The American Medical Association (AMA) recently released a broad update to CPT codes for 2021, including guidance for several new codes related to COVID-19. This update to the CPT code set was reviewed and approved by the CPT Editorial Panel convened by the AMA. This is seen as a rather significant event because it is the first AMA overhaul of office visit and outpatient E/M coding in more than 25 years. These new code changes range from 99201 to 99215 and are proposed to be adopted by CMS on January 1, 2021.
On the whole, this new CPT update includes 329 editorial changes, including 206 new codes, that are intended to simplify E/M coding and respond to the COVID-19 pandemic by eliminating history and physical exams as elements for code selection, allowing physicians to choose best patient care by permitting code level selection based on MDM or total time, and promoting payer consistency with more detail added to CPT code descriptors and guidelines.
In this blog, we will take a look at two of these new codes that are related to COVID-19.
Code 99072: Supplies & Expenses for COVID-19 Measures
The official description of CPT code 99072 is as follows: “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.” Obviously, this means that code 99072 has the potential to be used again in the future (after the COVID-19 pandemic is over), should the country again experience a Public Health Emergency (PHE) from yet another unknown virus.
Code 99072 represents a new practice expense code, and is meant to account for the costs of additional supplies and materials, as well as additional staff time, needed to maintain staff and patient safety during a PHE. First and foremost, it is important to note that code 99072 may only be used during an officially declared PHE situation. When the current COVID-19 PHE finally comes to an end, this code will no longer be usable until a new PHE is declared.
This code was created in response to the significant additional expenses that are being incurred so that practices can operate and see patients during the PHE. Code 99072 now allows providers to account for costs related to items such as the following during a PHE:
- Additional PPE beyond what was normally used for pre-PHE appointments
- Extra sanitization and cleaning supplies
- Clinical staff time for activities such as pre-screening phone calls, donning/removing PPE, and time spent performing increased sanitization measures.
Code 86413: COVID-19 Testing
Code 86413’s official description is “Severe acute respiratory syndrome coronavirus (SARS-CoV-2).” This code, which is less likely to be commonly used by most of our readers, was established to allow providers a way to report quantitative antibody detection for COVID-19. Since this really only applies to doctors who are regularly performing tests for COVID-19 infection in patients, we encourage readers to consult the AMA’s guidance document to learn more.