How to do billing for Radiology during COVID?

Radiologists who are practicing in an imaging center or other non-hospital facility have updates available which will potentially allow them to reimburse some of the added costs related to safety precautions taken during the COVID-19 emergency. Medicare will pay under the Medicare Physician Fee Schedule billing for radiology services when beneficiaries obtain services through a health care facility that isn’t a hospital.

CPT code 99072: Radiologist can take leverage of this code

Current Procedural Terminology (CPT®) code 99072 was added by the American Medical Association (AMA) Editorial Panel on Sept 8, 2020, approved for immediate use. Payment for this CPT code is yet not available from Medicare, it might be reimbursed by some commercial insurance companies.

CPT code 99072 is described to add “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.”

The CPT code 99072 may be reported only once per in-person patient visit per day irrespective of the number of services rendered at the patient visit.

The cost expected by CPT code 99072 must be over and above those usually added in a visit or service, and might include:

  • Extra Time Spent by Provider Staff to
    • Attend the pre-visit screening of patient
    • Patient initial check-up for symptoms
    • COVID-19 instructions e.g. social distancing during the visit
    • Sanitization of the procedure room and imaging equipment
    • Use of Personal Protective Equipment (PPE)
  • Extra Cost of
    • Surgical masks used during an office visit or procedure
    • Additional use of cleaning supplies such as disinfecting wipes and hand sanitizers, cleansers, and sprays

As per CPT code 99072 describes ‘clinical staff time’ in the performance of these tasks, the additional information shared by the AMA shows that it is equally appropriate when performed by a physician or other qualified healthcare professional.

The charges to be billed with this CPT code are developed by considering at the actual cost of the services and supplies involved. This will require some research and analysis, for the charge of the supplies, purchase price of a certain quantity of items which will have to be divided by the number of patients it will cover. The unit price of single items like masks are easy to identify, so you need to find out how many masks are used per patient visit.

The time spent by your staff who is performing tasks listed above can be calculated by observing and recording the time for each task.

  • How many patients’ appointments can be scheduled in an hour?
  • How much time will it take for each visit to check a patient for symptoms?
  • How much time does the patient utilize the exam room until it is ready for the next patient?

Each of the above tasks has to be evaluated to determine the extra time needed over and above what was normally required before this COVID-19 pandemic. Once the blocks of time identified, the cost of the staff can be added.

It is necessary to imaging consultation reports to add some documentation of the need of billing CPT code 99072. According to AMA guidelines, “Documentation requirements may vary among third-party payers and insurers; therefore, they should be contacted to determine their specifications.”

Documentation content can be included in all reports:

“During the COVID-19 Public Health Emergency, we are taking all necessary safety measures to safely provide required medical services to our patients, including the use of personal protective equipment (PPE) and increased sanitation actions to prevent the spread of infectious coronavirus diseases.”

The decision of use CPT code 99072 to submit claims, along with required charges to be submitted totally depends upon each practice owner on their own. There is no clear guidance as of now. We will keep an eye on updates of AMA in the near future to keep all radiologists updated.

About Medical Billers and Coders

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The Economic Impact of the COVID-19 Pandemic on Radiology Practices – Radiology Society of North America Link
The Economic Impact of the COVID-19 Pandemic on Radiology Practices October 14, 2020 by Rebecca Farrington Link

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