Organizations Developing New Codes for COVID-19, and a Primer on the Virus

Organizations Developing New Codes for COVID-19, and a Primer on the Virus

By Sue Bowman, MJ, RHIA, CCS, FAHIMA

Effective October 1, 2020,* the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) will implement a new ICD-10-CM diagnosis code for the 2019 novel coronavirus disease (COVID-19). Full addenda information regarding the new code and the final code title will be presented at the ICD-10 Coordination and Maintenance Committee meeting being held March 17–18. Establishment of a new ICD-10-CM code for COVID-19 is consistent with the World Health Organization’s (WHO) recent creation of an emergency ICD-10 code (code U07.1). In ICD-11, the code for COVID-19 would be RA01.0. The announcement of the new ICD-10-CM code for COVID-19 can be found on the CDC/NCHS web site.

*UPDATE as of 3/18/20: The Centers for Disease Control and Prevention (CDC) announced March 18 a change in the effective date of new diagnosis code U07.1, COVID-19 from October 1, 2020 to April 1, 2020. The unprecedented off-cycle update is due to the “urgent need to capture the reporting of this condition in our nation’s claims and surveillance data,” according to the CDC’s announcement.

Interim Coding Guidance

To address the proper coding of COVID-19 cases prior to the implementation of a new diagnosis code, interim coding guidance regarding the application of existing ICD-10-CM codes has been developed by the CDC/NCHS and approved by the four Cooperating Parties (NCHS, AHIMA, American Hospital Association, Centers for Medicare & Medicaid Services). According to this interim coding guidance, an ICD-10-CM diagnosis code should first be assigned for the specific respiratory condition the patient has developed (such as pneumonia, acute bronchitis, or lower respiratory infection, not otherwise specified). Code B97.29, Other coronavirus as the cause of diseases classified elsewhere, should be assigned as an additional diagnosis code for confirmed COVID-19 cases. It is important to note that this code should only be assigned when COVID-19 has been confirmed, not when COVID-19 is merely suspected.

For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, it would be appropriate to assign diagnosis 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, code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, should be reported.

Two New HCPCS Codes

The Centers for Medicare and Medicaid Services (CMS) developed two new Healthcare Common Procedure Coding System (HCPCS) codes for providers and laboratories to bill for COVID-19 diagnostic tests. CMS expects that having specific codes for these tests will encourage testing and improve tracking. The first HCPCS code (U0001) is used specifically for CDC testing laboratories to test patients for the virus that causes COVID-19. The second HCPCS code (U0002) allows laboratories to bill for non-CDC laboratory tests for the COVID-19 virus. The Medicare claims processing system will be able to accept these codes on April 1 for dates of service on or after February 4. Local Medicare Administrative Contractors are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates.

Series of Codes in LOINC in Development

The Regenstrief Institute is also creating a series of codes in Logical Observation Identifiers Names and Codes (LOINC) to identify the laboratory tests used to screen patients for the virus. Unique codes will make it easier to track cases of the 2019 novel coronavirus in the United States and globally. With more complete tracking, health leaders can study the virus and create strategies to address and contain the outbreak.

CPT Code Being Fast-Tracked

The American Medical Association also announced plans for fast tracking development of a CPT code for reporting novel coronavirus tests. The CPT Editorial Panel will manage the expedited process, including the creation of a test description to accompany the code and the effective date of the code. If approved, the new CPT code will support the response to the urgent public health need for streamlined reporting of novel coronavirus testing offered by hospitals, health systems, and laboratories in the United States.

Understanding COVID-19 and Coronaviruses

Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by a novel coronavirus. The name of the disease is COVID-2, whereas the name of the virus causing the disease is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The name of the virus was chosen because the virus is genetically related to the coronavirus responsible for the SARS outbreak of 2003. While related, the two viruses are different. Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). SARS is more deadly but much less infectious than COVID-19. There have been no outbreaks of SARS anywhere in the world since 2003.

At the end of January 2020, a total of 2,519 confirmed cases of MERS, including 866 associated deaths (fatality rate of 34.3 percent) were reported globally. The majority of these cases were reported from Saudi Arabia. Coronaviruses are zoonotic, meaning they are transmitted between animals and people. Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans. A novel coronavirus is a new strain that has not been previously identified in humans. The animal responsible for transmitting COVID-19 to humans has not yet been confirmed.

Since COVID-19 is a new disease, there is still much more to learn about the transmissibility, severity, and other features associated with COVID-19.

Risk of COVID-19 infection is higher for people who are in close contact with an individual known to have COVID-19, such as household members or healthcare workers. Other people at higher risk for infection are those who live in or have recently been in an area with ongoing spread of COVID-19. Individuals at higher risk of becoming seriously ill if they contract COVID-19 include older adults (over the age of 60) and people with serious chronic medical conditions, such as heart disease, diabetes, or lung disease. Since COVID-19 is a new disease, there is still much more to learn about the transmissibility, severity, and other features associated with COVID-19.

The CDC has developed a test to diagnose COVID-19 in respiratory and serum samples from clinical specimens. The National Institute of Allergy and Infectious Diseases also is accelerating efforts to develop additional diagnostic tests for COVID-19. These tests would help facilitate preclinical studies and aid in the development of medical countermeasures. Patients with COVID-19 develop mild to severe respiratory illness with symptoms of fever, cough, and shortness of breath.

There is no specific antiviral treatment for COVID-19. Medical care is focused on alleviating symptoms and providing supportive care. There is also no vaccine to protect against COVID-19. The best way to avoid contracting COVID-19 is to take everyday preventive measures such as avoiding close contact with people who are sick and washing your hands more often. The CDC has advised individuals at higher risk of getting very sick from COVID-19 to take precautions to keep space between yourself and others, limit close contact, avoid crowds as much as possible, avoid cruise travel and non-essential air travel, and to stay home as much as possible in the event of a COVID-19 outbreak in their community.

On January 30, the WHO’s International Health Regulations Emergency Committee declared the outbreak a public health emergency of international concern. On January 31, Health and Human Services Secretary Alex Azar declared a public health emergency for the United States to aid the nation’s healthcare community in responding to COVID-19. The WHO declared COVID-19 a pandemic on March 11.

CMS Call to Action

CMS issued a call to action to healthcare providers across the country to ensure they are implementing their infection control procedures, which they are required to maintain at all times. Additionally, CMS also announced that, until further notice, State Survey Agencies and Accrediting Organizations will focus their facility inspections exclusively on issues related to infection control and other serious health and safety threats, like allegations of abuse—beginning with nursing homes and hospitals. Critically, this shift in approach will allow inspectors to focus their energies on addressing the spread of COVID-19.

Additional Information

To learn more about coronaviruses and specifically about COVID-19, see the CDC and WHO websites:

 

Sue Bowman (sue.bowman@ahima.org) is senior director, coding policy and compliance at AHIMA.