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CDC issues testing and claims recommendations

The CDC has recommended collecting a single upper respiratory nasopharyngeal swab for diagnosis of COVID-19, as of March 13.  CPT code 87635 or HCPCS code U0002 can be reported for the non-CDC diagnostic lab test, depending on the method used. HCPCS code U0001 can be reported for the CDC diagnostic lab test. Labs, physician offices, hospitals and other settings can bill for tests ordered that they perform.

There are no co-payments for testing. Patients without insurance may be tested through State labs.

CMS has also provided additional flexibilities for patients receiving Medicare home health services by permitting a home health nurse, during an otherwise covered visit, to obtain a sample to send to the laboratory for COVID-19 diagnostic testing.

Effective with services on and after April 1, 2020, a confirmed diagnosis of COVID-19 (2019 novel coronavirus disease) should be reported with diagnosis code U07.1, COVID-19. Assignment of this code is applicable to positive COVID-19 test results and presumptive positive COVID-19 test results.

While this list is not comprehensive, here are some additional ICD-10-CM codes that may be helpful for reporting encounters related to possible COVID-19 exposure as described in the ICD-10-CM Official Coding and Reporting Guidelines.

• Z03.818: (Encounter for observation for suspected exposure to other biological agents ruled out)

• Z20.828: (Contact with and (suspected) exposure to other viral communicable diseases)

• Z11.59 (Encounter for screening for other viral diseases)

Interim coding guidance

Effective with services prior to April 1, 2020, the interim coding guidance for coding encounters related to COVID-19 should be followed. This guidance instructs that the applicable respiratory diagnosis code should be reported followed by diagnosis code B97.29 (Other coronavirus as the cause of diseases classified elsewhere) for patients with a confirmed diagnosis of COVID-19.

Coverage and payment for COVID-19 testing and care: Medicare Coverage and Payment Related to COVID-19 (PDF), COVID-19: New ICD-10-CM Code and Interim Coding Guidance











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