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Date: March 19, 2020
To: Health Plan of San Joaquin (HPSJ) Providers, Practices, and Facilities
From: HPSJ Provider Services Department
Subject: Updates for during COVID-19 (Coronavirus) – (1) Members’ Care & (2) Business Practices
Business: Medi-Cal

Clarification (March 10, 2020 Alert) – Billing

  • U07.1 is for confirmed cases only and is not available to bill until 04/01/2020.
  • B97.29 should be the diagnosis code providers use for confirmed cases through 03/31/2020.

Any testing or visits, prior to confirming a COVID-19 positive case should be billed with diagnosis codes pertaining to the patient’s symptoms at the time of the visit.

You should not bill diagnosis code B97.29 or U07.1 in order to be reimbursed for testing.

We have been working hard to arrange safe working conditions for all HPSJ employees. We remain open and you will find no break in our support for your work and the health of our members.   

As always, our Customer Service team members will remain available to answer any questions. Call us at 209-942-6320. You can also keep in touch with developments at the CDC site, https://www.cdc.gov/coronavirus/2019-ncov/about/index.html

Following is valuable information for HPSJ members’ care and your business operations. 

(1) HPSJ Members’ Care

For billing guidelines please reference the Medi-Cal Provider Billing Manual for Telehealth.

Tele-Visits Encouraged 

  • Phone Instead of Coming into the Office – We are telling our members that if they are concerned about COVID-19 and possible symptoms, they should stay home, practice social distancing, and NOT go into their provider’s office. Instead, they should call their provider to speak with staff for a phone screening.
  • MD Consults and the HPSJ HealthReach Nurse Advice Line – This toll-free 24/7 service is available to your HPSJ patients with viral respiratory symptoms, by calling 1-800-655-8294. When their provider is not available, if the Advice Nurse determines a consultation with a physician is needed, one can be made available to HPSJ members as part of the phone call.

Interpretation & American Sign Language (ASL) Service –  COVID-19 Interim Plan

HPSJ understands your need to practice social distancing and minimize face-to-face office visits. One of our priorities is to ensure that our Limited English Proficiency (LEP) and hearing-impaired members continue to receive quality care from you. 

The following will help you schedule interpretation services when there is a need during the COVID-19 outbreak – 

  • Continue contacting Customer Service to schedule needed interpretation and ASL services; call 209-942-6320.
  • All in-person interpretation requests will be routed to our “Over the Phone Interpretation” (OPI) vendor.
  • For ASL services, we will arrange a video-based interpretation.

(2) Business Operations

There will be NO delays in paying claims due to the COVID-19 pandemic.

Billing Reminder (from 1st page)

  • 1 is for confirmed cases only and is not available to bill until 04/01/2020.
  • 29 should be the diagnosis code providers use for confirmed cases through 03/31/2020.

Any testing or visits, prior to confirming a COVID-19 positive case should be billed with diagnosis codes pertaining to the patient’s symptoms at the time of the visit.   You should not bill diagnosis code B97.29 or U07.1 in order to be reimbursed for testing.  

ICD-10-CM Coding Updates

The Centers for Disease Control and Prevention (CDC) has issued reporting guidance for Clinical Modification (ICD-10-CM), effective with the next update (October 1, 2020). Full information regarding the new code and the final title will be available soon; we will provide an update as soon as available. 

For now, the ICD-10-CM Official Coding Guideline – Supplement Coding Encounters Related to COVID-19 Coronavirus Outbreak (February 20, 2020) provides you with the coding specifications HPSJ is using. They can be found at: https://www.cdc.gov/nchs/icd/icd10cm.htm

If you have any questions, please contact Customer Service at 209-942-6320.  

Posted on March 19th, 2020 and last modified on March 20th, 2020.

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