The chaos and confusion fomented throughout the American healthcare industry by the continuing COVID-19 pandemic has been bad enough in of itself – but when coders found themselves unable to accurately document what was even going on with patients, things got even worse.

Fortunately, that’s changing in 2021, thanks to a set of new codes formally introduced by the Centers for Medicare & Medicaid Services (CMS) late last year and now taking root across the country. They include 21 new procedure codes applying to COVID treatment and vaccination, as well as six diagnosis codes used to identify conditions resulting from COVID, according to remarks recently made on BESLER’s Hospital Finance Podcast by Panacea Healthcare Solutions Senior Healthcare Consultant Sandra Brewton.

The podcast aired just days before the number of Americans to receive at least one COVID vaccination soared past 26.5 million, eclipsing the number of Americans who have tested positive for the virus since the pandemic began early last year.

“There are so many of those different (procedure) codes because the differing vaccines are actually administered differently – so, for example, certain vaccines are delivered subcutaneously, (while) some of the other vaccines are delivered into the muscle,” Brewton explained. “And then the remainder of those vaccine codes actually capture the number of doses, with codes for the first dose and then a separate code for the second dose, applicable because some of those vaccines need two doses and some only need one to be administered.”

A Clearer Picture

The Pfizer and Moderna vaccines approved for emergency use by the Food and Drug Administration (FDA) both require two shots, while the Johnson & Johnson vaccine, for which the company requested FDA approval earlier this month, will only require one. The three companies have reportedly pledged to ramp up production to the tune of a combined 500 million doses by summer.

“Out of those 21 (procedure) codes, the remaining 15 new codes will allow us to capture therapeutic treatments for COVID-19,” Brewton added.

The diagnosis codes, while fewer in number, are similarly useful in creating an all-encompassing snapshot of an individual patient in the medical record. Three of them capture COVID-19 exposure, history, and screening, Brewton explained, while the other three capture COVID-related conditions, allowing coders to document matters such as connective tissue disorders, pneumonia, and multi-symptom inflammatory disorder arising from the virus.

“There’s a caveat, though, with these three new codes, because these … can only be assigned if the … COVID-19 infection code is applied first, which of course must be assigned based on the official coding guidelines concerning the sequencing directives for COVID-19 and its manifestations,” Brewton said. “So, no doubt there’s going to be more guidelines (and) clarification of coding guidance to come, with the implementation of these new codes.”

Quantity and Quality

A mass influx of new codes may generally yield consternation among coding professionals, but considering what COVID has done to the healthcare environment over the past year – also heralding a tsunami of federal regulatory changes – a bit more clarity is being welcomed, not bemoaned.

“What the addition of these codes does is it gives facilities a way to capture more specific information and more specific data concerning COVID-19, its manifestations, the treatments rendered, and vaccination procedures,” Brewton said. “As far as the procedure codes go, as with all procedure codes that are assigned specifically for hospital inpatient claims, the facilities themselves are going to need to decide whether or not they’ll be having their coding staff assign these procedure codes, or if the data will simply be gleaned from the charge capture details, because it can be taken from there. But the new diagnosis codes, they’ll absolutely be assigned by not only inpatient coding staff, but also outpatient coding staff. And it’ll be a huge help in reporting some the most common manifestations of COVID-19.”

Comprehensive information on the new codes is available in two areas online, Brewton said: consult the CMS website and Centers for Disease Control and Prevention (CDC) website for all the details.

For more information on how Panacea is assisting providers nationwide with preparations for these and other changes, go online to https://www.panaceainc.com