It has been almost a year by now! It wasn’t easy for healthcare professionals and common people to
understand and get used to the new normal. Updated medical coding sets for Covid-19 involves various
foundational modifications that was designed to make the coding and documentation hassle free and
flexible. However, the new normal isn’t leaving us anymore! It’s rather teaching us better ways to
live with it.
Apparently medical coding teams will have to face a bit of reprieve this year since learning new
procedure codes can be strenuous. The Centers for Medicare and Medicaid had approved new codes for
Covid-19 in 2021. The CPT code changes for 2021 include, 329 editorial changes, 206 new codes, 69
revised codes and 54 deleted codes.
As per American Medical Association, the CPT coding sets have been increasing with the majority of
63% involving new technology services as explained in category III and continue to expand PLA
section of CPT codes in medical coding.
Related Medical Coding sets for Covid-19:
Numerous codes have been introduced in 2021. CPT codes for Covid-19 were introduced last year public
health emergency.
87635: This code was used for Infectious agent detection by nucleic acid either DNA or RNA, severe
acute respiratory syndrome coronavirus 2 or (SARS-CoV-2) Coronavirus disease COVID-19, amplified
probe technique.
86328: This code was used for Infectious agent detection by nucleic acid either DNA or RNA; severe
acute respiratory syndrome coronavirus 2 or SARS-CoV-2, Coronavirus disease COVID-19 to report
single step antibody testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
86769: This code was used by Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Coronavirus disease COVID-19 to report multiple-step antibody testing for SARS-CoV-2. .
0202U: This code was used for Infectious disease either bacterial or viral respiratory tract
infection, pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each
pathogen reported as detected or not detected to report particular Respiratory Panel 2.
2020 medical coding sets for Covid-19:
In medical coding, CPT code changes for Covid-19 include the below:
0015M: This code was used for Adrenal cortical tumor, biochemical assay of 25 steroid markers,
utilizing 24-hour urine specimen and clinical parameters, prognostic algorithm reported as a
clinical risk and integrated clinical steroid risk for adrenal cortical carcinoma, adenoma, or other
adrenal malignancy.
0016M: This code was used for Oncology -bladder, mRNA, microarray gene expression profiling of 209
genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as molecular subtype
-luminal, luminal infiltrated, basal, basal claudin-low, neuroendocrine-like.
CPT medical coding changes for 2021:
In medical coding, CPT codes 2021 include various categories. New codes in pathology, laboratory and
medical sections.
New Category III codes, including computed tomography of the breast along with 3D rendering is
involved.
As known, CPT changes 2021 include several revised E/M codes out of which 99201 is deleted.
99202: This code is used for Office and other outpatient visit for the evaluation and management of
a new patient, which requires a medically appropriate and accurate history or examination and
immediate medical decision making. While utilizing time for code selection, 15-29 minutes of total
time is spent on the date of the encounter.
99203: This code is used for Office or other outpatient visit for the evaluation and management of a
new patient, which requires a medically appropriate history or examination and low level of medical
decision making. While utilizing time for code selection, 30-44 minutes of total time is spent on
the date of the encounter.
99204: This code is used for Office or other outpatient visit for the evaluation and management of a
new patient that requires a medically appropriate and accurate history or examination and moderate
level of medical decision making. While utilizing time for code selection, 45-59 minutes of total
time is spent on the date of the encounter.
99205: This code is used for Office or other outpatient visit for the evaluation and management of a
new patient, which requires a medically appropriate and accurate history or examination and high
level of medical decision making. While utilizing time for code selection, 60-74 minutes of total
time is spent on the date of the encounter.
99211: This code is used for Office or other outpatient visit for the evaluation and management of
an established patient, may not require the presence of a physician or other qualified healthcare
professional. Actually, the presenting problems are minimal or less.
99212: This code is used for Office or other outpatient visit for the evaluation and management of
an established patient that requires a medically appropriate and accurate history or examination and
straightforward medical decision making. While utilizing time for code selection, 10-19 minutes of
total time is spent on the date of the encounter.
99213: This code is used for Office or other outpatient visit for the evaluation and management of
an established patient that requires a medically appropriate and accurate history or examination and
low level of medical decision making. While utilizing time for code selection, 20-29 minutes of
total time is spent on the date of the encounter.
99214: This code is used for Office or other outpatient visit for the evaluation and management of
an established patient that requires a medically appropriate and accurate history or examination and
moderate level of medical decision making. While utilizing time for code selection, 30-39 minutes of
total time is spent on the date of the encounter.
99215: This code is used for Office or other outpatient visit for the evaluation and management of
an established patient that requires a medically appropriate and accurate history or examination and
high level of medical decision making. While utilizing time for code selection, 40-54 minutes of
total time is spent on the date of the encounter.
99354: This code is used for Prolonged services in the outpatient setting requiring direct patient
contact beyond the time of the usual service, first hour and list separately in addition to code for
outpatient Evaluation and Management or psychotherapy service, except with office or other
outpatient services (99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215)
99355: This code is used for prolonged services in the outpatient setting requiring direct patient
contact beyond the time of the usual service, each additional 30 minutes and list separately in
addition to code for prolonged service.
99356: This code is used for prolonged service in the inpatient or observation setting, requiring
unit/floor time beyond the usual service, first hour and list separately in addition to code for
inpatient or observation Evaluation and Management service.
99415: This code is used for prolonged clinical staff service i.e. the service beyond the highest
time in the range of total time of the service during an evaluation and management service in the
office or outpatient setting, and direct patient contact with physician supervision, first hour and
list separately in addition to code for outpatient Evaluation and Management service.
99416: This code is used for prolonged clinical staff service i.e., the service beyond the highest
time in the range of total time of the service during an evaluation and management service in the
office or outpatient setting, direct patient contact with physician supervision, each additional 30
minutes and list separately in addition to code for prolonged service.
99487: This code is used for Complex chronic care management services with the following required
elements: multiple or two chronic conditions expected to last at least 12 months, or until the death
of the patient, chronic conditions place the patient at risk of death, acute exacerbation or
decompensating, or functional decline, comprehensive care plan established, implemented, revised, or
monitored, moderate or high complexity medical decision making, first 60 minutes of clinical staff
time directed by a physician or other qualified health care professional, per calendar month.
99489: This code is used for Complex chronic care management services with the following required
elements: multiple or two chronic conditions expected to last at least 12 months, or until the death
of the patient, chronic conditions place the patient at risk of death, acute exacerbation or
decompensating, or functional decline, comprehensive care plan established, implemented, revised, or
monitored, moderate or high complexity medical decision making, each additional 30 minutes of
clinical staff time directed by a physician or other qualified health care professional, per
calendar month and list separately in addition to code for primary procedure.
99490: This code is used for Chronic care management services with the following required elements:
multiple or two chronic conditions expected to last at least 12 months, or until the death of the
patient, chronic conditions place the patient at risk of death, acute exacerbation or
decompensating, or functional decline, comprehensive care plan established, implemented, revised, or
monitored, first 20 minutes of clinical staff time directed by a physician or other qualified health
care professional, per calendar month.
ICD-11 Codes for Covid-19:
In ICD-11, the code confirmed for the diagnosis of Covid-19 is RA01.0 and the code for clinical
diagnosis is RA01.1
The coding guidelines are very technical and include very few template cases.
However, an emergency ICD-10 code of ‘U07.2 COVID-19, virus not identified’ is assigned to a
clinical or epidemiological diagnosis of COVID-19 where the laboratory confirmation is not
available.
Two ICD-10 codes U07.1 and U07.2 might be used for mortality coding as cause of death.
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