Independence is committed to ensuring that our members have access to the care they need, at the right time, and in the right setting. As COVID-19 has escalated into a pandemic, we are working to make sure that our members can receive appropriate testing and treatment for the virus causing COVID-19 if needed.
We encourage all Independence members to visit our dedicated COVID-19 webpage regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.
The Pennsylvania Department of Health (DOH) has mandated changes to the CHIP program during the COVID-19 disaster declaration authorized by the Governor. These policy clarifications will remain in effect from March 24, 2020, through the duration of the disaster declaration. The Office of CHIP may re-issue a policy clarification as appropriate.
Billing guidance for alternative screening sites
Effective immediately, hospitals do not need to enroll their on-campus or off-campus temporary screening sites separately with the Department of Human Services (Department).
The Department understands that the DOH considers these sites part of the hospital and the areas are set up as part of the hospital’s emergency preparedness plan.
Non-hospital community providers may choose to set up COVID-19 screening sites. Community screening sites not under the control of a hospital and being conducted by a health care provider, such as an independent clinic, federally qualified health care center, rural health center, physician or physician office, laboratory or certified registered nurse practitioner, also do not need to enroll these sites separately.
How to bill
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Screening sites at hospitals. Hospitals should use their existing acute care hospitals or hospital outpatient unit locations already enrolled with the Department to submit claims for services performed at these on or off campus screening sites.
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Screening sites at non-hospital community providers. As these sites are temporary in nature, providers should bill from office or clinic sites already enrolled using a place of service that best describes where the service was provided.
Prior authorization requirements for CT scans of the chest
As of March 24, 2020, Independence waived the prior authorization requirement for
all CT scans of the chest when CHIP members have or are being tested for COVID-19.
How to code
- For claims with a date of service through March 31, 2020, diagnosis codes for COVID-19 should be reported with:
- the primary illness diagnosis code; and
- diagnosis code
B97.29 (Other coronavirus as the diseases classified elsewhere).
Example:
|
Primary illness diagnosis code |
Description |
Secondary illness diagnosis code |
Description |
|---|
J12.89 | Other viral pneumonia | B97.29 | Other coronavirus as the cause of diseases classified elsewhere |
J22 | Unspecified acute lower respiratory infection | B97.29 | Other coronavirus as the cause of diseases classified elsewhere |
J80 | Acute respiratory distress syndrome | B97.29 | Other coronavirus as the cause of diseases classified elsewhere |
J20.8 | Acute bronchitis due to other specified organisms | B97.29 | Other coronavirus as the cause of diseases classified elsewhere |
J40 | Bronchitis, not specified as acute or chronic | B97.29 | Other coronavirus as the cause of diseases classified elsewhere |
J98.8 | Other specified respiratory disorders | B97.29 | Other coronavirus as the cause of diseases classified elsewhere |
- For claims with a date of service on or after April 1, 2020, you should use diagnosis code
U07.1 (2019-nCoV acute respiratory disease) for COVID-19 patients.
- Claims for members who have known exposure to someone with a confirmed COVID-19 diagnosis should be reported with diagnosis code
Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases).
- Claims for members who present with signs or symptoms but have not been confirmed as having COVID-19 and have no known exposure to COVID-19 should be reported with the appropriate sign or symptom diagnosis code.
-
Example:
- R05 – Cough
- R06.02 – Shortness of breath
- R50.9 – Fever, unspecified
- R68.89 – Other general symptoms and signs
Learn more
For more information about Independence’s position on COVID-19, please review the following resources: