Penny M. Jefferson, R.N., a clinical documentation improvement specialist at Mayo Clinic, reviews coding and billing guidelines in daily practice for confirmed and presumptive positive cases of COVID-19.
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Welcome to Mayo Clinic Cove in 19 expert insights and strategies. The following activity is supported in part by an independent medical education grant from Pfizer Inc and is in accordance with a C CMI guidelines. Hi, my name is Penny Jefferson. I'm a clinical documentation specialist at Mayo Clinic in Arizona. Today, I will be discussing coding and billing for the Cove in 19 patients and what you need to know. I would like to give a special thank you to a net. Thanks. Cindy Avery, Tony Bridget, Judy Dock in and Savannahs INS for assistance With Content Review Mayo Clinic destination locations are Phoenix, Arizona. Rochester, Minnesota, in Jacksonville, Florida At the end of this presentation, you will have an advanced understanding of and the ability to apply outlined coding guidelines to daily practice for accurate and complete billing, as well as demonstrate proper use of documentation guidelines for confirmed and presumptive positive cases of Copan 19. You'll be able to identify opportunities to capture the correct principal diagnosis through the use of president efficient indicators, and it identified the impact of Koven, 19, on billing and reimbursement for the hospital or providers and funds allocated for assistance that it cares act for confirmed and presumptive positive cases of Kobe. 19. Use code you 7.1. If Copa 19 is documented as suspected, probable or inconclusive, do not use code user or 7.1. Instead, assign a code explaining the reason for the encounter. Such a fever or Z 20.828 which is contact with and suspected exposure to other viral communicable diseases when Kobe, 19 meets the definition of principal diagnosis, use code user or 7.1 principal diagnosis is defined as that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital. For care coding guidelines. State Cove in 19 should be sequence first, followed by the appropriate codes for associated manifestations except in the case of substance. Do DeKoven 19 president Admission. Obstetrics patients for patients admitted with transplant complications. Respiratory illnesses due to Copa 19 are pneumonia, acute bronchitis, floor respiratory infections and acute respiratory distress syndrome. Principal diagnosis would be use your seven point 1/19 as the principal diagnosis, followed by each of the specific manifestations associating with Koba. 19 pneumonia confirmed as due to Koba, 19, would be coded as other viral pneumonia. J 12.89 for a patient with acute bronchitis confirmed those due to cope in 19 Assigned code J 20.8 if you bronchitis due to others, testified organisms. Bronchitis not otherwise specified due to Koba. 19. Should be coded using J 40 which is bronchitis not specified as acute or chronic. If Kobe, 19 is documented as being associate ID with a lower respiratory infection, not otherwise specified or an acute respiratory infection, not otherwise specified. Use code J two to unspecified acute lower respiratory infection if Kobe, 19 is documented as being associated with a respiratory infection. Otherwise specified. Code. J 98.8 Other specified respiratory disorder for acute respiratory distress syndrome. ARDS due to Cova, 19. Assigned code You 7.1 and J 80 Acute respiratory distress syndrome. Coding of possible exposure to Koven, 19. Ruled out after evaluation Used code. You're 3.818 Encounter for observation for suspected exposure to other biological agents. Ruled out coating of actual exposure to someone with Copan. 19. Confirmed or suspected when the test results are negative or results are unknown. Assigned Code Z 20.828 which is contact with and suspected exposure to other viral communicable diseases for individuals who are being screened for Cove in 19 with no known exposure to the virus and the test results are either unknown or negative. Use code Z 11.59 Asymptomatic individuals who test positive for cove in 19 assigned code you 7.1. Although the individual is asymptomatic, individual has tested positive and considered to have Koven 19. For individuals presenting with signs or symptoms associated with Koba, 19 such as fever, cough or shortness of breath. And no definitive diagnosis has been established. Used the appropriate code or codes for each of the presenting signs, signs and symptoms such as Are there If I Cough R 6.2 for shortness of breath for fever and specified use could are 50.9 section for individuals who have had actual or suspected contact or exposure presenting the signs and are symptoms of Copan 19. A sign code Z 20.828 As additional code women admitted with or presenting for a health care encounter during pregnancy. Childbirth of the aquarium Because of Kobe. 19. The principal diagnosis will be, 98.5 Other viral diseases complicating pregnancy, childbirth or the papyri Um, you 7.1 will be