The healthcare system is adapting as quickly as possible to the COVID-19 pandemic. This involves coming up with COVID-19 codes for medical billing purposes.
COVID-19 coding and billing ensure that physicians receive medical coverage and payment for their services. In the current public health emergency, these also assist in the registration of new COVID-19 cases, allowing researchers and health officials to track the spread of the coronavirus.
The AMA, CDC, and the CMS have continually updated their COVID-19 codes. These are some of the most important ones to document COVID-19 related services.
Released by the AMA, CPT code 99072 refers to expenses arising from safety regulations and preparations when treating a COVID-19 patient. This includes steps such as symptom-checking through phone calls, utilizing PPE, and frequency of room cleaning. CPT code 86413 provides the diagnosis for COVID-19 in a patient.
The CDC issued ICD-10 CM codes on March 11, which are modifications of the World Health Organization’s codes. The ICD-10 CM U07.1 code is used for confirmed COVID-19 cases. This code doesn’t require confirmation by documenting actual testing procedures. Instead, documentation provided by the physician of a positive case is sufficient.
The CMS released HCPCS billing codes to encourage healthcare providers to continue testing and tracking the spread of COVID-19. U0001 refers to COVID tests conducted in testing laboratories, whereas U0002 includes non-laboratory tests.
Medical Billing Issues Due to COVID-19
The turbulent COVID-19 period has resulted in an array of medical billing issues. The waiver on certain policies has created confusion over which rules are still applicable, and which are not.
Updates on COVID-19 billing guidelines are below.
Telehealth has always posed a medical billing challenge. Issues such as the lack of upfront paperwork evaluation, the need for an existing relationship with the patient, and the confusion over medical insurance coverage, has dissuaded some physicians from providing this service.
During COVID-19, these issues are even more pronounced because of the increased demand for telehealth services, and the added complexity of changing policies. Several state governments have worked with Medicaid to expand medical coverage and payment for telehealth.
The federal government has enacted changes to the Medicare program based on the Coronavirus Preparedness and Response Supplemental Appropriations Act. This includes the waiver of certain restrictions.
Medicare coverage now allows:
- Beneficiaries to live anywhere when receiving telehealth services, no more restrictions to rural areas
- Beneficiaries to access telehealth services from home
- Telehealth services to be delivered by smartphone
- A patient and a provider without a preexisting relationship
- Some audio-only services to be delivered
Medicare Advance Payments
In the midst of national emergencies, physicians require more funds to deal with the surge of patients and the need for protective equipment. To address this challenge, the CMS has expanded the Medicare advance payments program, which enables physicians to request accelerated Medicare payments.
To qualify, physicians must:
- Have billed Medicare for claims within 180 days of the date of signature of the application
- Not be facing bankruptcy
- Not be under medical investigation
- Not have outstanding Medicare overpayments
Healthcare providers will have to repay this over a period of time.
Stark Law Waivers
The Stark Law typically prevents physicians from referring patients to healthcare services with which they have an ongoing financial relationship. The CMS has released waivers regarding COVID-19 under this law.
This waiver allows hospitals to pay you above or below the market value for personal services, or below the market value for renting equipment. Healthcare providers can also supply you with COVID-19 equipment, if necessary. If you own a hospital, you can temporarily expand your premises.
Medicare COVID-19 Testing
The Medicare program has implemented COVID-19 test billing updates. You can receive payment when undergoing diagnostic tests for COVID-19. When you assess or collect COVID-19 samples, Medicare recognizes the CPT code 99211 to include established and unestablished patients.
Best Practices for COVID-19 Coding and Billing
The dynamic nature of the COVID-19 pandemic means that the medical response to it will continue to change. Regulations regarding medical coding and billing will adjust frequently, so being aware of this will be crucial for physicians.
Proper documentation through medical coding and billing is not simply important to receive payment, but it will also assist officials in monitoring the spread of the virus.
The MedConverge team has a thorough understanding of medical billing and coding systems, and can provide services to lighten your burden. To learn more, contact us today.