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COVID-19 Pandemic: What to Know About Billing, Testing and Diagnostic Codes
ACP is working to remove barriers for licensure and reimbursement of telemedicine services
March 20, 2020 (ACP) – Recently declared a pandemic by the World Health Organization, the novel coronavirus (COVID-19) is changing everything about how Americans live and work, including the way physicians see and bill patients.
This is a rapidly developing story and the American College of Physicians (ACP) is working hard behind the scenes to remove reimbursement barriers to telemedicine services so that doctors can screen or check on affected patients via video or telephone.
Specifically, changes are being made regarding what is covered related to COVID-19 and how to code for testing and diagnosis, said Brian Outland, ACP director of regulatory affairs. For starters, three new billing codes are available to capture non-face-to-face visits whether by patient portal or video. “These are patient-initiated, seven-day codes,” he said.
These codes include:
- 99421: This code is for online digital evaluation and management services for an established patient for up to seven days. The cumulative time during the seven days is five to 10 minutes.
- 99422: This code is for online digital evaluation and management services for an established patient for up to seven days. The cumulative time during the seven days is 11 to 20 minutes.
- 99423: This code is for online digital evaluation and management services for an established patient for up to seven days. The cumulative time during the seven days is 21 or more minutes.
“If you communicate to patients, keep a log of how much time is spent communicating over the seven-day period,” Outland said. “These codes are especially useful if physicians have to self-quarantine and can't get in to see their patients because they can connect and be reimbursed.” The codes also allow doctors to communicate with home-bound elderly and at-risk patients.
Claims for COVID-19 will not be reimbursed until April 1 but are retroactive to the date of treatment, Outland added.
COVID-19 Testing: How to Bill
The Centers for Medicare & Medicaid Services released the first Healthcare Common Procedure Coding System (HCPCS) code (U0001) to bill for tests and track new cases of COVID-19. This code is only for testing laboratories run by the Centers for Disease Control and Prevention (CDC). A second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory testing for COVID-19 when submitting claims to Medicare or health insurers.
The hope is that the new codes will encourage doctors to test for COVID-19 and improve tracking of transmission, Outland said. Medicare and many other payers are also waiving consumer copays for all medically necessary COVID-19 testing.
COVID-19 Diagnostic Codes
There are also certain diagnostic codes to keep in mind, Outland added. “Never use coronavirus- unspecified,” he said. “It should not be used as it is always associated with respiratory viruses.”
If a patient presents with suspected exposure to COVID-19 that is ruled out after evaluation, the appropriate code is Z03.818. A known exposure to COVID-19 (without diagnosis of COVID-19) should be coded as Z20.828. If you don't suspect COVID-19, use symptom codes instead, Outland suggested.
Additional tips for practices about telehealth and coding are available on the ACP website.