Coding and Documentation

CMS provided clarification on submitting inpatient claims for patients diagnosed with novel coronavirus (COVID-19) without a positive viral test, in an update to MLN Matters SE20015 released September 11.

UnitedHealthcare’s (UHC) plan to require in-network, freestanding and outpatient laboratory claims to contain a unique code for most lab testing services is poorly timed and poses significant implementation hurdles, the American Hospital Association (AHA) said in an August 14 letter.

Inpatient novel coronavirus (COVID-19) claims will require a positive viral test result to be eligible for the 20% increase in the MS-DRG weighting factor, effective for admissions on or after September 1.

The AMA on August 10 announced four new CPT® codes for reporting COVID-19 laboratory testing, including two codes for reporting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody detection. 

CMS’ latest round of updates to its novel coronavirus FAQs on Medicare fee-for-service billing provides additional information on hospital billing for remote services, including a decision tree guiding hospitals through their options for billing for telemedicine.

NAHRI’s July 28 Quarterly Call featured a jam-packed hour of association updates and informative, detailed presentations on revenue reconciliation and coding tips for novel coronavirus (COVID-19) claims.

Q: What is the recommended process for managing year-end CPT^® updates?

The guidelines are effective October 1 and highlights include new instructions for reporting manifestations of novel coronavirus (COVID-19), vaping, and social determinants of health among other changes.