COVID-19 Medicare 20%
We have two inpatient cases that were admitted for non-covid related conditions (One traditional Medicare, one Medicare Advantage). Both patients were tested for CV-19 on the day of D/C, and the results returned positive after the patients had already gone home. There was no covid related treatment/management during the entire hospital stay, only the test on the day of D/C. (Both had pre-hospital exposure)
Post hospital phone calls were made and care coordinator assisted with quarantine arrangements.
We are wondering if we should be coding the U07.1 on these cases. A few perspectives that we’re questioning:
1) Does it meet the coding guidelines for the addition of a secondary diagnosis on the claim?
2) Is it appropriate to claim the CMS additional 20% payment for these DRGs?
3) Is the day of discharge part of the acute hospital stay included in the DRG?
I know there’s the coding guideline: g) Asymptomatic individuals who test positive for COVID-19 For asymptomatic individuals who test positive for COVID-19, assign code U07.1, COVID-19. Although the individual is asymptomatic, the individual has tested positive and is considered to have the COVID-19 infection.
But should we still claim the 20% since coding guidelines for a secondary diagnosis say that resources do need to be used?
Thanks,
Sarah
Sarah Wicks, RN, MS, MBA
Clinical Documentation Improvement Program Manager
Utilization Management | Strong Memorial Hospital
P: 585.276.5705 | F: 585.276.2801
Sarah_Wicks@URMC.Rochester.edu