March 20, 2020

Coronavirus Update

As the COVID-19 situation evolves, Health Options is coordinating with the Maine CDC and local government and healthcare agencies to explore ways to support our Members and partners. We appreciate your partnership during this difficult time.

 

Will Health Options waive costs related to COVID-19 testing? 

We want to ensure that cost is not a barrier to our Members’ receiving testing for COVID-19. Until further notice, we are waiving cost sharing for the following services: provider-recommended COVID-19 testing and associated lab processing fees; the office, ER, or urgent care visit to collect the specimen; and COVID-19 telemedicine screening services. All other testing and services are subject to applicable cost share. 

What coding guidelines should be leveraged for COVID-19? 

Updated eviCore Medical Prior Approval Requirements for COVID-19 related illnesses are based on the CDC’s official coding guidelines related to COVID-19.  The CDC guidelines may be found on our site (under Guides) or on the CDC site.  Instructions for requesting Prior Approval from eviCore are found here. 

Prior approval requests for chest CT imaging related to the following conditions suspected to be related to COVID-19 should take the below guidelines into consideration, as provided by the CDC: 

  • For a pneumonia case confirmed as due to COVID-19, assign codes J12.89 (other viral pneumonia) and B97.29 (other coronavirus as the cause of diseases classified elsewhere) 
  • For a patient with acute bronchitis confirmed as due to COVID-19, assign codes J20.8 (acute bronchitis due to other specified organisms), and B97.29 (other coronavirus as the cause of diseases classified elsewhere). Bronchitis not otherwise specified (NOS) due to COVID-19 should be coded using code J40 (bronchitis, not specified as acute or chronic), along with B97.29 (other coronavirus as the cause of diseases classified elsewhere). 
  • For a patient with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, not otherwise specified (NOS), this should be coded with J22 (unspecified acute lower respiratory infection), with B97.29 (other coronavirus as the cause of diseases classified elsewhere).  If the COVID-19 is documented as being associated with a respiratory infection, not otherwise specified (NOS), it would be appropriate to assign code J98.8 (other specified respiratory disorders), and B97.29 (other coronavirus as the cause of diseases classified elsewhere). 
  • Acute respiratory distress syndrome (ARDS) may develop due to COVID-19, according to the Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (COVID-19) Infection.  For a patient with ARDS that developed due to COVID-19, assign code J80 (acute respiratory distress syndrome), and B97.29 (other coronavirus as the cause of diseases classified elsewhere).

 

Contact us:

If you have questions, please contact our Provider Relations team at (207) 402-3347 or provider@healthoptions.org.