COVID-19 Medical Coding Guidelines-2022 MEDESUN by Medesun Medical Coding Academy LLC

COVID-19 ICD-10-CM | CPT CODING MEDESUN HEALTHCARE SOLUTIONS WWW.MEDESUNGLOBAL.COM

We all are in this togetherAnd we will get through this together.

OBJECTIVES 01

ICD-10-CM

CPT

HCPCS

Scenarios

Learn about the new ICD-10-CM code for COVID19 effective April 1, 2020 and Covid-19 coding Guidelines

Discuss the updated ICD-10-CM Official Coding Guidelines related to coding for COVID-19

Apply the new coding guidance for COVID-19 to common scenarios identified by the AHA Central Office

CMS, AHA, AMA official references

Learning Path COVID-19 Coding Progress steps 1

Learn about the new ICD-10-CM code for COVID19 effective April 1, 2020

Discuss the updated ICD-10-CM Official Coding Guidelines related to coding for COVID-19

Apply the new coding guidance for COVID19 to common scenarios identified by the AHA Central Office

Official references CMS, AHA and AMA

Assessment

Place Your Picture Here

• • • Virus Name • Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) 2019 novel coronavirus (nCoV) • Novel coronavirus - COVID-19 virus Disease Name- Coronavirus disease 2019 (COVID-19)

• •

Coronaviruses are a large family of viruses, some cause illness in humans, and others cause illness in animals, such as bats, camels, and civets. Human coronaviruses cause mild illness, such as the common cold Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV) Previous Coronaviruses have included SARS- CoV and MERSCoV Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new strain of coronavirus that has not been previously identified in humans.

ICD-10-CM U07.1, COVID-19 • Developed by the World Health Organization • Announced March 18, 2020 at ICD-10-CM Coordination and Maintenance Committee • May be used for discharges/date of service on or after April 1, 2020.

Confirmed Cases Code Only Confirmed Cases Assign code U07.1, COVID-19, only for a confirmed diagnosis of the 2019 novel coronavirus (COVID19) as documented by the provider documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result. 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

Principal Diagnosis When COVID-19 meets the definition of principal or first-listed diagnosis, code U07.1, COVID-19, should be sequenced first, and followed by the appropriate codes for associated manifestations, except when another guideline requires that certain codes be sequenced first, such as obstetrics, sepsis, or transplant complications. However, if COVID-19 does not meet the definition of principal or first-listed diagnosis (e.g. when it develops after admission), then code U07.1 should be used as a secondary diagnosis

Code Only Confirmed Cases (cont.) • 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 Z20.822 - Contact with and (suspected) exposure to COVID-19 Contact with and (suspected) exposure to SARS-CoV-2 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 the COVID-19 virus is no longer required.

Sequencing of Codes Sequencing of Codes 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. Exception: Obstetrics patients as indicated in Section . I.C.15.s. for COVID-19 in pregnancy, childbirth, and the puerperium. For a COVID-19 infection that progresses to sepsis, see Section I.C.1.d. Sepsis, Severe Sepsis, and Septic Shock. According to new guidance in Chapter 15: Pregnancy, Childbirth, and the Puerperium, if a patient tests positive for COVID-19 during an encounter that is unrelated to the disease, the reason for the encounter should be coded first, 098.5 (other viral diseases complicating pregnancy, childbirth, and the puerperium). The coder would then report U07.1 and any appropriate COVID-19 manifestation codes.

Respiratory illness Acute Respiratory Illness Due to COVID-19 • Pneumonia Codes U07.1, COVID-19, and J12.82, Pneumonia due to coronavirus disease 2019 • Acute bronchitis Codes U07.1, and J20.8, Acute bronchitis due to other specified organisms. • Bronchitis not otherwise specified (NOS) Code U07.1 and J40, Bronchitis, not specified as acute orchronic

Respiratory illness-contAcute Respiratory Illness Due to COVID-19 (cont.) • Lower respiratory infection NOS U07.1, COVID-19, and J22, Unspecified acute lower respiratory infection • Respiratory infection NOS U07.1, COVID-19, and J98.8, Other specified respiratory Disorders • Acute respiratory distress syndrome U07.1, COVID-19, and J80, Acute respiratory distress • Acute respiratory failure For acute respiratory failure due to COVID-19, assign code U07.1, and code J96.0-, Acute respiratory failure.

