Wiki HOW DO YOU BILL FOR ADMINISTERING COVID TESTING SWABS IN A PRIVATE PRACTICE?

[dprice]

I work for a private colon rectal surgery practice. We can start back doing elective procedures but we are required to covid test each patient 2 days before their surgery at our ambulatory surgery center. The test go to the lab.
What cpt code and dx code can my office use for administering the swab testing. We are required to wear PPE equipment, use of office space and personnel and I would like to see some reimbursement.
Can the physician charge a level two office visit if he sees the patient and administers the test himself? If so what dx code should he use?

 

[gpbhanu]

I'm billing for curbside COVID-19 testing using Regular E/M for NEW-99201 or EST-99212 and DX codes depend on test results.If it's negative Z03.818 and R codes, positive U07.1 .
CS modifier, this is the new cost sharing modifier that tells the insurance to waive copay and deductible.

I hope this could help you.

 

[dprice]

I'm billing for curbside COVID-19 testing using Regular E/M for NEW-99201 or EST-99212 and DX codes depend on test results.If it's negative Z03.818 and R codes, positive U07.1 .
CS modifier, this is the new cost sharing modifier that tells the insurance to waive copay and deductible.

I hope this could help you.

Thank you Brian. that is what we are doing but I just wanted to make sure it was correct.

 

[smartin42]

I'm billing for curbside COVID-19 testing using Regular E/M for NEW-99201 or EST-99212 and DX codes depend on test results.If it's negative Z03.818 and R codes, positive U07.1 .
CS modifier, this is the new cost sharing modifier that tells the insurance to waive copay and deductible.

I hope this could help you.

Do you have enough documentation to bill a 99212, for just the collection we could only calculate a 99211?

 

[Rajesh1]

Do you have enough documentation to bill a 99212, for just the collection we could only calculate a 99211?

Yes, physician must document the history physical examination or MDM to capture a 99212 just for sample collection it won't qualify for 99212 it will qualifies for only 99211 if there is no proper E&M document.

 

[Its Bri]

Good afternoon, are you using CPT 87635-QW for the specimen collection in addition to the E/M code?

 

[SharonCollachi]

Good afternoon, are you using CPT 87635-QW for the specimen collection in addition to the E/M code?

If they're going to a lab, they aren't generally clia-waived tests.

 

[karamac]

Good afternoon, are you using CPT 87635-QW for the specimen collection in addition to the E/M code?

You should not be billing CPT code 87635 unless you are actually rendering the test. Additionally, there is only ONE CLIA waived molecular diagnostic test that is FDA authorized.

 

[Its Bri]

If they're going to a lab, they aren't generally clia-waived tests.

I read this information on a website: Code set used by many third-party payers, healthcare providers may use the new CPT code 87635 for respiratory swabs collected and sent to the laboratory to test for the novel coronavirus. Am I misunderstanding this information?

 

[Its Bri]

You should not be billing CPT code 87635 unless you are actually rendering the test. Additionally, there is only ONE CLIA waived molecular diagnostic test that is FDA authorized.

We are rendering the test, curbside. The reason I asked is because I read this on a website: Code set used by many third-party payers, healthcare providers may use the new CPT code 87635 for respiratory swabs collected and sent to the laboratory to test for the novel coronavirus.

 

[SharonCollachi]

We are rendering the test, curbside. The reason I asked is because I read this on a website: Code set used by many third-party payers, healthcare providers may use the new CPT code 87635 for respiratory swabs collected and sent to the laboratory to test for the novel coronavirus.

My comment was directed at the QW modifier, which indicates a CLIA-waived test. I was not commenting one way or the other on the code itself. Sorry I was unclear.

 

[Its Bri]

https://revcycleintelligence.com/ne...are-payment-rates-for-covid-19-test-cpt-codes

 

[karamac]

I read this information on a website: Code set used by many third-party payers, healthcare providers may use the new CPT code 87635 for respiratory swabs collected and sent to the laboratory to test for the novel coronavirus. Am I misunderstanding this information?

Can you provide the website? You are not the first person who has mentioned this. Unfortunately, there is quite a bit of confusion around testing and billing for collection. That CPT code is for the performance of the test... Medicare has language in their FAQ's similar, but they are not suggesting that a physician bill 87635 when they are not rendering the test. AMA created this code and it mirrors "somewhat" the HCPCS codes U0002, but is more specific. The main difference is that 87635 is a method based code- meaning that it is specific to the method being employed. So if your facility/office or lab is not using an amplified probe technique in qPCR molecular testing- then you should not be billing this code.

CPT/HCPCS	Descriptor	When to Bill	On CLFS	Eff. April 1st
87635 (Code is Method Based)	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	After March 13th	April 1st	$51.31

 

[SharonCollachi]

We are rendering the test, curbside. The reason I asked is because I read this on a website: Code set used by many third-party payers, healthcare providers may use the new CPT code 87635 for respiratory swabs collected and sent to the laboratory to test for the novel coronavirus.

Incorrect. That is not a code for providers to swab, that is a code for the lab to test: “Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavrius 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.”

