Guidelines of Medical Billing For Corona Virus: Important CPT Codes For COVID 19

Guidelines of Medical Billing For Corona Virus: Important CPT Codes For COVID 19

Introduction

The complex landscape of medical coding and billing has taken on a critical role, particularly in the context of the ongoing COVID 19 pandemic. Adapting to the changing dynamics of healthcare is crucial for accurately documenting tests, treatments, and diagnoses related to the virus. Healthcare practitioners have integrated new codes and guidelines, often sourced from bodies like the American Medical Association (AMA) and regulatory entities such as Medicare and Medicaid.
A comprehensive understanding of COVID 19 terminology, including terms like “COVID 19” and “SARS-CoV-2,” is essential to ensure coding accuracy. Not only have medical practices encountered disruptions, but the pandemic has also introduced economic challenges similar to the Great Depression, with widespread unemployment worsening the economy. Consequently, medical billing and the careful tracking of payments have become increasingly complex, requiring thorough record-keeping and strict adherence to established protocols.
In the ever-evolving landscape of the pandemic’s progression, healthcare providers must understand a multifaceted landscape. This involves remaining up-to-date with novel codes, evolving regulations, and revised treatment strategies. Accurate coding for COVID 19 tests, vaccines, and associated interventions holds significant value, facilitating precise reporting, streamlined reimbursement procedures, and enhanced patient care. Ultimately, the collaborative efforts of medical coders, billers, and healthcare professionals play a crucial role in mitigating the pandemic’s impact on both patient well-being and the broader healthcare ecosystem.

What is Corona?

COVID 19 is caused by the SARS-CoV-2 virus. Most people who get the virus have mild to moderate breathing problems. They recover without special treatment. But some get really sick and need doctors’ help. Older people and those with health issues like heart problems, diabetes, or cancer are more likely to get severe sickness. However, Anyone can get COVID 19 and become seriously ill or die, no matter their age.
In order to prevent the virus from spreading, It is important to learn how it moves. The virus spreads when someone who has it coughs, sneezes, talks, sings or breathes. Tiny drops from their mouth or nose carry the virus and can go into someone else. Some drops are big; some are small, like tiny bits in the air. The germ that causes COVID 19 is called SARS-CoV-2. It’s related to the germ that caused a different sickness called SARS in 2003, but they make people sick in different ways.
For medical codes regarding COVID 19, the American Medical Association (AMA) made new codes. These codes are for things like tests to find the germ, tests to see if you had the germ before, and shots to prevent it. These new codes started quickly because of the emergency. The first new code, 87635, for finding the germ using special methods, came out on March 13, 2020. Some codes for shots remain in pendency until they’re allowed by the Food and Drug Administration.

Is Corona Back Again In The U.S.?

The U.S. has observed rising COVID 19 cases in the past three summers, making the current surge unsurprising after a period of decline, said CDC spokesperson Kathleen Conley. Dr. Bernard Camins from Mount Sinai Health System in New York City reported managing approximately 40 daily COVID 19 patients, up from around 10 earlier in the summer. Luckily, severe cases are limited, with just about 5% needing intensive care, a small fraction.
Experts emphasized that the vulnerable groups for severe illness remain consistent: older adults, those with diabetes, heart or lung conditions, and weakened immune systems. Hospitalizations are generally higher among the unvaccinated. Presently, COVID-19-linked fatalities haven’t increased, which typically lags behind hospitalization spikes. So far, timely use of antiviral treatments like Paxlovid might prevent a fatality increase, as Camins indicated.
Bill Hanage, an associate professor of epidemiology at Harvard’s T.H. Chan School of Public Health, recognized a slightly higher risk of contracting COVID-19 compared to earlier this summer. However, he pleased, “The likelihood of getting it is still relatively low,”, particularly for vaccinated individuals with negligible chances of severe illness.

Medical Billing For Corona Virus (COVID 19)

The COVID 19 pandemic has not only disrupted the healthcare system but also bought economic challenges similar to the Great Depression due to widespread unemployment. In the midst of these difficulties, medical practices must adapt to new billing and payment tracking procedures while dealing with strained resources and staff shortages. The pandemic’s impact on medical billing is considerable, highlighted by surprise medical bills frustrating an already stressed healthcare system. This multi-layered condition requires attention and response from the community in this regard.