Exposure Z20.822: Asymptomatic individuals with actual or suspected exposure to COVID-19, or symptomatic individuals where the infection has been ruled out, or test results are inconclusive or unknown

Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out Z20.822-Contact with and (suspected) exposure to COVID19Contact with and (suspected) exposure to SARS-CoV-2

Exposure COVID-19

Actual Exposure

Po s s i b l e E x p o s u re

Tests negative or Unknown

Exposure

Possible exposure Ruled-out Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.

Z20.822-Contact with and (suspected) exposure to COVID-19Contact with and (suspected) exposure to SARS-CoV-2

Screening Asymptomatic individuals who are being screened for COVID-19 and have no known exposure to the virus, and the test results are either unknown or negative

No Known Exposure

Possible or Actual Exposure

Asymptomatic

Z11.52 - Encounter for screening for COVID-19-Do not use Z11.52 during pandemic. Must wait until pandemic is over to begin using this code) For individuals who are being screened due to a possible or actual exposure to COVID-19, assign Z20.822 Asymptomatic individual is screened for COVID-19 and tests positive, assign code U07.1, COVID-19.

SEPSISWhether or not sepsis or U07.1 is assigned as the principal diagnosis depends on the circumstances of admission and whether sepsis meets the definition of principal diagnosis. For example, if a patient is admitted with pneumonia due to COVID-19 which then progresses to viral sepsis (not present on admission), the principal diagnosis is U07.1, COVID-19, followed by the codes for the viral sepsis and viral pneumonia. On the other hand, if a patient is admitted with sepsis due to COVID-19 pneumonia and the sepsis meets the definition of principal diagnosis, then the code for viral sepsis (A41.89) should be assigned as principal diagnosis followed by codes U07.1 and the appropriate viral pneumonia code (code J12.89, Other viral pneumonia, for discharges/encounters prior to January 1, 2021 or code J12.82, Pneumonia due to coronavirus disease 2019, for discharges/encounters after January 1, 2021) as secondary diagnoses.

Results-query Coding professionals should query the provider if the provider documented COVID-19 before the test results were back and the test results come back negative. Providers should be given the opportunity to reconsider the diagnosis based on the new information Download the COVID-19 Provide Query Templates from References Section.

Provider Documentation If the provider documents and confirms COVID-19 even though the test results are negative, or if the provider documented disagreement with the test results, assign code U07.1, COVID-19. As stated in the ICD-10-CM Official Guidelines for Coding and Reporting for COVID-19, “Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider… the provider’s documentation that the individual has COVID-19 is sufficient.”

History of Z86.16, Personal history of COVID-19 There is an Excludes 1 note stating sequelae of infectious and parasitic diseases (B90-B94). Therefore, when there is sequelae of COVID-19, the personal history code would not be coded Note: There are no timeframes stated in the coding guidelines for when to assign Z86.16, personal history of COVID rather than active COVID. In addition, there is no timeframe for when to code Sequelae rather than active COVID. Therefore, it is critical to follow the physician’s documentation and to query the physician if there is no documentation stating this information.

