Coding COVID-19 Claims

Healthcare providers are working tirelessly to care for patients during the COVID-19 crisis. Many are isolated from their families so they can take care of our families. Supporting them are countless non-clinical professionals working to keep their organizations operating and create plans for how to successfully transition out of this crisis when the time comes. A big part of that is properly coding COVID-19 claims.

Which Code Sets Will You Need for Coding COVID-19 Claims?

Depending on what types of claims you are submitting, you will need a combination of HCPCS, CPT, ICD, and DRG codes. Several new codes are being implemented to ensure that healthcare providers can properly bill and receive reimbursement for the patient care they are providing during this critical time.

HCPCS Codes

Two new HCPCS codes were introduced to bill for patient testing for Coronavirus:

  • HCPCS code U0001 may be billed by providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel.
  • HCPCS code U0002 can also be used by laboratories and healthcare facilities for non-CDC, 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets).

CPT Codes

A new CPT code was introduced by American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel on March 13, 2020 that laboratories can use to bill Medicare when applicable:

  • 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).

Diagnosis Codes

A new diagnosis code for COVID-19 is being implemented April 1, 2020 by Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS):

  • U07.1 is assigned to a disease diagnosis of COVID-19 confirmed by laboratory testing.

DRG Codes

DRG coding is a little trickier; the codes that will most likely be applicable for COVID-19 diagnoses are:

  • DRG 177 Respiratory Infections and Inflammations with MCC
  • DRG 178 Respiratory Infections and Inflammations with CC
  • DRG 179 Respiratory Infections and Inflammations without CC/MCC

There are additional DRG codes for infants and HIV patients.

The Importance of Properly Coding COVID-19 Claims

Practices will likely have to manually load these new codes into their Practice Management/EMR systems for use on claims. Accuracy and specificity are important when coding COVID-19 claims so healthcare professionals can not only get paid properly but can learn from the data. The new codes will allow for more specific coding and later reporting on how COVID-19 has impacted the country. As always, check your references and stay current on coding requirements, and THANK YOU for taking care of the people who are taking care of our people!

Helpful resources for coding COVID-19 claims:

Other COVID-19 resources from Guideway Care:

Editor’s note: This article has been corrected to reflect the fact that U07.1 is the only new diagnosis code being implemented by the CDC at the time of this writing.