The federal agency has recommended that healthcare workers self-report symptoms and not work if ill.
EDITOR’S NOTE: On March 5, the Centers for Disease Control and Prevention (CDC) held a call to update the provider community on the latest guidance related to COVID-19. During the call, several CDC physicians described the ever-changing landscape of the screening, diagnosis, and care for patients with COVID-19 and suspected patients. RACmonitor.com asked Dr. Ronald Hirsch of R1RCM, a RACmonitor editorial board member, to listen in and provide some notes for our readers.
According to the participants on the CDC COVID-19 call Thursday, there are 100 cases diagnosed in the U.S., 30 of which involved patients who had recently traveled to an area where COVID-19 is known to be present, and 17 with contact with known cases. The number is fluid, and there are many investigations ongoing.
“The most encouraging news was that the capacity to test patients is rapidly increasing,” reported Dr. Ronald Hirsch, who noted that Quest Diagnostics, a national lab company, will have the capacity to perform the test as of March 9, with a very high volume. “Those tests will be performed at their West Coast facility, so there will be no point-of-care results available.”
Hirsch said that one of the biggest frustrations expressed by providers is the inability to test for COVID-19 if the patient did not meet the strict screening criteria set by public health labs due to the limited test kit availability. This addition, along with other labs getting test kits, will help greatly.
Hirsch said the conference leaders also discussed mortality rates as a constantly moving number, with new data being produced, especially from China. The overall pattern does suggest that younger, healthy people have a very low mortality rate, and older patients and those with chronic illnesses have a significantly higher rate.
“Of those patients in China who developed pneumonia, 20 percent went on to acute respiratory distress syndrome (ARDS),” Hirsch said, citing the discussion of the conference call presenters. “Children have a very low risk of not only mortality, but also severe illness, with only one report of an infant in China who developed acute respiratory failure.”
According to the conference call participants, the overall rates suggest that 80 percent of patients will have a mild illness, and 20 percent will have moderate or severe illness that could require hospital care. Worth noting, according to Hirsch, is that there appears to be a trend of worsening in the second week of illness, so vigilance in monitoring of homebound patients is warranted.
“Clinically, COVID-19 appears to present like a typical respiratory illness, with fever and cough most common,” Hirsch said. “Patients may also have myalgia, fatigue, and sore throat, and some patients have reported nausea and diarrhea prior to the onset of respiratory symptoms. Rarely there is hemoptysis.”
Physicians leading the discussion during the call reported that lab testing tends to show leukopenia in two-thirds of patients, and often, profound lymphopenia. One-third of patients have elevated liver function tests, and it appears that procalcitonin is of no value. Imaging is best done with chest X-ray, and although there are typical findings on CT scan, there have been reports of false-negative studies in patients with confirmed COVID-19, so they do not recommend it as a diagnostic test, instead continuing to recommend swab testing for RT-PCR.
Hirsch learned during the call that treatment remains supportive, with many trials in the U.S. and around the world of various anti-viral agents and compassionate use of a promising antiviral from Gilead. Hirsch said the speakers made it clear that there is no role for corticosteroids, unless there is another compelling indication for them, as steroids can increase viral replication.
“On the prevention front,” Hirsch said, “the speakers all emphasized what we have been hearing: avoidance of exposure is key. Patients must be screened carefully and immediately placed in contact and droplet precautions to prevent transmission to healthcare workers.”
Hirsch said one speaker also offered what he described as “alternative methods of patient contact, such as telehealth,” that should be used. The speakers also noted that they are regularly updating their guidance on monitoring of healthcare workers for signs and symptoms of COVID-19, both to protect patients and to ensure that healthcare workers get the proper care.
“Because of the growing number of cases, the recent change was to recommend healthcare workers self-report symptoms and not work if ill,” said Hirsch. “The potential shortage of N95 masks to protect healthcare workers is being addressed, with waivers being drafted at the Food and Drug Administration (FDA) to allow certain ‘industrial’ respirators, as used in construction and manufacturing, to be used in hospitals.”
Hirsch emphasized that his summary should not be considered official guidance and that healthcare workers should consult the CDC COVID-19 website for up-to-date and constantly updated information. He also said that healthcare workers would find a separate page for nearly any scenario, including the possible exposure of a healthcare worker, guidance for EMTs, guidance for coordinating home care of a patient with COVID-19, and much more.
On a related note, CMS on Thursday announced that it has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases. In addition, the agency released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services.
“CMS continues to leverage every tool at our disposal in responding to COVID-19,” CMS Administrator Seema Verma said in a statement. “Our new code will help encourage doctors and laboratories to use these essential tests for patients who need them. At the same time, we are providing critical information to our 130 million beneficiaries, many of whom are understandably wondering what will be covered when it comes to this virus. CMS will continue to devote every available resource to this effort, as we cooperate with other government agencies to keep the American people safe.”
Last month, CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus; this code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) announced Thursday allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).
Toward the end of last month, the FDA issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers.
CMS reported that the Medicare claims processing systems will be able to accept these new codes starting on April 1, 2020, for dates of service on or after Feb. 4, 2020. Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates, CMS said, further noting that laboratories may seek guidance from their MAC on payment for these tests prior to billing for them.
To read Thursday’s press release in its entirety, including the links to the aforementioned coverage-specific fact sheets, go online to https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests.