Article - Important Updates about COVID-19 Billing and Coding for Healthcare Providers!

The USA healthcare badly affected due to COVID-19 outbreak. This pandemic situation also affected business as usual for Providers. Accurate Medical Billing and Coding can help healthcare organizations to keep them financially healthy and ready for future outbreak. We will discuss further about important updates about COVID-19 billing and coding for healthcare providers.

Providers can keep a track of COVID-19 spread with help of COVID-19 Billing and Coding, and will get paid for treatment and testing for patients who are showing symptoms of Novel Coronavirus. Efficient medical billing and coding process will help providers to surpass the challenges of COVID-19.

Pain areas of healthcare providers

Due to the surge in the novel coronavirus cases, there is a huge need of primary care providers and the proper medical staff to address the infected Americans and give proper treatment. Shortage of reserved care facility is another big issue for the healthcare systems to manage the country’s rising cases of COVID-19. City has seen many mergers - acquisition & closure of hospitals, leading to shortage of adequate number of beds and the required healthcare staff.

As during any pandemic, the infected patients rises exponentially to the hospitals is different than the normal period. The healthcare providers’ needs to be well organised and seek for government assistance to give maximum care to the patients. Having an organised system and well equipped with resources shall enable the providers to address the surge in better manner.

Again, there are many healthcare equipment’s which has a huge shortage and high demand as their importance plays a primary role in the patient’s life. ICU Beds, Ventilators, Masks and the PPE kits are the crucial ones are necessary medical equipment’s to empower the hospital in functioning correctly and treating the patients.

U.S has earlier also seen similar epidemics like bird flu or swine flu or SARS or MERS and this has always alarmed the government agencies about the need of scaling up on the healthcare providers and the medical essentials.

This is not a business as usual time, healthcare providers had to reinvent the normal working model to address this surge of novel coronavirus patients. In such a short-term, challenges over billing and coding has drastically become unusual due to the increasing job cuts are acquiring another blend of patients to associations.  Adoption of new codes on medical billing and coding will be a major change for the providers and will be more effective.

Must to know codes on medical billing and coding under COVID-19 Circumstances:

Healthcare providers have a list of codes designed with respective to the illness and these are essentials for patients’ documentation and billing purpose. There are multiple new codes added to system to get reimbursement during this pandemic.

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) CODE

World Health Organization (WHO) has declared Novel Coronavirus as a pandemic and CDC has announced an important update on ICD-10-CM code. Under the National Emergencies Act Section 201 and 301, the diagnosis code U07.1 will be used for CVOID-19 treatment.

CODE U07.1

CDC has said that the diagnosis code U07.1 should be only used on the confirmed cases with the test result as positive (+ve) and made an exception to the hospital inpatient guideline Section II, H. In this context, “confirmation” document does not require for the type of test performed; the healthcare provider’s document mentioning an individual has COVID-19 is sufficient.

According to the CMS, the ICD-10 Medicare Severity-Diagnosis Related Group (MS-DRG) Grouper assigns each case in a format of MS-DRG which involves reported diagnosis and procedure codes and demographic information. This MS-DRG Grouper software package to add-on the new code, Version 37.1 R1, is effective for discharges on or after April 1, 2020.

Current Procedural Terminology (CPT) CODE

The American Medical Association (AMA) has officially declared about the addition to the CPT code to streamline the medical billing and coding data management. 

AMA President Patrice A. Harris, M.D., M.A Said “Antibody testing that identifies patients that have been exposed to the novel coronavirus (SARS-CoV-2) and developed an immune response is likely to have important public health implications by providing a clearer picture of the prevalence of the disease in the U.S.”.

AMA has announced addition two new codes in category of CPT i.e. 86328 & 86769 ((severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])) for testing of antibody tests.

As per the AMA, they have asked the healthcare providers to manually update their systems which shall streamline the process of testing these new CPT codes were introduced and should be complied with the existing the code system for the future reference.

During the national health emergency, AMA has released an important coding advice to all healthcare providers.

Healthcare Common Procedure Coding System (HCPCS) CODE

CMS has taken additional measures on safety of Americans hence introduced HCPCS that can be used by laboratories for the medical billing of COVID-19 patients.

For settlement of claims, HCPCS has done a standardization of codes that is beneficial to the patients for health insurance claims. On the testing of COVID-19 purpose, CMS has introduced two new codes i.e. U0001 and U0002 they play a vital role in testing and billing of laboratories to SARS-CoV-2/2019-nCoV (COVID-19).

CMS has declared new HCPCS codes on March 5 and February 13, 2020 for healthcare providers to test patients of COVID-19. CMS believes that these codes will help testing and improve tracking.

Medicare will be reimbursing $35 on U0001 and $51 on U0002 tests as per the Medicare Administrative Contractor (MAC) pricing list.

New Telehealth Billing and Coding system

Under President Trump’s administration, CMS has extended medical services to Telehealth medical service which has been beneficiary to many Americans till now, as this also help in person’s visit to hospital and make doctors be available on flexible working hours.

Medicare coverages has broadened claims and includes Medicare telehealth visits, virtual check-ins, and e-visits.

Telehealth visits

By using audio or video platforms, the patients can interact with Doctors at Hospitals and Healthcare providers can actually diagnose and recommend the necessary procedure further.

Virtual check-ins:

Patients have been using this platform to benefit on their real times symptoms by sharing the reports and testing images and get the appropriate consultations from the healthcare providers.


This is also known as non-Face to Face communication done by the patient to the healthcare providers at their own comfort level and later, the providers can follow-up with the patients and advised them to seek for an in-person examination for further check-ups.

CMS has introduced Medicare Physician Fee Schedule for telehealth service.

Recommendation for Healthcare Providers on Billing and Coding systems: 

Maria Noelle Ward, MEd, RHIA, CCS, CCS-P, director of HIM practice excellence at AHIMA said Rules and regulations are seemingly changing every day as new information emerges regarding COVID-19, and with that billing and coding policies shift to account for the latest information. With that in mind, providers need to be diligently following billing and coding guidance from the CDC, CMS, AMA, and other official organizations.

During this epidemic period, Hospitals are also required to give priority on their OPD and the reserve their facility for on-going period.

For accuracy of billing and documentation in the healthcare provider’s electronic health record (EHR) digital systems. The American Health Information Management Association (AHIMA) has made a Clinical Documentation Integrity (CDI) template necessary for all providers.

Patients care can be significantly achieved with all the coded data complied with the greatest accuracy and reimbursement details.

To get an assistance and complete accuracy, we have our trained and most trusted experts on billing and coding who shall partner you during this pandemic.

Published By - Medical Billers and Coders
Published Date - Aug-06-2020 Back

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