Your link is incorrectly quoting another article they have linked to. Go to https://www.ama-assn.org/system/files/2020-05/cpt-reporting-covid-19-testing.pdf and you will see a chart that clearly says the swabbing is included in the E&M visit.

 

[Its Bri]

Can you provide the website? You are not the first person who has mentioned this. Unfortunately, there is quite a bit of confusion around testing and billing for collection. That CPT code is for the performance of the test... Medicare has language in their FAQ's similar, but they are not suggesting that a physician bill 87635 when they are not rendering the test. AMA created this code and it mirrors "somewhat" the HCPCS codes U0002, but is more specific. The main difference is that 87635 is a method based code- meaning that it is specific to the method being employed. So if your facility/office or lab is not using an amplified probe technique in qPCR molecular testing- then you should not be billing this code.

CPT/HCPCS	Descriptor	When to Bill	On CLFS	Eff. April 1st
87635 (Code is Method Based)	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	After March 13th	April 1st	$51.31

https://revcycleintelligence.com/ne...are-payment-rates-for-covid-19-test-cpt-codes

 

[SharonCollachi]

https://revcycleintelligence.com/ne...are-payment-rates-for-covid-19-test-cpt-codes

That is the article that is misinterpreting the information that I mentioned above.

 

[SharonCollachi]

Today's MLN email from Medicare contains this:

COVID-19 Diagnostic Laboratory Tests: Billing for Clinician Services
Physicians and Non-Physician Practitioners (NPPs): Here are several reminders related to billing for COVID-19 symptom and exposure assessment and specimen collection performed on and after March 1, 2020:

• Use CPT code 99211 to bill for assessment and collection provided by clinical staff (such as pharmacists) incident to your services, unless you are reporting another Evaluation and Management (E/M) code for concurrent services. This applies to all patients, not just established patients.
• Submit the CS modifier with 99211 (or other E/M code for assessment and collection) to waive cost sharing.
• Contact your Medicare Administrative Contractor if you did not include the CS modifier when you submitted 99211 so they can reopen and reprocess the claim.
• We will automatically reprocess claims billed for 99211 that we denied due to place of service editing.

 

[BMWilliams]

what if the collection was done at a SNF/ALF for the employee's. We have NPP's that are going to go to the SNF/ALF and test the employee's. what CPT code, POS, & location code should be used??

 

[SharonCollachi]

what if the collection was done at a SNF/ALF for the employee's. We have NPP's that are going to go to the SNF/ALF and test the employee's. what CPT code, POS, & location code should be used??

Are you billing each of the employees' insurance individually, or is the facility paying for it? What if someone is a part-timer and doesn't have insurance?

 

[BMWilliams]

Are you billing each of the employees' insurance individually, or is the facility paying for it? What if someone is a part-timer and doesn't have insurance?

What my providers are asking is basically: can they bill for doing the test but sending out sample to the lab. What CPT code, what POS, & what location? as far as part-timer and no insurance. That is something to look at with the higher ups.

Thank you for your reply. brings up more questions that I will give to the administration to look into.

 

[SharonCollachi]

What my providers are asking is basically: can they bill for doing the test but sending out sample to the lab. What CPT code, what POS, & what location? as far as part-timer and no insurance. That is something to look at with the higher ups.

Thank you for your reply. brings up more questions that I will give to the administration to look into.

I think it's going to be problematic, because the POS for the SNF is not related to the patient, so you can't use that. It would be POS 18, Place of Employment-Worksite, which would be the only difference from the info I noted above, IF their insurance follows Medicare guidelines (and IF that would be a payable POS for that CPT code):

COVID-19 Diagnostic Laboratory Tests: Billing for Clinician Services
Physicians and Non-Physician Practitioners (NPPs): Here are several reminders related to billing for COVID-19 symptom and exposure assessment and specimen collection performed on and after March 1, 2020:

• Use CPT code 99211 to bill for assessment and collection provided by clinical staff (such as pharmacists) incident to your services, unless you are reporting another Evaluation and Management (E/M) code for concurrent services. This applies to all patients, not just established patients.
• Submit the CS modifier with 99211 (or other E/M code for assessment and collection) to waive cost sharing.
• Contact your Medicare Administrative Contractor if you did not include the CS modifier when you submitted 99211 so they can reopen and reprocess the claim.
• We will automatically reprocess claims billed for 99211 that we denied due to place of service editing.

Also, another thing to think about - is this voluntary? There are issues when employees are required to undergo testing. In my state, that MUST be paid by the employer. Okay, one more thing to think about - I know how much work is involved in putting a new patient into my computer system. In my area, Medicare pays $24.62 for a non-facility 99211. Is it going to be worth it to enter all these people into your computer system, enter the specimen info and whatever you need to send with the specimen, enter the claims, process the payments, deal with any denials, and how much is their insurance going to pay? They aren't going to be Medicare but probably the majority have the same insurance through the workplace. I think if we were asked to do this, I would explore the employer-payment angle and go for a set amount per person, AND have the employer provide info sheets and copies of insurance cards, and anything else that needs to accompany the specimens.