COVID-19 Related ICD-10 and Billing Updates

Since the beginning of the pandemic, there has been progressive activation and up-dation of COVID-19 codes by the CDC. In this blog, we present an overhaul of these along-with specific changes in coding and billing guidelines related to COVID-19, for the year CY2022.

ICD-10 Updates

• When COVID-19 meets the definition of principal diagnosis, code U07.1, COVID-19, should be sequenced first, followed by the appropriate codes for associated manifestations, except when another guideline requires that certain codes be sequenced first, such as obstetrics, sepsis, or transplant complications.
• For sequela of COVID-19, or associated symptoms or conditions that develop following a previous COVID-19 infection, assign a code(s) for the specific symptom(s) or condition(s) related to the previous COVID-19 infection, if known, and code U09.9, Post COVID-19 condition, unspecified.
• Code U09.9 should not be assigned for manifestations of an active (current) COVID-19 infection.
• For individuals who previously had COVID-19, without residual symptom(s) or condition(s), and are being seen for follow-up evaluation, and COVID-19 test results are negative, assign codes Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, and Z86.16, Personal history of COVID-19.
• If a patient has a condition(s) associated with a previous COVID-19 infection and develops a new active (current) COVID-19 infection, code U09.9 may be assigned in conjunction with code U07.1, COVID-19, to identify that the patient also has a condition(s) associated with previous COVID-19 infection. Code(s) for the specific condition(s) associated with the previous COVID-19 infection and code(s) for manifestation(s) of the new active (current) COVID-19 infection should also be assigned.
• Under immunization for COVID-19, use code Z18.310, Unvaccinated for COVID-19, when the patient has not received at least one dose of any COVID-19 vaccine; Code Z28.311, Partially vaccinated for COVID-19, may be assigned when the patient has received at least one dose of a multi-dose COVID-19 vaccine regimen but has not received the full set of doses necessary to meet the Centers for Disease Control and Prevention (CDC) definition of “fully vaccinated” in place at the time of the encounter.
• There is an addition of 15 new codes specific to COVID-19 vaccines effective from January 2022 to clinically distinguish each vaccine and dosing schedule.

COVID-19 Vaccines and Monoclonal Antibody Treatment

• CMS will maintain the current payment rate of $40 per dose for the administration of the COVID-19 vaccines through the end of the calendar year in which the PHE ends, after which a rate of about $30 will be set like other preventive vaccines. The add-on payment of $35.50 will continue to be paid when a COVID-19 vaccine is administered in the home until the end of the year in which the PHE expires. However, it will not be billable when a different preventive vaccine is concurrently being administered in the home.
• CMS will continue to pay for COVID-19 monoclonal antibody therapeutic products as vaccines until the end of the calendar year in which the PHE expires. In the interim, CMS will continue to pay for the products at 95 percent of the Average Wholesale Price (unless provided for free by the government), plus administration rates of $450 for administration in a healthcare setting and $750 for administration at home.

Remaining abreast with coding and billing updates is a best practice that should be adopted by providers to ensure maximized reimbursement for their services. At Curemed solutions, all our staff is up to date with the latest codes and guidelines for billing, ensuring to be a reliable partner for all your revenue
cycle management needs.

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2022