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Latest Updates Related To COVID-19 Coding and Billing: July 31, 2020

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The COVID-19 public health emergency (PHE) continues to inspire changes to coding and billing practices and guidelines that impact physicians and other healthcare providers – as well as coding and billing professionals. Several changes were recently announced related to COVID-19 that all healthcare professionals should be aware of.

Disclaimer: This article summarizes information that was current at the time it was published and provided via the web. This information is not intended to take the place of either the written policies or regulations. We encourage everyone to review the specific regulations and other interpretive materials as necessary.

12 New Codes Related to COVID-19 Infections and Therapeutic Substances

Effective August 1, 2020, the Centers for Medicare & Medicaid Services (CMS) announced the addition of 12 new codes to the New Technology Section of the ICD-10-PCS code set. The new codes identify treatments that are currently being utilized in the management of COVID-19 infections, including codes for the introduction or infusion of therapeutic substances such as remdesivir and convalescent plasma. Additionally, there are new codes to describe the introduction of therapeutic substances that may be developed in the near future that are not currently named.

Effective August 1, 2020, the Centers for Medicare & Medicaid Services (CMS) announced the addition of 12 new codes to the New Technology Section of the ICD-10-PCS code set. The new codes identify treatments that are currently being utilized in the management of COVID-19 infections, including codes for the introduction or infusion of therapeutic substances such as remdesivir and convalescent plasma.

The 12 new codes are:
  • XW013F5 - Introduction of Other New Technology Therapeutic Substance into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 5
  • XW033E5 - Introduction of Remdesivir Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 5
  • XW033F5 - Introduction of Other New Technology Therapeutic Substance into Peripheral Vein, Percutaneous Approach, New Technology Group 5
  • XW033G5 - Introduction of Sarilumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5
  • XW033H5 - Introduction of Tocilizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5
  • XW043E5 - Introduction of Remdesivir Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 5
  • XW043F5 - Introduction of Other New Technology Therapeutic Substance into Central Vein, Percutaneous Approach, New Technology Group 5
  • XW043G5 - Introduction of Sarilumab into Central Vein, Percutaneous Approach, New Technology Group 5
  • XW043H5 - Introduction of Tocilizumab into Central Vein, Percutaneous Approach, New Technology Group 5
  • XW0DXF5 - Introduction of Other New Technology Therapeutic Substance into Mouth and Pharynx, External Approach, New Technology Group 5
  • XW13325 - Transfusion of Convalescent Plasma (Nonautologous) into Peripheral Vein, Percutaneous Approach, New Technology Group 5
  • XW14325 - Transfusion of Convalescent Plasma (Nonautologous) into Central Vein, Percutaneous Approach, New Technology Group 5

In order to accommodate these new codes, the MS-DRG Grouper will also be updated to version 37.2, effective August 1, 2020. However, the new codes will not affect MS-DRG assignment for fiscal year 2020.

Separately, the frequently asked questions on COVID-19 that are jointly developed and approved by the American Hospital Association (AHA) and the American Health Information Management Association (AHIMA) were recently updated to address questions related to post-acute care for COVID patients and coding for multisystem inflammatory syndrome in children. The guidance outlines multiple clinical scenarios to assist coders with sequencing of conditions for patients presenting with sequelae following an acute COVID-19 infection and also provides guidance for patients who are transferred following acute care of their infections.

MLN Matters Number SE20011 Updated Related to Counseling Patients

CMS also updated MLN Matters Number SE20011, “Medicare Fee-For-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)” to include a new section on Counseling and COVID-19 testing. The new section contains an announcement that payment is available to physicians and healthcare providers who counsel patients at the time of COVID-19 testing about the importance of self-isolation after they are tested, and prior to the onset of symptoms.

The revision also includes guidance on when counseling regarding self-isolation and contact tracing is appropriate and provides a list of talking points as well as a helpful checklist to ensure that providers cover all key components during the counseling session.

In addition, CMS provides guidance on billing for counseling services, which will be reported using existing evaluation and management codes. CMS has provided links to additional resources, including a Provider Counseling Q&A document and handouts for patients, all of which can be accessed from the MLN Matters document. All of these additional references and resources should be a welcome addition for providers who are already providing these counseling services.

Because COVID-19 continues to alter the landscape for healthcare providers and for patients, Vitalware will continue to keep you apprised of pertinent changes. Check out our COVID-19 Coding and Billing Resource Center for more COVID related help.

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