COVID-19 coronavirus disease 2019 caused by SARS-CoV-2
by dr Z Halat
Medical Epidemiology Consultant

SARS-CoV-2 formerly known as Novel Coronavirus (2019-nCoV)  novel-coronavirus-2019-nCoV.com, Wuhan coronavirus 武汉冠状病毒  武漢冠狀病毒) causing 2019-nCoV acute respiratory disease (ICD-10: U07.1). Codes U00-U49 are to be used by WHO for the provisional assignment of new diseases of uncertain etiology. In emergency situations codes are not always accessible in electronic systems.


How to use ICD-10-CM, new lab testing codes for COVID-19

from the AAP Division of Health Care Finance
March 12, 2020
Coding Corner
How to use ICD-10-CM, new lab testing codes for COVID-19

from the AAP Division of Health Care Finance

The introduction of 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) in the United States has produced an influx of patients into the health care system. While knowing how to diagnose and treat these patients is vital, being able to appropriately capture this information for data tracking and payment also is important. The National Center for Healthcare Statistics has developed a resource for International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding that already is in effect.

COVID-19 attacks the respiratory system; therefore, suspicion of the disease typically will accompany respiratory conditions. A confirmation of COVID-19 will therefore be linked to a specific respiratory condition.

Coding guidance: ICD-10-CM

Pneumonia: For a pneumonia case confirmed as due to the 2019 novel coronavirus (COVID-19), assign codes J12.89, Other viral pneumonia, and B97.29, Other coronavirus as the cause of diseases classified elsewhere.
Acute bronchitis: For a patient with acute bronchitis confirmed as due to COVID-19, assign codes J20.8, Acute bronchitis due to other specified organisms, and B97.29. If the bronchitis is not specified as acute, due to COVID-19, report code J40, Bronchitis, not specified as acute or chronic, along with code B97.29.
Lower respiratory infection: If the COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, report with code J22, Unspecified acute lower respiratory infection, with code B97.29. If the COVID-19 is documented as being associated with a respiratory infection, NOS, it would be appropriate to assign code J98.8, Other specified respiratory disorders, with code B97.29.
Acute respiratory distress syndrome (ARDS): ARDS may develop in conjunction with COVID-19. Cases with ARDS due to COVID-19 should be assigned the codes J80, Acute respiratory distress syndrome, and B97.29.
Exposure to COVID-19: For cases where there is possible exposure to COVID-19, but the disease is ruled out, report code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. For cases where there is an actual exposure to someone who is confirmed to have COVID-19, report code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. This code is not necessary if the exposed patient is confirmed to have COVID-19.
Signs and symptoms: For patients presenting with any signs/symptoms and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as: Cough (R05); Shortness of breath (R06.02) or Fever unspecified (R50.9).
Do not report “suspected” cases of COVID-19 with B97.29. In addition, diagnosis code B34.2, Coronavirus infection, unspecified, typically is not appropriate.

Coding guidance: procedural

There are no unique codes for evaluating and managing this condition; however, be sure to clearly document any additional time spent with the family or time spent coordinating any care that is not face-to-face with the patient and/or family.

Testing

There is no code for swabbing the patient for COVID-19, much like there is no code for swabbing for influenza. However, if the specimen will be prepared by your office and sent to an outside lab, report the specimen collection code 99000.

The Centers for Medicare & Medicaid Services (CMS) developed two new lab testing codes:

U0001 will be reported for coronavirus testing using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel.
U0002 will be reported for validated non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).
If your office is not running the test for COVID-19 or incurring the cost, you will not report these codes.

The American Medical Association Current Procedural Terminology (CPT) Editorial Panel has developed a CPT code which streamlines novel coronavirus testing offered by hospitals, health systems, and laboratories in the United States. The code was effective March 13, 2020, for use as the industry standard for reporting of novel coronavirus tests across the nation’s health care system.

