With COVID-19 and its variants and subvariants continuing to be a moving target, U.S. Health and Human Services Secretary Xavier Becerra extended the COVID-19 public health emergency (PHE) on April 13 – just days before it was set to expire. This declaration allows millions of Americans to continue to get free tests and treatments for at least 90 days. Unfortunately, the COVID-19 Uninsured Program and the Coverage Assistance Fund (CAP) has not been renewed. In this post, we’ll provide details on this, information on Medicare’s updates on Locum Tenens, and some tips for UTI diagnosis and coding.
The COVID-19 Uninsured Program and the Coverage Assistance Fund (CAF) is out of money. It is unknown if it will be refunded by Congress at this time.
On 03/15/2022, the Health Resources & Services Administration (HRSA) announced deadlines to submit claims. The deadline to submit testing and/or treatment claims has passed. The deadline to submit claims for COVID-19 vaccines expired on 04/05/2022. Any claims that were submitted will be paid only if funds are still available.
In light of these changes, practices should be following their self-pay protocols for uninsured patients that present for COVID-19 testing or treatment.
Vaccines are another story. One of the requirements for the CDC COVID-19 Vaccination Program is that providers administer the vaccine at no out-of-pocket cost to the patient. This means:
The good news is that with the extension of the public health emergency, the government will continue to support COVID-19 testing, treatments and vaccines largely at no cost.
Experity will continue to monitor this situation.
Staffing changes and summer vacation planning may have you considering temporary replacements for physicians in your practice. All services provided by substitute physicians must be reported using locum tenens billing, which allows you deserved reimbursement for your substitute physician’s services.
If you look for locum tenens Medicare guidelines, you’ll learn that locum tenens billing has a new name – fee-for-time compensation (FTC). And although the name changed, the billing concept is the same.
Remember, locum tenens/FTC is only for physicians that are “holding the place of” another physician. It is not to be used for extra help. If you’re hiring a physician on a temporary basis for any other reason, you can’t use locum tenens/FTC billing to report the physician’s services.
Use Modifier 6
Also, your locum tenens/FTC claims should include modifier Q6 (Service furnished under a fee-for-time compensation arrangement by a substitute physician; or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area); append it to every code on every claim you file for a locum tenens/FTC physician.
Use the Correct NPI
When billing for a FTC physician, you should use the name and National Provider Identifier (NPI) of the physician they’re substituting for.
Observe Time Limits
An FTC doctor can fill in for 60 continuous days starting with their first date of service. If you need to continue coverage by that physician after 60 days, that physician should be added to the group and begin using his/her own NPI number.
Even though an ICD-10 code, N39.0 (Urinary tract infection, site not specified), exists for urinary tract infections (UTI), landing on the right code for a UTI diagnosis is not necessarily clear cut. It’s always important to remember that specificity is crucial for accurate coding, and UTIs are no exception.
Try these strategies for landing on the most accurate code for a UTI diagnosis.
Know Why an Unspecified UTI Code May Be Problematic
As the industry moves toward diagnostic-based reimbursement, the use of unspecified codes – common for UTIs – is becoming less accepted.
Determining the Right Codes
Diagnosing a UTI – which may be related to the bladder, kidneys, or urethra –without a culture may become a thing of the past. That’s why the use of N39.0 is becoming more problematic. In addition, N39.0 contains a note telling clinicians to use an additional code from B95-B97 to identify the infectious agent, if applicable, after your provider has administered a test. In some cases, a provider may not have in-house resources to identify the infectious agent to meet coding guidelines. In those cases, it makes sense to recommend coding based on signs and symptoms from Chapter 18. While these signs and symptoms are also unspecified, they are a good choice in the absence of a definitive diagnosis.
Depending on provider documentation, you can use one of the following before your provider can provide the specific diagnosis:
But once your provider pins down the specific UTI, you will move to other, more specific codes.
Pinpoint Location and Severity
Once the provider makes a formal UTI diagnosis, they should narrow the diagnosis based on the location of the infection, as the table below shows:
|Body Location||Condition Name||Relevant ICD-10 Codes|
|Kidneys||Pyelonephritis||N10 (Acute pyelonephritis)|
|Urethra||Urethritis||N34.- (Urethritis and urethral syndrome)|
For the N30.- codes, you will also have to pay close attention to your provider’s note to see if the patient has been diagnosed with acute (sudden) or chronic (persistent) cystitis. If your physician documents the patient with acute cystitis, you’ll report N30.0- (Acute cystitis); but if the documentation states chronic cystitis, you’ll report N30.1- (Interstitial cystitis (chronic)) or N30.2- (Other chronic cystitis).
Don’t Forget to Consider Associated Diagnoses
These UTI codes also come with “Use additional code” instructions that tell you to use a code from the B95-B97 (Bacterial and viral infectious agents) if a test ordered by your provider shows that a bacterium or virus is the cause of the condition. So, you should keep these additional common bacterium or virus codes handy:
Some UTI Codes are Elsewhere
UTIs during and after pregnancy: “Organisms causing UTI in pregnancy are the same uropathogens which commonly cause UTI in non-pregnant patients” (www.ncbi.nlm.nih.gov/books/NBK537047/). But your coding for pregnant patients will be a little different.
Most often, you’ll use a code from the O23.- (Infections of genitourinary tract in pregnancy) group, which contains a “Use additional code” instruction for bacterial etiology coded to B95.- or B96.-. But you’ll use a code from O86.2- (Urinary tract infection following delivery) for patients diagnosed with a UTI after giving birth. And you’ll also find pregnancy-related UTI codes among the Pregnancy with abortive outcome (O00-O08) codes should your provider document the condition. For example, you may report O03.38 in the case of a UTI following incomplete spontaneous abortion.
UTIs in neonates: If the patient is under 28 days old and has a UTI, use P39.3.
UTIs in patients with stomas: Code a patient who has a stoma (an opening in the body to remove bodily waste following surgery) with N99.521 (Infection of incontinent external stoma of urinary tract) or N99.531 (Infection of continent stoma of urinary tract). But before using one of these codes, you will need to make sure that your provider has documented and confirmed a cause-and-effect relationship between the procedure and the condition.
Patients with a history of UTIs: You’ll code this with Z87.440 (Personal history of urinary (tract) infections).
Change In Cigna’s Reimbursement of Virtual Care Billed by Urgent Care Centers
Effective with March 13, 2022 dates of service and later, Cigna will no longer reimburse virtual care services provided by urgent care centers when billed with code S9083.
Urgent care centers may continue to be reimbursed for virtual care if they:
When virtual services are covered, an urgent care center will be reimbursed for their contracted face-to-face rate(s).
ALL Kids Program Claims Audit
Blue Cross and Blue Shield of Alabama is assisting in a CMS-mandated claims audit for the ALL Kids Program that requires providers to submit medical records to an independent company for review.
NCI Information Systems, Inc., will request medical records from specific providers for this audit. Providers who receive a medical records request must submit the requested records in a timely manner as outlined by NCI.
The request from the auditing company will include detailed instructions for submitting the medical records. The requests will start being sent to providers in April and continue quarterly through 2022.
If you have questions about this audit, contact Provider Networks at Ask-PSC@bcbsal.org.
Look for a Name Change for Anthem, Inc.
Anthem, Inc., has filed a preliminary proxy statement to change its name. The new name, pending shareholder approval, will be Elevance Health.
If the name change is approved by shareholder vote, the following will not change:
Elevance Health will continue to do business as Anthem Blue Cross and Blue Shield.
Interested in more? Our RCM experts use smart solutions and best practices to stay on top of revenue cycles and reimbursement.