ICD-10-CM Code(s)
The Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS), the federal agency responsible for maintaining the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM) in the United States, implemented the following ICD-10-CM code effective April 1, 2020:
U07.1 COVID-19
In addition, new guidelines specific to COVID-19 were added to the ICD-10-CM Official Guidelines for Coding and Reporting effective April 1, 2020 through September 30, 2020.
ICD-10-PCS Code(s)
The Centers for Medicare and Medicaid Services (CMS) has added twelve new procedure codes to the International
Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), effective August 1, 2020. These codes describe the introduction or infusion of therapeutics, including remdesivir and convalescent plasma, current treatments used to manage COVID-19 patients. These codes do not affect MS-DRG assignment.
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
HCPCS Level II Code Changes
Two new HCPCS Level II codes were created for coronavirus testing, effective April 1, 2020, for dates of service starting February 4, 2020.
U0001 CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel
For tests developed only by the CDC (reporting allows CDC testing laboratories to test new patients and track new cases).
U0002 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC
For laboratories performing non-CDC testing.
Two new HCPCS Level II codes were created for coronavirus testing using high throughput technologies, effective April 14, 2020 (reportable for services provided on March 18, 2020, and forward).
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
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
Two new HCPCS Level II codes were created for specimen collection, effective 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 SNF or by a laboratory on behalf of a HHA, any specimen source
A new HCPCS Level II code was created for coronavirus specimen collection for hospital outpatient clinics effective March 1, 2020.
C9803 Hospital outpatient clinic visit specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source
Modifier CS was revised and may be appended to COVID-19 related testing services provided on or after March 18, 2020 to identify the cost-sharing waiver is applied and the Medicare patient should not be charged co-insurance or
deductible.
CS Cost-sharing for specified COVID-19 testing-related services that result in an order for or
administration of a COVID-19 test
Modifier CS was revised and may be appended to COVID-19 related testing services provided on or after July 1, 2020, to identify the cost-sharing waiver is applied and the Medicare patient should not be charged co-insurance or deductible, for services furnished via telehealth in Rural Health Clinics and Federally Qualified Health Centers.
CS Cost-sharing waived for specified COVID-19 testing-related services that result in an order for, or administration of, a COVID-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in Rural Health Clinics and Federally Qualified Health Centers during the COVID-19 public health emergency
CPT Code Changes
One new CPT code was created for reporting coronavirus 2 (SARS-CoV-2) COVID-19 testing, effective March 13, 2020.
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
Two new CPT codes were created and one revised for reporting COVID-19 antibody testing, effective April 10, 2020.
86318 Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method
(eg, reagent strip);
#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])
# Code 86328 is a resequenced code that follows code 86318.
86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease
[COVID-19])
A new proprietary laboratory analysis CPT code was created for reporting coronavirus 2 (SARS-CoV-2) COVID-19 testing, effective May 20, 2020.
0202U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected A new CPT code and two PLA CPT codes were created for reporting coronavirus 2 (SARS-CoV-2) COVID-19 testing, effective June 25, 2020.
87426 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA])
qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome
coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])
0223U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not
detected
0224U Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed
A HCPCS code and CPT code should not be reported together. Providers should contact third-party payer(s) for their guidance on whether to report a CPT or a HCPCS code, as well as for retroactive billing and reimbursement guidelines.
References:
https://www.optum360coding.com/upload/docs/Optum360%20Coding%20for%20Coronavirus%20Final8.pdf
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