Coding in Age of COVID-19: Deciphering Coding Nuances, Best Practices

Without much warning, the novel Coronavirus, or COVID-19 , has taken over our healthcare system. It has taxed our healthcare workers, our national stockpiles of PPE, and affected millions of Americans nationwide. In addition to healthcare workers on the front lines, the pandemic has also impacted the healthcare revenue cycle , causing major confusion, questions, and inconsistencies as coding specialists learn the latest COVID-19 codes and guidelines at warp speed. With cases rising by the tens of thousands on a weekly basis (as of late April), it has been difficult for coders to keep up with the rapidly changing guidelines that come with this new and relatively unknown virus.

The Basics

As this health crisis turned into a pandemic, The Centers for Medicare & Medicaid Services (CMS) was forced to jump into action quickly. Going into effect in early February, CMS created two new HCPCS codes to report COVID-19 testing and two additional codes in early March for COVID-19 specimen collection. The American Medical Association (AMA) also released a new CPT code shortly thereafter to capture lab testing and two new CPT codes in April to report antibody testing. If that was not enough to keep track of, CMS also released an interim final rule in early April in response to the COVID-19 public health emergency that provides additional guidance for healthcare providers, followed by the release of a special ruling on April 14 that created two new HCPCS codes to capture COVID-19 testing using high throughput technologies.

Codes continue to change seemingly by the day and there is far more to keep track of than ever before. At the same time, it is crucial that coding departments are consistent with their use of the new codes and coding guidelines to measure the outbreak. By providing an understanding of the number of people who have the disease through accurate coding and allowing for location tracking of those infected we are much better able to understand how the disease is spreading. And, as hospitals run out of PPE and other crucial supplies to treat patients, they must ensure they have the revenue to which they are entitled under the new rules to continue to purchase these necessities.

The Nuances

Because COVID-19 is a novel virus that had not previously infected humans, healthcare providers did not have codes available to uniquely identify patients who were infected with the COVID-19 virus in the early days of the outbreak. This continues to cause major confusion as patients come into healthcare facilities with myriad symptoms, all of which could be caused by various upper respiratory issues. For example, U07.1, COVID-19, is used to report all confirmed cases of COVID-19 followed by additional codes to identify a specific respiratory illness such as pneumonia or bronchitis, caused by the virus. Inpatient cases that are suspected or likely to be COVID-19 should not be coded using...