Wiki COVID19 SPECIMEN COLLECTION

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OnelM2023

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Cape Coral, FL
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Hello all. can someone explain to me how to bill for the collection to be sent to labs for CPT 87536 or 86769? is it 99000 with what modifier?
 
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Good afternoon, I need some guidance in billing for the specimen collection to be sent to labs. I work for an urgent care and would like to know if we are billing CPT 87635-QW or U0002-QW with DX codes Z11.59, Z03.818 and Z20.828. Any guidance would be greatly appreciated. Thank you.
 
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Its Bri said:
Good afternoon, I need some guidance in billing for the specimen collection to be sent to labs. I work for an urgent care and would like to know if we are billing CPT 87635-QW or U0002-QW with DX codes Z11.59, Z03.818 and Z20.828. Any guidance would be greatly appreciated. Thank you.
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If you are billing either of those codes with a QW modifier than that means you are rendering the test in your urgent care. Those codes are for the laboratory that is rendering and billing the test.
At this time there is only 1 FDA Authorized diagnostic molecular test that is CLIA waived and that is the Cepheid testing platform.



As an example:

U00022019-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 laboratoriesDOS After Feb. 4thApril 1st$51.31



Are you performing the labs, or are you attempting to pass thru bill the labs that are being rendered by another lab? If so, I would highly recommend you review your payer contracts, and current regulatory guidance specific to test reporting with COVID. If you decide to pass thru bill, then a 90 modifier is required on the CPT code, along with disclosure of the laboratory. A clinical laboratory would bill (G2023 or G2024) for specimen collection, in your setting, collection of a specimen would be billed with 99000. I am not aware of a modifier specific to collection, but remember that 99000 is not often reimbursed by commercial payers.

I would also recommend going to the AMA's COVID-19 resource page for coding and clinical examples.

Hope that this helps...
 
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I just posted this on a similar question, go here for a chart: https://www.ama-assn.org/system/files/2020-05/cpt-reporting-covid-19-testing.pdf

The swabbing is included in the E&M code, unless you're performing the actual test itself. The QW modifier is for an in-house test that is CLIA-waived. You don't use that when you send the specimen to a lab to be tested. Think rapid strep, pregnancy test, point-of-care urine drug screening (rapid cup), etc.
 
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Ok so U0002 cannot be used either, just the E&M code only? the 99000 its not getting paid by anyone. There should be a code for this since we are at risk taking the spicemen at the office and sending it off to the lab ( quest, labcorp)
 
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Onelm said:
Ok so U0002 cannot be used either, just the E&M code only? the 99000 its not getting paid by anyone. There should be a code for this since we are at risk taking the spicemen at the office and sending it off to the lab ( quest, labcorp)
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Not to be flippant, but aren't you taking a risk when you take any specimen? The flu kills too.

If all you are doing is the swab and no visit, wouldn't 99211 pay about the same as 99000 (I don't know, as we don't do anything outside of a visit, and we don't take specimens in the office except urine in a cup)?
 
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