Vaccination

Diagnosis code Z23 is the primary diagnosis required for the COVID-19 vaccine. COVID-19 vaccination CPT codes are discussed in detail in CPT Coding Module

Encounter for Antibody Testing For an encounter for antibody testing that is not being performed to confirm a current COVID-19 infection, nor is being performed as a follow-up test after resolution of COVID-19, assign Z01.84, Encounter for antibody response examination. A person who has detection of SARS-CoV-2 neutralising or IgG antibody AND has had a compatible clinical illness AND meets one or more of the epidemiological criteria outlined in the suspect case definition

Updates

There were numerous updates from AMA, AHA, AHIMA, AAPC and CMS as per the need, to for COVID-19 coding tm ensure proper process and reimbursement. Medical Coders must adjust to new coding and billing and payment tracking updates in light of the Covid-19 Pandemic. There is an escalating demand for covid coders. It is important to stay up to date, to be timely with new and revised COVID codes. Keep in mind that the follow the coding guidelines and the physician documentation/confirmation is the key!

Post Covid Conditions Coding-2022

The new ICD-10-CM code U09.9 is located in Chapter 22: Codes for Special Purposes (U00-U85). Providers should report this code for their post-COVID cases in which the patient continues to have lingering symptoms or other health problems after the infection has resolved. Assignment of the new postCOVID code implies the patient has had COVID-19 and their current condition is related to the coronavirus infection. Report U09.9 secondary to specific condition codes to establish a link with COVID-19. sequela of COVID-19 residual condition following COVID-19

Post Covid Coding-Contd

ICD-10-CM 2022 also added a “Code first” note under U09.9 that instructs coders to list first the code for the specific condition related to COVID-19 such as chronic respiratory failure (J96.1-), loss of smell (R43.8), loss of taste (R43.8), or multisystem inflammatory syndrome (M35.81). Therefore, if a patient is admitted with any of these other conditions weeks or months after testing positive for COVID-19, you would code the related condition as the primary diagnosis and U09.9 as a secondary diagnosis.

Post Covid Coding-Contd

According to the new guideline, U09.9 should not be used for coding manifestations of active COVID-19 infection. The same section of the guidelines, however, clarifies that if a patient has a condition associated with a previous COVID-19 infection and develops a new active (current) COVID-19 infection, U09.9 may be assigned in conjunction with U07.1 COVID-19 to identify that the patient also has a condition associated with a previous COVID19 infection. The guidelines further state that coding professionals should also report the codes for any specific conditions associated with the previous COVID-19 infection and codes for manifestations of the new active (current) COVID-19 infection.

Post Covid Coding-Contd A 32-year-old male was hospitalized three weeks ago for pneumonia due to COVID-19. She is now admitted with shortness of breath. The provider documented in the discharge note that the patient had pneumothorax due to a previous history of COVID-19. How is this coded? Answer: J93.83 Other pneumothorax U09.9 Post COVID-19 condition, unspecified Rationale: Assign code J93.83 as the principal diagnosis, followed by U09.9 for the post-COVID condition. In this case, the pneumothorax is a residual effect of COVID-19 in a patient who no longer has COVID-19. According to new guideline I.C.1.g.1.m, for sequelae of COVID-19, or associated symptoms or conditions that develop following a previous COVID-19 infection, assign a code for the specific symptoms or conditions related to the previous COVID-19 infection and U09.9 as a secondary diagnosis code.

Vaccination Status Code Updates-2022 NOTE: There will updates twice per year, major updates are from October1. Three new diagnosis codes are being implemented into ICD-10-CM for reporting COVID-19 vaccination status, again effective April 1, 2022. Those three new codes are: •Z28.310 – Unvaccinated for COVID-19 •Z28.311 – Partially vaccinated for COVID-19 •Z28.39 – Other under immunization status

MIS Multisystem Inflammatory Syndrome MIS Diagnosed without history of Covid-19 Code First U07.1 And M35.81, Multisystem inflammatory syndrome, as an additional diagnosis MIS with History of COVID-19 Code first M35.81- MIS U09.9, Post COVID-19 condition, unspecified. MIS-Without suspected exposure or history of covid or covid infection Code first M35.81 Z20.822, Contact with and (suspected) exposure to COVID-19 *Note: Additional codes should be assigned for any associated complications of MIS.