listed as a secondary diagnosis, followed by any appropriate codes for associated manifestations. Cytokine release syndrome Inside a Kind storm syndrome are used interchangeably in literature. Cyber find Release Storm is a systemic inflammatory response to infections and certain immune therapies that trigger the immune system. The reaction to the side of pine release varies from mild symptoms. Life threatening organ failure or even death. Currently, for the clinical data suggests evidence of mild or severe CIDA kind release syndrome in severe covert 19 patients. Consequently, treatment of the Santa Kind storm has become an important part of saving severe Covad 19 patients. There has also been a new coding clinic released in fourth quarter 2020 that addresses how to code the side of kind release syndrome due to kill with 19 question answer for Coben Neck for coding. Cider can release syndrome to DeKoven 19 question. The patient was admitted for treatment of cytokine release syndrome. Grade three due to Koba. 19. What is the appropriate sequencing for this admission? A sign code. You 7.1 Copa 19 is the principal diagnosis. The Sign Code D 89.833 Cytokine release syndrome. Great three. As an additional diagnosis, this sequencing is supported by the instructional note that subcategory D 89.83 cytokine release syndrome go first. The underlying condition This slide includes reference for coding scenarios of what coats to use and when appropriately. Note the sequencing of Koven 19 and sepsis is dependent on the Princeton on admission status. In response to the Koven 19 pandemic, the Centers for Medicare and Medicaid Services implemented 12 new I C D 10 PCs procedure codes to describe the introduction or infusion of therapeutics for the treatment of Kobe. 19. Effective with discharges on or after August 1st 2020. These codes should only be assigned when these drugs are administered to treat cova 19. But a more specific I see 10 PCs code exists, such as a stem cell transfusion assigned that code rather than one of less specific technology codes. The new codes for introduction of other new technology therapeutic substances are only intended for new substances that are not classified elsewhere in 10 PCs. This is a quick reference table for the added procedure codes to capture the introduction or infusion of therapeutics to treat Cove in 19. As you can see, code X w 033 e five is the procedure code for a patient that is receiving room disappear. Inclusion of these codes will aid in data collection for treatments provided to Copa 19 patients. The coronavirus has taken a devastating toll on Americans across the country, whether in lives, lost or economic impacts. The health care system is no different. Providers have been greatly affected as they strive to do the right thing. Delaying elective surgeries, causing destruction critical revenue streams. Hospitals have been hit hard, economically as well. Added equipment utilization for critically ill patients. Increased critical care staffing needs needs from massive amounts of e and cancelation of revenue. Producing surgeries caused a sudden decline in revenue for hospitals and entire health systems. Non essential employees or were either furloughed or had hours cut to assist in revenue stabilization. The Cares Act is a $2.2 trillion economic stimulus bill passed by President Donald Trump on March 27th 2020 in response to the economic fallout of the Go go 19 pandemic in the United States. Cares Act has allocated $100 billion for health care providers. A portion of funding will be used to cover providers costs of delivering Koba 19 care for the uninsured as a condition of receiving funds. Under this program, providers will be will be forbidden from balance billing the uninsured for the cost of their care providers will be reimbursed at Medicare rates. The first round of the high impact relief fund to hospitals is a distribution of $10 billion. The primary driver for the costs related to Koba, 19, is in patient admissions to the hospital. U. S Department of Health and Human Services identified those facilities with 100 or more Koven 19 admissions. These facilities encountered 129,911 admissions, or over 70% of the total number of Kobe, 19 inpatient admissions reported. The number of admissions accounted by these hospitals was then used to determine the allocation of relief funds across the pool of of eligible recipients. Each recipient received funding equal to 76,975 dollars per admission. Note. Payments to these facilities on this basis is not intended to reimburse the facilities for their specific cost of these admissions. Rather, a Cobra 19 admissions is being used as a proxy for the extent to which each facility experience lost revenue and increased expenses associated with directly treating a substantial number of over 19 page inpatient admissions. There are two more rounds of financial defense plan for hospitals. The estimated financial impact is $50.7 billion per month, which is limited to the impacts