12X, Hospital Inpatient

Inpatient Coding: Inpatient coding assigns codes for diagnoses and procedures for patients admitted to hospitals. It uses ICD-10-CM for diagnoses and ICD-10-PCS for procedures. In the U.S., ICD-10-PCS is only for inpatient care. It covers complex hospital procedures, not routine ones.

13X, Hospital Outpatient

Outpatient Coding: Outpatient coding is for patients not staying overnight in hospitals. It’s for services like doctor visits, tests, and surgeries in clinics or offices. It uses ICD-10-CM for diagnoses and CPT or HCPCS for procedures. Unlike inpatient coding, it doesn’t need ICD-10-PCS. Outpatient coding helps with billing, records, and care outside hospitals.

22X, Skilled Nursing Facility (SNF)

The “Medicare Claims Processing Manual,” Chapter 18, is a vital reference that offers comprehensive insights into the complex landscape of medical service billing. This chapter serves as a guiding compass, defining distinct billing protocols personalized to various healthcare scenarios. Here’s a concise overview of the billing procedures for different medical services under 22X, Skilled Nursing Facility (SNF).
Influenza and Pneumococcal Polysaccharide Vaccines: The manual underscores a clear separation for billing practices in this realm. Skilled Nursing Facilities (SNFs) are commended for billing the Medicare Administrative Contractor (MAC) for the services they provide. If services are not delivered by SNFs, the onus shifts to the servicing provider, practitioner, or supplier, ensuring a transparent billing process.
Hepatitis B Vaccines: SNFs are authorized to bill MAC not just for the Hepatitis B vaccine but also for its administration. This streamlined approach simplifies the billing process for this specific type of vaccine.
Colorectal Cancer Screenings, Prostate Cancer Screenings, and Bone Mass Measurements (BMM): The manual offers directives for billing in distinct contexts. While screening colonoscopies in SNFs are excluded from Medicare coverage, SNFs are directed to bill for hospital-based colonoscopies. Additionally, SNFs are to bill MAC for services furnished by them. Otherwise, billing responsibilities transfer to the servicing provider, practitioner, or supplier. These guidelines ensure alignment between billing practices and service specifics.
Glaucoma Screenings: Uniformity characterizes billing for glaucoma screenings. The manual establishes the absence of separable technical components across all provider types, leading to consistent billing approaches.

23X, SNF Outpatient

In cases where an institution limits its Medicare participation to a specific SNF segment, using bill type 23x (instead of 22x) is advised for beneficiaries. This prevents misidentifying beneficiaries as SNF residents, preventing inaccurate billing edits for outpatient therapy services. Bill type 23x is designated for services given to SNF outpatients, including those in the non-certified Medicare segment. This command aligns with the Medicare SNF Manual emphasizing bill type differences.
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82X, Hospice (Hospital)

Medicare hospitals use consistent billing processes for both Medicare Advantage and fee-for-service beneficiaries. The billing process starts with a notice of election for the Hospice benefit period, followed by claims using bill types 81X or 82X. If a hospital election is revoked, a final claim with occurrence code 42 is submitted to ensure ongoing care and payment.
Medicare physicians can bill fee-for-service A/B MAC (H) for Medicare Advantage beneficiaries, provided hospice billing criteria are met. Claims should have G.V. or G.W. modifiers and follow standard processing rules. A supersede code is used for review and payment approval in Medicare systems.
According to regulations, fee-for-service A/B MACs (H) remain responsible for payments until the end of the month in which hospice services are withdrawn. For Medicare Advantage, fee-for-service A/B MACs (H) handle claims until the following month. This approach guarantees continuous and seamless payment regardless of coverage type.

34X, Home Health

billing for Part B medical and health services and osteoporosis injections is done using Bill Type 34X When a patient is not under a Home Health (H.H.) plan of care. This is characterized by the following;
• A deductible is applicable.
• Coinsurance also applies.
However, there is an exception for certain protective services outlined in Chapter 18, where the deductible and coinsurance can be ignored. This provision emphasizes the importance of preventive care and aims to improve financial burdens for eligible patients seeking such services.

