For the most part, updates to code sets and the guidelines that govern their utilization are predictable. Every year, we can bank on changes to the Inpatient Prospective Payment System going into effect on October 1st, and changes to the Outpatient Prospective Payment System going into effect on January 1st. The consistency in update timing, scope, and format, is comforting to the creatures of habit among our ranks, myself included. Not to mention that the update pattern and cadence provides a logical and controlled framework for implementing new changes.
Rapid Changes Due to COVID-19
And then there’s the past six weeks or so. Catalyzed by the COVID-19 pandemic, critical updates to COVID-19 related codes and coding guidelines have been published in rapid-fire succession. No doubt this was the right thing to do. The more information, the better. But it has certainly left a lot to make sense of in a short period of time. Here are some tips to activate on emerging guidance or navigate those grey areas where guidance does not yet exist.
Navigating Emerging Guidance
Be Patient
In a perfect world, we would have had all the codes and guidance that we needed as part of the CDC/NCHS’ initial announcement on February 20. Perfect worlds don’t involve pandemics, so that plan never stood a chance.
I was very encouraged to see thoughtful general guidance issued as part of this announcement…even if it didn’t cover all possible angles. Rest assured that additional guidance will be issued as coding complications for other COVID-19 scenarios bubble their way up through these same rule-making channels.
Fill the Gaps
Some stopgap guidance will go a long way until more authoritative guidance is published, even if it’s only until the new ICD-10-CM code for COVID-19 goes effective for discharges occurring on or after April 1, 2020. Identify the common COVID-19 scenarios that defy current guidance and determine how your team should handle them.
For example, for COVID-19 positive patients who are present without systemic manifestations, the case can be made both for and against various code and code combinations here. None are perfect at present. Decide on your guidance and make that guidance part of an interim policy and procedure.
Emphasize Key Points
- B97.29, Other coronavirus as the cause of diseases classified elsewhere should not be used for cases where the provider has characterized COVID-19 status as “suspected,” “possible,” “probable,” or similar terminology indicating uncertainty.
- The term “Presumptive positive” seems to simultaneously suggest certainty and uncertainty. However, these cases should be coded as confirmed. This is an incredibly important distinction compared to the point listed directly above.
- Code assignment is driven by clinical impression. In other words, we as coders do not need evidence of a positive test to code COVID-19. We can take the provider’s word for it if those words don’t convey uncertainty.
Evaluate COVID-19 Queries
Our thirst for clarification, often obtained through queries, needs to be considered in the context of healthcare systems persevering through sudden disarray, concerned about collapsing under the stress of COVID-19-related visits. There is no doubt that COVID-19 will bring with it query opportunities. How aggressively to pursue these query opportunities is something that should be decided sooner rather than later.
Communicate Constantly
Knowledge shared is knowledge amplified…or something like that. Consider a quick COVID-19 huddle to start or end your day. This will provide an open forum for COVID-19-related questions and dialogue. Discuss a COVID-19 case, real or hypothetical, and how it should be handled. Anchor the discussion against an authoritative guideline of facility policy and procedure to take the guesswork out of the decision-making process.
Good luck navigating! As difficult as it is to comprehend how we got here, it’s not at all difficult to imagine a time where we reflect proudly on how we got through this.
We recently hosted a Coding Round Table webinar on COVID-19 Coding. Access a recording here.
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