Q&A: Reporting an E/M visit for a patient exposed to COVID-19

April 7th, 2020

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains broad coding and billing considerations for a new patient who was exposed to COVID-19 and was directed to a testing site. It discusses how the scenario relates to E/M services, specimen handling, laboratory testing, telehealth reporting, place-of-service reporting, and current guidance from CMS and the AMA. It is intended for coders, billers, and healthcare professionals who need a general overview of COVID-19-related reporting topics.

Why This Topic Matters

COVID-19 created frequent questions about how to report office, telehealth, telephone, testing-site, and laboratory services. Understanding the scope of the guidance helps coding and billing teams identify when the article is relevant to their workflow and where to look for official policy updates.

Article Sections

  1. Q&A on reporting an E/M visit for COVID-19 exposure

    The article opens with a coding question about a new patient encounter tied to COVID-19 exposure and referral to a diagnostic testing site. It frames the general reporting issues addressed in the remainder of the article.

  2. In-person and testing-site reporting considerations

    This section addresses the general categories of reporting involved in an in-person visit, specimen handling, laboratory testing, and place-of-service selection. It also references the code sets involved in those workflows.

  3. Virtual visit reporting and telemedicine guidance

    This section covers the broader topics of virtual E/M reporting, telemedicine, and telephone-based encounters. It also discusses the role of modifiers and place-of-service reporting in COVID-19 telehealth situations.

  4. CMS and AMA COVID-19 billing guidance

    This section summarizes the availability of broader CMS and AMA resources related to COVID-19 coding, reporting, and payment policies. It highlights that the article is discussing general guidance rather than a single payer policy.

  5. Editorial note and usage reminder

    The closing material identifies the contributors and includes a reminder to verify documentation for individual scenarios. It also notes the informational nature of the answer.

What You Will Learn

  • The general coding topics raised by a COVID-19 exposure and testing referral scenario
  • How the article frames in-person, virtual, and telephone-based visit reporting
  • What kinds of billing and reporting resources are referenced for COVID-19-related services
  • Which organizations and guidance sources are mentioned in connection with COVID-19 coding
  • How place of service and telemedicine reporting are discussed at a high level

Who Should Read This

  • Medical coders
  • Billing staff
  • Physician practice managers
  • Compliance staff
  • Healthcare professionals involved in COVID-19 visit reporting

Codes Discussed

  • ICD-10-CM: Z20.828
  • CPT: 99001
  • CPT: 87635

Code Ranges Discussed

  • CPT: 99201-99205
  • CPT: 99212-99215
  • CPT: 99441-99443

Modifiers Discussed

  • CPT: -95

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