Wiki help with CPT code 99072 Please

elenipete

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Can anyone elaborate on CPT code 99072? I am having a hard time believing that this code can be billed for extra supplies used during this pandemic. Exam rooms should be wiped down and sterilized after each patient regardless of Covid-19 or not. As for the extra masks and gloves sanitizer etc., is this just not the cost of doing business? The code description is a little vague for me, please excuse my ignorance.
So just asking for any help and how and what documentation is needed to support this code?
 
99072 Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease
99072 is not just for the cost of gloves/gowns/masks, but for the additional staff time you are currently incurring. Some offices have an additional clinical staff member at the front door checking temperatures. Some are having RNs call every patient before appointments to pre-screen. Maybe you used to buy 3 bottles of Purell a year, and now you are buying 3 a day. The actual additional cost will vary from office to office (and even day to day). The intent was to bill for those additional costs of supplies, materials and clinical staff time. Each office should set their fee at an average of what they approximate those additional costs are.
I work for a large healthcare organization. We were not instructed that we needed to add anything specific to the note. But we do have a "protocol" document that explains the additional steps being taken.
All that being said, just because you can bill for it, does not mean you are being paid for it. Almost all carriers are bundling 99072 with the other services. Many carriers have the policy on their website. No one is obligating you to bill 99072.
My personal opinion is that every practice is currently incurring SOME additional cost. Some it might be $2 per patient. Some it might be $40 per patient if you are caring for Covid patients. Each practice should determine what their cost is to set their fee. It is also my personal opinion that it does not really cost anything to add 99072 to visits, and we simply write if off if bundled or otherwise denied. We are not wasting time appealing.
 
99072 Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease
99072 is not just for the cost of gloves/gowns/masks, but for the additional staff time you are currently incurring. Some offices have an additional clinical staff member at the front door checking temperatures. Some are having RNs call every patient before appointments to pre-screen. Maybe you used to buy 3 bottles of Purell a year, and now you are buying 3 a day. The actual additional cost will vary from office to office (and even day to day). The intent was to bill for those additional costs of supplies, materials and clinical staff time. Each office should set their fee at an average of what they approximate those additional costs are.
I work for a large healthcare organization. We were not instructed that we needed to add anything specific to the note. But we do have a "protocol" document that explains the additional steps being taken.
All that being said, just because you can bill for it, does not mean you are being paid for it. Almost all carriers are bundling 99072 with the other services. Many carriers have the policy on their website. No one is obligating you to bill 99072.
My personal opinion is that every practice is currently incurring SOME additional cost. Some it might be $2 per patient. Some it might be $40 per patient if you are caring for Covid patients. Each practice should determine what their cost is to set their fee. It is also my personal opinion that it does not really cost anything to add 99072 to visits, and we simply write if off if bundled or otherwise denied. We are not wasting time appealing.
Are you receiving some payment for this code though? We haven't bothered billing as we thought most payers were bundling.
 
Another department actually posts payments, and the instructions are to adjust off if denied with no further input needed from the practice.
Whenever I am in an account, I have looked to see if previous visits paid for the 99072 and I have yet to see any claim pay for it.
I'll say if I was still a private practice, I probably would have made the decision by now not to bother (or do it just for the carriers that have paid). But we're in a large healthcare system and the system is set up to automatically append 99072 even if I don't enter it.
 
Are you receiving some payment for this code though? We haven't bothered billing as we thought most payers were bundling.
We used to bill it on every encounter, some of the small insurance companies paid. I had to take it off this month, however, BCBS started denying every claim with it. Since we never got paid for it anyway, I took it off. We still document the code in the encounter note, however. When AAP released their recommendations, they requested insurance companies pay that code and pay it retroactively to the date it was created to make up for all the money pediatric offices lost due to the pandemic. Obviously insurance companies don't care, but if the code ever was to be paid retro, I didn't want to not have coded it. But oh well.
 
CPT 99072 we are currently coding for Global location only.

Billing: per each encounter, not per CPT code. Code 99072 is to be reported only once per in-person patient encounter per provider identification number (PIN), regardless of the number of services rendered at that encounter.

Documentation verbiage should contain: Documentation should include "PHE precautions taken" for 99072 procedure code billing.

POS setting: Non-facility place of service (POS) setting.

Intention of 99072 procedure code: Code 99072 is also intended to account for the additional time required by clinical staff to provide the service safely

Coding
99072 is a technical component (TC) applicable code only. This code does not apply to the professional component for physician services.
Code 99072 would not report this code in conjunction with an evaluation and management (E/M) service or procedure when a PHE is not in effect.
 
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