Practicefirst, would like to notify all our clients about two new CPT codes that were added by AMA. These codes are effective immediately.
The details of the codes are below:
86413 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative.
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.
Based on the CPT Special Edition: September Update (https://www.ama-assn.org/system/files/2020-09/cpt-assistant-guide-coronavirus-september-2020.pdf) below are the requirements/details of the code 99072:
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 diseases.
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.
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 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.
Cleaning supplies, including additional quantities of hand sanitizer and disinfecting wipes, sprays, and cleansers
Question: What documentation is required to report code 99072?
Answer: Given that code 99072 may only be reported during a PHE, one would not report this code in conjunction with an evaluation and management (E/M) service or procedure when a PHE is not in effect. Therefore, code 99072 is reported justifiably only when health and safety conditions applicable to a PHE require the type of supplies and additional clinical staff time explained in the code descriptor. Documentation requirements may vary among third-party payers and insurers; therefore, they should be contacted to determine their specifications.
For Coding questions, please contact our Coding Managers, Vidya Baliga at email@example.com and Kelly Cole at firstname.lastname@example.org or at 716-389-3262.