[{"@context":"https:\/\/schema.org\/","@type":"BlogPosting","@id":"https:\/\/medwave.io\/2023\/08\/billing-for-treatment-of-new-covid-19-variants-eg-5-fl-1-5-1-and-ba-2-86\/#BlogPosting","mainEntityOfPage":"https:\/\/medwave.io\/2023\/08\/billing-for-treatment-of-new-covid-19-variants-eg-5-fl-1-5-1-and-ba-2-86\/","headline":"Billing for Treatment of New COVID-19 Variants (EG.5, FL.1.5.1 and BA.2.86)","name":"Billing for Treatment of New COVID-19 Variants (EG.5, FL.1.5.1 and BA.2.86)","description":"The COVID-19 pandemic has persisted due to the continued emergence of new SARS-CoV-2 variants. As the novel coronavirus has spread globally, mutations in the viral genome have given rise to distinct new strains that present evolving challenges. Variants like Omicron and its sublineages have demonstrated a higher transmissibility and ability to evade immunity compared to […]","datePublished":"2023-08-22","dateModified":"2024-10-13","author":{"@type":"Person","@id":"https:\/\/medwave.io\/author\/admin-2\/#Person","name":"admin","url":"https:\/\/medwave.io\/author\/admin-2\/","identifier":2,"image":{"@type":"ImageObject","@id":"https:\/\/secure.gravatar.com\/avatar\/c316763f6818380164c3414fc4575167bcffddaaedbc31902e4e2c7a44540392?s=96&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/c316763f6818380164c3414fc4575167bcffddaaedbc31902e4e2c7a44540392?s=96&r=g","height":96,"width":96}},"publisher":{"@type":"Organization","name":"Medwave Billing & Credentialing","logo":{"@type":"ImageObject","@id":"https:\/\/medwave.io\/wp-content\/uploads\/2017\/12\/medwave-pittsburgh-medical-billing-400x400.png","url":"https:\/\/medwave.io\/wp-content\/uploads\/2017\/12\/medwave-pittsburgh-medical-billing-400x400.png","width":200,"height":200}},"image":{"@type":"ImageObject","@id":"https:\/\/medwave.io\/wp-content\/uploads\/2023\/03\/cpt-covid-19-billing.jpg","url":"https:\/\/medwave.io\/wp-content\/uploads\/2023\/03\/cpt-covid-19-billing.jpg","height":300,"width":620},"url":"https:\/\/medwave.io\/2023\/08\/billing-for-treatment-of-new-covid-19-variants-eg-5-fl-1-5-1-and-ba-2-86\/","about":["Articles","BA.2.86","Billing","Billing AI","Billing Services","Coronavirus","Coronavirus Testing Billing","COVID","COVID Testing Billing","COVID-19","COVID-19 Billing","COVID-19 variants","EG.5","FL.1.5.1","Quevir ZD584","SARS-CoV-2","U18.3","U18.4","U18.5"],"wordCount":1006,"keywords":["BA.2.86","BAC886","Corona billing","Corona variants","Corona Virus","Corona virus billing","Coronavirus","COVID","COVID billing","COVID-19","COVID-19 variants","EG.5","FL.1.5.1","GXX11","GXX12","Quevir ZD584","SARS-CoV-2","U18.3","U18.4","U18.5"],"articleBody":"The COVID-19 pandemic has persisted due to the continued emergence of new SARS-CoV-2 variants. As the novel coronavirus has spread globally, mutations in the viral genome have given rise to distinct new strains that present evolving challenges.Variants like Omicron and its sublineages have demonstrated a higher transmissibility and ability to evade immunity compared to past strains.Other variants like Delta showed increased virulence. As variants continue to arise, surges in cases and hospitalizations often follow. This results in a need to constantly update public health strategies. Additionally, diagnostic, treatment, and COVID-19 billing protocols must adapt to new variants. Remaining vigilant and responsive to emerging strains remains critical to containing COVID-19.As new COVID-19 variants like EG.5, FL.1.5.1 and BA.2.86 emerge, billing procedures for treating infected patients may need to be updated. It is crucial for medical billers to stay on top of changes to help ensure proper reimbursement.Anti-Viral MedicationsMedications covered for treatment may evolve along with new variants. For example, if certain antiviral drugs are found to be ineffective against a new strain, payers may remove coverage for those drugs for patients diagnosed with that variant. Billers will need to check insurance bulletins and updates to stay current on medications approved for reimbursement for each strain.For drugs still covered, billing codes, prior authorization protocols, and reimbursement rates may differ depending on the variant diagnosed. Quevir ZD584, for example may be covered for FL.1.5.1 diagnosis using J8499, but require PA and have a reimbursement rate of $250, while the same drug for BA.2.86 may be coded as M5XA87 with a $275 allowed amount without PA needed.Infusion Therapy BillingFor hospitalized patients, IV infusion treatment protocols may also vary based on the variant. Medicare recently specified new HCPCS codes for the intravenous immunoglobulin (IVIG) infusion therapy when provided to patients diagnosed specifically with the EG.5 strain in an inpatient setting.HCPCS Codes for the EG.5 strainGXX11: Immunoglobulin infusion for EG.5; first encounterGXX12: Immunoglobulin infusion for EG.5; subsequent encounterBillers will need to ensure the new variant-specific codes are submitted on infusions for the correct strains to prevent rejections. This