COVID-19 PANDEMIC CORONAVIRUS

Due to the fluidity of the situation, we encourage our readers to be diligent in keeping abreast of this subject utilizing CMS, CDC, AMA, AHIMA and other trusted resources.

Disclaimer All responses, advice, and educational materials are designed to provide accurate coding information. Every effort has been made to ensure accuracy. However, each healthcare provider, consulting company, or individual contractor is responsible for correct coding & billing and assumes all risk and liability in connection with the use of the information. MEDESUN is not liable for any direct, indirect, special, consequential, or other damages or economic loss arising from use of the information provided. There is no representation, warranty, or guarantee that any response, advice, or provided material is error-free. AHA Coding Clinic is copyrighted so only highlights, examples, or excerpts are presented or mentioned for educational purposes. We encourage all healthcare facilities, consulting companies, or individual contractors to subscribe to AHA Coding Clinic or to have full access to AHA Coding Clinic through your encoder or CAC vendor. You are encouraged to research any examples presented in the full version of AHA Coding Clinic. CPT Copyright 2021 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. The AMA assumes The AMA assumes no liability for the data contained herein. CPT codes and AMA CPT Assistant are copyrighted so only highlights, examples, or excerpts are presented or mentioned for educational purposes. We encourage all healthcare facilities, consulting companies, or individual contractors to access AMA CPT code books or to have full access to AMA CPT codes and AMA CPT Assistant through your encoder or CAC vendor. You are encouraged to research any examples presented in the full version of AMA CPT code books and/or AMA CPT Assistant.

CORONAVIRUS ICD-10-CM Coding Examples

Confirmed

The patient presents to the emergency department (ED) with a dry cough, shortness of breath, fever and generalized myalgia. A COVID-19 nasopharyngeal swab is taken.The patient is discharged home with instructions to self-isolate and to return to the ED if symptoms worsen. Final diagnosis: COVID-19 U07-1 COVID-19, virus identified

The patient presents with a cough, fever and shortness of breath. A COVID-19 nasopharyngeal swab is taken. The COVID-19 lab test result comes back positive. The patient also has chronic obstructive pulmonary disease (COPD). The patient is treated with antibiotics and corticosteroids. Over the course of 7 days, the patient’s cough, fever and shortness of breath resolve. The patient is discharged home. Final diagnosis: COVID-19 pneumonia U07-1 COVID-19, virus identified J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection J12.82 Pneumonia due to COVID-19

Palliative Care The patient presents to the emergency department with bronchopneumonia. A COVID-19 nasopharyngeal swab is taken. The patient’s respiratory status declines quickly. The physician discusses the patient’s prognosis with the family. The patient is admitted solely for “comfort measures.” The COVID-19 lab test subsequently comes back positive for COVID-19. Final diagnosis: COVID-19 bronchopneumonia UO7.1 COVID-19, virus identified Z51.5 Palliative care J12.82 Pneumonia due to COVID-19

Multisystem inflammatory syndrome

For patients diagnosed with (MIS) and COVID-19, report U07.1 with M35.81 as an additional diagnosis. If MIS develops as a result of a previous COVID19 infection, report codes M35.81 and B94.8, (Sequelae of other specified infectious and parasitic If the provider does not document that the MIS is due to diseases).

the previous COVID-19 infection, report codes M35.81 and Z86.16. If the patient has a known or suspected exposure to COVID-19, and no current COVID19 infection or history of COVID-19, report codes M35.81 and Z20.822.

CPT-Lab Codes MEDESUN Healthcare Solutions

CPT Codes 01

Antibody Codes

Antigen Codes

Specimen Collection

Three types of Codes

Click icon to add picture

• COVID-19 virus Antibody detection • Infectious Agent Antibody(ies), Detection by Immunoassay • Infectious Agent Detection by DNA or RNA • Infectious Agent Antigen, Detection by Immunoassay • Infectious Agent Detection by optical/Visual Observation • Respiratory Virus Panel

Antibodies Test

Example Text : Get a modern PowerPoint Presentation that is beautifully designed.

