National Uniform Billing Committee Releases New Condition Code for COVID-19 Claims

By
Original story posted on: April 6, 2020

New condition code for COVID-19 released for healthcare claims. 

We are in a state of flux with information, details, instructions, and changes impacting the revenue cycle in healthcare, due to the 2019 novel coronavirus (or COVID-19) pandemic and crisis. One such change is the release by the National Uniform Billing Committee (NUBC) of a new condition code for COVID-19 healthcare claims.

The following is from the NUBC announcement, made March 23:

Without codes to specifically indicate COVID-19 (including those cases for which services were provided but the patient ultimately tested negative), the ability of payers to trigger special handling of institutional claims for COVID-19-related services has been significantly limited.  

NUBC Recommendation: in order to ensure appropriate flagging of COVID-19-related care, institutional claims for COVID-19 diagnosis or treatment should include:

1. The “DR” condition code, which is used to identify claims that are or may be impacted by specific policies related to a national or regional disaster/emergency.  

2. One of the following diagnosis codes, as included in the interim ICD-10-CM Official Guidelines for Coding and Reporting (for more information, see https://www.cdc.gov/nchs/icd/icd10cm.htm):

o B97.29 (Other coronavirus as the cause of diseases classified elsewhere) for services provided before April 1, 2020

o U07.1 (COVID-19) for services provided on or after April 1, 2020

 o Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out)

 o Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases)

3. An appropriate service date. 

The “DR” condition code should be utilized for COVID-19-related care occurring since Jan. 27, the date that the Department of Health and Human Services declared the COVID- 19 crisis as a federal public health emergency.

For different testing location claims:

In order to meet patient needs, many hospitals and health systems have moved testing locations from hospitals to off-campus facilities (e.g. parking lots, parks, football stadiums). In such cases, the NUBC recommends usage of the Hospital Outpatient Type of Bill (013x), the main hospital address, and National Provider Identifier (NPI). When paired with the DR condition code (as directed above), the claim will help payers correctly apply site of service restrictions/edits.

The ”DR” condition code is effective immediately, as of March, for all COVID-19-related claims.

Condition Code DR - Disaster related; Reported at the claim level in Item Number 10d

It's important to share this information with your revenue cycle leadership, health information management, and coding and billing professionals. A best practice would be to perform a review of some of your COVID-19-related claims before sending them out to ensure that the condition code is in place on the claim. Also, monitor your claim denials closely to see if there are denied or returned claims due to a missing condition code. 

Keep up with healthcare news; we’re in this together!

Resources: https://www.nubc.org/nubc-announcement-covid-19-claims

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer

Gloryanne Bryant is an independent health information management (HIM) coding compliance consultant with more than 40 years of experience in the field. She appears on Talk Ten Tuesdays on a regular basis and is a member of the ICD10monitor editorial board.

Related Stories

  • The Sad Plight of Burnout among America’s Frontline Nurses
    EDITOR’S NOTE: With the resurgence of the coronavirus, the toll among America’s frontline caregivers could be especially taxing, particularly for nurses. And while much attention has been focused on physician burnout, in a recent interview conducted by Chuck Buck with…
  • 2021 AMA E&M Changes: A Provocative Overview
    Many of us have been immersed in COVID-19 and telehealth billing, coding, and the varying rules among payors of late, all the while the clock has remained ticking on the looming changes to evaluation and management (E&M) services, effective Jan.…
  • Eviction Protections, Unemployment, and Housing Insecurity amid COVID-19
    Housing has long been a hot topic among healthcare organizations striving to address the complex needs of populations at risk of homelessness. Over half a million people were living on the street during the January 2019 annual point-in-time count, and…