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Medical Coding Guidelines for COVID-19 Treatment and Vaccines

Medical Coding Guidelines for COVID-19 Treatment and Vaccines

There is no doubt that when a pandemic, such as COVID-19, arrives, the repercussions and ramifications are felt throughout the economy. We cannot deny the continued presence of the COVID-19 pandemic in the world or ignore its effects any longer. It is worth noting that healthcare facilities and hospitals are taking the brunt of the coronavirus cases while also serving the many non-COVID-related cases simultaneously.

As you try to navigate the various daily uncertainties and complexities of providing top-quality patient care and service during the coronavirus outbreak, ensuring suitable medical coding for COVID-19 treatment might not be top of mind for all your clinicians. Note that COVID-19 coding allows health providers in the US to easily track the spread of the coronavirus and receive payment for testing as well as treating the surge in patients with symptoms of the contagious disease.

Also, effective and robust processes will help health providers in the country overcome the challenges and complexities of COVID-19 now as well as in the coming years. You can use the following medical coding guidelines and information to answer any evaluation and management coding questions while communicating best practices to your staff in order to keep your clinic or hospital as healthy as your patients.

Current COVID-19 Medical Coding Guidelines

For proper and timely reimbursement for your medical practice, it is important that the medical coding be correct for various COVID-19 related services that you offer.

Diagnosis Coding

From Jan 1, 2021, you will have to use new ICD-10 codes for reporting various COVID-19 related diagnoses. Note that these codes have replaced the existing ones and are as follows:

Medical Condition ICD-10 (2020) ICD-10 (2021)
Encounter for COVID-19 screening Z11.59 Z11.52
Contact with and/or (assumed) exposure to the coronavirus Z20.828 Z20.822
Personal history of COVID-19 Z86.19 Z86.16
Pneumonia because of the coronavirus U07.1 & J12.89 U07.1 & J12.82

Additional Coding Guidelines for COVID-19

Did you know that in the release of the latest Official ICD-10 Guidelines, NCHS (National Center for Health Statistics) added certain instructions and guidelines for coding the accurate diagnoses for coronavirus-related services? Keep in mind that these updated guidelines differ a bit from the last interim guidance. And the official coding guidelines are updated yearly on October 1st.

Positive COVID-19 Diagnosis

Only confirmed COVID-19 cases as formally documented by the healthcare provider or confirmed by written test results must be coded using ICD U07.1. Note that this medical code should be the primary or principal diagnosis on the claim. On the other hand, codes for acute respiratory manifestations because of COVID-19 should be considered additional diagnoses (such as pneumonia).

New Medical Codes Enable and Facilitate COVID-19 Tracking and Billing

You will be happy to know that healthcare providers can use a variety of medical code sets in order to document and then bill for patient encounters. Note that the primary sets that providers use have all created new codes in order to capture COVID-19 testing and medical care.


Triggered by the urgent need to timely capture COVID-19 diagnoses on medical claims and surveillance information, in March, the CDC announced that it added the new ICD (International Classification of Diseases), 10th Revision, Clinical Modification emergency code that the World Health Organization created in 2020.

Laboratory Testing

Using Combination Codes

You may know that because of the onset of flu season, many manufacturers in the US have created single tests to detect influenza A as well as influenza B and COVID-19, and, in a few cases, respiratory syncytial virus.

Did you know that there are 2 main types of tests? One includes the PCR (also known as polymerase chain reaction) test, while the other test consists of the famous antigen test.


This covers infectious agent detection through nucleic acid (RNA or DNA) and severe acute respiratory syndrome (also known as SARS-CoV-2), and influenza virus type A and type B.


This covers infectious agent detection through nucleic acid (RNA or DNA) and severe acute respiratory syndrome (also known as SARS-CoV-2), influenza virus type A and type B, and respiratory syncytial virus.


Detection of infectious agent antigen by an immunoassay technique, (such as enzyme immunoassay, fluorescence immunoassay, and immunochemiluminometric assay) semiquantitave or qualitative; severe acute respiratory syndrome (also known as SARS-CoV, SARS-CoV-2) and influenza virus type A and type B.

