagnosis codes, they’ll absolutely be assigned by not only inpatient coding staff, but also outpatient coding staff. And it’ll be a huge help in reporting some of the most common manifestations of COVID-19. So as an example, in 2020, we could only capture COVID-related pneumonia as other viral pneumonia. But now, after implementation of these new codes, we now have a pneumonia due to coronavirus-19 code. So we can capture specifically COVID-related specific pneumonia. These new diagnosis codes also give us the ability to better capture those patients who’ve already had COVID-19 and who’s been exposed without contracting the illness. The really helpful and– I think it’s going to really glean down the data that’s being collected and being analyzed and used.
Mike: And Sandy, Where can someone find more information on these new codes?
Sandy: So you can find all of the information regarding these new codes and the implementation, DRG information, grouping information on the CMS website including a complete list of the new diagnosis and procedure code. And they were actually published on the CMS website I think on December 1st of 2020. Additionally, CDC back on December 3rd of 2020 officially listed the new ICD 10 CM diagnosis codes for COVID-19 on their website. So you can visit the CDC website and look under the resources tab if you want to look it up there. So CMS website has all the codes. The CDC website under resources has the diagnosis codes.
Mike: Excellent. And as I mentioned at the head of the broadcast, Sandy is a Healthcare Consultant with Panacea Healthcare Solutions. If you’d like to find out more about them, you can go to panacea inc. That’s panacea i-n-c dot com for more about what they do. Sandy Brewton, thanks so much for joining us today on the Hospital Finance podcast.
Sandy: Thank you, Mike.