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
In recent years, generative artificial intelligence (GenAI) has passed medical exams, diagnosed complex cases, and even come up with ways to combat a pandemic. In fact, large
On June 27, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update payment rates and policies for renal dialysis services
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 ICD10monitor. Powered by MedLearn Media.
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. 2 with code CYBER24
