BEST PRACTICES AND GUIDELINES FOR CODING OF COVID-19 TESTING AND VACCINATION CLAIMS

Dec 21

The four organizations approve best practices and guidelines for coding and vaccination claims: the American Health Information Management Association (AHIMA), the American Hospital Association (AHA), National Center for Health Statistics (NCHS), and the Centers for Medicare & Medicaid Services (CMS). These policies and guidelines are a set of rules and regulations to accompany the official instructions of the ICD-10-CM. These best practices and guidelines are based on the authorized coding list of codes in chronological order. Moreover, these guidelines are assigned with the procedures, diagnosis codes, documentation, and reporting under the Health Insurance Portability Accountability Act (HIPAA). In Addition, these practices are helpful for medical coders and healthcare providers, and it is beneficial for the coders to quickly identify the diagnosis codes for reporting. It is essential to keep the complete medical documentation consistent and accurate coding.

The list of these ICD-10-CM codes are listed below:

Suppliers should be registered at Medicare to bill the public payer for the COVID-19 immunization organization. Even though providers are interested in a Medicare Advantage plan to submit claims to the conventional Medicare for all patients selected, the arrangement in 2020 and 2021, Centers for Medicare and Medicaid Services(CMS) states.

Suppliers looking for reimbursements for uninsured patients can demand claims repayment electronically through the COVID-19 Uninsured Program Portal. The Portal will just acknowledge claims submitted utilizing an 837 EDI exchange set.

Medical billing services for state Medicaid projects and private payers will shift. Suppliers should speak with an expert outsourcing medical billing company. UControl Billing can assign contract resources for analyses on submitting claims for the COVID-19 immunization and organization. For more information, kindly contact them.

E.g.

Immunology

86318 Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (e.g., reagent strip);

86328 Immunoassay for contagious agent antibody(ies), qualitative or semiquantitative, single-step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

86408 Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen

86409 Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer

86413 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative

86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

Microbiology

87426 Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g.program, SARS-CoV, SARS-CoV-2 [COVID-19])

87428 Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B

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

87636 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique

87637 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique

87811 Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

Proprietary Laboratory Analyses (PLA)

0202U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected

0223U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected

0224U Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s) when performed

0225U Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including reverse multiplex transcription for RNA targets, each analyte reported as detected or not detected

0226U Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum 0

240U Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected

0241U Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected.

ICD 10 Codes

Code only confirmed diagnosis as documented by the clinician, documentation of a positive test result, or a presumptive positive test result.

NOTE: NEWcodes are effective 1/1/2021

U07.1 - 2019-nCoV acute respiratory disease. Effective April 1, 2020, the CDC has issued a new ICD10CM emergency code.

NEWM35.81 – Multisystem inflammatory syndrome

NEWM35.89 – Other specified systemic involvement of connective tissue

Z03.818 - Encounter for observation for suspected exposure to other biological agents ruled out (possible exposure, but ruled out after evaluation).

NEWZ11.52 – Encounter for screening for COVID-19

NEWZ20.822 - Contact with and suspected exposure to COVID-19

NEWZ86.16 – Personal history of COVID-19

Sequencing: U07.1 should be the primary diagnosis, followed by appropriate codes for associated manifestations:

NEWJ12.82 (Pneumonia due to coronavirus disease 2019)
J20.8 (acute bronchitis due to other specified organisms)
J22 (unspecified acute lower respiratory infection NOS)
J40 (bronchitis, not specified as acute or chronic)
J80 (acute respiratory distress syndrome)
J98.8 (other specified respiratory disorders)

Use appropriate codes for the signs and symptoms, e.g., R05 (cough), R06.02 (shortness of breath), or R50.9 (fever, unspecified).