72X, Independent and Hospital-Based Renal Dialysis Facility

Outpatient dialysis services for patients with acute or chronic kidney failure who aren’t eligible for Medicare under ESRD provisions at the service time must be billed by the hospital.
Hospitals possessing a certified renal dialysis facility should bill outpatient ESRD-related services via the hospital-based facility using bill type 72x. If a hospital lacks a certified renal dialysis facility, it can bill for outpatient emergency or unscheduled dialysis services without receiving the base rate of the Prospective Payment System (PPS).
For more details about outpatient hospital billing policies for ESRD-related services, consult Chapter 4, section 210 of the manual. This policy definition ensures appropriate billing practices and effective management of outpatient dialysis services.

75X, Comprehensive Outpatient Rehabilitation Facility

A Comprehensive Outpatient Rehabilitation Facility (CORF) is a medical center offering outpatient diagnostic and restorative services to rehabilitate injuries, disabilities, or illnesses. Commonly referred to as outpatient rehabilitation care, CORFs provide medical treatment, therapy, and selected social or psychological services. Eligibility for Medicare Part B coverage of CORF services requires a doctor’s certification indicating a need for skilled rehabilitation care. Your doctor usually crafts a treatment plan and recertifies you every 90 days for ongoing Medicare coverage.
Services covered by a CORF encompass:
• Doctor sessions
• Physical, occupational, respiratory therapy, and speech-language pathology services
• Prosthetic and orthotic devices, including fitting, testing, and training in usage
• Relevant social and psychological services essential for the rehabilitation treatment
• Nursing care administered by a registered professional nurse or under their supervision
• Supplies and durable medical equipment (DME)
CORFs provide vital rehabilitation services under Medicare, fostering recovery and improved well-being for eligible individuals.

81X, Hospice (Non-Hospital)

The SNF has the authority to bill for additional services. Additional services, outlined in the Level of Coverage (LOC) Reimbursement Exclusions, can also be billed by the SNF if there’s a mutual agreement with the Plan to include them in the LOC.
For physical or occupational therapy provided in an outpatient setting, the relevant two-character CPT modifier codes (G.N. for speech-language pathology, G.O. for occupational therapy, and G.P. for physical therapy) must be added alongside the corresponding HCPCS code for each service date. The SNF manages and bills therapy services irrespective of where they were delivered, ensuring the services are properly consolidated and attributed back to the SNF.
This comprehensive approach ensures that ancillary services and therapy treatments are accurately billed and managed within the SNF’s scope, contributing to efficient and effective healthcare administration.

85X, Critical Access Hospital

Hospitals use either the ANSI X12N 837 I electronic format or Form CMS-1450 UB-92 to bill for covered outpatient services. These are categorized as a type of bills 13X, 83X, and 85X. Important references for this process are Medicare manuals such as Benefit Policy (Chapter 6), which defines outpatient care, Claims Processing (Chapter 3), which addresses inpatient-like outpatient services; and Chapter 25, for billing instructions.
HCPCS codes are used to describe Hospital OPPS or other outpatient payment method services. Precise reporting of line item dates of service for each required HCPCS code under OPPS is essential. Any missing or incorrect dates can result in Fiscal Intermediaries returning bills to providers. Accurate reporting ensures compliance with Medicare rules and guidelines.

Medical Coding For Corona Virus (COVID 19)

CPT Code: 91300

Description: COVID 19 vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use
Use with Administration Codes: 0001A (First dose), 0002A (Second dose), 0003A (Third dose), 0004A (Booster dose)
Vaccine: Pfizer-BioNTech

CPT Code: 91301

Description: COVID 19 vaccine, mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL dosage, for intramuscular use
Use with Administration Codes: 0011A (First dose), 0012A (Second dose), 0013A (Third dose)
Vaccine: Moderna

CPT Code: 91302

Description: COVID-19 vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative-free, 5×1010 viral particles/0.5mL dosage, for intramuscular use
Use with Administration Codes: 0021A (First dose), 0022A (Second dose)
Vaccine: AstraZeneca

CPT Code: 91303

Description: COVID-19 vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative-free, 5×1010 viral particles/0.5mL dosage, for intramuscular use
Use with Administration Code: 0031A (First dose), 0034A (Booster dose)
Vaccine: Janssen

CPT Code: 91304

Description: COVID-19 vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative-free, 5 mcg/0.5mL dosage, for intramuscular use
Use with Administration Codes: 0041A (First dose), 0042A (Second dose)
Vaccine: Novavax
These codes help healthcare providers accurately document the type of vaccine given and the corresponding administration.