analyzed. The total of A of four analyses completed over a four month period was $202.6 billion in losses for American Americans. Hospitals and health systems for analyses included the effects of Copan 19 hospitals and costs, the effects of canceled and 4 g services, Kozlikova 19 on hospital revenue. The additional costs associated with purchasing needed personal protective equipment, or PPE, and the cost of additional support. Some hospitals were providing their workers. Do you telling of the reimbursements? Reimbursement will be based on her ear Medicare fee schedule rates except for otherwise noted publication of new codes and updates to existing codes will be made in accordance with published CMS guidance for any new codes where a Samos published rate does not exist, claims will be held until same as publishes correspondent Bree. Enforcement Information. When an individual no longer meets the need for acute in patient care, the patient may remain in hospital for public health reasons to prevent infecting other individuals. If the patient is a Medicare beneficiary and is a hospital inpatient for medical necessary care, Medicare will pay for hospitals. The diagnosis related group break in any costs outliers for the entire stay. This includes any of the quarantine time when the patient does not meet the need for acute in patient care until the Medicare patient is discharged. It is extremely important for providers to document in the medical record the reason the patient remains in the hospital following inpatient acute care. The health resource is and service administration Coma. 19. Uninsured reimbursement program does not meet the definition of a health plan. The program is not subject to HIPPA requirements. The H. R s, a administrator states program, does not provide coding guidance for Cove in 19. The program provides billing guidance to allow providers to identify and submit Onley claims eligible for reimbursement under this program, which is exclusively for UM, a reimbursing providers for Cova 19. Testing of uninsured individuals and treatment for insured individuals from Koven 19 is the primary reason for treatment. The American Health Information Management Association sent a letter to the administrator of the Health Resource Is and Services Administration, expressing its concern that The HRs days program guidance directing providers to disregard official coding rules in order to receive reimbursement under the code of 19 uninsured program. This is provider at risk, a violation of the Health Insurance and Portability and Accountability Act, or even charges of fraud and abuse of the office of the inspector general. A Hema, respectively, disagrees with the hrs. A statement in its frequently asked questions that the I. C B 10 same official coding guidelines do not apply to the hrs. A uninsured Koven 19 Program Health care providers treating patients with Koba 19 diagnosis are HIPPA covered entities and are therefore required to comply with the official coding rules and guidelines for HIPPA code set standards. Please click on the link for further resource is billing and reimbursement providers. They submit claims for individuals in the U. S without health care coverage. Reimbursement will be based on current year Medicare fee schedule rates. Except for otherwise noted, reimbursement will be based on encouraged date of service, publication of new codes and updates to existing codes. When we made in accordance with CMS. For any new codes for a CMS published rate does not exist. Claims will be held until CMS publishes correspondent reimbursement information. Discharges of an individual diagnosed with Kovar 19 year old be identified by the presence of the international classification of diseases. 10th Revision Clinical modification diagnosis codes for covert 19 Medicare claims processing systems will apply an adjustment factor to increase the Medicare severity Diagnosis related group. The M s DRG relative weight that would otherwise be applied will be increased by 20% when determining I PPS operating payments for discharges described above. That cares act 20% adjustment can only be applied when the actual lab test is in the medical record during this day for gated. Within 14 days of the mission, positive tests must be demonstrated using only the results of viral testing such as molecular or Auntie Jen, consistent with the CDC kaegel. The test may be performed either during the hospital admission or prior to the hospital admission in the rare circumstances where a viral test was performed more than 14 days prior to the hospital admission, saying this will consider whether there are complex medical factors. In addition to the test result, purposes of this documentation requirements, coding and billing of Koba 19 will be an evolving process for any questions related to current practice following the date of this presentation. Please reference the current year guidelines. Please follow the link below for the 2021 official quoting guidelines. Thank you.