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American Medical Association Approves New CPT Code for Coronavirus Testing

Craneware® Insights Regulatory Updates – CWI1209 (17 March 2020)

Topic

American Medical Association Approves New CPT Code for Coronavirus Testing

On March 13, 2020, the American Medical Association (AMA) posted a publication to their website announcing the release of a new CPT® code for coronavirus testing.

Provider Types Affected

Critical Access Hospitals
OPPS Hospitals
Provider-Based FQHC
Provider-Based Rural Health Clinics
Physicians

Departments/Areas Affected

Business Office
Compliance / Revenue Integrity
Emergency Department
Finance
Laboratory – General
HIM/Medical Records
OP Clinics

What You Need to Know

The AMA released a publication on March 13, 2020 announcing the approval by the AMA CPT® Editorial Panel of a new CPT® code for laboratory testing of “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”:

CPT® Code Long Description
87635 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

According to the AMA this code is effective immediately and will assist in the reporting and tracking of services related to SARS-CoV-2. The AMA provided the following clinical example and a description of the procedure for CPT® code 87635:

Clinical Example (87635)

“A 47-year-old male presents to the emergency department with fever, cough, and shortness of breath. The physician or other qualified health care professional (QHP) suspects the patient may have coronavirus (COVID-19). Respiratory swabs are collected and sent to the laboratory”.

Description of Procedure (87635)

Place specimens (eg, nasopharyngeal or oropharyngeal swab, sputum, lower respiratory tract aspirate, bronchoalveolar lavage, and nasopharyngeal wash or aspirate or nasal aspirate) into specimen-transport containers. Use oligonucleotide primers and probes for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (formally known as 2019-nCoV), and any pan-coronavirus types or subtypes if included, to identify viral gene target(s). Isolate and purify ribonucleic acid (RNA) from the specimens, followed by molecular amplification and analysis. Send the test result (positive, negative, inconclusive) to the patient’s physician or other QHP and report or refer to the appropriate public health officials, as indicated.”

In addition to the new CPT® code, CMS has also established two new HCPCS codes for laboratory testing of the coronavirus disease (COVID-19):

HCPCS Code Long Description
U0001 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel should be used when specimens are sent to the CDC and CDC-approved local/state health department laboratories
U0002 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC should be used when specimens are sent to commercial laboratories, e.g. Quest or LabCorp, and not to the CDC or CDC-approved local/state health department laboratories.

HCPCS code U0001 is to be used for CDC testing laboratories to test and track patients for SARS-CoV-2. HCPCS code U0002 is to be used for specimens sent to commercial laboratories to test for SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types, or subtypes (includes all targets). Medicare will be prepared to accept these codes as of April 1, 2020 for dates of service on or after February 4, 2020.

The AMA Special Edition bulletin includes several questions and answers. One question concerns how to report when both nasopharyngeal and oropharyngeal swabs are collected for the initial diagnostic testing. According to the AMA , CPT® codes 87635 and 87635-59 should be reported to reflect when separate assays are performed on multiple specimens. To read more questions/answers provided by the AMA, please access the link to the AMA Special Edition bulletin listed under the “Reference” section of this Insights article.

Reporting of CPT® code 87635 or HCPCS codes U0001 or U0002 will be dependent upon the third-party payer reporting guidelines for testing SARS-CoV-2/2019-nCoV (COVID-19).  For example, Aetna states that they are complying with the CMS guidelines for testing and will accept HCPCS codes U0001 and U0002 (link to Aetna article under “Background” section of this article).

ICD-10 Reporting

In addition to the above-mentioned CPT-HCPCS codes, a new ICD-10 diagnosis code has been developed to report COVID-10, effective October 1, 2020:

ICD-10 Diagnosis Code Description
U07.1 2019-nCoV acute respiratory disease

Until the above-mentioned code is effective, providers are to use available ICD-10 diagnosis codes to describe any determined illness or signs/symptoms for the reporting of COVID-19 encounters. For more information pertaining to current applicable diagnosis codes for COVID-19,  please access the link entitled “CDC Official Guidelines for Coding and Reporting COVID-19” under the “Background” section of this Insights article.

Action Needed

Facilities and providers need to read the AMA, CDC, and CMS documents in their entirety. Efforts should be made to determine third party payer guidelines for the reporting of COVID-19 testing.

Hospital and provider chargemasters and charge capture tools should include the new CPT/HCPCS codes for SARS-CoV-2/2019-nCoV testing. Laboratory staff and personnel responsible for order entry need to be informed of the new HCPCS codes.

Effective Date

13 March 2018

Background

Coverage and Payment Related to COVID-19 Medicare Fact Sheet:

https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf

Aetna Fact Sheet COVID 19:

https://www.aetna.com/health-care-professionals/provider-education-manuals/covid-faq.html

CDC Official Guidelines for Coding and Reporting COVID-19:

https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf

Reference

https://www.ama-assn.org/system/files/2020-03/cpt-assistant-guide-coronavirus.pdf

CPT Codes © 2020 American Medical Association, use of this site denotes acceptance of below terms and conditions

CPT codes, descriptions, and material only are copyright 2020 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained here in. CPT is a trademark of the American Medical Association.

The responsibility for the content of any ‘National Correct Coding Policy’ included in this product is with Centers for Medicare and Medicaid Services, formerly known as Health Care Financing Administration, and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information contained in this product.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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