New COVID-19 – CPT code 99072 was established to report additional practice expenses incurred during COVID-19, including supplies and additional clinical staff time.
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 COVID-19 over and above those usually included in a medical visit or service.
This new CPT code 99072 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 pandemic was declared. A comprehensive list of POS codes and their facility/non-facility designations are found in the Medicare Claims Processing Manual.
The new COVID-19 – CPT code 99072, were approved by the AMA for immediate use
“The CPT code set continues to quickly adapt during the COVID-19 pandemic to streamline the reporting of innovative tools and services now available to help reduce the COVID-19 disease burden, improve health outcomes and reduce long-term care costs. This update is the latest in a series of modifications to the CPT codes set to meet the needs of the health care industry as medical advancements expand the fight against COVID-19,” Susan R. Bailey, MD, president of the AMA, stated in the announcement.
Coding and billing during the public healthcare emergency have been the main challenge for providers
AMA specifically mentioned that 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.
This new CPT Code 99072 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
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