The landscape of healthcare has changed dramatically in the few weeks from the COVID-19 virus. And it is not lost on us that our roles as technical, regulatory, and EHR experts are key in the battle of helping healthcare providers and their patients alike to navigate this new landscape. Everyday new regulations are signed into effect, testing and procedures are created or modified and it’s a daunting task to try and keep up with all the information.
Our teams communicate regularly regarding new codes, regulations, and best practices in supporting our MEDITECH and EPIC customers. Below you’ll find a collection of resources that have been shared by our team members to help you keep track of the latest health IT updates and options that support coronavirus treatment.
Extended Functionality Usage:
While vendors are rushing to be sure that their EHR is updated with the most current functionality to meet the needs of facilities, there is a good amount of information already published to assist sites with necessary set-up. MEDITECH has a webpage dedicated to Coronavirus and posts updates on a regular basis.
Be aware, that while many sites may not currently use all the functionality in the defined best practice, such as Surveillance, they have the option to use this functionality now even if it is just to assist with COVID-19. This applies to Notices, Messages and Tasks, Telemedicine and Remote Monitoring features as well. The CereCore team is reviewing and testing new updates in our own MEDITECH system. We are happy to answer questions and demonstrate options that are new to you.
Set up for Coronavirus:
There is dictionary update that needs to take place in order for sites to order, track and bill for testing and treatment specific to COVID-19. In many cases the agencies that oversee this information may not have automated updates ready, so this does require facilities to make these updates manually. This includes:
Set up of Test/Procedures:
The Centers for Medicare & Medicaid Services (CMS) developed two new lab testing codes:
- U0001 will be reported for coronavirus testing using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel.
- U0002 will be reported for validated non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).
Note, if your office is not running the test for COVID-19 or incurring the cost, you will not report these codes.
The American Medical Association Current Procedural Terminology (CPT) Editorial Panel has developed a CPT code, which streamlines novel coronavirus testing offered by hospitals, health systems, and laboratories in the United States. The code was effective March 13, 2020, for use as the industry standard for reporting of novel coronavirus tests across the nation’s health care system:
- 87635 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
IMO nomenclature, LOINC Codes and EMR ID’s will also need to be updated manually. Also be aware that while some of these codes are released now, CMS will not be able to except them until April.
Point of Contact Queries:
Most sites currently use Point of Contact Queries. However they may need to be added to or updated specific to CDC criteria for COVID-19, as well notifications, messages and reports associated to the queries.
- The first query (Travel/Contact query) being used is a Yes/No query asking if the patient has traveled to an affected area or had contact with a person from an affected area, or has been in contact with someone who is under investigation for or confirmed for COVID-19.
- The second query (Coronavirus Symptom query) is also a Yes/No query asking if the patient has experienced any coronavirus symptoms.
- The third query (Coronavirus Symptoms Experienced query) is a group response multiple where nursing staff must identify the symptoms that the patient is experiencing.
E&M Codes (Evaluation and Management):
There are no unique codes for evaluating and managing this condition; however, be sure to clearly document any additional time spent with the family or time spent coordinating any care that is not face-to-face with the patient and/or family.
There is no code for swabbing the patient for COVID-19, much like there is no code for swabbing for influenza. However, if the specimen will be prepared by your office and sent to an outside lab, report the specimen collection code 99000.
ICD-10 Coding Guidance:
On March 18th the Centers for Disease Control and Prevention (CDC) announced that the effective date of new diagnosis code U07.1, COVID-19 has moved from Oct 1 to April 1, 2020. AHIMA ICD-10-CM interim coding guidance can be found here.
COVID-19 attacks the respiratory system; therefore, suspicion of the disease typically will accompany respiratory conditions. A confirmation of COVID-19 will therefore be linked to a specific respiratory condition.
- Pneumonia: For a pneumonia case confirmed as due to the 2019 novel coronavirus (COVID-19), assign codes 89, Other viral pneumonia, and B97.29, Other coronavirus as the cause of diseases classified elsewhere.
- Acute bronchitis: For a patient with acute bronchitis confirmed as due to COVID-19, assign codes 8, Acute bronchitis due to other specified organisms, and B97.29. If the bronchitis is not specified as acute, due to COVID-19, report code J40, Bronchitis, not specified as acute or chronic, along with code B97.29.
- Lower respiratory infection: If the COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, report with code J22, Unspecified acute lower respiratory infection, with code 29. If the COVID-19 is documented as being associated with a respiratory infection, NOS, it would be appropriate to assign code J98.8, Other specified respiratory disorders, with code B97.29.
- Acute respiratory distress syndrome (ARDS): ARDS may develop in conjunction with COVID-19. Cases with ARDS due to COVID-19 should be assigned the codes J80, Acute respiratory distress syndrome, and 29.
- Exposure to COVID-19: For cases where there is possible exposure to COVID-19, but the disease is ruled out, report code 818, Encounter for observation for suspected exposure to other biological agents ruled out. For cases where there is an actual exposure to someone who is confirmed to have COVID-19, report code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. This code is not necessary if the exposed patient is confirmed to have COVID-19.
- Signs and symptoms: For patients presenting with any signs/symptoms and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as: Cough (R05); Shortness of breath (02) or Fever unspecified (R50.9).
Do not report “suspected” cases of COVID-19 with B97.29. In addition, diagnosis code B34.2, Coronavirus infection, unspecified, typically is not appropriate. (reference: https://www.aappublications.org/news/2020/03/12/coding031220)
There are many vendors and suppliers offering options to health systems to enable remote work and telemedicine. A couple options for MEDITECH customers are:
- MeMD is launching a short-term telehealth business to address the needs of coronavirus patients. Companies can now purchase a 90-day virtual health package called Total Telehealth-Rapid Response.
- MEDITECH offers Expanse Ambulatory and Patient Portal users complimentary deployment of Scheduled Virtual Visits functionality for a six-month period. This applies to: EXPANSE 2.1.2, 6.15 pp45 and Global pp43.
- Limiting of non-essential adult elective surgery and medical and surgical procedures, including all dental procedures
- Expansion of Telehealth benefits for COVID-19
- Limited Waiver of HIPAA Sanctions, Minimum Necessary, Need to know and Appropriate Access
Other Great Reads:
If we can help you enabling Health IT for your facility in the battle against Coronavirus, please don’t hesitate to connect with us.