COVID-19 Resource Center

COVID-19 Z Codes

By Garnette McLaughlin | June 3, 2020 | Coding, Education, COVID-19

Given the complexity and ever changing guidance on Z codes for COVID-19, here is a quick look at the current Z codes with examples. Yes, the guidelines and instructional notes makes use of the Z codes super tricky. The codes are new and still require additional official guidance or changes to the coding system  to use them correctly. And, depending on how the codes are applied and combined with the ever changing CPT testing codes, we will likely see denials later that relate back to this.

Note: Many are struggling with the challenges presented by codes Z03.818 and Z20.828. In fact, there is even debate on whether Z11.59 Screening is appropriate. A question has been submitted to Coding Clinic on this a response is pending. These are the best recommendations that can be made at this time given the CDC guidance, Coding Guidelines, and instructional notes.

COVID Related Z Code Examples

Below are examples of scenarios for the use of Z codes. Please be aware that every account stands alone, and guidelines should be collectively applied based on the scenario of the case being coded. If there is a question to the appropriate code assignment, please contact the necessary resources for assistance. As in all coding, code selection should be made on a case-by-case basis using the documentation provided; follow all coding guidelines carefully.

Patient presents to the hospital for a hip fracture and, prior to surgery, they are testing the patient for COVID-19 due to protocol.  The patient has no signs or symptoms and has not been exposed to anyone with/or suspected to have COVID-19. Test results are negative.

Code Z11.59 Screening would be added as an additional diagnosis.

The patient is being moved to a nursing home after a stay for management of CHF exacerbation and is tested for COVID-19 before the transfer per protocol, no signs and symptoms noted, and test results are negative.

Code Z11.59 Screening would be added as an additional diagnosis.

The patient presents with no exposure to have a routine COVID-19 screening test in the outpatient setting, no signs and symptoms are present, and the test is negative.

Code Z11.59 Screening would be used as your first listed code.

The patient was recently working at the grocery store with high volume traffic.  The patient has not felt any symptoms but was due to the nature and potential exposure to COVID-19 was sent over to the clinic to be tested. Test results were found to be negative and therefore ruled out.

Code Z03.818 Possible exposure to COVID-19 would be used as your first listed code.

The patient presents to be tested for COVID-19 due to exposure. She is the caregiver of her husband, who recently tested positive. She has had no symptoms up to this point and is generally well appearing.  The test was negative, and the patient returned home.

Code Z20.828 Actual exposure to someone confirmed or suspected of having COVID-19 as your first listed code

The patient presents with a fever and shortness of breath, and a COVID-19 test is performed. The test returns a negative result.

Code fever, shortness of breath followed by Z20.828 Actual exposure to someone confirmed or suspected of having COVID-19 as an additional diagnosis.

About the Author: Garnette McLaughlin DBA, RHIA, CCS, CDIP, CICA serves as a Senior Consultant at Intersect Healthcare and Denial Research Group/AppealMasters. Garnette can be reached at gmclaughlin@intersecthealthcare.com.

END OF COVID-19 FINANCIAL IMPACT WHAT HOSPITALS SHOULD CONSIDER

Written by James Haering, DO, SFHM, CHCQM | April 14, 2020

Following the END of the COVID19 PANDEMIC, it will likely take months if not years to untangle the mess caused by the fast and furious implementation of changes and waivers to the Utilization Management (UM) process.

Expect that Payers and Providers will have disagreements about the interpretation of these waivers.

ENSURING REIMBURSEMENT of MEDICALLY NECESSARY SERVICES, will be CRITICAL to the FINANCIAL STABILITY of MANY HOSPITALS. Payers too, will look to minimize losses, especially with projected declines in member enrollment, and increased payment for medically complex patients who require a prolonged period of recovery.

While it is difficult to keep in the forefront of our thoughts, it’s still important for Physician Advisors and UM services to IMPLEMENT STRATEGIES NOW to DECREASE the IMPACT later.

CONSIDERATIONS:

1. When it does not compromise patient safety, or the performance of the system, FOLLOW THE STANDARD RULES AND REGULATIONS. In other words, just because there is a waiver does not necessarily mean you must use it.

2. CLEARLY DOCUMENT at the time of service, when EXTERNAL FORCES have ALTERED the NORMAL PROCESS. E.g. a lack of payer authorization for hospitalization, due to either the payer’s inability to review the case, or the urgency of medical care within the facility.

3. DOCUMENT CLEARLY when there is a NEED for CONTINUED HOSPITALIZATION of a STABILIZED (but still infectious) PATIENT, DUE to a COMMUNITY BENEFIT. E.g. a danger to the community due to potential spread of a communicable disease.

