Healthcare Fraud Shield’s Latest Article: FWA in the Age of the Coronavirus: Coding Review!

9 Mar
Everywhere you turn, the Coronavirus (COVID-19) is the topic of reporting and what’s on everyone’s mind. As with new strains throughout history (Spanish Flu epidemic, Black Death), the resulting panic can result in the emergence of new and sometimes questionable treatments and vaccines. While this pathogen is a very real concern, a plan may be besieged with claims with services of dubious effectiveness.
The first step in any investigation is to be informed. While there are many insights and opinions on this, the best place to start is the Center for Disease Control (CDC).* As per the CDC, symptoms include fever, cough and shortness of breath. Probability of infection increases if you experience the symptoms with close contact with confirmed cases or have recently traveled from an area with widespread infections.
Diagnosis Coding
There is no ICD-10 code for this specific strain of the coronavirus at this time in the U.S.  The World Health Organization recently established ICD-10 code U07.1*; however, it was not included in the current ICD-10 CM guidelines.
In the interim, codes currently reported include:

 

B27.29-Other coronavirus as the cause of diseases classified elsewhere
This secondary code can be assigned to other COVID-19-related conditions, such as:
J12.89-Other Viral Pneumonia
J20.8- Acute Bronchitis
J22-Acute Lower Respiratory Infection
J80- Acute Respiratory Distress Syndrome
J98.8- Other Specified Respiratory Disorders
If a patient has confirmed exposure:
Z20.828-Contact with and (suspected) exposure to other viral communicable diseases
If the patient has suspected exposure, but it was ruled out:
Z03.818-Encounter for observation for suspected exposure to other biological agents ruled out.
If the patient exhibit symptoms, but there are no definitive diagnoses, the codes for the symptoms should be used:
R05-Cough
R06.02- Shortness of Breath
R50.9- Fever, Unspecified

Procedure Coding
While there are currently no CPT codes specifically describing COVID-19, CMS has issued two new HCPCS Codes (U0001 and U0002) effective April 1, allowing dates of service back to February 4th, 2020.
What to look for
Using these diagnosis codes, alone or in combination (such as symptoms), the investigator can identify outlying providers and the services used to address them. Further analysis on both suppliers and services can further focus the investigative effort to identify vulnerabilities to those who would take advantage of this crisis.
In addition, look for excessive volume or increases in the HCPCS codes and/or services such as laboratory tests.
If you have any questions or comments, please contact SIU@hcfraudshield.com.
*References:
3) CMS-Coding
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