New condition code released for COVID-19 claims

The National Uniform Billing Committee released a new condition code for claims related to COVID-19.

In a March 23 announcement, NUBC said without codes that specifically indicate COVID-19, including service for cases when a patient ultimately tests negative, payers will struggle to know which claims should be handled differently.

NUBC recommended the following to ensure claims for COVID-19-related care are flagged appropriately: 

1. Use the "DR" condition code, which identifies claims that are or could be affected by policies related to a national or regional disaster.

2. Use one of the following diagnosis codes:

  • B97.29 (other coronavirus as the cause of diseases classified elsewhere) for services provided before April 1
  • U07.1 (COVID-19) for services provided on or after April 1
  • Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out)
  •  Z20.828 (Contact with and suspected exposure to other viral communicable diseases)

3. Use an appropriate service date. The "DR" condition code should be used for related COVID-19 care with a Jan. 27 or later service date, as that's when HHS declared COVID-19 a federal public health emergency.

Read the full guidance here.


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