Answers to Some of the Most Frequently Asked Questions on COVID-19 Billing
Thanks to the prevalence of the disease, rapidly developing guidelines and treatment processes, and vaccines, COVID-19 is raising a lot of questions regarding medical billing and coding. The national public health emergency that was declared in March of 2020 created a huge push to get testing done and a vaccine developed, which meant that the usual processes for creating new medical billing codes were circumvented.
Rules were changed to allow for less person to person contact, resulting in much more remote interaction being billable, and every new thing requires new billing codes. On top of that, payers have different requirements, so it has been quite a year for practitioners who are trying to keep up with the latest rules, codes and procedures. The state of emergency has been extended as of March 2021, so these changes are likely to be with us for a while longer.
There are some questions that seem to come up more than others, and we’ve put together a list with answers to try and simplify things for you.
What are the billing codes for laboratory testing?
CMS created two HCPCS codes:
- U0001, CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel
- U0002, 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC.
AMA created a CPT code:
- 87635 (Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique).
How do I bill for testing with the CDC test kit?
When testing is done using the CDC test kit, use HCPCS Code U0001 as described above.
If a new test comes out, do I have to wait for a new code to be able to bill for it?
No, if new tests come out, U0002 is the appropriate HCPCS code as long as the test method is not specified by U0001 or 87635 above. CMS has said they will adjust coding as necessary if new testing methodologies are developed.
How do I bill for telemedicine?
The public health emergency has caused some restrictions on telemedicine to be removed to allow practitioners to see patients without potentially exposing them to COVID-19 in the waiting room or other parts of the medical facility. Likewise, seeing patients remotely prevents staff from becoming infected if the patient is a carrier of the coronavirus.
CMS provided guidelines for billing Medicare for telemedicine encounters. Other payers will have their own policies for what is allowable as telemedicine.
CMS has provided a downloadable pdf with the list of telehealth services that are payable by Medicare. It was updated on March 9, 2021, so is very current. Some services are billable for an audio-only encounter; details are in the pdf at that link. Approved services range from evaluations and therapeutic exercises to end stage renal disease services.
Are there other codes that relate to COVID-19?
There are several ICD-10 codes that should be used to specify the following conditions or actions that include or closely relate to COVID-19.
- U07.1 – COVID-19
- J12.82 – Pneumonia due to coronavirus disease 2019
- M35.81 – Multisystem inflammatory syndrome (MIS)
- M35.89 – Other specified systemic involvement of connective tissue
- Z11.52 – Encounter for screening for COVID-19
- Z20.822 – Contact with and (suspected) exposure to COVID-19
- Z03.818 – Encounter for observation for suspected exposure to other biological agents ruled out. This code is used when the individual is seen because of possible exposure, but infection with COVID-19 is ruled out.
- Z20.828 – Contact with and (suspected) exposure to other viral communicable diseases). This code is for cases where the individual has been exposed to someone who is known or suspected to have COVID-19, but tests negative (or results are unknown).
This is far from a complete list, but hopefully will provide answers to some of the most essential questions providers have regarding coronavirus billing.
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