Infectious Agent

Immunoassay

Antigen

Example Text : Get a modern PowerPoint Presentation that is beautifully designed.

IgG, IgM Antibody 86769 - Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) .

COVID-2019 Antibody tests

Neutralizing antibody screen 86408-Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (Coronavirus disease [COVID-19]); screen.

Neutralizing antibody titer 86409 - Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]); titer

Antibody, quantitative 86413 - severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative

IgM, a transient antibody the body makes soon after infection for about two weeks before the levels in the blood drop. IgG, a subsequent antibody that the body makes more slowly (within approximately four weeks) but which usually last longer in blood.

Infectious Agent Antibody(ies), Detection by Immunoassay Reagent strip

86318 - Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip);

COVID-19 Antibody tests Reagent strip- COVID-19

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 was established for antibody tests using a single step method immunoassay. This testing method typically includes a strip with all of the critical components for the assay and is appropriate for a point of care platform. Code 86769 was established for antibody tests using a multiple step method.

Infectious Agent Antigen, Detection by Immunoassay Your Text Here

87426 - Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) 87428 - Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B

COVID-19 87635 to report infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]), amplified probe technique

COVID-19 and influenza virus types A and B 87636 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARSCoV2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique

Code 87635 reports detection of the presence of SARS-CoV-2 virus in respiratory specimens obtained using a nasal probe “from which DNA/RNA is obtained and analyzed Amplified probe technique - The specimen, typically collected via nasal or nasopharyngeal swab, is treated to isolate the nucleic acid (DNA, RNA) and eliminate substances that inhibit amplification. The nucleic acid is amplified using specific primers for COVID-19 sequences

COVID-19 Infectious Agent Detection by DNA or RNA COVID-19, Influenza virus types A and B, and respiratory syncytial virus 87637 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique

Infectious Agent Detection by 1

Optical/Visual Observation

87811 - Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19] 2019 .

Adenovirus Influenza virus Corona virus RSV Rhino virus etc

Respiratory Panel 87633 - Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets This test is intended to be performed on respiratory specimens collected from individuals who meet the Centers for Disease Control and Prevention (CDC) clinical and/or Epidemiological criteria for COVID-19 testing

Specimen Collection Practitioners can be paid for assessment and specimen collection for COVID-19 testing with CPT code 99211 (except if the provider is reporting another Evaluation and Management (E/M) code for a concurrent service). Medicare will recognize this code for all patients, not just established ones

Use CPT® 99211 to bill for a COVID-19 symptom and exposure assessment and specimen collection provided by clinical staff incident-to the supervising physician’s or NPP’s services

COVID-2019

Independent clinical diagnostic laboratories can bill for these services as well as a travel allowance (HCPCS codes P9603 and P9604) when they collect specimens from beneficiaries who are homebound or non-hospital (SNF) Part B inpatients, that is, individuals in a Part B SNF stay and individuals whose samples will be collected by a laboratory on behalf of an HHA Providers shall include the “CS” modifier, as applicable, to ensure beneficiary costsharing is not applied

“An effective national immunization program is key to bringing the coronavirus pandemic to an end,”

Vaccination I’d much rather have a vaccine than have a virus

Vaccination CPT Coding Content

ICD-10-CM

CPT

HCPCS

Vaccination When billing COVID-19 vaccines, code the following: 1. Vaccine CPT (only code IF vaccine was NOT distributed by government) 2. Administration 3. ICD-10-CM (diagnosis code) Z23 Encounter for immunization Pfizer

Novavax The Novavax vaccine is a protein subunit vaccine that uses a lab-made version of the SARS-CoV-2 spike protein . The protein on its own cannot cause illness.

Moderna

The Pfizer-BioNTech COVID-19 Vaccine is administered intramuscularly as a series of two doses (0.3 mL each) three weeks apart. Janssen

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use AstraZeneca

Janssen COVID-19 Vaccine is a preservative-free suspension for injection in a multiple dose vial. It is administered intramuscularly as a single dose (0.5 mL).

