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Regulatory guidelines continue to change as we navigate through COVID-19 and new rules for coding visits. In this month’s “3 Things to Know About RCM,” we provide information on additional COVID-19 ICD-10 codes that just went into effect, the government’s efforts to alleviate provider burden, and tips for avoiding scams at your urgent care clinic.
New ICD-10 Codes were officially announced by the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS). These new codes went into effect on January 1, 2021 and replace existing codes that are not specific to COVID-19.
|Condition||2020 ICD-10||2021 ICD-10|
|Encounter for screening for COVID-19||Z11.59||Z11.52|
|Contact with and (suspected) exposure to COVID-19||Z20.828||Z20.822|
|Personal history of COVID-19||Z86.19||Z86.16|
|Pneumonia due to coronavirus disease||U07.1 and J12.89||U07.1 and J12.82|
Two additional codes were also announced: M35.81 (Multisystem inflammatory syndrome (MIS)) and M35.89 (Other specified systemic involvement of connective tissue).
The COVID-19 virus continues to roll through the country leaving a legacy of exhausted providers, coding confusion, and unanswered billing questions. With the extension of the public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) published an interim final rule in November covering a broad mix of coronavirus updates. This fourth COVID-19-inspired IFC follows through on CARES Act mandates originally outlined in March. These are the top five takeaways:
CMS Administrator Seema Verma said in a release, “We have developed a comprehensive plan to support the swift and successful distribution of a safe and effective vaccine for COVID-1. CMS is acting now to remove bureaucratic barriers while ensuring that states, providers, and health plans have the information and direction they need to ensure broad vaccine access and coverage for all Americans.”
According to a Federal Communication Commission (FCC) alert, “As the COVID-19 pandemic continues to impact the United States, the FCC has learned of scam text-message campaigns and robocalls that prey on virus-related fears.”
Scammers texting as representatives of the government lure recipients to click, send, or get in touch, preying on virus-related fears and the uncertainty of day-to-day changes to regulations and restrictions.
The HHS Office of Inspector General (OIG) also updated its COVID-19 scam site on Dec. 3. The OIG warns healthcare operations that “fraudsters are offering COVID-19 tests, HHS grants, and Medicare prescription cards in exchange for personal details, including Medicare information. However, these services are unapproved and illegitimate.”
Both the Cybersecurity and Infrastructure Security Agency (CISA) and the Federal Bureau of Investigation (FBI) have warned repeatedly about ransomware, phishing, and other cyber-attacks targeting the healthcare industry specifically (see Health Information Compliance Alert, Vol. 20, Nos. 9 & 11).
With more remote workers and the increased use of mobile devices, it’s not surprising that more people are falling victim to the hacks. Unfortunately, these hacks can expose patients’ electronic protected health information (ePHI).
Don’t be a victim.