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COVID-19 Billing Codes & Modifiers

The Public Health Emergency (PHE) due to COVID-19 has not only changed the landscape for how healthcare organizations treat, diagnose, and communicate (telehealth) with patients, but it has also impacted the revenue cycle from the billing, coding, and reimbursement aspect. New diagnosis codes, CPT codes, modifiers, classifications of visits, and changes in reimbursement are topics that healthcare leaders need to be informed of and to have processes for auditing compliance and tracking payer tendencies.

Have you asked your revenue cycle team members the following questions?

Patient Visits

  • Do you have a tracking mechanism for:
    • Telehealth visits
    • COVID-19 suspected and confirmed cases
  • Can you easily report the total number of telehealth visits and billed cases?
  • How are you identifying uninsured COVID-19 patients?

Documentation

  • How did you communicate with the patient?
  • Did you document how much time you spent with the patient?
  • Does your assessment & plan capture the complexity of the visit?

Reimbursement

  • Are payers reimbursing appropriately?
    • DRG
    • Telehealth
    • Outpatient visits
  • Are you receiving denials?

Coding

  • What CPT Codes are you using for:
    • Telehealth
    • COVID-19
    • Lab Testing
    • Specimen Collection
  • What diagnosis is primary?
  • Are you addressing any comorbidities that increase your level of concern for the patient?

Billing

  • How are you submitting UB04 and 1500 claims?
    • Revenue Codes
    • Modifiers
    • Place of Service Codes
    • Condition Codes

If your team is unable to answer or provide satisfactory answers to these questions, we may be able to help. We can offer the following assistance:

  • General educational material regarding billing codes and modifiers
  • Billing documentation including templates for required clinical medical record documentation
  • Auditing of records for coding/billing compliance
  • Validating accurate reimbursement by payer
  • Providing interim billing and coding duties for those clients that may experience staff absence due to illness related to COVID-19 or paid time off after the pandemic

If you would like to talk about your organization’s situation or needs, please contact us using the form below.

Connect with our team.

To learn more about our services and areas of expertise, send us a message.

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