Pay attention to dates associated with the new COVID–19 codes, Z20.822 and Z20.828, to avoid billing errors.
In December 2020, the Centers for Disease Control and Prevention (CDC) announced six new International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, developed to capture the disease process of COVID-19 better. These codes were first introduced at the Sept. 8, 2020 Coordination and Maintenance Committee meeting, and have since been approved and made available on Jan. 1, 2021, for reporting purposes.
There have been multiple code changes and updates related to COVID-19 (SARS-CoV-2) since the beginning of the pandemic. In particular, among the ICD-10-CM diagnosis codes implemented on Jan. 1 is code Z20.822, Contact with and (suspected) exposure to COVID-19, which previously required the code Z20.828. Pay attention to the specific dates associated with Z20.822 and Z20.828, as this will be critical for billing.
Payers require that a claim be split-billed by year when the claim spans both the 2020 and 2021 calendar years, as it relates to Z20.822 and Z20.828. Though not official payment guidance, providers are discovering that this is the case for the majority of payerss. For instance, if a patient had pre-op testing done, including a COVID screening (Z20.828), in December 2020, with a January 2021 outpatient surgery date, the claim will likely be split-paid by the year. Please reference the specific claim example below:
New ICD-10-CM codes implemented Jan. 1, 2021 include the following:
This unprecedented time of coding updates evidences the critical importance of securing quality and consistent medical coding education for your team. Additionally, in consideration of the expanded documentation, coding, and reporting of COVID-19 encounters, providers will be expected to demonstrate their efforts to be compliant with published guidelines. Engaging a clinical documentation integrity (CDI) team has proven beneficial in helping facilities complete concurrent and retroactive documentation and coding assessments of COVID-19 encounters. These efforts could greatly help in demonstrating compliance in practices, and potentially avoid payers audit recoupments.
There were 27 new ICD-10 codes for COVID-19-related conditions, monoclonal antibodies, and more, that became effective Jan. 1, 2021. The impact COVID-19 has had on medical coding and billing is nothing less than remarkable. It has undoubtedly been a year filled with challenges; however, in addressing these challenges, the industry has discovered opportunities for efficiency and long-term improvements that will extend far beyond the pandemic.
Programming Note: Listen to Susan Gatehouse report this story live today during Talk Ten Tuesdays, 10 a.m. Eastern.
The January 2021 ICD-10-CM addenda and updated ICD-10-CM Official Guidelines for Coding and Reporting are available on the CDC website:
https://www.cdc.gov/nchs/icd/icd10cm.htm
Clinical documentation integrity (CDI) professionals work in a variety of settings, and although I mostly focus on topics related to hospital inpatient billing, this week
With so much focus within the federal government on abuse, fraud, and waste, I thought it might be helpful to review a couple of federal
Please log in to your account to comment on this article.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