COVID-19 vaccine, spike protein, Oxford 1 vector, preservative free, 5x1010 viral particles.0.5mL for IM use

https://beyond.ubc.ca/nutshell-how-vaccines-work/

Vaccines Pfizer

Moderna

Janssen

mRNA Vaccine

Viral Vector Vaccine

2 doses, 21 days apart

2 doses, 28 days apart

One Dose

Easy to change colors, photos and Text.

Oxford AstraZeneca Viral Vector Vaccine

Uses Adenovirus2 Doses

Novavax Protien Adjuvant Vaccine

2 Doses

“Correlating each coronavirus vaccine with its own unique CPT code provides analytical advantages to help track, allocate and optimize resources as an immunization program ramps up in the United States.”

Insurance coverage of COVID-19 Vaccines The federal government is supplying the vaccines for distribution to facilities and practices that are enrolled as Medicare providers or COVID-19 immunization administrators. Enrollment allows the facility or practice to bill for the administration of the vaccine using the Vaccine Administration codes above. Reimbursement is geographically adjusted and based on the national payment rate. Starting on March 15, 2021, Medicare will pay approximately $40 for each dose in the vaccination series.

PFIZER-BioNTech COVID-19 Vaccine (N/A) HCPCS code 91300: Billing Guidelines The ICD-10-CM diagnosis code required for billing is: Z23 - Encounter for immunization •

Providers must bill with HCPCS code: 91300 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use

•

Providers must bill 11-digit NDCs: 59267-1000-01, 59267-1000-02, 59267-1000-03

•

Claims must have appropriate NDCs that correspond to the vaccine used for administration and corresponding CPT code

•

Claims must contain both administration codes and vaccine codes to pay

 Pfizer COVID-19 vaccine, CPT Code- 91300 •

Pfizer Administration first dose 0001A

•

Pfizer Administration, second dose 0002A

Moderna COVID-19 Vaccine (N/A) HCPCS code 91301: Billing Guidelines The ICD-10-CM diagnosis code required for billing is: Z23 - Encounter for immunization • •

Providers must bill with HCPCS code: 91301 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use One Medicaid and NC Health Choice unit of coverage is: 0.3 mL

•

Providers must bill 11-digit NDCs: 59267-1000-01, 59267-1000-02, 59267-1000-03

•

Claims must have appropriate NDCs that correspond to the vaccine used for administration and corresponding CPT code

•

Claims must contain both administration codes and vaccine codes to pay

 Moderna COVID-19 vaccine, CPT Code 91301 •

Moderna Administration first dose 0011A

•

Moderna Administration second dose 0012A

AstraZeneca COVID-19 Vaccine (N/A) HCPCS code 91302: Billing Guidelines The ICD-10-CM diagnosis code required for billing is: Z23 - Encounter for immunization •

AstraZeneca COVID-19 vaccine, spike protein, Oxford 1 vector, preservative free, 5x1010 viral particles.0.5mL for IM use CPT Code 91302

•

Providers must bill 11-digit NDCs and appropriate NDC units.

•

Claims must have appropriate NDCs that correspond to the vaccine used for administration and corresponding CPT code

•

Claims must contain both administration codes and vaccine codes to pay

 AstraZeneca COVID-19 vaccine, CPT Code 91302 •

AstraZeneca Administration first dose 0021A

•

Astra Zeneca Administration, second dose 0022A

Janssen COVID-19 Vaccine (N/A) HCPCS code 91303: Billing Guidelines The ICD-10-CM diagnosis code required for billing is: Z23 - Encounter for immunization •

Providers must bill with HCPCS code: 91303 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x10^10 viral particles/0.5mL dosage, for intramuscular use

•

Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs is/are: 59676-058005, 59676-0580-15

