New condition code for COVID-19 released for healthcare claims.
We are in a state of flux with information, details, instructions, and changes impacting the revenue cycle in healthcare, due to the 2019 novel coronavirus (or COVID-19) pandemic and crisis. One such change is the release by the National Uniform Billing Committee (NUBC) of a new condition code for COVID-19 healthcare claims.
The following is from the NUBC announcement, made March 23:
Without codes to specifically indicate COVID-19 (including those cases for which services were provided but the patient ultimately tested negative), the ability of payers to trigger special handling of institutional claims for COVID-19-related services has been significantly limited.
NUBC Recommendation: in order to ensure appropriate flagging of COVID-19-related care, institutional claims for COVID-19 diagnosis or treatment should include:
1. The “DR” condition code, which is used to identify claims that are or may be impacted by specific policies related to a national or regional disaster/emergency.
2. One of the following diagnosis codes, as included in the interim ICD-10-CM Official Guidelines for Coding and Reporting (for more information, see https://www.cdc.gov/nchs/icd/icd10cm.htm):
o B97.29 (Other coronavirus as the cause of diseases classified elsewhere) for services provided before April 1, 2020
o U07.1 (COVID-19) for services provided on or after April 1, 2020
o Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out)
o Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases)
3. An appropriate service date.
The “DR” condition code should be utilized for COVID-19-related care occurring since Jan. 27, the date that the Department of Health and Human Services declared the COVID- 19 crisis as a federal public health emergency.
For different testing location claims:
In order to meet patient needs, many hospitals and health systems have moved testing locations from hospitals to off-campus facilities (e.g. parking lots, parks, football stadiums). In such cases, the NUBC recommends usage of the Hospital Outpatient Type of Bill (013x), the main hospital address, and National Provider Identifier (NPI). When paired with the DR condition code (as directed above), the claim will help payers correctly apply site of service restrictions/edits.
The ”DR” condition code is effective immediately, as of March, for all COVID-19-related claims.
Condition Code DR – Disaster related; Reported at the claim level in Item Number 10d
It’s important to share this information with your revenue cycle leadership, health information management, and coding and billing professionals. A best practice would be to perform a review of some of your COVID-19-related claims before sending them out to ensure that the condition code is in place on the claim. Also, monitor your claim denials closely to see if there are denied or returned claims due to a missing condition code.
Keep up with healthcare news; we’re in this together!
Resources: https://www.nubc.org/nubc-announcement-covid-19-claims
With the April 1 update, the Centers for Medicare and Medicaid Services (CMS) implemented 80 new PCS codes. To break it down, there are 24
In the FY 2027 Inpatient Prospective Payment System (IPPS) Proposed Rule, the Centers for Medicare and Medicaid Services (CMS) has introduced a notable and potentially
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