Published 3/23/2020, last updated 4/20/2020

Medical Coding for COVID-19 Novel Coronavirus

Optum360® is committed to ensuring that you have the information you need to effectively and efficiently address COVID-19 from a medical coding, billing and reimbursement perspective. We have compiled information from the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), American Medical Association (AMA), and the Centers for Medicare and Medicaid Services (CMS), so you can easily access the most up-to-date medical code detail and effective dates in one convenient place.


COVID-19 ICD-10-CM Coding

There is one new ICD-10-CM code for COVID-19, effective April 1, 2020:

U07.1 COVID-19

The CDC posted the official ICD-10-CM Coding and Reporting Guidelines for COVID-19 for April 1, 2020-September 30, 2020.

Summary of COVID-19 code changes as of 4.20.2020 (144 KB).


COVID-19 CPT® Coding

One new CPT® code was created for reporting new coronavirus 2 (SARS-CoV-2) COVID-19 testing, effective March 13, 2020.

87635    Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (New Coronavirus disease [COVID-19]), amplified probe technique)

Two new CPT® codes were created, one revised, for reporting COVID-19 antibody testing, effective April 10, 2020. 

86318     Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip);

#86328   Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

Code #86328 is a resequenced code that follows code 86318.

86769     Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

NOTE: A HCPCS code and CPT® code should not be reported together. Providers should contact third-party payer(s) for reporting either a CPT® or a HCPCS code, as well as for retroactive billing and reimbursement guidelines.

Summary of COVID-19 code changes as of 4.20.2020 (144 KB).


COVID-19 HCPCS Coding

Two new HCPCS Level II codes were created for new coronavirus testing, effective April 1, 2020, for dates of service starting February 4, 2020.

U0001   CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel For tests developed only by the CDC (reporting allows CDC testing laboratories to test new patients and track new cases).

U0002   2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC

For laboratories performing non-CDC testing.

Two new HCPCS Level II codes were created for coronavirus testing using high throughput technologies, effective April 14, 2020 (reportable for services provided on March 18, 2020 and forward).

U0003   Infectious agent detection by nucleic acid (DNA or RNA); Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R.

U0004   2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R

Two new HCPCS Level II codes were created for specimen collection, effective March 1, 2020.

G2023   Specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source

G2024   Specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source


Summary of COVID-19 code changes as of 4.20.2020 (144 KB).


COVID-19 DRG Coding

The CMS has released an update to the ICD-10 MS-DRG grouper software package to accommodate the new diagnosis code, U07.1 for COVID-19, effective with discharges on and after April 1, 2020.

The ICD-10 MS-DRG Grouper assigns each case into an MS-DRG based on the reported diagnosis and procedure codes and demographic information (age, sex, and discharge status).

The assignment of new ICD-10-CM diagnosis code U07.1 COVID-19 is as follows:

Diagnosis Code Description CC MDC MS-DRG
U07.1 COVID-19 MCC
04
15
25
177,178,179
791,793
974,975,976


Summary of COVID-19 code changes as of 4.20.2020 (144 KB).


Optum360 COVID-19 Product Updates

We recognize our coders rely on various resources and tools to access the most up-to-date medical codes. We are committed to ensuring you have all the information you need regarding COVID-19 codes, guidelines and effective dates.

Content updates pertaining to COVID-19 for your 2020 edition print books are now posted online:

ICD-10-CM (90 KB) | CPT® (55 KB) | HCPCS (63 KB) | DRG (140 KB)

Optum360 online coding tools (e.g. EncoderPro.com, RevenueCyclePro.com, etc.) published the necessary code and reference content updates on April 1, 2020. More information will be posted to the various online coding tool homepages – please sign in for details.

Optum360 data file/web service content is updated to include new COVID-19 codes. Please refer to the above-mentioned effective dates to comply with CDC, NCHS, AMA, and CMS guidelines. Log in to the data vault to access the newest content updates.


We Are Here to Help

Live Webinars | COVID-19 Coding and CDI Education
Looking for coding and CDI education around COVID-19? Optum360 Learning has you covered with several webinar courses to help you stay informed on the industry’s most pressing COVID-19-related topics.

Complimentary 30-day Trial | Online Coding Tools
As some of you are transiting to work-from-home status, we want to ensure you have the coding content you need at your fingertips. Request a 30-day trial for our online coding tools where all codes are up to date, in one solution.

COVID-19 | Optum360 Specialty Articles
Optum360 articles are created and reviewed by our clinical and product experts. Optum360 Specialty Articles Add-on provides exclusive access to the most recent and relevant specialty newsletter content available today. Due to the current COVID-19 situation, we are offering complimentary access to these articles:

Contact Us
For customer service and tech support, contact us with any questions you might have in regards to our coding products.


Other COVID-19 Resources

Optum

American Medical Association

Centers for Medicare and Medicaid Services

Centers for Disease Control and Prevention

American Hospital Association


CPT © Copyright 2020 American Medical Association. All rights reserved.
AMA and CPT are registered trademarks of the American Medical Association.