This article presents a brief guide for COVID-19 billing and coding procedures with ICD-10-CM and Modifiers. It includes any E/M updates pertaining to COVID-19 in 2024. CPT coding changes that affect COVID-19 will go into effect on January 1, 2024. We hope that this guide will prove useful to your medical practice in maintaining effective billing practices during the era of COVID-19.
ICD-10-CM Diagnostic Tests Relating to COVID-19
There is one new ICD-10-CM code that went into effect on October 1, 2023:
Z11.52-Encounter for screening for COVID-19 (appropriate to use when testing a patient Covid-19 prior to surgery).
Diagnostic Tests Relating to COVID-19
For tests relating to COVID-19, other than a COVID-19 test, the usual codes are:
Z03.818 -Encounter for observation for suspected exposure to other biological agents ruled out
Z20.822 –Contact with (suspected) exposure to COVID-19
Z20.828 -Contact with and (suspected) exposure to other viral communicable diseases
Z28.310 -Unvaccinated for COVID-19
Z28.311 -Partially vaccinated for COVID-19
Z28.39 -Other under immunization status
According to the ICD-10-CM Tabular List of Diseases and Injuries, when reporting code J12.82 Pneumonia due to coronavirus disease or M35.81 Multisystem inflammatory syndrome, coders are required to first report code U07.1 for COVID-19, if it is applicable.
The usual ICD-10-CM codes used to bill virtual/face-to-face visits for suspected COVID-19 exposure are:
ICD-10 codes Z03.818, Z20.822, and Z20.828
As of May 12, 2023, use of Modifier CS is no longer needed to bypass cost sharing for COVID-19.
A virtual or face-to-face visit for suspected or likely COVID-19 exposure E/M visit should include modifier 95. With POS for face-to-face service normally billed.
CPT Codes for COVID-19 immunizations range in the 90000 series and HCPCS code M0201. These are valid in 2023 and for 2024, COVID-19 vaccines and their currently authorized administrations include:
|Admin Sarscov2 Vacc 1 dose
|Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) COVID-19 vaccine, single dose
|COVID-19 vaccine home admin
|Home vaccine admin
|COVID-19 vaccine administration inside a patient’s home; reported only once per individual home per date of service when only COVID-19 vaccine administration is performed at the patient’s home
|Sarscov2 vac 5MCG/0.5ML IM
|Novavax COVID-19 (aged 12 years and older) vaccine, adjuvanted
3 MCG TRS-SUC
|Pfizer-BioNTech COVID-19 vaccine 2023-2024 formula (yellow cap)
10MCG TRS-SUC IM
|Pfizer-BioNTech COVID-19 vaccine 2023-2024 formula (blue cap)
30MCG TRS-SUC IM
|COMIRNATY (COVID-19 vaccine, mRNA) 2023-2024 vormula
|Sarscov2 vac 25 MCG/.25ML IM
|Moderna COVID-19 vaccine 2023-2024 formula
|Sarscov2 vac 50 MCG/0.ML IM
|SPIKEVAX 2023-2024 formula
When administering an COVID-19 vaccine the selection of ICD-10-CM code Z23 Encounter for Immunization is appropriate.
We truly hope this guide to COVID-19 billing and coding practices has been useful to you and your medical practice.
For more information, fill out the form below. We truly hope this guide to COVID-19 billing and coding practices has been useful to you and your medical practice.
For more assistance with services for medical billing and coding during this uncertain time, please do not hesitate to reach out to us directly. Neolytix offers a complete selection of medical billing, coding, and VA services to meet your practice’s needs.
For more information, fill out the form below.