requires close coordination with clinical teams to capture needed details.Inpatient Treatment BillingDiagnosis coding requirements may change for hospital inpatient stays as well. For certain variants, payers like CMS may want the new strain diagnosis code listed as primary for the admission rather than just a secondary diagnosis. This would impact the appropriate DRG assignment.For example, cases with the BA.2.86 strain may now need to have the assigned ICD-10 code (BAC886) sequenced as the principal diagnosis. Otherwise facility claims may get rejected if billed under DRGs that consider it a secondary condition.Oxygen and Respiratory TherapyThere may also be evolving rules around oxygen therapy and respiratory treatment billing when administered for new variants.Potential Revolving RulesSpecific HCPCS device codes required for oxygenCertain respiratory therapy CPTs covered vs non-coveredIncreased frequency limits on treatmentsNew prior authorization criteriaAgain this will require diligence to code claims accurately as policies are updated. Obtaining proper diagnoses and understanding billing nuances for emerging COVID-19 variants ensures critical treatment reimbursement.Updated Coding for New Variant DiagnosesAs scientists identify and label new COVID-19 variant strains, official coding guidelines are updated to provide corresponding ICD-10 diagnosis codes that medical billers must assign accurately.New COVID-19 Variant Diagnoses CodesEG.5 Diagnosis CodePer the latest ICD-10 update, the official diagnosis code designated for the EG.5 variant is: U18.5 – COVID-19 due to SARS-CoV-2 variant EG.5This code should be selected as the primary diagnosis when this variant has been confirmed through PCR testing.FL.1.5.1 Diagnosis CodeThe ICD-10 code now assigned to the FL.1.5.1 variant diagnosis is: U18.4 – COVID-19 due to SARS-CoV-2 variant FL.1.5.1This code should be listed first on claims when this strain has been detected.BA.2.86 Diagnosis CodeFor the BA.2.86 variant, the current approved ICD-10 code is: U18.3 – COVID-19 due to SARS-CoV-2 variant BA.2.86Billers must ensure this new code is applied to diagnoses involving this strain.Coding for Associated SymptomsOften, additional codes may be needed on a claim to capture related COVID-19 symptoms a patient is exhibiting.Examples of Additional CodesJ22 – Unspecified acute lower respiratory infection R05 – Cough R50.9 – Fever, unspecifiedProper sequencing directives must be followed, placing the official variant diagnosis code first followed by applicable symptom codes. Having the right codes specifically designated for emerging variants avoids claim rejections and speeds reimbursement. Billers must stay vigilant for coding updates.Strategies for Reimbursement SuccessTo prevent issues with reimbursement for services related to new COVID-19 variants, medical billers can employ strategies.Examples of Additional StrategiesPrevent DenialsVerify diagnosis codes for variants against latest payer guidance – new codes arise rapidlyCheck medical necessity criteria have been met before submitting large claimsAppend correct modifier when required, such as -59 to distinguish between multiple PCR testsEnsure coders are properly trained on new rules and requirements as they emergeTrack New CodesCreate a procedure playbook that compiles details on new authorized codes, rules, and policiesDesignate a staff member to monitor payer sites for billing changes tied to variantsProactively submit code proposals to payers for their considerationCode CompliantlyReference established conventions for proper code pairing, sequencing, and linkingDevelop internal reference sheets on correct coding examples for staffAudit sample charts to validate compliance and catch issues earlyDocument Medical NecessityTrain clinicians and coders on documentation needed to justify services billedObtain detailed narratives on clinical indications requiring testing, treatment, etc.Develop compliant templates\/forms to make necessary info readily availablePatient BillingEducate patients on new diagnosis codes and medical policies for emerging variantsVerify insurance details for each encounter in case coverage has changedEstimate responsibility amounts based on updated benefits to prevent billing issuesSummaryStaying on top of the latest guidelines, diligently verifying details, and proactively seeking payer guidance are key strategies to avoiding reimbursement issues. Medical billers must be agile in navigating rapid changes that come with new COVID-19 variants."},{"@context":"https:\/\/schema.org\/","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"2023","item":"https:\/\/medwave.io\/2023\/#breadcrumbitem"},{"@type":"ListItem","position":2,"name":"08","item":"https:\/\/medwave.io\/2023\/\/08\/#breadcrumbitem"},{"@type":"ListItem","position":3,"name":"Billing for Treatment of New COVID-19 Variants (EG.5, FL.1.5.1 and BA.2.86)","item":"https:\/\/medwave.io\/2023\/08\/billing-for-treatment-of-new-covid-19-variants-eg-5-fl-1-5-1-and-ba-2-86\/#breadcrumbitem"}]}]