Chris Mazzolini is the editorial director of Medical Economics

, discusses why practices that have leaned into value-based care have weathered the COVID-19 pandemic successfully.

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Farzad Mostashari, MD, CEO of Aledade, discusses why physician practices that have leaned into value-based care have weathered the COVID-19 pandemic successfully.

How value-based care can save your practice

Battling COVID-19 may be a costly endeavor as remdesivir, the antiviral drug shown to shorten the time of recovery, is expected to cost thousands of dollars, according to an open letter from head of drug manufacturer Gilead.

 Gilead Chairman and CEO Daniel O’Day writes that the drug will cost $390 a vial in developed countries. As patients are expected to receive a five-day treatment course using six vials of remdesivir, the total cost for the treatment will be about $2,340 per patient. Even at that price, the drug is expected to produce hospital savings of about $12,000 per patient, due to earlier discharge.

"In normal circumstances, we would price a medicine according to the value it provides," Day writes. "We have decided to price remdesivir well below this value."

Day goes on to say that, in developing countries, Gilead will enter into agreements with generic manufacturers to "deliver treatment at a substantially lower cost."

O’Day says that Gilead has entered into an agreement with the U.S. Department of Health and Human Services (HHS) which tasks the agency and the states with managing allocation to hospitals until the end of September.

 the U.S. Food and Drug Administration (FDA) issued an emergency use authorization for remdesivir after it was shown to shorten the time of recovery for COVID-19 in a clinical trial, though there is limited information of the safety and effectiveness in treating patients hospitalized with the disease.

The authorization allows the drug to be distributed in the country and administered intravenously by doctors to treat suspected or confirmed COVID-19 in children and adults with severe disease, i.e. low blood oxygen levels, in need of oxygen therapy, or on a mechanical ventilator.

Possible side effects of remdesivir include increased liver enzymes which may indicate inflammation or damage to liver cells, and infusion-related reactions like low blood pressure, nausea, vomiting, sweating, and shivering, according to the FDA.

Articles

Gilead announced the drug will go for $390 per vial in developed countries but is still expected to save the healthcare system money.

Gilead announces cost of Remdesivir for COVID-19 treatment

The Trump administration continued its fight to have the Affordable Care (ACA) declared unconstitutional with a last-minute brief filed with the U.S. Supreme Court on June 25.

 asks the court to agree with a panel of appellate judges that the healthcare law, commonly known as Obamacare, is now unconstitutional due to Congress’ 2017 legislation making the individual mandate, a tax penalty for failing to buy health insurance, to $0.

Essentially, the administration’s argument rests on previous court decisions that the law was constitutional because it fell under Congress’ power to levy taxes. Because the tax penalty is now eliminated, the law should no longer be seen as constitutional.

 the individual mandate was ruled unconstitutional in a 2-1 decision by the U.S. Court of Appeals for the Fifth Circuit in New Orleans, the majority chose to return the case to Judge Reed O’Connor in the Federal District Court in Fort Worth, Texas, to determine whether the mandate can be severed from the rest of the law.

In 2018, O’Connor ruled the ACA was unconstitutional because of how central the mandate was to the law, according to a report from 

O’Connor’s previous ruling based on Congress’s belief when it enacted the ACA that the individual mandate was a key element to the law that could not be severed from it. He found the mandate unconstitutional because a 2012 Supreme Court decision upheld the mandate, saying that it fell under Congress’ powers over taxation, according to the 

When the tax penalty was eliminated in 2017, 20 state attorneys general, the plaintiffs in the case, argued that defense of the law was no longer effective and that the rest of the law should be invalidated along with it. The Department of Justice refused to defend the law, and later joined the plaintiffs in arguing against the law, according to the 

The Fifth Circuit decision has since been appealed, thus bringing the case to the U.S. Supreme Court where the health insurance coverage of about 23 million Americans hangs in the balance, according to 

The fight over the ACA is coming to a head at a time where the COVID-19 coronavirus pandemic as much of the country has healthcare on the brain. It is unlikely that a decision will come before the 2020 Presidental Election, in which Democrat Joe Biden seeks to unseat President Donald J. Trump, who originally ran on an unsuccessful plan to repeal and replace the law.

