The American Medical Association (AMA) on 8th Sept 2020 published an update to the Current Procedural Terminology (CPT®) code set that includes two code additions for reporting medical services sparked by the public health response to the COVID-19 pandemic. The update to the CPT code set was approved by the CPT Editorial Panel and these two additions to the CPT code set been approved for immediate use. 

The two new Category I CPT codes and long descriptors are:

  • CPT 86413: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative.
  • CPT 99072: Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease.

CPT 86413

New CPT code 86413 was established to report quantitative antibody detection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). By providing precise quantitative measurements, code 86413 is intended for use as an aid in investigating the presence and temporal evolution of the adaptive immune response to SARS-CoV-2. The aim of this quantitative antibody assay is to assist in studies of the epidemiology, pathogenesis, prevention, and treatment of COVID-19.

CPT 99072

New code 99072 represents a new practice expense code specifically intended for use during a declared PHE as defined by law, due to respiratory-transmitted infectious disease. It accounts for additional supplies, materials, and clinical staff time required for patient symptom checks over the phone and upon arrival, donning and removing personal protective equipment (PPE), and increased sanitation measures to prevent the spread of communicable disease. This new code is established in response to the significant additional practice expenses related to activities required to safely provide medical services to patients in person during a PHE over and above those usually included in a medical visit or service. 

This new code should only be reported when the service is rendered in a non-facility place of service (POS) setting, and in an area where it is required to mitigate the transmission of the respiratory disease for which the PHE was declared. This new code is designed to capture the following practice expense factors such as:

  • Time over what is included in the primary service of clinical staff time (registered nurse [RN]/ licensed practical nurse [LPN]/ medical technical assistant [MTA]) to conduct a pre-visit phone call to screen the patient (symptom check), provide instructions on social distancing during the visit, check patients for symptoms upon arrival, apply and remove PPE, and perform additional cleaning of the examination/procedure/imaging rooms, equipment, and supplies.
  • Three surgical masks
  • Cleaning supplies, including additional quantities of hand sanitizer and disinfecting wipes, sprays, and cleansers

Code 99072 is to be reported only once per in-person patient encounter per provider identification number (PIN), regardless of the number of services rendered at that encounter. In the instance in which the noted clinical staff activities are performed by a physician or other qualified health care professional (e.g., in practice environments without clinical staff or a shortage of available staff), the activity requirements of this code would be considered as having been met; however, the time spent should not be counted in any other time-based visit or service reported during the same encounter.

Clinical Example for 86413

A 52-year-old female was discharged from the hospital after a lengthy stay with severe COVID-19, which is confirmed by molecular testing for SARS-CoV-2. Four weeks after her recovery, a blood specimen was submitted for quantitative antibody evaluation to assess her immune response to the virus.

Incubate and wash patient serum and diluent added to a SARS-CoV-2 spike protein receptor-binding domain (RBD)-complexed solid-phase surface, followed by adding antihuman-signal antibodies to detect bound anti-RBD antibodies. The relative amount of signal measured is directly proportional to the anti-RBD antibody concentration in the specimen and is interpreted using a standards-generated calibration curve with results reported in quantitative units.

Clinical Example for 99072

A 65-year-old female presents to the physician’s office, requiring care for an illness, acute injury, or ongoing care for a chronic condition. The encounter occurs during a Public Health Emergency (PHE), as defined by law, due to respiratory-transmitted infectious disease.

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CPT Assistant guide: Coronavirus (SARS-CoV-2); September 2020

AMA announces new CPT codes as COVID-19 advancements expand

Published By - Medical Billers and Coders
Published Date - Dec-15-2020 Back

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