by Wyn Staheli, Director of Research
September 15th, 2020
The American Medical Association (AMA) recently announced the addition of two more CPT codes in relation to COVID and the Public Health Emergency (PHE). Codes 99702 and 86413 were posted to the AMA website on Tuesday, September 8, 2020 and new guidelines have been added as well.
86413 Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative
99072 Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease
Code 99072 is an interesting new addition. There are some additional costs linked directly to this PHE and so this new code was created to report that cost. However, payers may or may not allow this code to be reimbursed. Since it has just been announced, it may take some time for payers to update their policies.
The new guidelines for code 99702 are as follows (emphasis added):
Code 99072 is used to report the additional supplies, materials, and clinical staff time over and above the practice expense(s) included in an office visit or other non-facility service(s) when the office visit or other non-facility service(s) are rendered during a Public Health Emergency (PHE), as defined by law, due to respiratory-transmitted infectious disease. These required additional supplies, materials, and clinical staff time are intended to mitigate the transmission of the respiratory disease for which the PHE was declared. These include, but are not limited to, additional supplies, such as face masks and cleaning supplies, as well as clinical staff time for activities such as pre-visit instructions and office arrival symptom checks that support the safe provision of evaluation, treatment, or procedural service(s) during the respiratory infection-focused PHE. When reporting 99072, report only once per in-person patient encounter per day regardless of the number of services rendered at that encounter. Code 99072 may be reported during a PHE when the additional clinical staff duties as described are performed by the physician or other qualified health care professional in lieu of clinical staff.
It is essential that documentation for the patient encounter includes information to support the criteria required for using code 99072. Consider including a statement such as “Due to COVID-19, pre-visit patient instructions were explained to the patient and their symptoms were checked upon arrival. Masks were used by the healthcare provider and staff and the examination room was cleaned after the patient visit concluded.”
- No specific diagnosis code is necessary to report code 99702. The patient does not need to have or be suspected of having COVID-19. Use the diagnosis code that you would typically report for that encounter.
- Code 99070 may also be reported with 99072, where applicable.
- In case you missed it, the following testing codes were added August 10th: 86408, 86409, 0225U, and 0225U.
It should be noted the following CPT codes will NOT be included in the 2021 CPT codebook due to the fact that it has already gone to print.:
Be sure to download our updated cheat sheet by CLICKING HERE.