HealthDecember 21, 2020

Keeping up with COVID-19: December update

2020 has been a very chaotic year for everyone including terminology and December is no different. This year has highlighted the need for accurate and up to date coding and data collection. As the world remains hyper focused on the testing, treatment, and more recently the upcoming deployment of a vaccine for COVID-19, the standards that are used for near-real time data collection have had to produce continuous updates. The recent announcement from CMS that new diagnosis and procedure codes were being added effective January 1, 2021, is just the newest development.

There are hundreds of medical terminologies that document every step of the healthcare process through admission, testing, treatment, discharge, and billing. So, when there is a large health event like COVID-19, it requires quick updates to those terminology sets. Those updates then need to be disseminated to all healthcare organizations and relevant downstream systems. Accurate and timely updates are of the essence to ensure that healthcare operations are not impacted, and healthcare data is collected accurately at the point-of-care.

In March of this year, we took the opportunity to summarize changes to the billing and coding sets, their effective dates, provided links to the various standards bodies, and summarized how these codes will benefit clinicians who are tasked with documenting the COVID-19 condition at the point-of-care. It seems appropriate to update this information as many more codes have been released throughout this year and the situation continues to evolve.

ICD-10-CM and ICD-10-PCS COVID-19 updates

In March, under the National Emergencies Act Section 201 and 301, the Centers for Disease Control (CDC) authorized the addition of U07.1, a new diagnosis code specific to COVID-19, effective April 1, 2020. This new code falls under the Conditions of uncertain etiology hierarchy that will be new with the 2021 release. While no additional COVID-19 codes came out with the annual release of ICD-10-CM, CMS has now released an additional 6 Diagnosis codes covering Pneumonia due to Coronavirus, multisystem inflammatory syndrome, systemic involvement of connective tissue and three Z codes for documenting screening, exposure to and personal history of COVID-10. They also announced 21 new Procedure codes representing new technologies for the prevention and treatment of COVID-19. All the codes will be effective January 1, 2021. As of the publishing of this blog, all the new codes are available for our Reference Data Management (RDM) and Clinical interface terminology (CIT) clients through normal distribution channels.

Current procedural terminology (CPT) COVID-19 updates

In March, we reported that the American Medical Association (AMA) had created a new CPT code to streamline the testing process by U.S. healthcare providers. Code 87635 for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2) (Coronavirus disease [COVID-19]) was accepted as the new industry standard CPT code for reporting COVID-19 testing, made effective March 13, 2020. Since that time, they have released several transmittals that led to the introduction of 14 additional COVID related codes. The most recent release included 6 new codes that will be effective January 1, 2021 and are related to immunization for COVID-19.

Healthcare common procedure coding system (HCPCS) COVID-19 updates

In February, CMS developed a new HCPCS code to allow healthcare providers and laboratories the ability to appropriately document and bill for COVID-19 specific testing. The new HCPCS code, U0001, can be used specifically for CDC testing laboratories to test patients for SARS-CoV-2 COVID-19. The second HCPCS billing code, U0002, allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). As of April 1, 2020, Medicare claims processing systems were able to accept this new HCPCS code for COVID-19 specific services provided to their patients.

As knowledge of COVID-19 evolved, so did the HCPCS code set. To date, there have been 20 updates to the 2020 HCPCS code set. While multiple updates are not altogether unusual, this does represent an increase of 15% over previous years and represents 10 new codes directly related to COVID-19. Some examples of these new codes include medications to treat COVID-19, specimen collection codes, and U0003 and U0004 being adding to expand the ability to more granularly document and bill for testing for the coronavirus.

SNOMED CT® COVID-19 updates

In March we released an interim release of SNOMED CT that provided clinicians, researchers, and administrators with the most current terminology needed to code, analyze and appropriately address the Coronavirus. These 24 codes have since been fully released in the July 2020 release of SNOMED CT and have been fully incorporated into the Health Language content. We do not expect any additional interim releases from SNOMED International at this time.

LOINC® COVID-19 updates

In a typical year, LOINC releases two major updates. 2020 is anything but typical. We have processed 15 releases of LOINC in 2020. Found within the extra 13 releases are over 50 new codes related to COVID. Many of these cover the multitude of tests that are used for antibody, antigen and genes related to COVID-19 infection. There are several other codes that cover the encounters, evaluation forms and intubation reports for COVID-19 patients.

RxNorm COVID-19 updates

RxNorm is a very active content set with standard releases from Health Language each month. While COVID did not create much activity in this content relative to other terminologies, we have seen some activity from them and have at least 33 new codes added to the content set that are directly related to COVID-19. You might be familiar with Remdesivir, but also on the list are Regiocit and Casirivimab/Imdevimab. Each of these comes in varying doses with multiple NDCs.

Documenting problems & diagnosis at the point-of-care

In partnership with our EHR vendors, clinicians who utilize our Clinical Interface Terminology solution to search and document problems and diagnoses at the point-of-care had access to new search terms and codes associated with COVID-19 before the codes were active. These updates enabled clinicians to adhere to the new codes released by SNOMED International and CMS in order to properly document, analyze, benchmark and report patients who contract COVID-19. Most recently, Health language was able to produce an out of cycle update in record time to incorporate the new ICD-10-CM codes and their associated mappings to SNOMED CT so that providers will have those codes available in the electronic health record systems on January 1, 2021 when they become officially active and billable.

Healthcare organizations managing reference data

For clients that subscribe to our ICD-10, SNOMED CT, LOINC, RxNORM, HCPCS or CPT products, our team has continuously updated the respective data files to reflect the current guidance around COVID-19. Those codes are available via our Content Portal or our hosted Reference Data Management solution. In fact, one of our clients commented recently that that they could not keep up with the updates and knew that they could trust Health Language to deliver accurately and timely updates.

While many of the codes are now official, it is best to keep in mind that some of these codes have been created due to an urgent and emergent situation and are subject to a change or deletion at any time. As the situation develops Health Language will continue to monitor the changes and update our content as needed as quickly as possible for our clients to remain compliant and up to date.

If you have any questions, please do not hesitate to reach out to the Health Language team.