4. ENSURE INSTITUTIONAL MEMORY regarding the TIMEFRAME RELATED to the EMERGENCY DECLARATION and ASSOCIATED CMS/PAYER WAIVERS. Any retrospective denials between 13 MARCH, 2020 (the date the Stafford-based declaration of a national emergency was announced), and the yet to be determined end date of the emergency, should be based upon the rules and regulations in place to manage services during the COVID19 Pandemic.

Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge

By Denise Wilson | March 30, 2020

The Centers for Medicare & Medicaid Services (CMS) announced temporary regulatory changes to assist the American healthcare system in responding to the COVID-19 pandemic. The changes include permission for certain non-hospital buildings and spaces such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories to be used for patient care and quarantine sites. Remote COVID-19 testing will be allowed in drive-through and off-campus test sites. Telehealth services are also being promoted as a means to expand available medical services while practicing social distancing.

CMS is also allowing hospitals and healthcare systems to increase their workforce by removing barriers to the rapid hiring of clinicians in the community. Some waivers are allowing relaxation of some oversight or supervisory requirements for practitioners.

For denial and appeal management professionals, CMS has announced a temporary relief from many audit requirements and a suspension of documentation requests.

Downloads

Clinical Documentation Integrity

Make sure that the diagnoses of acute respiratory failure, ARDS, and associated infections, as appropriate, are supported on a clinical basis and documented clearly.

  • What is the P/F ratio?
  • What do you see and hear?
  • What needs done and why?
  • How did the patient respond to interventions?
  • Is the RR really only 18 when you are examining the patient?
  • Did the patient require O2 at home? How much?

Respiratory distress or acute respiratory distress does not equal acute respiratory failure.

  • Be careful about copying and pasting or using default language. Documentation of “lungs clear bilaterally”, “no distress”, “respirations even and unlabored” , “RR 18” does not support acute respiratory failure, pneumonia, ARDS, or the need for intubation.

Be precise about reasons for intubation.

  • Intubation for airway protection is not the same as intubation for respiratory failure.
  • “Impending” respiratory failure is nonspecific. If the patient is being intubated for airway protection or if the patient actually meets criteria for acute respiratory failure, document as such.

Coders and CDS’ – query when you must!

  • Compliant queries, along with thoughtful and appropriate answers, can be used to clarify situations and argue denials successfully.
  • Be sure the specific types and sites of infections are very clear and coded appropriately. Is it pneumonia, bronchitis, or lower respiratory infection unspecified?

Coders and CDS’: If the patient is on a ventilator, be sure to count the number of hours appropriately and according to guidelines.

  • If not sure, ask a second person to also count the hours.

ICD-10-CM Official Coding and Reporting Guidelines

In the CDC’s ICD-10-CM Official Coding and Reporting Guidelines, April 1, 2020 through September 30, 2020, the CDC states:

  • For a confirmed diagnosis, assign code U07.1, COVID-19. This is an exception to the hospital inpatient guideline Section II, H. In this context, “confirmation” does not require documentation of the type of test performed; the provider’s documentation that the individual has COVID-19 is sufficient.

See: https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf

MS-DRG Grouper

The ICD-10 MS-DRG Grouper, Version 37.1, will assign diagnosis code U07.1, COVID-19 to MS-DRGs:

  • 177, 178, 179 (Respiratory Infections and Inflammations)
  • 791, 793 (Prematurity, Full Term Neonate with Major Problems)
  • 974, 975, 976 (HIV with Major Related Condition)

See:https://edit.cms.gov/files/document/icd-10-ms-drgs-version-371-r1-effective-april-1-2020-updated-march-23-2020.pdf

Coding

Make sure to use the current advice when coding the novel coronavirus infections. Some good coding resources are:

ICD-10-CM

The Centers for Disease Control (CDC) has created the ICD-10 code U07.1 for COVID-19 starting April1, 2020.
Use additional code to identify pneumonia or other manifestations.

  • Only confirmed cases are to be coded.
  • For suspected COVID-19 exposure but subsequently ruled out (no confirmed infection) after evaluation/testing assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.
  • For definite COVID-19 exposure, but no confirmed infection assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.

