COVID 19 Has New Code in April

Coordination and Maintenance committee meeting announces COVID 19 code effective April 1, 2020.

The Coordination and Maintenance Committee Meeting announced that the COVID-19 code that was originally scheduled to become effective October 1, 2020 will now be effective April 1, 2020. The code that will be effective is U07.1.  The effective date was changed due to the national health emergency of COVID-19.

The Coordination and Maintenance Committee Meeting met on March 18, 2020 virtually to discuss the twenty-six topic proposals plus the requested addenda to the classification. During this meeting, the change to the effective date was announced for COVID-19. The chapter will be renamed Emergency Use. More information will be posted on the CDC website by Friday, March 20, 2020. There was no information regarding the inclusion of this code in the FY20 Inpatient Prospective Payment System grouper v36.

The World Health Organization (WHO) created the code for coronavirus on January 31, 2020 in response to the declaration of a public health emergency with international concern. WHO has indicated in ICD-10 classification that categories U00 – U49 are set aside for provisional assignment of conditions of uncertain etiology. The CDC uses ICD-10 as a basis for ICD-10-CM and waited to ensure that the code that was created would be consistent with ICD-10. The ICD-10-CM code U07.1 is classified to Chapter 22 (Codes for Special Purposes). The coding instructions for U07.1 are:

          Use additional code to identify pneumonia or other manifestations

          Excludes1: Coronavirus infection, unspecified site (B34.2)

                           Coronavirus as the cause of diseases classified to other chapters (B97.2-)

                           Severe acute respiratory syndrome [SARS], unspecified (J12.81)

In addition to the update regarding the ICD-10-CM code, there is also an update regarding the pricing for the COVID-19 testing. The Centers for Medicare and Medicaid Services (CMS) has posted a document that provides pricing for the HCPCS code by Medicare Administrative Contractor (MAC). The URL is listed in the resources. Providers will need to contact their payers to know if the payer wants the CPT® code or the HCPCS code. The CPT code was announced last Friday, but there is still no pricing information available. 

CMS announced yesterday, that all adult elective surgeries, non-essential medical, surgical, and dental procedures should be postponed during the novel coronavirus outbreak. Facilities and clinicians need to assess the patient’s status in determining if the procedure or treatment can be delayed.

As workflow procedures are being changed for COVID-19, please think about creating a method to identify all claims that are associated with COVID-19.  At some point, the identification of these claims will be needed.    It will be important to be able to look at them from a claim perspective as well as from a coding perspective.  From a claim perspective, these claims should not be unpaid for any reason based on the declaration of a national emergency on March 13, 2020.   From a coding perspective, there is not a specific code until April 1, 2020 to identify COVID-19 so another method must be created.   It could be a flag in the electronic health record or a user-defined field in the claims system. You may consider having the flag/field to be flexible so that you are prepared for the next national health emergency. Remember to add it to your policies and procedures.

For all things that are related to COVID-19, you can use this URL:  https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page. This page contains coding advice, updates to regulations, and pricing information.