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COVID-19 in the News March 31, 2020 - April 6, 2020

Published on 

Tuesday, April 7, 2020

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Institute for Health Metrics and Education (IHME) COVID-19 Projections Models

In a related FAQs document the IHME indicates that they “were initially asked to develop models by our colleagues at the University Of Washington School Of Medicine to help in planning their response. As other US hospital systems and state governments reached out for help in determining when COVID-19 would overwhelm their ability to care for patients, we pushed to release a national-level tool. Ultimately, these forecasts were developed to provide hospitals, health care workers, policymakers, and the public with crucial information about what demands COVID-19 may place on hospital capacity and resources, so that they could begin to plan.” The Models assume social distancing is in place and the data is updated frequently (link to Project: https://covid19.healthdata.org/projections).

March 27, 2020: The Coronavirus Aid, Relief, and Economic Security (CARES) Act signed into Law

The CARES Act is jam packed with efforts to provide relief to hospitals, businesses and individuals during the National State of Emergency due to Coronavirus (COVID-19).  Following are resources to help you learn more about this Act.

SEC. 3710. MEDICARE HOSPITAL INPATIENT PROSPECTIVE PAYMENT SYSTEM ADD-ON PAYMENT FOR COVID–19 PATIENTS DURING EMERGENCY PERIOD.

Section 3710 of the CARES Act indicates that “for discharges occurring during the emergency period, in the case of a discharge of an individual diagnosed with COVID-19, the Secretary shall increase the weighting factor that would otherwise apply to the diagnosis-related group to which the discharge is assigned by 20 percent. The Secretary shall identify a discharge of such an individual through the use of diagnosis codes, condition codes, or other such means as may be necessary.” Note, this add-on payment will be available through the duration of the COVID-19 emergency.

March 31, 2020: ICD-10-CM Official Coding Guidelines for COVID-19 April 1, 2020 – September 30, 2020

ICD-10-CM Official Guidelines for COVID-19 for April 1, 2020 through September 30, 2020 were released. Included in this document are the following topics:

  • Code only confirmed cases
  • Sequencing of codes,
  • Acute Respiratory Illness due to COVID-19,
  • Exposure to COVID-19,
  • Screening for COVID-19,
  • Signs and Symptoms without definitive diagnosis of COVID-19,
  • Asymptomatic individuals who test positive for COVID-19; and
  • COVID-19 infection in pregnancy, childbirth and the puerperium

I would like to call attention to the specific guidance regarding coding confirmed cases. The guidelines indicate that you are to “Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider, documentation of a positive COVID-19 test result, or a presumptive positive COVID-19 test result. For a confirmed diagnosis, assign code U07.1, COVID-19. 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 sufficient.”

With the add-on payment for hospitals treating COVID-19 patients only occurring when a patient is identified by diagnosis codes, it is essential for Physicians to document when a case is confirmed so that Coding Professionals can code the new ICD-10-CM code U07.1 that became effective April 1, 2020.

The complete guidelines are available on the CDC ICD-10-CM webpage and the CMS 2020-ICD-10-CM webpage.

March 31, 2020: Palmetto GBA Provides Accelerated Payment Posts FAQs

Included in last week’s COVID-19 Updates was information about the CMS announcing an expansion of its accelerated and advance payment program. You can read more about this in the March 28 CMS Press Release. On March 31st Palmetto GBA, the Jurisdictions J and M Medicare Administrative Contractor (MAC) Posted Accelerated Payment Hotline FAQs on their website. 

As a reminder, CMS has established COVID-19 hotlines at each MAC to assist providers with their accelerated payment requests. MAC hotline numbers, details on the eligibility and the request process are available in a Fact Sheet.  The expansion of this program is only for the duration of the public health emergency.

March 31, 2020: Cigna COVID-19 Billing Guidelines and FAQ Document for Providers  

This March 31, 2020 document includes the following new guidance as of March 31st pertaining to reimbursement for treatment of confirmed cases of COVID-19:

“Effective 3/30/2020, customer cost-share (if applicable depending on the customer’s benefit plan) for COVID-19 treatment (inpatient and outpatient) for in-network and out-of-network providers is waived until 5/31/2020.This applies to treatment with dates of service of 2/3/2020 to 5/31/2020. Covered treatment includes all services covered under Medicare and applicable state regulations for the management of a COVID-19 diagnosis. In-network providers will be reimbursed consistent with their fee schedules for services rendered. Out-of-network providers will be reimbursed 100% of Medicare or Medicaid allowable depending on the customer’s benefit plan. When COVID-19 is confirmed, the following codes should be used for treatment once COVID-19 is confirmed.

**If these codes are not used, regular plan benefits apply.”
CodeUseCustomer cost-shareDescription
B97.29TreatmentWaivedOther coronavirus as the cause of diseases classified elsewhere.
U07.1TreatmentWaived2019-nCoV acute respiratory disease. New code with implementation date of 4/1/2020.

‍March 31, 2020: Special Edition MLN Connects:

In a March 31st Special Edition of MLN Connects, CMS further expounded upon the sweeping Blanket Waivers and Flexibilities announced on March 30th, provided information about Professionals billing for Telehealth Services during the Public Health Emergency and provided the following information about new specimen collection codes for laboratories billing for COVID-19 Testing:

Clinical diagnostic laboratories: To identify and reimburse specimen collection for COVID-19 testing, CMS established two Level II HCPCS codes, effective with line item date of service on or after 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 skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source               

These codes are billable by clinical diagnostic laboratories.

