Wiki Coding for COVID-19 Testing

[2bedaisy]

I work in billing at an Urgent Care in Texas. Our Occ Med department manager sent me this question:

"I have several businesses that want us to come onsite and test their employees for covid, but using the patient’s private insurance.

But if we bill insurance, we’d have to
(1) have a full chart to bill it out, and
(2) a provider would need to see that person to have an E&M code,

is that right?

Or could it it be billed as a ‘nurse’ visit with the appropriate labs?"

Any guidance would be appreciated. Thank you.

 

[thomas7331]

What exactly do you mean by 'test their employees'? Would you just be sending someone to collect specimens?

You can't bill a 'nurse visit' (i.e. 99211) for this - a nurse visit must be an E&M service ordered by a physician as part of their plan of care. And I don't think you can bill an E&M service for this situation anyway because there isn't an E&M code appropriate to this unless the patient is presenting with symptoms or a problem that requires evaluation.

It sounds like a bit of an administrative nightmare, to be honest, and I'm not sure it would be worthwhile to spend the time collecting all of the patient information and billing claims and doing the follow-up and collection work for all of these patients for the small amount of reimbursement that you may or may not receive to just collect a specimen. And if the employees that you'll be testing are healthy and asymptomatic, and the tests have not been ordered by their physicians, then there's a good chance that their insurance may not cover the service anyway. In your place, I would recommend that your providers set a fee for this and ask the companies to reimburse you directly.

 

[2bedaisy]

What exactly do you mean by 'test their employees'? Would you just be sending someone to collect specimens?

You can't bill a 'nurse visit' (i.e. 99211) for this - a nurse visit must be an E&M service ordered by a physician as part of their plan of care. And I don't think you can bill an E&M service for this situation anyway because there isn't an E&M code appropriate to this unless the patient is presenting with symptoms or a problem that requires evaluation.

It sounds like a bit of an administrative nightmare, to be honest, and I'm not sure it would be worthwhile to spend the time collecting all of the patient information and billing claims and doing the follow-up and collection work for all of these patients for the small amount of reimbursement that you may or may not receive to just collect a specimen. And if the employees that you'll be testing are healthy and asymptomatic, and the tests have not been ordered by their physicians, then there's a good chance that their insurance may not cover the service anyway. In your place, I would recommend that your providers set a fee for this and ask the companies to reimburse you directly.

Thank you! I will pass this along.

 

[karamac]

Agree with thomas7331! Additionally, while this testing may be currently reimbursed under a patient's commercial insurance, it would be considered occupational testing and/or workplace testing so this will come to an end as Thomas stated. Also, the cost of the PPE, and the test kits, along with the reimbursement not being established is a very high risk. Also, since you are an urgent care, how are you going to triage the positives, or false positives/negatives from the kits that are occurring since these aren't your patients. My guess is that the employer does not even really understand what information that the testing is going to give them on the employee.