By Catherine O’Leary, RN, managing director, healthcare advisory/CDI, KPMG.
COVID-19 is imposing a humanitarian and economic toll around the world, and healthcare providers are on the front lines of the response. New COVID-19 medical codes that went into effect on April 1 have an important part in clinical decision making, disease surveillance, population health management and research on the pandemic.
The new codes allow healthcare officials, clinicians, and researchers to capture claims data and use the information to better inform a course of action tied to COVID-19, whether that is for setting aside more beds, creating special units to handle the highly contagious viral infection, routing ambulances to facilities that can handle the emergency or other responses.
Because of the evolving situation, codes are rapidly changing. With every coding update, it is vital for everyone involved in the reporting of claims data, such as coding professionals, clinical documentation improvement specialists, healthcare IT professionals and coding auditors to respond to the changes.
All COVID-19 confirmed cases, documentation of a positive COVID-19 result, or a presumptive positive COVID-19 test result should be coded as U07.1, COVID-19. As a general rule, it is still imperative to follow the Official Coding Guidelines in the selection of principal or first-listed diagnosis (i.e., sepsis, obstetrics, etc.). Furthermore, it is important to report the other conditions/co-morbidities to present the overall severity and risk of mortality of a patient. If a patient presents with signs and symptoms with no definitive diagnosis, there are codes available to capture the reason for the encounter.
For patient discharges prior to April 1, providers should use the supplemental ICD-10-CM coding guidance for reporting cases related to COVID-19.
The tables accompanying this post outline some of the signs and symptoms, as well as codes for a diagnosis, related to COVID-19.
Telehealth guidance and COVID-19 coding
We are getting a lot of questions tied to telehealth, especially since the Coronavirus Aid, Relief, and Economic Security (CARES) Act, health plans, and Centers for Medicare & Medicaid eased several of restrictions.
This is the guidance that we’re receiving on telehealth:
- Services provided do not need to be COVID-19 related and can be offered in all settings, including a patient’s home.
- Payers will not enforce the requirement that patients will have an existing relationship with the physician (clinician?) providing telehealth.
- Physicians in one state may provide services to patients in another state, but state licensure applies.
- Providers will be reimbursed at the same rates as if the service was provided in person.
- Telehealth claims should properly reflect the place of service code (02-Telehealth).
With the coding guidance from CDC, the onus is still on healthcare providers to stay informed about the current regulations, as well as potential changes to ensure that COVID-19 encounters are recorded appropriately. Also, the data gathering helps with clinical decision making for quality patient care, disease surveillance, population health management, research and regulatory mandates.