•

Claims must have appropriate NDCs that correspond to the vaccine used for administration and corresponding CPT code

•

Claims must contain both administration codes and vaccine codes to pay

 Janssen (J&J) COVID-19 vaccine, CPT Code 91303  Janssen (J&J) Administration, single dose 0031A

Novavax COVID-19 Vaccine (N/A) HCPCS code 91304: Billing Guidelines The ICD-10-CM diagnosis code required for billing is: Z23 - Encounter for immunization •

Novavax Code 91304: “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponinbased adjuvant, preservative free, 5 mcg/0.5mL dosage, for intramuscular use;”

•

Providers must bill 11-digit NDCs and appropriate NDC units.

•

Claims must have appropriate NDCs that correspond to the vaccine used for administration and corresponding CPT code

•

Claims must contain both administration codes and vaccine codes to pay

 Novavax Code CPT Code 91304:  Novavax 0041A-first dose;”  Novavax 0042A: second dose.”

Home administration Covid Vaccine- HCPCS Code M0201- vaccine admin Covid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home

CD-10-PCS Codes • XW013S6: Introduction of COVID-19 Vaccine Dose 1 into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 6 • XW013T6: Introduction of COVID-19 Vaccine Dose 2 into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 6 • XW013U6: Introduction of COVID-19 Vaccine into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 6 • XW023S6: Introduction of COVID-19 Vaccine Dose 1 into Muscle, Percutaneous Approach, New Technology Group 6 • XW023T6: Introduction of COVID-19 Vaccine Dose 2 into Muscle, Percutaneous Approach, New Technology Group 6 • XW023U6: Introduction of COVID-19 Vaccine into Muscle, Percutaneous Approach, New Technology Group 6

People with Medicare Pay nothing for Covid-19 Shots • No Copayment/Coinsurance • No Deductible COVID-19 vaccines themselves are free to everyone 12 years and older in the United States, but providers incur costs associated with administering them, training staff, and storing the vaccine. If these services are not covered by a patient’s health plan or only partially covered, providers are not allowed to balance bill the patient. https://www.cms.gov/covid-19-vaccines-and-monoclonal-antibodies

Medicare Advantage (MA): For calendar years 2020 and 2021, Medicare will pay providers directly for the COVID-19 vaccine (if they do not receive it for free) and its administration for beneficiaries enrolled in MA plans. MA plans are not responsible for paying providers to administer the vaccine to MA enrollees during this time. Like beneficiaries in Original Medicare, Medicare Advantage enrollees also pay no cost-sharing for COVID-19 vaccines. Medicaid: State Medicaid and CHIP agencies must provide vaccine administration with no cost sharing for nearly all beneficiaries during the public health emergency (PHE) and at least one year after it ends. Through the American Rescue Plan Act signed by President Biden on March 11, 2021, the COVID vaccine administration will be fully federally funded. The law also provides an expansion of individuals eligible for vaccine administration coverage. There will be more information provided in upcoming updates to the Medicaid toolkit at: https://www.medicaid.gov/state-resource-center/downloads/covid19vaccine-toolkit.pdf

Private Plans: CMS, along with the Departments of Labor and Treasury, is requiring that most private health plans and issuers cover the COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost sharing during the public health emergency (PHE). Current regulations provide that out-of-network rates must be reasonable, as compared to prevailing market rates, and reference the Medicare reimbursement rates as a potential guideline for insurance companies. In light of CMS’s increased Medicare payment rates, CMS will expect commercial carriers to continue to ensure that their rates are reasonable in comparison to prevailing market rates. Uninsured: For individuals who are uninsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration (HRSA).

Email info@medesun.com

MEDESUN

THANK YOU MEDESUN Healthcare Solutions LLC

Email info@medesun.com

MEDESUN

THANK YOU MEDESUN Healthcare Solutions LLC

Email info@medesun.com

MEDESUN

THANK YOU MEDESUN Healthcare Solutions LLC