See: https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-3-18-2020.pdf

ICD-10-PCS

Effective August 1, 2020, CMS is implementing 12 new procedure codes to describe the introduction or infusion of therapeutics, including remdesivir and convalescent plasma, into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). These new codes are effective for discharges on or after August 1, 2020. As the procedure codes are designated as non-O.R. procedures, there is no assigned MDC or MS-DRG. The ICD-10 MS-DRG assignment is dependent on the reported principal diagnosis, any secondary diagnoses defined as a complication or comorbidity (CC) or major complication or comorbidity (MCC), procedures or services performed, age, sex, and discharge status. You can access the announcement at: https://www.cms.gov/files/document/icd-10-ms-drgs-version-372-effective-august-01-2020.pdf

The ICD-10 MS-DRG V37.2 Grouper Software, Definitions Manual Table of Contents and the Definitions of Medicare Code Edits V37.2 manual will be available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software.html.

The Code Tables, Index and related Addenda files for the 12 new procedure codes are available at: https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-PCS.

ICD-10-CM Official Coding and Reporting Guidelines

In the CDC’s ICD-10-CM Official Coding and Reporting Guidelines, April 1, 2020 through September 30, 2020, the CDC states:

  • For a confirmed diagnosis, assign code U07.1, COVID-19. This is an exception to the hospital inpatient guideline Section II, H. In this context, “confirmation” does not require documentation of the type of test performed; the provider’s documentation that the individual has COVID-19 is sufficient.
  • Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or state level, but it has not yet been confirmed by the Centers for Disease Control and Prevention (CDC). CDC confirmation of local and state tests for COVID-19 is no longer required.
  • If the provider documents “suspected,” “possible,” “probable,” or “inconclusive” COVID-19, do not assign code U07.1. Assign a code(s) explaining the reason for encounter (such as fever) or Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.
  • 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 in the case of obstetrics patients as indicated in Section . I.C.15.s. for COVID-19 in pregnancy, childbirth, and the puerperium.

See: https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf

MS-DRG Grouper

The ICD-10 MS-DRG Grouper, Version 37.1, will assign diagnosis code U07.1, COVID-19 to MS-DRGs:

  • 177, 178, 179 (Respiratory Infections and Inflammations)
  • 791, 793 (Prematurity, Full Term Neonate with Major Problems)
  • 974, 975, 976 (HIV with Major Related Condition)

See: https://edit.cms.gov/files/document/icd-10-ms-drgs-version-371-r1-effective-april-1-2020- updated-march-23-2020.pdf

Billing

Billing for laboratory testing of SARS-CoV-2 (COVID-19)

HCPCS code (U0001) – This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2
HCPCS code (U0002) – This code allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2

The Medicare claims processing systems will be able to accept these codes starting on April 1, 2020, for dates of service on or after February 4, 2020.

See: https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-test

Billing for laboratory testing of SARS-CoV-2 (COVID-19) using high throughput technologies

CMS-Ruling 2020-1-R

HCPCS code (U0003) – 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, making use of high throughput technologies as described by CMS-2020-01-R.

HCPCS code (U0004) – 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.

It is noted that U0003 should identify tests that would otherwise be identified by CPT code 87635 but for being performed with these high throughput technologies. It is further noted that U0004 should identify tests that would otherwise be identified by U0002 but for being performed with these high throughput technologies. Finally, it is noted that neither U0003 nor U0004 should be used for tests that detect COVID-19 antibodies.

This Ruling expires upon the expiration of the ongoing emergency period defined in paragraph (1)(B) of section 1135(g) of the Act beginning on or after March 18, 2020.

See: https://www.cms.gov/files/document/cms-2020-01-r.pdf

COVID-19: Modified Ordering Requirements for Laboratory Billing

During the COVID-19 Public Health Emergency, CMS is relaxing billing requirements for laboratory tests (PDF) required for a COVID-19 diagnosis. Any health care professional authorized under state law may order tests. Medicare will pay for tests without a written order from the treating physician or other practitioner:

  • If an order is not written, an ordering or referring National Provider Identifier (NPI) is not required on the claim
  • If an order is written, include the NPI of the ordering or referring professional, consistent with current billing guidelines

For More Information:

Reporting Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) Laboratory Testing

On March 13, 2020 the American Medical Association (AMA) Current Procedural Terminology (CPT®) Editorial Panel published a new CPT code for reporting SARS-CoV-2 laboratory testing. The code is effective immediately and will be included in the CPT 2021 code set in the Microbiology subsection of the Pathology and Laboratory setting.

  • 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

Per guidance issued by the AMA, if the claim is submitted to a payer that requires CPT codes, then code 87635 should be reported. Conversely, if the payer requires use of the HCPCS Level II code, the HCPCS Level II code should be reported. CPT and HCPCS codes should not both be reported on the same claim.

See: https://www.ama-assn.org/system/files/2020-03/cpt-assistant-guide-coronavirus.pdf

On April 14, 2020 the American Medical Association (AMA) Current Procedural Terminology (CPT®) Editorial Panel published a new CPT code for reporting blood tests performed to specifically detect antibodies associated with the SARS-CoV-2 virus. The two new codes were effective immediately.

