Knowledge Base Article

Additional Code for Coronavirus Lab Test

Included in MMP’s February Coding Corner was news about CMS developing a new Healthcare Common Procedure Coding System (HCPCS) code for providers and laboratories testing patients for SARS-CoV-2.

In a March 5th Press Release, CMS announced a second HCPCS code has been developed “that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases. In addition, CMS released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services to help patients prepare as well.”

• February 2020 HCPCS code U0001 is to be used specifically for CDC testing laboratories to test patients for SARS-CoV-2.
• March 2020 HCPCS U0002 allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).

The Press Release also notes the Food and Drug Administration issued a new, streamlined policy on February 29th for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare and health insurers.

The Medicare claims processing systems will be able to accept these codes starting April 1, 2020 for dates of service on or after February 4, 2020.

Medicare Fact Sheet: Inpatient Hospital Quarantines

As mentioned above, included in the press release about a second HCPCS code were fact sheets. Following is an excerpt from the Medicare Fact Sheet specifically about Inpatient Hospital Quarantines:

“There may be times when beneficiaries with the virus need to be quarantined in a hospital private room to avoid infecting other individuals. These patients may not meet the need for acute inpatient care any longer but may remain in the hospital for public health reasons. Hospitals having both private and semiprivate accommodations may not charge the patient a differential for a private room if the private room is medically necessary. Patients who would have been otherwise discharged from the hospital after an inpatient stay but are instead remaining in the hospital under quarantine would not have to pay an additional deductible for quarantine in a hospital.

If a Medicare beneficiary is a hospital inpatient for medically necessary care, Medicare will pay hospitals the diagnosis-related group (DRG) rate and any cost outliers for the entire stay, including any the quarantine time when the patient does not meet the need for acute inpatient care, until the Medicare patient is discharged. The DRG rate (and cost outliers as applicable) includes the payments for when a patient needs to be isolated or quarantined in a private room.”

https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests

Cigna Adopts Sepsis-3

Cigna announced in their First Quarter 2020 Cigna Network News that “As part of our effort to promote the accurate diagnosis and treatment of sepsis, and use the appropriate billing and coding, we have adopted the Third International Consensus Definitions or Sepsis and Septic Shock (Sepsis-3), effective immediately.” https://www.cigna.com/sites/email/2020/937483-2020-q1-network-news.pdf

What this means to you

“If after reviewing a patient’s medical record and the Sepsis-3 criteria a Cigna Medical Director determines that sepsis was not present, a diagnosis-related group (DRG) claim assignment may be adjusted because sepsis treatment services should not have been included as part of the claim. In these cases, covered claims will be processed with the appropriate revised DRG supported in the medical record.”