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Related are any test reporting and billing requirements in labs and medical facilities. The International Statistical Classification of Diseases and Related Health Problems (ICD) is a commonly used system of diagnostic codes for classifying diseases, including nuanced classifications of a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Their ICD-10-CM code set has been modified to include lab testing codes for COVID-19, as has the Current Procedural Terminology (CPT) code set. This guide provides basic information about these codes (which should not be considered legally binding advice); however, see the referenced material (and following citations) for more details concerning those codes[1][2][3][4][5]:

  • The CPT code 87635 has the long descriptor of "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." The American Medical Association's CPT Assistant fact sheet for SARS-CoV-2 reporting proves useful in supplying assistance on how and when to apply this CPT code in reporting.
  • Since the pandemic has progressed, numerous other CPT codes have become available. This includes a series of parent and child codes for antibody testing, neutralizing antibody screens, antigen testing, and vaccination. Resources for guidance concerning these codes include the American Medical Association and the American Society of Clinical Oncology (PDF).
  • The U.S. government-adopted ICD-10-CM—an authorized version of WHO's ICD-10[6]—has been updated by the CDC and the National Center for Healthcare Statistics. It includes not only codes for conditions associated with COVID-19, but also codes for exposure, screening, and vaccination. The principal diagnosis code "U07.1, COVID-19" is sequenced first for a confirmed COVID-19 diagnosis, followed by any appropriate codes for associated manifestations (though there is an obstetrics exception). CMS's coding guidelines, as well as American Medical Association guidance, may prove useful in choosing the correct codes. The American Society of Clinical Oncology (PDF) is also maintaining a document with ICD-10-CM information.
  • Since the pandemic started, new HCPCS codes have been released by the Centers for Medicare & Medicaid Services (CMS). These are to be used solely for Medicare claims. The American Society of Clinical Oncology (PDF) is maintaining a helpful document with that information.

Laboratories analyzing specimens for SARS-CoV-2 must be equipped to implement and handle analytical testing and test orders using the new test codes. However, they also must be able to quickly and accurately transfer vital case information to the appropriate health authority. This may include using other types of codes such as Logical Observation Identifiers Names and Codes (LOINC) and SNOMED-CT codes, which are briefly discussed in the next subsection.

References

  1. American Medical Association. "COVID-19 CPT coding and guidance". COVID-19 CPT codes. https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-coding-and-guidance. Retrieved 14 September 2021. 
  2. "Frequently Asked Questions Regarding ICD-10-CM Coding for COVID-19". AHA Coding Clinic Advisor. American Hospital Association. 27 August 2021. https://www.codingclinicadvisor.com/faqs-icd-10-cm-coding-covid-19. Retrieved 14 September 2021. 
  3. Centers for Medicare and Medicaid Services (10 August 2021). "ICD-10-CM Official Guidelines for Coding and Reporting FY 2022" (PDF). https://www.cms.gov/files/document/fy-2022-icd-10-cm-coding-guidelines.pdf. Retrieved 14 September 2021. 
  4. "COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing" (PDF). Centers for Medicare and Medicaid Services. 2 July 2021. https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf. Retrieved 14 September 2021. 
  5. "COVID-19 Coding and Reporting Information New CPT, HCPCS, and ICD-10 CM Codes" (PDF). American Society of Clinical Oncology. 26 August 2021. https://www.asco.org/sites/new-www.asco.org/files/content-files/advocacy-and-policy/documents/2020-COVID19-Billing-and-Coding-Resource.pdf. Retrieved 14 September 2021. 
  6. National Center for Health Statistics (30 July 2021). "International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)". Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/icd/icd10cm.htm. Retrieved 14 September 2021.