Telehealth Medical Coding

You probably know that besides caring for patients with a novel virus, most providers in the US are also venturing into unchartered territory: telemedicine and telehealth. It is worth noting that hospitals and other facilities are using telehealth and telemedicine services when needed to triage patients. Note that ambulatory organizations are also following suit as non-urgent and elective services decline.

However, for many healthcare providers, telehealth is a relatively new service that emerged because of the COVID-19 crisis. Note that it’s presenting new and unprecedented medical coding and medical billing challenges for many organizations.

You will be glad to know that HHS has recently relaxed various rules, laws, and regulations in an effort to enable health providers to make the most of telehealth during this health crisis and get paid the exact same amount for treating their patients virtually.

Did you know that some of these services include virtual check-ins, telehealth visits, as well as e-visits? Also, the department continues to add new healthcare services to this list as the health crisis continues. And to document various telehealth services and virtual visits, CMS has also provided a comprehensive list of HCPCS codes to be paid under the new Physician Fee Schedule during this national emergency.

Vaccine Coding

Did you know that the American Medical Association developed a new medical code set for various COVID-19 vaccine services? You can find them in a new Appendix Q. To receive reimbursement, health providers have to use the right codes for COVID-19 vaccine administration.

According to the CMS, it will reimburse healthcare providers under Medicare Part B instead of Part D to help ensure broad and diverse vaccine coverage. And as providers received these vaccines free from the US government, they are not allowed to bill Medicare for these vaccines. It is worth noting that for vaccine administration, the current payment allowances are $16.94 for the initial dose of a vaccine while $28.39 for the next dose.

Keep in mind that the Provider Relief fund offers reimbursements for administering COVID-19 vaccines for uninsured patients. You should know that the structure is a little different from other vaccines. And each vaccine will have its unique administration codes(s). This will depend on the number of doses.

Why Outsource Medical Coding for COVID-19 Treatment


Because of the coronavirus pandemic, the economy is reeling. This why keeping the cash flowing into your medical practice will likely be your topmost priority. If you outsource medical coding and billing tasks for COVID-19 treatment, revenue collection tends to increase.

This is because competent medical billing and medical coding companies, like UControlBilling, are better equipped and trained to handle the flow of a larger number of cases as well as process their information accurately.

Increased Collections

Did you know that inefficient medical billing, not tracking your denied claims, erroneous claims submission, and missed A/R follow-ups, can considerably affect your revenue and monthly collection? A medical billing and coding company with experienced medical billers and coders that provides quality work will help eliminate these issues and ensure maximum reimbursement for your practice.

Regulatory Compliance

The benefit of outsourcing is that all reliable and leading medical billing companies in the US keep themselves updated with frequently changing and complex regulatory guidelines. They achieve this by ensuring that their employees and staff undergo training and development related to the relevant fields and familiarize themselves with the medical coding guidelines.

Note that with regard to the pandemic, many regulatory bodies in the US, such as FDA and AMA, have been issuing new rules and guidelines to accelerate the medical billing and coding process.

You will be happy to know that outsourced medical billing and coding companies, like UControlBilling, take control of all aspects of the billing and coding process.

Final Thoughts

The challenges and uncertainties the US healthcare system faces will not end with this health pandemic. And new threats and challenges will keep surfacing for practitioners. Indeed, it is reckless and short-sighted to simply assume that the current unprecedented circumstances are a one-time occurrence. Rather, it is better to keep your medical practice prepared for all types of unforeseen circumstances and situations by leveraging the benefits of medical coding outsourcing to meet your needs.

As healthcare strategies in the US evolve and move toward telemedicine and telehealth, medical billing and coding need to adhere to this evolving panorama. For example, you have to streamline urgent care procedures towards the new normal, with all of the necessary measures in place. And note that medical billing and coding for COVID-19 treatment and vaccination are no exception.

While sustaining the business might have never been this demanding and challenging, there is certainly light at the end of the tunnel.

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