The Trump administration continues its fight against the Affordable Care Act (ACA) at the Supreme Court.

Trump administration makes case for ACA destruction

The American Medical Association (AMA) has a release an update to the Current Procedural Terminology (CPT) which includes a new code for reporting antigen testing of patients suspected to be infected with COVID-19.

The update was approved June 25 during a meeting of the CPT Editorial Panel, the independent panel with the sole authority to expedite the review of proposed changes and additions to the CPT code set, according to 

Designed to be quicker and simpler than other tests for COVID-19, antigen testing can be conducted at the point of care. A breakthrough in this testing could become a part of the solution for testing shortages, the release says.

“The new CPT code for antigen testing to detect the coronavirus is the latest in a series of CPT codes developed in rapid response to the pandemic,” AMA President Susan R. Bailey, MD, says in the release. “Moving quickly during this crisis to meet the medical coding needs of the health care industry has enhanced the reporting of innovative tools now available to advance medicine's overarching goals of reducing the COVID-19 disease burden, improving health outcomes and reducing long-term care costs.”

The new Category I CPT codes and long descriptors are:

 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])

 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique

 Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

In addition to the long descriptors, short and medium descriptors can be accessed on 

The new code was announced June 25 after a meeting of the CPT Editorial Panel.

Coronavirus: AMA releases new CPT code for antigen tests

Julianne Andrews, principal and co-founder of Atlanta Financial Associates LLC, discusses some strategies to help physicians minimize their tax liability.

How physicians can limit their tax liability

On April 1, 2020, the Centers for Disease Control (CDC) updated ICD-10 coding guidance as follows when it comes to coding for COVID-19. 

Codes for diagnosing COVID-19 (April 1, 2020 - September 30, 2020)

For diagnosis coding consider the following:

Use additional code to identify pneumonia or other manifestations. i.e:

Pneumonia confirmed as due to COVID-19: U07.1 (COVID-19) AND J12.89 (Other viral pneumonia)

Acute bronchitis: J20.8 or J.40 if unspecified bronchitis

Acute respiratory distress syndrome (ARDS): J80

Additional coronavirus codes not due to COVID-19:

Coronavirus infection, unspecified: B34.2

Coronavirus as the cause of diseases classified elsewhere: B97.2-

Pneumonia due to SARS associated coronavirus: J12.81

, the following encounter codes should be used:

Encounter for observation for suspected exposure to other viral communicable diseases (Possible Exposure to COVID-19 ruled out): Z03.818

Contact with and suspected exposure to person to other viral communicable disease (Contact with COVID-19, Suspected exposure: Z20.828

Encounter for screening for other viral diseases, Asymptomatic, no known exposure, results unknown or negative: Z11.59

The guidelines were very specific in their choice of code sets and sequence of codes. Please make certain that your codes, and coding resources, are up to date.

ICD-10-CM Official Coding and Reporting Guidelines April 1, 2020 through September 30, 2020

ICD-10-CM Tabular List of Diseases and Injuries April 1, 2020 Addenda

Bill Dacey, MHA,MBA, CPC, is principal in The Dacey Group, Inc., a consulting firm dedicated to coding, billing, documentation, and compliance concerns for physicians. Dacey is a AAPC-certified coding instructor and has been active in physician training for more than 25 years. He can be reached at

These are the COVID-19 ICD-10 codes physicians need to know, accurate as of CDC's April 1, 2020 update. 

How value-based care can save your practice

Gilead announces cost of Remdesivir for COVID-19 treatment

Trump administration makes case for ACA destruction

Coronavirus: AMA releases new CPT code for antigen tests

How physicians can limit their tax liability

COVID-19 coding: What you need to know