Date: May 22, 2020
To: Enrolled Hospitals; Ambulatory Surgical Treatment Centers; Renal Dialysis Centers; Hospice Agencies; and Long Term Care Providers – Nursing Facilities, Intermediate Care Facilities for Individuals with Intellectual Disabilities, Supportive Living Program, Medically Complex for the Developmentally Disabled Facilities, and Specialized Mental Health Rehabilitation Facilities
Re: Use of Condition Code DR for Institutional Claims – COVID-19
This notice instructs providers to use Condition Code DR – Disaster Related, for tracking of claims potentially related to treatment of COVID-19. These instructions apply to claims for participants covered under the fee-for-service program as well as a HealthChoice Illinois managed care plan or Medicare/Medicaid Alignment Initiative (MMAI) plan.
In order to ensure appropriate flagging of COVID-19 related care, Condition Code DR must be present if an institutional claim contains one of the following ICD-10 diagnosis codes:
· B97.29 - Other coronavirus as the cause of diseases classified elsewhere (for services provided prior to April 1, 2020)
· U07.1 - COVID-19 (for services provided on or after April 1, 2020)
· Z03.818 - Encounter for observation for suspected exposure to other biological agents ruled out
· Z11.59 - Encounter for screening for other viral diseases
· Z20.828 - Contact with and suspected exposure to other viral communicable diseases
Per National Uniform Billing Committee Guidance, Condition Code DR should be utilized for COVID-19 related care occurring for service dates beginning January 27, 2020, the date that the Department of Health and Human Services declared the COVID- 19 crisis as a federal public health emergency.
Questions regarding this notice may be directed to the Bureau of Hospital and Provider Services at 877-782-5565 or the Bureau of Long Term Care at 844-528-8444.
Interim Medicaid Administrator