Question 99072 for only one patient per day

[kdomek]

At the small clinic I work for, the nurses (2) and provider (1) wear one mask all day during clinic. I've heard that this would mean that we can only charge 99072 for one patient that was seen that day, since the AMA states '3 masks' for this CPT. We do screen all patients over the phone before their appointment and when they walk through the door, and we are also using extra cleaning supplies in between each patient. Also, the nurse sometimes sees a patient and gives them antibiotics per the provider's order, which would only be one mask on that day for the nurse, so I assume we cannot charge 99072 on that day. Any comments on this would be very helpful.

 

[SharonCollachi]

I would say it would be unethical to bill for PPE supplies for every patient when you are not using fresh supplies for every patient. As far as cleaning supplies, you are using one cleaning wipe per room? Maybe two? That cost is negligible, and I would say would be included in the one 99072 for the day.

My ethical stance goes something like this (which I solidified when I was going through a contentious divorce with child custody issues): Can I stand in front of a judge and not be ashamed of what I've done, can I be proud of my actions, and are they logical and good?

So, can you stand in front of a judge and would you say, "Well, I'm allowed to bill it so I did, even though we didn't use fresh supplies for each patient."

So in other words, Just because you can, doesn't mean you should.

 

[kdomek]

I would say it would be unethical to bill for PPE supplies for every patient when you are not using fresh supplies for every patient. As far as cleaning supplies, you are using one cleaning wipe per room? Maybe two? That cost is negligible, and I would say would be included in the one 99072 for the day.

My ethical stance goes something like this (which I solidified when I was going through a contentious divorce with child custody issues): Can I stand in front of a judge and not be ashamed of what I've done, can I be proud of my actions, and are they logical and good?

So, can you stand in front of a judge and would you say, "Well, I'm allowed to bill it so I did, even though we didn't use fresh supplies for each patient."

So in other words, Just because you can, doesn't mean you should.

Thank you for your response. The AMA CPT Assistance Guide Sept. 2020 says "The new code is designed to capture the following practice expense factors such as" and then gives the list, so the such as words are not definitive enough to me. So far, I have only billed 99072 for one patient per day since I am still looking for more clarification on it.

 

[LWarner]

Hi! Also, important to note that certain major insurance carriers have been putting their position on code 99072 on their websites. At least two of them have said not payable for Commercial plans.

 

[csperoni]

I have yet to see a payor issue separate payment for 99072, so it might be a moot point. However, I don't think it's wrong or unethical to bill it.
I would not have an issue using 99072 in your scenario. 99072 is not for only the supplies (as opposed to 99070). It was intended to also capture additional work being done by staff.
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
For example, if your nurse spends an additional 2 hours per day asking Covid screening questions over the phone and when the patient arrives, then to me that clearly is over and above what is usually included. The AMA used 3 surgical masks as an example.

https://www.ama-assn.org/system/files/2020-09/cpt-assistant-guide-coronavirus-september-2020.pdf

If in your practice, your supplies, materials, and clinical staff time is only 2 additional minutes per patient and $1 of supplies, then just charge a small fee ($10).
Some practices are having an additional clinical staff member at the front door to do screenings/temperature checks. Maybe you are having patients wait in their cars, and have to spend additional time explaining that to every patient. Maybe some of your patients come in without a mask and you need to supply one. Maybe you went from spending $25 per year on Purell to $25 per week. Maybe you had a patient with recent exposure or symptoms and everyone needs to fully gown/mask up. Think about all the additional minute here and there, and all the pennies here and there; it does add up.
Every practice should be incurring additional expenses during the PHE. Depending on your practice, it could be negligible or significant, so your fee should reflect that accordingly.

 

[ddsimpson]

What type of documentation would we have in the chart to support this charge per visit?

 

[csperoni]

What type of documentation would we have in the chart to support this charge per visit?

IF the carrier does allow payment for 99072, it is up to their policy as what documentation is required. We are not documenting anything specific in each chart, but we do have guidelines about the questions/screenings being asked.
https://www.ama-assn.org/system/files/2020-09/cpt-assistant-guide-coronavirus-september-2020.pdf Specifically page 3:
Question: What documentation is required to report code 99072?
Answer: Given that code 99072 may only be reported during a PHE, one would not report this code in conjunction with an evaluation and management (E/M) service or procedure when a PHE is not in effect. Therefore, code 99072 is reported justifiably only when health and safety conditions applicable to a PHE require the type of supplies and additional clinical staff time explained in the code descriptor. Documentation requirements may vary among third-party payers and insurers; therefore, they should be contacted to determine their specifications.

 

[patty35bus]

How much is everyone charging for the code 99072? I can't find any information on the fee schedule.

 

[kdomek]

How much is everyone charging for the code 99072? I can't find any information on the fee schedule.

We are charging $11.00. This is based on the extra nurse time and the extra costs for supplies.

 

[csperoni]

How much is everyone charging for the code 99072? I can't find any information on the fee schedule.

To me, your charge should reflect an average of the additional expenses (supplies and/or labor) that you are incurring. I have seen everything from $10 to $125. The fee schedule (which is different than the amount you charge) is set by the carrier, and my contract could very well vary from your contract.