You can complement your COVID-19 coding arsenal with two new additions -- testing code 86413 and extra services code 99072 -- as the AMA continues to build out its CPT code set in response to the ongoing public health emergency (PHE).
The AMA announced the release of the new Category I codes on Sept. 8, along with
a special edition of CPT Assistant that elaborates on the rationale behind the codes' release and their intended use. The creation and release of the new codes comes as part of the AMA's effort to contend with the "unprecedented and multidimensional" impact of the PHE, which demands rapid action, the organization states.
Note: While the codes don't appear in the 2021 edition of the CPT Manual, they take effect immediately. Below you'll find the full code descriptions:
- 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).
- 86413 (Severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)] antibody, quantitative).
In the special September update of CPT Assistant, the AMA elaborates on the intended use of new codes.
"New code 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," the AMA states. "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 disease."
The code is intended to account for the "significant additional practice expenses" that providers and facilities are incurring due to COVID-19 preparation and treatment protocols.
The AMA draws a distinction between 99072 and 99070 (Supplies and materials [except spectacles], provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered). Code 99072 should only be reported during a PHE, the AMA explains. Additionally, it is intended to capture additional staff time.
Code 99070 is considered a bundled service and isn't paid under Medicare Part B. It remains to be seen if payers, including Medicare, will cover 99072. "Eligibility for payment, as well as coverage policy, is determined by each individual insurer or third-party payer," the AMA states.
The release of code 86413 adds another reportable testing service for suspected COVID-19 cases. "Code 86413 is intended for use as an aid in investigating the presence and temporal evolution of the adaptive immune response to SARS-CoV-2," the AMA states. "The aim of this quantitative antibody assay is to assist in studies of the epidemiology, pathogenesis, prevention, and treatment of COVID-19."
For additional details and scenarios,
access the special edition of CPT Assistant.