87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique

Telehealth

As concerns arise over the easy spread of COVID-19, increasing the use of telehealth has been proposed. In this instance, telehealth is referring only to the synchronous live videoconferencing. Knowing your state laws and payer rules is important in this instance. (See resources for AAP fact sheet on coding for telehealth services and help in navigating your state laws on telehealth services.)

Advocacy and payment

The AAP is monitoring health plan carrier uptake of the new Healthcare Common Procedure Coding System (HCPCS) Level II codes: U0001 and U0002. Per CMS, the Medicare claims processing system will be able to accept this code for payment as of April 1 for dates of service on or after Feb. 4, 2020.

The Academy sent inquiries to the largest national carriers (Aetna, Anthem, Cigna, Humana and UnitedHealthcare) to ascertain their coverage policies. The carriers will offer the test with no patient out-of-pocket expense, and as of press time, Humana replied that it will follow CMS with retroactive coverage to Feb. 4, 2020. Carriers are waiting for CMS to value COVID-19 testing before establishing their fee schedules for the test. In the interim, providers should check their carrier contract regarding payments for services not included in the fee schedule (e.g., payment as a percentage of billed charges).

Additionally, several carriers are waiving co-payments for all diagnostic testing related to COVID-19 and for video visits (in lieu of office visits) for synchronous virtual care (live videoconferencing only).



HCoV-19 (SARS-2) virus could be detected in aerosols up to 3 hours post aerosolization, up to 4 hours on copper, up to 24 hours on cardboard and up to 2-3 days on plastic and stainless steel. HCoV-19 and SARS-CoV-1 exhibited similar half-lives in aerosols, with median estimates around 2.7 hours. Both viruses show relatively long viability on stainless steel and polypropylene compared to copper or cardboard: the median half-life estimate for HCoV-19 is around 13 hours on steel and around 16 hours on polypropylene. Our results indicate that aerosol and fomite transmission of HCoV-19 is plausible, as the virus can remain viable in aerosols for multiple hours and on surfaces up to days.

The Coronavirus May Linger On Plastic And Stainless Steel For Days, A Preliminary Study Found
A preliminary study sheds more light on the virus’s ability to linger in the environment.
Stephanie M. Lee
BuzzFeed News Reporter
Posted on March 11, 2020, at 6:33 p.m. ET

“This is not surprising — it’s excellent science,” said David Weber, an epidemiologist and infectious disease expert at the University of North Carolina at Chapel Hill, who was not involved with the new paper. “It adds to what we know about COVID[-19],” the name of the disease caused by the new coronavirus.

Previous studies have detected the MERS virus, also a type of coronavirus, on steel and plastic surfaces for up to two days, and the SARS virus on plastic for up to five days.

Weber said that the paper is important because it sheds further light on how SARS-CoV-2 behaves. But he noted that it doesn’t explain how much surface or air contact might actually contribute to someone’s likelihood of getting sick.

Suppose that an infected person rubs their nose and touches a plastic door handle, which is in turn touched by someone else who rubs their own nose. “Does that account for 0.01% of transmissions or 15% of transmissions?” Weber said. “We don't know how frequent it is.”

The scientists ran a battery of tests with a strain of SARS-CoV-2. They sprayed it into a rotating drum and measured how long it stayed in the air: three hours. They also deposited small amounts on plastic and stainless steel (up to two to three days), copper (up to four hours), and on cardboard (24 hours). The authors of the paper did not immediately return a request for comment.

Weber said that although the results of the aerosol study seemed legitimate, they weren’t clearly applicable to real-world conditions. “The question is, do you have enough virus in the air so that someone 15 feet away could get infected like they could with measles?” he said. “This doesn't really prove this to me one way or another.”

He also noted that in the open air, viruses tend to dry out from humidity or be killed off by ultraviolet light.

If proven true, the findings would further reinforce the need to adhere to the CDC’s existing coronavirus guidelines, Weber said.

The agency advises staying at least six feet away from people who are coughing and sneezing, and cleaning and disinfecting frequently touched surfaces in household common areas, from sinks to light switches to tables.






