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Long-Haul COVID-19 Cases Are Potential Risk for Claim Denials | Health Care Compliance Association (HCCA)


With the pandemic in its second year, coding and documentation of long-haul COVID-19 patients who are admitted or readmitted to the hospital may be a sleeper risk. They pose coding challenges because long-haul COVID-19 patients don’t have active infections and documentation may be murky, an expert said. At the same time, hospitals have seen denials for other COVID-19 claims, including patient status and sequencing.
Admissions for long-haul COVID-19 usually aren’t coded with a principal diagnosis of COVID-19 (U07.1), said Garnette McLaughlin, senior consultant and compliance officer at Intersect Healthcare + AppealMasters in Towson, Maryland. “If people aren’t actively infected with COVID, you don’t assign the COVID code. You would assign a sequela code,” which captures the residual effects of an acute illness or injury. The problem is “the documentation gets real muddy in terms of the current acute infection due to COVID or a sequela,” said McLaughlin, who is a ....

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