Every year, CPT coding changes take place enormously which leads to drastic medical coding changes in the healthcare billing industry. Earlier this fall, American Medical Association had announced the release of 2021 Current Procedural Terminology codes with 329 editorial changes, including 206 new codes, 54 deletions and 69 revisions. It also involves the first major overhaul in more than 25 years to the codes and guidelines for office and other outpatient evaluation and management (E/M) services.
Covid-19 procedural codes have gone through many changes and updates since they were released last year. Recently new CPT coding for Covid-19 vaccines have been released in order to cooperate with healthcare professionals by all means. Covid-19 laboratory testing also plays an important role in the current scenario as it includes all the laboratory testing taken for patients. Four new codes have been introduced for coronavirus testing.
Announcing the release of the four codes, the American Medical Association (AMA) stated that new codes had been created to streamline the novel coronavirus testing currently available in the United States market. This article reveals the new CPT coding changes including Covid-19 laboratory testing. Let’s go!
CPT coding changes for E/M Services
- The most powerful changes were made to the office and outpatient E/M services. According to the American Medical Association, the modifications included for E/M services are:
- Eliminating history and physical exam as elements for code selection.
- Allowing physicians to choose the best patient care by permitting code level selection based on medical decision-making (MDM) or total time.
- Promoting payer consistency with more detail added to CPT code descriptors and guidelines.
The new CPT coding guidelines also retain 5 levels of coding for established patients and reduce the number of levels to 4 for office/outpatient E/M visits for new patients. Moreover, the AMA RVS Update Committee (RUC) updated the values for the office/outpatient E/M visit codes. It also increases payments for these services by Medicare and possibly other insurance companies.
“To get the full benefit of the relief from the E/M office visit changes, health care organizations need to understand and be ready to use the revised CPT codes and guidelines by Jan. 1, 2021,” said AMA President Susan R. Bailey, M.D. “The AMA is helping physicians and health care organizations prepare now for the transition and offers authoritative resources to anticipate the operational, infrastructural and administrative workflow adjustments that will result from the pending transition.”
As a matter of fact, American Medical Association has been offering online library of resources which includes checklists, videos, modules and guidebooks associated with other tools and resources to help with the transition to the revised E/M office visit codes and guidelines.
What are prolonged services?
- Several new codes are added to bill the prolonged services. It involves direct and indirect patient contact provided in various settings beyond usual evaluation and management services.
Direct patient contact- Outpatient:
- 99354-99357 codes are used when a physician or other qualified healthcare professional provides prolonged service involving direct patient contact that is provided beyond the usual service in the inpatient, observation or outpatient setting (not including office or other outpatient E/M services).
- 99354-99355codes are used to report the total duration of face-to-face time spent by a physician or other qualified healthcare professional on a given date providing prolonged service in the outpatient setting.
- 99354code is used to report the first hour of prolonged service. It should be used only once per date per location, even if the time spent is not continuous. If more than one hour of prolonged service is provided, 99355 is used to report each additional 30 minutes beyond the first hour.
- Prolonged services for less than 30 minutes of the total duration on the provided date are separately reported.
- Prolonged services that are less than 15 minutes beyond the first hour, or less than 15 minutes beyond the final 30 minutes, are not reported separately.
|Prolonged Service Time – Outpatient||Code|
|75-104 Minutes||99354 + 99355|
|105-134 Minutes||99354 + 99355 + 99355|
Direct Patient Contact – Inpatient:
- 99356-99357 codes are used to report the total duration of time spent by a physician or other qualified health care professional providing prolonged service to a patient at the bedside and on the patient’s floor or unit in the hospital or nursing facility.
- 99356code is used to report the first hour of prolonged service. It should be used only once per date per location, even if the time spent is not continuous. If more than one hour of prolonged service is provided, 99357 is used to report each additional 30 minutes beyond the first hour.
- Prolonged service of less than 30 minutes total duration on a given date is not separately reported. Also, prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately.
|Prolonged Service Time – Inpatient||Code|
|75-104 Minutes||99356 + 99357|
|105-134 Minutes||99356 + 99357 + 99357|
Direct Patient Contact – Office or Other Outpatient Services
- 99417is the CPT code to be used to report prolonged time provided on the date of office or other outpatient services.
- Moreover, in the Medicare physician fee schedule final rule, the Centers for Medicare and Medicaid Services (CMS) created their own HCPCS code for this prolonged service. It was done because according to their analysis, 99417 lacked “clarity in the code descriptor and the potential for double-counting time.”
- While billing Medicare, HCPCS Code G2212 must be used for prolonged office or other outpatient evaluation and management services beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service.
Indirect Patient Contact
- 99358 and 99359codes are used when the prolonged service is provided that is neither face-to-face time in the outpatient, inpatient, or observation setting, nor additional unit/floor time in the hospital or nursing facility setting.
- 99358, 99359codes might be used during the same session of an evaluation and management service (except office or other outpatient services) or on a date other than the date of a face-to face encounter, even if the time spent is not continuous.
- 99358 code is used to report the first hour of prolonged service. If more than one hour of prolonged service is provided, 99359 is used to report each additional 30 minutes beyond the first hour.
- 87635: Added to report infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Coronavirus disease – Covid-19, amplified probe technique.
- 86318: Revised to report immunoassay for infectious agent antibodies and to be a parent to 86328.
- 86328: Added to report single step antibody testing for severe acute respiratory syndrome coronavirus 2.
- 86769:Added as a child code to report multiple-step antibody testing for severe acute respiratory syndrome coronavirus 2.
- 0202U: Added to report the Bio Fire Respiratory Panel 2.1 (RP2.1) test.
- 87426:Added to report infectious agent antigen detection by immunoassay technique of SARS-CoV and SARS-CoV-2.
PLA codes 0223U and 0224U: Added for detection of SARS-CoV-2.
- 86408-86409:Added for reporting coronavirus 2 (SARS-CoV-2) neutralizing antibody screen and titer.
PLA codes 0225U and 0226U: Added for detection of SARS-CoV-2.
- 99072:Added for the additional supplies and clinical staff time required to mitigate transmission of respiratory infectious disease while providing evaluation, treatment, or procedural services during a public health emergency, as defined by law.
- 86413:Added for reporting quantitative antibody detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
- 87636:Added for reporting combined respiratory virus multiplex testing for either SARS-CoV-2 with Influenza A&B.
PLA codes 0240U and 0241U: Added for detection of SARS-CoV-2, Influenza A and Influenza B.
- 87637:Added for reporting combined respiratory virus multiplex testing for either SARS-CoV-2 with Influenza A&B and RSV.
- PLA code 0241U:Added for detection of RSV.
- 87811: Added for antigen detection of SARS-CoV-2 by direct optical (i.e., visual) observation.
- 87301, 87802, and their subsidiary codes: Revised immunology guidelines.
- Accepted addition of code 87428for reporting multiplex viral pathogen panel using antigen immunoassay technique for SARS-CoV-2 testing along with influenza A and influenza B.
- 91300, 91301: Added to report Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccines.
- 0001A, 0002A, 0011A, 0012A: Added to report the immunization administration of these vaccines.
The other CPT codes for Covid-19 lab tests:
- 86408Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen
- 86409Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer
- 0225UInfectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte is reported as detected or not detected
- 0226USurrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum.
The above codes provide the details of the procedures and tests involved for Covid-19. These codes must be perfectly analyzed and accurately coded during the billing process. Outsourcing medical billing companies do an expert job associated with CPT coding.
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