Oct 7, 2020, the American Medical Association (AMA) published an update to the Current Procedural Terminology (CPT®) code set that includes new code additions and editorial revisions for reporting medical services impacted by the public health response to the COVID-19 pandemic.
These newly added CPT codes allow providers to report nucleic acid assays that allow a single test to detect novel coronavirus and other seasonal viruses, like the flu.
The newly added Category I CPT codes and long descriptors are:
CPT Code 87636
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique
CPT Code 87637
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique.
Providers would have normally used the CPT code 87631 for reporting a test panel that detects the flu and respiratory syncytial virus (RSV) infections. But according to AMA’s new coding guidance, the public health emergency has created a need for clinicians to rapidly distinguish these viruses from COVID-19.
Multi-virus tests could help boost testing capacity for the healthcare industry, which continues to face a shortage of testing supplies, according to Susan R. Bailey, MD, AMA president.
“Two of the newly approved codes report nucleic acid assays that allow a single test to simultaneously detect the novel coronavirus and a combination of common viral infectious agents, including influenza A/B and respiratory syncytial virus. Concurrent detection promises to conserve important testing resources, allowing for ongoing surveillance of influenza while testing for the novel coronavirus,” Bailey said in the CPT codes announcement made on Oct 7, 2020.
The announcement also highlighted the amendment of CPT codes 87301 through 87430, which report tests for infectious agency antigen detection by the immunoassay technique. Effective immediately, code descriptors for the impacted CPT codes no longer have the undefined term “multi-step method.”
According to the AMA announcement, “The revision clarifies the proper reporting for antigen tests that are read by a machine, as compared to those which can be visually interpreted without a machine. This revision impacts the newly added descriptor for CPT code 87426.”
According to AMA’s new revision, the CPT Editorial Panel also approved a new Category I code to report infectious agent antigen detection by immunoassay with direct visual observation.
CPT Code 87811
Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
The Panel has added several codes to the Proprietary Laboratory Analyses (PLA) code set, including the most recent addition of codes 0240U and 0241U for the detection of COVID-19, influenza A, and influenza B. Another new code (0240U) also detects RSV.
The latest coding guidance from AMA also includes revisions to Immunology guidelines. The revisions “correct and clarify reporting of infectious agent antigen studies in the Microbiology subsection in the Pathology and Laboratory section of the CPT code set,” the guidance states.
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FAQs:
1. What are the new CPT codes introduced by the AMA on October 7, 2020?
The AMA introduced new CPT codes 87636 and 87637 for testing COVID-19 and other viruses, allowing simultaneous detection.
2. Why were these new codes necessary?
The new codes help clinicians quickly distinguish COVID-19 from other viruses like the flu, addressing the urgent need during the public health emergency.
3. What is the significance of the multiplex amplified probe technique?
This technique allows a single test to detect multiple viruses, conserving testing resources and improving overall testing capacity.
4. How do the new codes affect antigen tests?
The AMA revised certain CPT codes to clarify the reporting of antigen tests, distinguishing between machine-read and visually interpreted tests.
5. What role does Medical Billers and Coders (MBC) play in this context?
MBC specializes in revenue cycle management and coding services, assisting healthcare providers in navigating the complexities of billing and coding for these new CPT codes.