ICD 10 Codes For COVID 19

XW 013S6

This code represents the process of giving the first dose of a COVID 19 vaccine. The vaccine is introduced into the subcutaneous tissue, which is the layer just beneath the skin. The method used is called “percutaneous approach,” which means the vaccine is injected by piercing the skin. This procedure is classified under a specific technology group marked as Group 6.

XW 013T6

Similar to the previous code, this one represents the process of the second dose of a COVID 19 vaccine. The approach and method are the same as in the first code—injecting under the skin through a percutaneous approach—and it also belongs to technology Group-6.

XW 013U6

This code represents a broader description of injecting COVID 19 vaccine. Unlike the previous two codes, it doesn’t specify; the first or second dose. This code just refers to a procedure of injecting vaccine into the subcutaneous tissue using the same percutaneous approach.  This procedure is also classified under a specific technology group marked as Group-6.

XW 023S6

This code represents the processes of giving first dose of the COVID 19 vaccine into a muscle using a percutaneous approach. The vaccine is injected into the muscle tissue by piercing the skin. This procedure is also classified under a specific technology group marked as Group 6.

XW 023T6

Similar to the previous code (XW023S6), this code refers to administering the second dose of the vaccine into a muscle through a percutaneous approach. This procedure is also classified under a specific technology group marked as Group 6.

XW 023U6

This code represents the general process of giving a COVID 19 vaccine into a muscle using the same percutaneous approach. This procedure is also classified under a specific technology group marked as Group 6.

CPT Codes for COVID 19 Vaccines

CPT Code 91300

Administration Code(s): 0004A (Booster), 0001A (1st Dose), 0002A (2nd Dose), 0003A (3rd Dose)
Manufacturer: Pfizer, Inc
Vaccine Name: Pfizer-BioNTech COVID 19 Vaccine
NDC: 59267-1000-1, 59267-1000-01

CPT Code 91301

Administration Code(s): 0011A (1st Dose), 0012A (2nd Dose), 0013A (3rd Dose)
Manufacturer: Moderna, Inc
Vaccine Name: Moderna COVID 19 Vaccine/spikevax
NDC: 80777-273-10, 80777-0273-10

CPT Code 91302

Administration Code(s): 0021A (1st Dose), 0022A (2nd Dose)
Manufacturer: AstraZeneca
Vaccine Name: AstraZeneca COVID 19 Vaccine
NDC: 0310-1222-10, 00310-1222-10

CPT Code 91303

Administration Code(s): 0034A (Booster), 0031A (Single Dose)
Manufacturer: Janssen
Vaccine Name: Janssen COVID 19 Vaccine
NDC: 59676-580-05, 59676-0580-05

CPT Code 91304

Administration Code(s): 0044A (Booster), 0041A (1st Dose), 0042A (2nd Dose)
Manufacturer: Novavax
Vaccine Name: Novavax COVID 19 Vaccine
NDC: 80631-100-01, 80631-1000-01

CPT Code 91305

Administration Code(s): 0054A (Booster), 0051A (1st Dose), 0052A (2nd Dose), 0053A (3rd Dose)
Manufacturer: Pfizer, Inc
Vaccine Name: Pfizer-BioNTech COVID 19 Vaccine
NDC: 59267-1025-1, 59267-1025-01

CPT Code 91306

Administration Code(s): 0064A (Booster)
Manufacturer: Moderna, Inc
Vaccine Name: Moderna COVID 19 Vaccine
NDC: 80777-273-10, 80777-0273-10

