The COVID-19 outbreak is key to keeping hospitals and practices running and ready for patients. When it comes to billing, it is Important to consider some Changes that apply to medicare coverage specific to COVID-19. A big concern for the senior population regarding the coronavirus is Medicare coverage. if you’re a healthcare provider looking for an HCC billing and coding Technology, tools you can visit our website

1. Coronavirus Impact on HCC Billing and
Coding - Inferscience
The COVID-19 outbreak is key to keeping hospitals and practices running and
ready for patients. When it comes to billing, it is Important to consider some
Changes that apply to medicare coverage specific to COVID-19. A big concern for
the senior population regarding the coronavirus is Medicare coverage.
The situation in the US with COVID-19 has continued to escalate day by day.
Healthcare providers are at the front line of this challenging situation that is
impacting the healthcare system in unprecedented ways. In these times of
uncertainty, healthcare providers have many moving pieces to worry about, today
we will focus on the documentation aspects of the novel coronavirus.
Patient safety is without a doubt the priority, but it is also important that
healthcare organizations keep up-to-date records and documentation in order to:

2. • Continue receiving the appropriate funding and payments to avoid any
operational disruptions.
• Ensure that the new regulations put into place by the government about
waiving costs for patients with COVID-19 are applied correctly.
• Keep accurate records of COVID-19 for data tracking.
Billing and Coding for COVID-19
• As challenging as it is, maintaining good procedures in the billing office
during the COVID-19 outbreak is key to keeping hospitals and practices
running and ready for patients. CMS has made different adjustments to
make sure providers are rightfully equipped to handle the billing and coding
for COVID-19 testing and treatment. There are a few new codes available
for laboratories to bill for specific COVID-19 diagnostics.
• According to Revcycle Intelligence, “the first billing code released this year
(U0001) was for SARS-CoV-2 diagnostic tests performed specifically for CDC
testing laboratories. The second billing code (U0002) released in the
beginning of March will expand medical billing and coding for coronavirus
lab tests, permitting laboratories to bill for non-CDC laboratory tests for
SARS-CoV-2/2019-nCoV, otherwise known as the novel coronavirus or
COVID-19”.
• Additionally, CMS mentions “on March 13, 2020, the American Medical
Association (AMA) Current Procedural Terminology (CPT) Editorial Panel
created 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)”.
• Besides logging the newly created codes specific to COVID-19, it is also
important to track and capture the appropriate codes to accompany
evaluations of suspicious COVID-19 cases. The American Academy of
Pediatrics provided in the beginning of March 2020, a list of codes related
to respiratory conditions that may need to be included as companion codes
for COVID-19 cases.

3. Pneumonia For a pneumonia case confirmed as due to the 2019 novel
coronavirus (COVID-19), assign codes J12.89, Other viral
pneumonia, and B97.29, Other coronavirus as the cause of
diseases classified elsewhere.
Acute bronchitis For a patient with acute bronchitis confirmed as due to COVID-
19, assign codes J20.8, Acute bronchitis due to other specified
organisms, and B97.29. If the bronchitis is not specified as
acute, due to COVID-19, report code J40, Bronchitis, not
specified as acute or chronic, along with code B97.29.
Lower
respiratory
infection
If the COVID-19 is documented as being associated with a
lower respiratory infection, not otherwise specified (NOS), or
an acute respiratory infection, NOS, report with code J22,
Unspecified acute lower respiratory infection, with code
B97.29. If the COVID-19 is documented as being associated
with a respiratory infection, NOS, it would be appropriate to
assign code J98.8, Other specified respiratory disorders, with
code B97.29.
Acute
respiratory
distress
syndrome
(ARDS)
ARDS may develop in conjunction with COVID-19. Cases with
ARDS due to COVID-19 should be assigned the codes J80,
Acute respiratory distress syndrome, and B97.29.
Exposure to
COVD-19
For cases where there is possible exposure to COVID-19, but
the disease is ruled out, report code Z03.818, Encounter for
observation for suspected exposure to other biological agents
ruled out. For cases where there is an actual exposure to
someone who is confirmed to have COVID-19, report code
Z20.828, Contact with and (suspected) exposure to other viral
communicable diseases. This code is not necessary if the
exposed patient is confirmed to have COVID-19.
Signs and
symptons
For patients presenting with any signs/symptoms and where a
definitive diagnosis has not been established, assign the
appropriate code(s) for each of the presenting signs and
symptoms such as: Cough (R05); Shortness of breath (R06.02)
or Fever unspecified (R50.9).

4. When it comes to billing, it is also important to consider some of the changes that
apply to medicare coverage specific to COVID-19. As we know by now, our
geriatric population is at greater risk to develop severe complications caused by
the novel coronavirus. A big concern for the senior population regarding the
coronavirus is Medicare coverage. Following President Trump’s declaration of a
national emergency, a lot of changes have been applied to Medicare coverage for
COVID-19.
An article by Forbes lists CMS specifics on what every Medicare and Medicare
Advantage plan must cover during the coronavirus special regulations. The
following specifications apply to coverage for COVID-19 under Original Medicare:
• Part A will cover inpatient stays in a hospital and skilled nursing facility
subject to the cost-sharing. Also, a beneficiary should not pay more for a
single room if quarantined.
• Medicare Part B will cover the test to diagnose Coronavirus with no
copayment after February 4, 2020. Medicare will cover outpatient
treatment usual to cost-sharing.
• There are also changes related to telehealth services, as Medicare Part B
now also covers services that are not face-to-face with a doctor, using an
online patient portal.
The following applies specifically to Medicare Advantage:
• Waive in full requirements for gatekeeper referrals, where applicable.
• Cover services that are provided at out-of-network facilities.
• Provide the same cost-sharing as if the service or benefit had been
furnished at in-network facilities.
• Make changes that benefit enrollees effective immediately, without the 30-
day notification requirement.
As we enter this uncharted territory it is important to look out for the changes in
rules and regulations. It is also important to be as prepared as possible with all
the necessary tools when it comes to billing and documentation. Having
technology such as HCC coding and risk adjustment tools in place now is what is
going to help providers make sure they don’t miss out on capturing critical billing
and diagnosis codes in either in-person or online visits.

5. If not already in place, this might be a good time for providers to consider adding
HCC Coding technology. Although it is challenging to keep up with documentation
in the midst of a pandemic crisis, the use of technology can help providers
uncover gaps and document more proficiently.
Technology companies like Inferscience offer tools specific for clinicians providing
services to Medicare Advantage patients: with the purpose of providing
technology that can optimize the HCC documentation process and help increase
RAF scores. Inferscience’s HCC Assistant and HCC Validator solutions make
prospecting and code validation quick and easy.
At Inferscience, we’d like to extend our appreciation of healthcare providers all
over the United States, if you’re a healthcare provider looking for HCC billing and
coding technology tools you can visit our website at
inferscience.s7.devpreviewr.com or contact us at 617 848 9502.