What’s the news: Two additions for reporting medical services sparked by the public health response to the COVID-19 pandemic were included in a recent update to the AMA Current Procedural Terminology (CPT®) code set and have been approved for immediate use.
Long described as the “common language of medicine,” the CPT code set is kept current through the work of the CPT Editorial Panel, an independent body convened by the AMA. The panel collects input from the health care community and beyond to ensure CPT content reflects the coding demands of digital health, precision medicine, augmented intelligence, and other aspects of the evolving health care system.
The new codes describe two very different aspects of the COVID-19 response.
CPT code 99072 relates to the additional supplies and clinical staff time required to perform safety protocols for the provision of evaluation, treatment or procedural services during a public health emergency in a setting where extra precautions are taken.
CPT code 86413 relates to laboratory tests that provide quantitative measurements of SARS-CoV-2 antibodies. This differs from qualitative, positive or negative assessment of SARS-CoV-2 antibodies provided by laboratory tests that are already reported by other CPT codes.
Why it’s important: CPT code 99072 was developed in response to measures taken by medical practices and health care organizations related to curtailing the spread of COVID-19 and protecting patients and health care professionals while also providing patients access to high-quality care.
The official descriptor for the code notes that it covers additional materials and staff time “over and above those usually included in an office visit or other non-facility service(s).”
The AMA/Specialty Society RVS Update Committee (RUC) worked with 50 national medical specialty societies and other organizations over the summer to collect data on the costs of maintaining safe medical offices during the public health emergency and submitted recommendations to the Centers for Medicare & Medicaid Services to inform payment of code 99072.
The SARS-CoV-2 antibody-measurement tests reported by code 86413 help to investigate a person’s adaptive immune response to the virus and help assess the effectiveness of treatments used against the infection.
“The CPT code set continues to quickly be adapted during the COVID-19 pandemic to streamline the reporting of innovative tools and services now available to help reduce the COVID-19 disease burden, improve health outcomes and reduce long-term care costs,” said AMA President Susan R. Bailey, MD.
“This update is the latest in a series of modifications to the CPT codes set to meet the needs of the health care industry as medical advancements expand the fight against COVID-19,” Dr. Bailey added.
Read about how the 2021 CPT code set reflects tech innovation and the response to COVID-19.
To learn more: Long, medium and short descriptors for the new codes and other guidance are included in an AMA resource on the recent modifications to the CPT code set that were developed as part of the public health response to COVID-19.
A section on CPT content education has been created for the AMA Ed Hub™ online learning platform containing CME modules covering E/M codes, Clinical Examples of Radiology, as well as an overview of CPT coding basics.
Coding books and products, including the CPT 2021 Professional Codebook, can be ordered from the AMA Store. The 2021 CPT codes and descriptors can be licensed and imported straight into existing claims and billing software using the downloadable CPT 2021 Data File. The file contains the updated code set’s complete descriptor package, including official descriptors for consumers and physicians, and the complete official CPT coding guidelines.
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