South African Medical Association



Coding during COVID-19 Pandemic – Ventilation Coding for High Flow Nasal Cannula Therapy



Coding during COVID-19 Pandemic – Ventilation Coding for High Flow Nasal Cannula Therapy
Leonie Maritz (Specialist Coding Consultant, SAMA Coding Division)

As the SAMA procedural coding structure does not make provision for treatment of COVID-19 positive patients, decisions had to be made to use comparable codes (See Rule C – item 6999), for certain services.

First of all, coding for Covid-19 positive patients and COVID-19 negative patients, are exactly the same.

Doctors are being urged to code in an ethical way for COVID-19 positive and COVID-19 treatment. Even though it is a Prescribed Minimum Benefit (PMB) condition, doctors should take into account that the hospitalisation is not elective from the patient’s side. Medical schemes still have the prerogative to only pay benefit rates, or not pay at all, for certain services.

Doctors must take the patient’s socio-economic situation, PMB protocols and medical scheme benefits into consideration when rendering their accounts, otherwise the patient will be held liable for extravagant co-payments which they may not be able to afford.

Coding for High Flow Oxygen Therapy (HFNC)
It was decided that the Ventilation codes (Items 1212-1214 as appropriate) should be used as a comparable code for HFNC. Therefore, the appropriate Ventilation code should be used, the description changed to ‘HFNC item 6999’.

It must be accentuated that the decision to provide additional benefits for HFNC Therapy is up to the medical schemes because HFNC does not form part of the original meaning of Items 1212-1214. This coding decision to endorse the use of Items 1212-1214 with Rule C for HFNC is therefore an allowance for Covid19 cases ONLY.

In cases where ventilation of a patient is converted from HFNC to conventional intubated ventilation, EITHER item 1213 Ventilation: Subsequent days, per calendar day OR item 1214 Ventilation: After two weeks, per calendar day

The total time of ventilation, whether HFNC or intubated ventilation, should therefore be seen as one continuous timeline. Item 1212 may not be coded twice during one continuous period of ventilation.

One of the following ICD-10 codes MUST be added to the account to indicate that the treatment was provided to a COVID-19 patients:
U07.1 COVID-19, virus identified
U07.2 COVID-19, virus not identified (For use in epidemiological diagnoses)
U08.9 - Personal history of COVID-19, unspecified
U09.9 - Post COVID-19 condition, unspecified
U10.9 - Multisystem inflammatory syndrome associated with COVID-19, unspecified
U11.9 - Need for immunization against COVID-19, unspecified
U12.9 - COVID-19 vaccines causing adverse effects in therapeutic use, unspecified.

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