We have had multiple outbreaks of COVID in recent weeks. There has been confusion when coding isolation. Can we code isolation if we have two positive residents sharing a room?


Coding isolation requires specific criteria. One of these characteristics is if the patient is being isolated alone in a separate room due to an active infection.

However, CMS released a statement in response to stakeholder feedback. They are requesting to change some of the criteria to code infection isolation. CMS is soliciting comments on the degree to which the current criteria for coding infection isolation should be expanded to allow cohorted patients to be included and to ensure that the payment rate impact of infection isolation is consistent with the increase in relative costliness associated with these patients. While the current criteria has not changed just yet, stay tuned to Proactive’s newsletters for future updates.


Jessica Cairns, RN, RAC-CT, CMAC
Director of Audit Services

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