CPT Code 91307

Administration Code(s): 0074A (Booster), 0071A (1st Dose), 0072A (2nd Dose), 0073A (3rd Dose)
Manufacturer: Pfizer, Inc
Vaccine Name: Pfizer-BioNTech COVID 19 Vaccine
NDC: 59267-1055-1, 59267-1055-01

CPT Code: 91308

Administration Code(s): 0081A (1st Dose), 0082A (2nd Dose), 0083A (3rd Dose)
Manufacturer: Pfizer, Inc
Vaccine Name: Pfizer-BioNTech COVID 19 Vaccine
NDC: 59267-0078-1, 59267-0078-4

CPT Code: 91309

Administration Code(s): 0094A (Booster), 0091A (1st Dose), 0092A (2nd Dose), 0093A (3rd Dose)
Manufacturer: Moderna, Inc
Vaccine Name: Moderna COVID 19 Vaccine
NDC: 80777-275-05, 80777-0275-05

Conclusion

In the ever-changing landscape of healthcare, the roles of medical coding and billing have become crucial, especially in the context of the COVID 19 pandemic. Adapting to the shifts brought on by the pandemic is crucial for precise reporting of tests, treatments, and diagnoses. The healthcare sector has quickly incorporated new codes and guidelines, both from bodies like the American Medical Association (AMA) and regulatory entities like Medicare and Medicaid. Staying well-informed through reliable sources such as the AAPC Knowledge Center is essential for medical coders and practitioners.
A clear understanding of COVID 19 terminology, including terms like COVID 19 and SARS-CoV-2, is important for ensuring accurate coding. The pandemic has not only affected medical practices but has also posed economic challenges. Medical billing and payment tracking have become even more complicated, requiring thorough documentation and adherence to guidelines.
As the pandemic continues its growth, healthcare providers must understand a multifaceted environment. It helps in staying updated on fresh codes, regulations, and treatment protocols. Accurate coding for COVID 19 tests, vaccines, and related treatments is helpful in precise reporting, reimbursement, and effective patient care. By and large, the collaborative efforts of medical coders, billers, and healthcare professionals contribute significantly to improving the pandemic’s impact on patient health and the healthcare system as a whole.

Frequently Asked Questions (FAQs)

What is medical coding in the context of COVID 19?

Medical coding is the process of translating medical diagnoses, treatments, and procedures into universally recognized alphanumeric codes. These codes play a crucial role in accurate billing, reimbursement, and maintaining proper medical records. In the case of COVID 19, medical coding helps healthcare providers report and track tests, treatments, and diagnoses related to the pandemic accurately.

What are CPT codes in the context of COVID 19?

Current Procedural Terminology (CPT) codes are standardized codes used to describe medical procedures and services. For COVID 19, specific CPT codes have been established to identify and bill for services such as tests, vaccines, and treatments related to the virus. These codes help ensure consistency and accuracy in medical billing for COVID 19-related healthcare services.

How has the COVID 19 pandemic impacted medical billing practices?

The COVID 19 pandemic has brought significant changes to medical billing practices. With the introduction of new tests, treatments, and vaccines, medical coders and billers have had to adapt to these changes and ensure proper documentation quickly. The pandemic has also highlighted the importance of accurate billing for telehealth services and the challenges of billing during times of economic uncertainty.

How can one stay updated on COVID 19 coding and billing guidelines?

The healthcare industry has various resources to stay informed about COVID 19 coding and billing guidelines. Organizations like the American Medical Association (AMA) and regulatory bodies such as Medicare and Medicaid provide guidelines and updates for healthcare providers.

What are ICD 10 codes, and how are they used for COVID 19?

International Classification of Diseases, 10th Edition (ICD 10) codes are used to classify diseases and medical conditions. They are crucial for diagnosing and treating patients accurately. In the context of COVID 19, specific ICD 10 codes have been designated to identify cases, complications, and related conditions caused by the virus.

How do medical coding practices differ between inpatient and outpatient care for COVID 19 patients?

Medical coding practices vary between inpatient and outpatient care. Inpatient coding involves assigning codes for diagnoses and procedures for patients admitted to hospitals, while outpatient coding covers services provided outside of hospital stays. Proper coding ensures accurate billing and documentation for both types of care, especially considering the unique challenges posed by COVID 19.


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