Cardiology Coding Alert

Add 87635 to your CPT^® coding arsenal.

Because of the COVID-19 pandemic, you will gain several new code options that you must learn how to report correctly. These include a new ICD-10 code, a new CPT^® code, and several new HCPCS Level II codes.

Read on to learn more about these new codes you can expect to see during this COVID-19 public health emergency (PHE).

Contemplate This 87635 Scenario

The CPT^® Editorial Panel has approved 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) as a new code for novel coronavirus testing. Code 87635 will be available “on the HCPCS and [Clinical Laboratory Fee Schedule] (CLFS) file beginning April 1, 2020 for dates of service on or after March 13, 2020,” per the CMS COVID-19 FAQs PDF.

“Laboratories can also use this CPT^® code to bill Medicare if your laboratory uses the method specified by CPT^® 87635,” according to the Coverage and Payment Related to COVID-19 Medicare Fact Sheet.

Don’t miss: Since 87635 is an early release code, you will need to manually upload its code descriptor into your electronic health record system (EHR).

Code 87635 is not in the CPT^® 2020 manual; it will be added to the 2021 code set in the microbiology subsection of the pathology and laboratory section. Code 87635 will be a child code under parent code 87471 (Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, amplified probe technique) in the 2021 CPT^® code set.

“Use of code 87635 will help to efficiently report and track testing services related to SARS-CoV-2 and will streamline the reporting and reimbursement for this test in the United States,” according to a special edition of CPT^® Assistant, Vol. 30.

Take a look at one scenario where you could report 87635: Coding example: The physician sees a new patient in his office and performs an evaluation and management (E/M) service, which includes a problem focused history, a problem focused exam, and straightforward medical decision making. The physician tests the patient for COVID-19 during this encounter. An RN in the physician’s office collects the patient’s swab sample. The lab in the physician’s office then conducts the COVID-19 test where they perform agent detection by DNA; Bartonella henselae and Bartonella quintana, using the amplified probe technique.

You should report 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making …) for the E/M visit and 87635 for the COVID-19 lab testing. You would not separately report the collection of the patient’s swab sample because that is included in the E/M service, according to the AMA’s instructions.

Observe New Coronavirus Testing Codes U0001 and U0002

The Centers for Medicare & Medicaid Services (CMS) also established the following two HCPCS Level II codes for coronavirus testing. “Both codes can be used to bill Medicare as well as by other health insurers that choose to utilize and accept the codes,” per the Coverage and Payment Related to COVID-19 Medicare Fact Sheet:

• U0001 (Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel). You should report this code specifically for CDC testing laboratories to test patients for SARS-CoV-2 and to track new cases of the virus, according to CPT^® Assistant, Vol. 30.
• U0002 (2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc). This code is intended for laboratories to report non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).

Medicare claims processing systems will be able to accept U0001 and U0002 starting on April 1, 2020 for dates of service on or after February 4, 2020, according to a recent CMS press release.

Coding guidance: If you are wondering whether to report CPT^® code 87635 or the HCPCS Level II codes U0001 or U0002 for coronavirus testing, the special edition of CPT^® Assistant, Vol. 30 answers this question for you.

“The appropriate code to be reported is dependent upon the payer to which the claim is being submitted. If the claim is submitted to a payer that requires CPT^® codes, then code 87635 should be reported,” per CPT^® Assistant. “Conversely, if the payer requires use of the HCPCS Level II code, the HCPCS Level II code should be reported. CPT^® and HCPCS codes should not both be reported on the same claim.”

Important: CPT^® Assistant instructs coders to always contact their local third-party payers directly to learn their specific reporting guidelines.

Explore New Specimen Collection Codes

For the COVID-19 PHE only, CMS will allow a specimen collection fee for sputum collection performed by trained laboratory personnel. CMS is establishing two new HCPCS Level II codes: G2023 (Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source) and G2024 (Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source).