The Difficulties of Medical Coding COVID in 2021

At this writing, there have been more than 30M COVID-19 cases in the United States.

This fact and the circumstances of the past year make it hard to fathom that when the AMA was reviewing and reformulating the CPT guidelines to take effect in 2021, SARS-CoV-2, which would soon wreak global havoc, didn’t exist.

This happenstance of timing only adds to the medical coding difficulty across all types of specialties and practices. How were they to know that a new cold virus could be everything from asymptomatic to fatal? How does a clinician classify risk when a patient who seems fine today may be critically ill or dead tomorrow? How does COVID-19 fit as an exception to the self-limited infection rule? The guidelines don’t begin to address these questions and the other impacts of the pandemic. This gap leads to widespread medical coding difficulty with reporting services furnished for COVID-19.

Reventics’ CDI team spent over 60 days re-interpreting and using these guidelines in real-time to provide facilities feedback on their clinical documentation to improve accuracy, compliance, and reimbursement and reduce the ambiguity around COVID-19 as well as address the medical coding difficulty surrounding it.

We’ve determined that COVID-19 should never be considered as a self-limiting illness, even if the patient is only concerned about exposure, due to the high potential for mortality shortly after exposure. Therefore, COVID exposure elevates level to at least low due to potential morbidity, thus taking the minimal risk category off the table.

With that concept in mind, we’ve created additional guidelines around the number and complexity of problems addressed and the risk of complications, morbidity, and mortality regarding COVID-19:

Number and complexity of problems addressed:

  • Low – COVID concern with exposure or ENT symptoms
  • Moderate – COVID concern with systemic symptoms
  • High – COVID workup for threat to life, treatment with oxygen or steroids, or sent to ER/hospital

Risk of complications, morbidity, and mortality

  • Low – COVID screen only
  • Moderate – COVID concern with exposure or ENT symptoms
  • High – COVID with identified risk factors for complications or workup with threats to life, hypoxia, treatment in urgent care or office

For more information regarding these suggestions regarding the guidelines, as well as tables with additional language addressing many of the potential difficulties of implementation, please download our white paper, Making Sense of the 2021 Documentation Guidelines.

To learn more about how Reventics’ CDI solution can help improve clinical documentation by educating your physicians and implementing these guidelines, get a RevCDI demo.