Without much warning, the novel Coronavirus, or COVID-19, has taken over our healthcare system. It has taxed our healthcare workers, our national stockpiles of PPE, and affected millions of Americans nationwide. In addition to healthcare workers on the front lines, the pandemic has also impacted the healthcare revenue cycle, causing major confusion, questions, and inconsistencies as coding specialists learn the latest COVID-19 codes and guidelines at warp speed. With cases rising by the tens of thousands on a weekly basis (as of late April), it has been difficult for coders to keep up with the rapidly changing guidelines that come with this new and relatively unknown virus.
As this health crisis turned into a pandemic, The Centers for Medicare & Medicaid Services (CMS) was forced to jump into action quickly. Going into effect in early February, CMS created two new HCPCS codes to report COVID-19 testing and two additional codes in early March for COVID-19 specimen collection. The American Medical Association (AMA) also released a new CPT code shortly thereafter to capture lab testing and two new CPT codes in April to report antibody testing. If that was not enough to keep track of, CMS also released an interim final rule in early April in response to the COVID-19 public health emergency that provides additional guidance for healthcare providers, followed by the release of a special ruling on April 14 that created two new HCPCS codes to capture COVID-19 testing using high throughput technologies.
Codes continue to change seemingly by the day and there is far more to keep track of than ever before. At the same time, it is crucial that coding departments are consistent with their use of the new codes and coding guidelines to measure the outbreak. By providing an understanding of the number of people who have the disease through accurate coding and allowing for location tracking of those infected we are much better able to understand how the disease is spreading. And, as hospitals run out of PPE and other crucial supplies to treat patients, they must ensure they have the revenue to which they are entitled under the new rules to continue to purchase these necessities.
Because COVID-19 is a novel virus that had not previously infected humans, healthcare providers did not have codes available to uniquely identify patients who were infected with the COVID-19 virus in the early days of the outbreak. This continues to cause major confusion as patients come into healthcare facilities with myriad symptoms, all of which could be caused by various upper respiratory issues. For example, U07.1, COVID-19, is used to report all confirmed cases of COVID-19 followed by additional codes to identify a specific respiratory illness such as pneumonia or bronchitis, caused by the virus. Inpatient cases that are suspected or likely to be COVID-19 should not be coded using U07.1, which is an exception to the Official Guidelines for Coding and Reporting for most conditions. Another caveat to coding for COVID-19 is when a patient does not test positive for the virus but has been exposed. This patient should be coded for their symptoms, such as fever, cough, or shortness of breath as well as assigned an additional code that denotes that the patient is known or is suspected to have been exposed to COVID-19.
As patients continue to flood hospitals and the bills begin to inundate hospital billing departments, coders must continue to churn out precisely coded bills as they learn these new codes almost on the fly. At this rapidly moving pace, it is difficult to not only answer questions but have the time to ask them. But with more healthcare workers coding for the treatment of patients and more diverse situations to code for (e.g. telehealth), it is critical that coders are going back and asking all their questions and receiving answers.
Although patients come first, without the proper attention to the revenue cycle within healthcare facilities it is impossible to have the budget to continue to pay the salaries of the over 7 million workers that support the care of millions of patients. As reported in a recent National Hospital Flash Report from Kaufman Hall, the consequences of having to lay off thousands of workers and potentially close hundreds of hospitals nationwide due to revenue issues would be devastating and extreme. Asking questions on the coding side before bills go out the door, no matter how busy departments might be is crucial under today’s circumstances.
The Best Practices
There is a light at the end of the tunnel with this pandemic, but while we continue to trudge through such a time there are ways to ensure coding accuracy the first time around. Some best practices include:
- Take the time to educate coders on the new coding guidelines as often as possible.
- Flag all patient records who have had testing for COVID-19 to ensure that positive test results are coded appropriately since tests performed outside of the facility may have delayed results.
- Check official websites often. The CDC published official guidelines and the American Health Information Management Association (AHIMA) has published a free COVID-19 query template. CMS publishes daily updates on billing and coverage and has several FAQ documents. The AMA has published guidance for physicians on billing and documentation.
As hospitals are stretched incredibly thin, proper reimbursement becomes more critical than ever as they look to maintain financial viability and long-term success. According to the National Hospital Flash Report from Kaufman Hall, hospital revenue margins have been down by almost 13 percentage points since March. As first responders and other critical healthcare workers risk their lives fighting this virus on the front lines, we owe it to them to be able to compensate their efforts accordingly, meaning sending bills out the door that are coded accurately the first time by avoiding costly mistakes.
The Bottom Line
As we’ve heard time and time again throughout this pandemic, we will see the end of this one day soon. For now, we can only do our best to keep things moving quickly and accurately to ensure all patients get the proper care and hospitals get accurate bills out the door. Coders must work harder than ever to ensure both hospitals and patients are being reimbursed and charged correctly. Coders have a responsibility that greatly impacts the revenue cycle and the financial viability of hospitals nationwide. With the right knowledge and tools during this time, coders can do their part as we all navigate through the COVD-19 pandemic together.