World Health Organization declared that the outbreak of 2019-nCoV constitutes a Public Health Emergency of International Concern (PHEIC)
see how they dealt with ebola crisis before and now
ebola-virus-disease.com


The epidemic of 1679 commemoration: The Plague Column formally Holy Trinity and the nine choirs of angels, 1694, Pestsäule, Heilige Dreifaltigkeit und zu den 9 Chören der Engel, Graben, Vienna, Austria. Fine Art Photography by Zbigniew Halat i.e. HalatFineArt
Upamiętnienie epidemii z 1679 r .: Kolumna Morowa formalnie Święta Trójca i dziewięć chórów aniołów, 1694, Pestsäule, Heilige Dreifaltigkeit und zu den 9 Chören der Engel, Graben, Wiedeń, Austria.The epidemic of 1679 commemoration: The Plague Column formally Holy Trinity and the nine choirs of angels, 1694, Pestsäule, Heilige Dreifaltigkeit und zu den 9 Chören der Engel, Graben, Vienna, Austria. Fine Art Photography by Zbigniew Halat


Discovery of a novel coronavirus associated with the recent pneumonia outbreak in humans and its potential bat origin
Peng Zhou, Xing-Lou Yang, Xian-Guang Wang, Ben Hu, Lei Zhang, Wei Zhang, Hao-Rui Si, Yan Zhu, Bei Li, Chao-Lin Huang, Hui-Dong Chen, Jing Chen, Yun Luo, Hua Guo, Ren-Di Jiang, Mei-Qin Liu, Ying Chen, Xu-Rui Shen, Xi Wang, Xiao-Shuang Zheng, Kai Zhao, Quan-Jiao Chen, Fei Deng, Lin-Lin Liu, Bing Yan, Fa-Xian Zhan, Yan-Yi Wang, Gengfu Xiao, Zheng-Li Shi
doi: https://doi.org/10.1101/2020.01.22.914952
This article is a preprint and has not been certified by peer review [what does this mean?].
AbstractInfo/HistoryMetrics Preview PDF
Abstract
Since the SARS outbreak 18 years ago, a large number of severe acute respiratory syndrome related coronaviruses (SARSr-CoV) have been discovered in their natural reservoir host, bats. Previous studies indicated that some of those bat SARSr-CoVs have the potential to infect humans. Here we report the identification and characterization of a novel coronavirus (nCoV-2019) which caused an epidemic of acute respiratory syndrome in humans, in Wuhan, China. The epidemic, started from December 12th, 2019, has caused 198 laboratory confirmed infections with three fatal cases by January 20th, 2020. Full-length genome sequences were obtained from five patients at the early stage of the outbreak. They are almost identical to each other and share 79.5% sequence identify to SARS-CoV. Furthermore, it was found that nCoV-2019 is 96% identical at the whole genome level to a bat coronavirus. The pairwise protein sequence analysis of seven conserved non-structural proteins show that this virus belongs to the species of SARSr-CoV. The nCoV-2019 virus was then isolated from the bronchoalveolar lavage fluid of a critically ill patient, which can be neutralized by sera from several patients. Importantly, we have confirmed that this novel CoV uses the same cell entry receptor, ACE2, as SARS-CoV.



The 1567 plague epidemic killed a third of the inhabitants of Wroclaw. Are we globally helpless again?
 
The 1567 plague epidemic killed a third of the inhabitants of Wroclaw. Are we globally helpless again? Epitaph paintings by Tobias Fendt, 1567: Christ pronounces the Final Judgement and Family of the deceased on the background panorama of Wroclaw. Fine Art Photography by Zbigniew Halat
Epitaph paintings by Tobias Fendt, 1567: Christ pronounces the Final Judgement and Family of the deceased on the background panorama of  Wroclaw, National Museum in Wroclaw, Poland. Fine Art Photography by Zbigniew Halat


Novel Coronavirus (2019-nCoV)

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