  • 86328 Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
  • 86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

See: https://www.ama-assn.org/press-center/press-releases/ama-announces-expedited-updates-cpt-covid-19-antibody-tests

Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Code U0002 and 87635

Medicare will permit the use of codes U0002QW and 87635QW for claims submitted by facilities with a valid, current CLIA certificate of waiver with dates of service on or after March 20, 2020. Modifier QW is used to indicate that the diagnostic lab service is a CLIA (Clinical Laboratory Improvement Amendment) waived test and that the provider holds at least a Certificate of Waiver.

Tests listed on the FDA’s Emergency Use Authorizations (EUAs) for COVID-19 website, https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations, under the Test Kit Manufacturers and Commercial Laboratories Table that include the terms “patient care settings outside of the clinical laboratory environment,” “near patient testing,” or “point of care” in the EUA can be used by facilities having a current CLIA certificate of waiver. On March 20, 2020, FDA issued the first EUA containing the previous terms. HCPCS code U0002 and 87635 must have the modifier QW to be recognized as a test that can be performed in a facility having a CLIA certificate of waiver.

See: https://www.cms.gov/files/document/mm11765.pdf

New Specimen Collection Codes for Laboratories Billing for COVID-19 Testing

Clinical diagnostic laboratories: To identify and reimburse specimen collection for COVID-19 testing, CMS established two Level II HCPCS codes, effective with line item date of service on or after March 1, 2020:

  • G2023 – Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
  • G2024 – Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source

These codes are billable by clinical diagnostic laboratories.

See: https://www.cms.gov/files/document/mm11681.pdf

Hospital OPPS: New Coronavirus Specimen Collection Code

To identify and pay for specimen collection for COVID-19 testing, CMS established a new Level II HCPCS code for billing Medicare under the Outpatient Prospective Payment System (OPPS).

The new code, C9803, Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source, is effective for services provided on or after March 1, 2020.

OPPS claims received on or after May 1, 2020, with Coronavirus Specimen Collection HCPCS Codes G2023 and G2024 will be returned to you with edit W7062. Resubmit returned claims as a packaged service to include Code C9803, when appropriate.

Billing for Professional Telehealth Services During the Public Health Emergency rev 2020-04-06

Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. When billing professional claims for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with:

  • Place of Service (POS) equal to what it would have been had the service been furnished in-person
  • Modifier 95, indicating that the service rendered was actually performed via telehealth

As a reminder, CMS is not requiring the CR modifier on telehealth services. However, consistent with current rules for telehealth services, there are two scenarios where modifiers are required on Medicare telehealth professional claims:

  • Furnished as part of a federal telemedicine demonstration project in Alaska and Hawaii using asynchronous (store and forward) technology, use GQ modifier
  • Furnished for diagnosis and treatment of an acute stroke, use G0 modifier

There are no billing changes for institutional claims; critical access hospital method II claims should continue to bill with modifier GT. This message issued from CMS on April 4, 2020, corrects a prior message that appeared in their March 31, 2020 MLNConnects Special Edition.

See: https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-04-03-mlnc-se

Families First Coronavirus Response Act Waives Coinsurance and Deductibles for Additional COVID-19 Related Services

The Families First Coronavirus Response Act waives cost-sharing under Medicare Part B (coinsurance and deductible amounts) for Medicare patients for COVID-19 testing-related services. These services are medical visits for the HCPCS evaluation and management categories described below when an outpatient provider, physician, or other providers and suppliers that bill Medicare for Part B services orders or administers COVID-19 lab test U0001, U0002, or 87635.

Cost-sharing does not apply for COVID-19 testing-related services, which are medical visits that: are furnished between March 18, 2020 and the end of the Public Health Emergency (PHE); that result in an order for or administration of a COVID-19 test; are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test; and are in any of the following categories of HCPCS evaluation and management codes:

• Office and other outpatient services
• Hospital observation services
• Emergency department services
• Nursing facility services
• Domiciliary, rest home, or custodial care services
• Home services
• Online digital evaluation and management services

Cost-sharing does not apply to the above medical visit services for which payment is made to:

• Hospital Outpatient Departments paid under the Outpatient Prospective Payment System
• Physicians and other professionals under the Physician Fee Schedule
• Critical Access Hospitals (CAHs)
• Rural Health Clinics (RHCs)
• Federally Qualified Health Centers (FQHCs)

For services furnished on March 18, 2020, and through the end of the PHE, outpatient providers, physicians, and other providers and suppliers that bill Medicare for Part B services under these payment systems should use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services and should NOT charge Medicare patients any co-insurance and/or deductible amounts for those services.

For professional claims, physicians and practitioners who did not initially submit claims with the CS modifier must notify their Medicare Administrative Contractor (MAC) and request to resubmit applicable claims with dates of service on or after 3/18/2020 with the CS modifier to get 100% payment.

For institutional claims, providers, including hospitals, CAHs, RHCs, and FQHCs, who did not initially submit claims with the CS modifier must resubmit applicable claims submitted on or after 3/18/2020, with the CS modifier to visit lines to get 100% payment.

See: https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-04-07-mlnc-se

COVID-19: Expanded Use of Ambulance Origin/Destination Modifiers

During the COVID-19 Public Health Emergency, Medicare will cover a medically necessary emergency and non-emergency ground ambulance transportation from any point of origin to a destination that is equipped to treat the condition of the patient consistent with state and local Emergency Medical Services (EMS) protocols where the services will be furnished. On an interim basis, we are expanding the list of destinations that may include but are not limited to:

• Any location that is an alternative site determined to be part of a hospital, Critical Access Hospital (CAH), or Skilled Nursing Facility (SNF)
• Community mental health centers
• Federally Qualified Health Centers (FQHCs)
• Rural health clinics (RHCs)
• Physicians’ offices
• Urgent care facilities
• Ambulatory Surgery Centers (ASCs)
• Any location furnishing dialysis services outside of an End-Stage Renal Disease (ESRD) facility when an ESRD facility is not available
• Beneficiary’s home

CMS expanded the descriptions for these origin and destination claim modifiers to account for the new covered locations:

• Modifier D – Community mental health center, FQHC, RHC, urgent care facility, non-provider-based ASC or freestanding emergency center, location furnishing dialysis services and not affiliated with ESRD facility
• Modifier E – Residential, domiciliary, custodial facility (other than 1819 facility) if the facility is the beneficiary’s home
• Modifier H – Alternative care site for hospital, including CAH, provider-based ASC, or freestanding emergency center
• Modifier N – Alternative care site for SNF
• Modifier P – Physician’s office
• Modifier R – Beneficiary’s home

For the complete list of ambulance origin and destination claim modifiers see Medicare Claims Processing Manual Chapter 15, Section 30 A.

See: https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-04-07-mlnc-se

Therapy Codes Update – MLN Matters: MM11791

CMS is designating the below listed codes they have collectively termed as Communications Technology-Based Services (CTBS) as “sometimes therapy,” to permit physicians and Non-Physician Practitioners (NPPs), including nurse practitioners, physician assistants, and clinical nurse specialists to provide these services outside a therapy plan of care when appropriate.

When provided by psychologists, licensed clinical social workers, or other practitioners, these CTBS codes are never considered therapy services and may not be reported with a GN, GO, or GP therapy modifier. When provided by therapists in private practice or therapists in institutional providers of therapy services, the CTBS codes are always provided under a physical therapy, occupational therapy, or speech-language pathology plan of care and must be reported with the associated GP, GO, or GN therapy modifier.

These three CPT codes, with their short descriptors, are added for telephone assessment and management services:

CPT code 98966 (Hc pro phone call 5-10 min)
CPT code 98967 (Hc pro phone call 11-20 min)
CPT code 98968 (Hc pro phone call 21-30 min)

These five HCPCS codes, with their short descriptors, are added for remote evaluation of patient images/video, virtual check-ins, and online assessments (e-visits):

HCPCS code G2010 (Remote image submit by pt)
HCPCS code G2012 (Brief check in by MD/QHP)
HCPCS code G2061 (Qual nonMD est pt 5-10 min)
HCPCS code G2062 (Qual nonMD est pt 11-20 min)
HCPCS code G2063 (Qual nonMD est pt 21 min)

See: https://www.cms.gov/files/document/MM11791.pdf

Appeals

Medicare Appeals in Fee for Service (FFS), Medicare Advantage (MA) and Part D

CMS is allowing Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) in the FFS program, as well as the MA and Part D Independent Review Entities (IREs) to:

  • allow extensions to file an appeal;
  • waive requests for timeliness requirements for additional information to adjudicate appeals;
  • process an appeal even with incomplete Appointment of Representation forms. however, any communications will only be sent to the beneficiary;
  • process requests for appeals that do not meet the required elements using information that is available;
  • utilize all flexibilities available in the appeal process as if good cause requirements are satisfied.

See: https://www.cms.gov/files/document/covid19-emergency-declaration-health-care-providers-fact-sheet.pdf

COVID-19 AHIMA Resources

COVID-19 News and Resources
https://www.ahima.org/covid19

Webinars