NEW! Screening for COVID-19 Diagnosis Guidance

Screening for COVID-19 Diagnosis Guidance

Asymptomatic and pre-surgical COVID-19 diagnostic testing is covered when medically appropriate and supported by the accepted standards of current medical practice. Diagnostic tests will not be a benefitable service when conducted for return to work or surveillance purposes. All COVID-19 diagnostic test claims should be submitted with an ICD-10 code(s) that appropriately describes the patient’s diagnosis. To ensure proper reimbursement for COVID-19 diagnostic tests, please follow the guidelines set out below.

See updates below in red.

In these cases: Code Description
Concern about a possible exposure to COVID-19, but this is ruled out after evaluation. Z03.818 Encounter for observation for suspected exposure to other biological agents ruled out.

 

Actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown. Z20.828 Contact with and (suspected) exposure to other viral communicable diseases.
Actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown. Z20.822 Contact with and (suspected) exposure to COVID19
Asymptomatic individuals who are being screened for COVID-19 prior to a surgical procedure. Z01.818 Encounter for other preprocedural examination.
Asymptomatic individuals who are being screened for COVID-19 and have no known exposure to the virus, and the test results are either unknown or negative. Do not code when the individual is presenting with signs & symptoms. Z11.59

 

Encounter for screening for other viral diseases.

Asymptomatic screening for COVID-19 is not a benefit. Do not code when the individual is presenting with signs and symptoms.

Individuals who are being screened for COVID-19 Z11.52 Encounter for screening for COVID-19.

 

Please include signs and symptoms of COVID-19 if present.

 

Presenting with any signs/symptoms associated with COVID-19 (such as fever, etc.) but a definitive diagnosis has not been established.

 

If a patient with signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to someone who has COVID-19, assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, as an additional code.

For example:

R05

R06.02

R50.9

 

 

 

 

 

 

Cough

Shortness of Breath

Fever (unspecified)

(codes listed are not the only Dx codes that can be used)

 

Asymptomatic individuals who test positive for COVID-19. U07.1 Although the individual is asymptomatic, the individual has tested positive and is considered to have the COVID-19 infection.

 

COVID-19 Related Diagnosis Codes

New COVID-19 related diagnosis codes such as J12.82, M35.81, and M35.89 will not waive cost share unless U07.1 is included on the claim.

 

 

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