Medicare Cuts Looming and Coding Updates for COVID-19

Billing E&M Services with COVID-19 Vaccines

Blue Cross Blue Shield of Illinois (BCBS IL) sent a recent notice that they do not want providers billing evaluation and management services (E&M) with COVID-19 immunization administrations. Counseling regarding the vaccine is included in the administration code and does not justify billing a separate code. If providers do perform an unrelated E&M service on the same day as vaccine administration, BCBS IL recommends that it be billed on a completely separate claim. 

ICD-10 Code for Long COVID

A new ICD-10 code for Long COVID became active on October 1st. Providers can now use code U09.9, officially labeled “Post COVID-19 condition, unspecified,” for patients who no longer have an active COVID-19 infection, but continue to suffer from lingering symptoms. Debate continues over the required length of symptoms before making a diagnosis of Long COVID. Currently, the CDC maintains that providers should not make such a diagnosis until the symptoms persist for at least four weeks after the initial COVID-19 infection.

More Medicare Cuts on the Horizon

Providers are all too familiar with having to worry about Medicare cuts. However, the threat in 2022 is greater than usual thanks to COVID-19. Fierce Healthcare calculated that a combination of budget cuts and pandemic-related rollbacks could result in a very worrisome 9.75% reduction in 2022. COVID-19 prompted the government to increase reimbursement by 3.75% in 2020, and pause the 2% sequester reduction. However, unless extended by Congress, these changes will expire, hitting providers with de-facto 5.75% pay cut. The remaining cuts stem from Congress’ Pay-as-you-go rule (PAYGO), which mandates cuts across the board if spending reaches a certain threshold. This rule will result in an additional 4% reduction next year. Provider interest groups are already pushing back against the government and asking that the PAYGO rule be delayed, as has happened in the past. The American Medical Group Association (AMGA) warned that such severe cuts will prevent many providers from moving to value-based care, and may result in hiring freezes, reduced services, and providers dropping out of Medicare.