April 1, 2020: Update to ICD-10-CM for Vaping Related Disorder and 2019 Novel Coronavirus (COVID-19)

MLN Article MM11623 was revised on April 1st to reflect updated Change Request (CR) 11623 which added the new ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19).

April 1, 2020: CDC Posts Healthcare Infection Prevention and Control FAQs for COVID-19

The FAQs align with the revised Interim Infection Preventio and Control Recommendations for patients with a confirmed COVID-10 diagnosis or are under investigation in healthcare settings. They are being made available to assist healthcare facilities in preventing transmission of COVID-19 in healthcare settings.

April 2, 2020: Key Recommendations Issued to Nursing Homes, State and Local Governments

In an April 2nd CMS Press Release the CMS and CDC, at the direction of the President, “issued critical recommendations to state and local governments, as well as nursing homes, to mitigate the spread of the 2019 Novel Coronavirus (COVID-19) in nursing homes.” Recommendations announced on April 2nd include:

  • Nursing homes should immediately ensure that they are complying with all CMS and CDC guidance related to infection control.
  • As nursing homes are a critical part of the healthcare system, and because of the ease of spread in long term care facilities and the severity of illness that occurs in residents with COVID-19, CMS/CDC urges State and local leaders to consider the needs of long term care facilities with respect to supplies of PPE and COVID-19 tests.
  • Nursing homes should immediately implement symptom screening for all staff, residents, and visitors – including temperature checks.
  • Nursing homes should ensure all staff are using appropriate PPE when they are interacting with patients and residents, to the extent PPE is available and per CDC guidance on conservation of PPE.
  • To avoid transmission within nursing homes, facilities should use separate staffing teams for residents to the best of their ability, and, as President Trump announced at the White House today, the administration urges nursing homes to work with State and local leaders to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents and individuals with unknown COVID-19 status.

In the Press Release CMS Administrator Seema Verma is quoted as saying that “The Trump Administration is calling on the nursing home industry and state and local leaders to join us by taking action now to ensure the safety of their residents, who are among our most vulnerable citizens. The Administration urges them to carefully review our recommendations, and implement them immediately.”

April 3, 2020: Special Edition MLN Connects: COVID-19 Telehealth Billing Correction, Nursing Home Recommendations, Billing for Multi-Function Ventilators, New ICD-10 Diagnosis Code

CMS issued a Special MLN Connects newsletter on April 3rd highlighting revised telehealth billing information, nursing home recommendations released earlier the day, billing for multi-function ventilators and the new ICD-10 COVID-19 Diagnosis code U07.1.

https://www.cms.gov/files/document/2020-04-03-special-edition.pdf

Telehealth: Billing Distant Site Services during Public Health Emergency (PHE) Revised

CMS notes this information corrects a prior message that appeared in our March 31, 2020 Special Edition. Specifically, CMS will now allow for more than 80 additional services to be furnished via telehealth.  Professional claims for all telehealth services with dates of service on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE) are to be billed with the following:

  • Place of Service (POS) equal to what it would have been had the service been furnished in-person, and
  • Modifier 95, indicating that the service rendered was actually performed via telehealth.

CMS is not requiring the CR modifier. However, CMS does describe two scenarios that do require modifiers on Medicare telehealth professional claims.

  • Furnished as part of a federal telemedicine demonstration project in Alaska and Hawaii using asynchronous (store and forward) technology, use GQ modifier, and
  • Furnished for diagnosis and treatment of an acute stroke, use G0 modifier.

Billing for Multi-Function Ventilators (HCPCS Code E0467)

Effective immediately, CMS is suspending claims editing for multi-function ventilators when there are claims for separate devices in history that have not met their reasonable useful lifetime.

April 6, 2020: CMS News Alert: New Video on Telehealth, 45th Medicaid Waiver Approved, and Guidance for Processing Attestations from Ambulatory Surgical Centers (ASCs) Temporarily Enrolling as Hospitals during COVID-19 PHE

In an April 6th Press Release, CMS provided a summary of recent actions taken in response to COVID-19, as part of the ongoing White House Task Force. They note the information in the release is current as of April 6th at 10:00 AM.

  • New Video about Telehealth: CMS has released a video providing answers to common questions about telehealth. This benefit has been expanded on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. This Video was posted on YouTube on April 3, 2020.
  • Medicaid and Appendix K Waivers: The District of Columbia has received approval for the 45th Medicaid waiver, which provides “urgent regulatory relief to ensure the District can quickly and efficiently care for their most vulnerable citizens.” States can access the CMS developed toolkit to facilitate expedited application and approval of State waivers requests in record time. You can go to the Medicaid.gov website to view all Section 1135 Waivers due to the COVID-19 PHE. The Press Release also references Appendix K Waivers available at 1915(c) Appendix K Waivers.
  • ASCs Temporarily Enrolling as Hospitals: The last update in the Press Release notes that as part of the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers CMS is allowing Medicare-enrolled ASCs to temporarily enroll as hospitals and to provide hospital services to help address the urgent need to increase hospital capacity to take care of patients and provides a link to the Guidance made available on the CMS website.
Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.