Payor Split-bill Requirement: Separate Claims for Z20.822 and Z20.828

By Brenda Ray, CCS, CCS-P, COC, AHIMA-Approved Trainer 

Since the beginning of the pandemic, there have been many code changes and updates related to COVID-19 (SARS-CoV-2), with even more for 2021, including new ICD-10-CM diagnosis codes implemented on January 1, 2021. Among these is code Z20.822, contact with and (suspected) exposure to COVID-19, which previously required the code Z20.828.  Pay attention to the specific dates around Z20.822 and Z20.828, as this will be critical for billing. 

Providers have discovered that most Payors are requiring that a claim be split-billed by year when the claim spans both calendar years, as it relates to Z20.822 and Z20.828. For example, if a patient had pre-op testing done, including a COVID screening (Z20.828), in December of 2020 with a January 2021 outpatient surgery date, likely the claim will be split paid by the year.  Please reference specific claim example below:
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Example:

• A patient has pre-op testing done, including COVID screening (Z20.828), on December 31, 2020
• The patient has outpatient surgery on January 5, 2021
• Claim dates are 12/31/20 to 1/5/21 (which includes the pre-op testing and the outpatient procedure on the claim)
• The Coder correctly assigns Z20.828 based on the pre-op COVID screening 2020 date of service
• Code Z20.828 edits as an invalid code on this claim with a discharge date 2021 due to DOS of the COVID test, December 31, 2020
• With a 2020 date of the COVID test, you must split out the 2020 charge with Z20.828; and submit a separate claim for the specific 2021 charges to avoid the edit.  

Z20.822 vs. Z20.828

​New ICD-10-CM codes being implemented January 1, 2021 are:
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• J12.82  Pneumonia due to coronavirus disease 2019
• M35.81 Multisystem inflammatory syndrome
• Z11.52  Encounter for screening for COVID-19 (Please Note: this code is not to be used until after the end of the Public Health Emergency)
• Z20.822 Contact with and (suspected) exposure to COVID-19   
• M35.89 Other specified systemic involvement of connective tissue
• Z86.16 Personal history of COVID-19
  
  

 
The January 2021 ICD-10-CM Addenda and updated ICD-10-CM Official Guidelines for Coding and Reporting are available at:  https://www.cdc.gov/nchs/icd/icd10cm.htm. 
 

This information is provided as an overview of the billing challenge with Z20.822 vs Z20.828. It is intended as informational only, and should not be considered as official payment guidance. Axea Solutions recommends readers inquire directly with payers for appropriate reporting guidelines, as they may vary by payer.