Wiki When to use the CS modifier

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kathiepa

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Hi. We are a surgical practice and all patients are required to get a COVID test before their surgery, which we are ordering. Should we be billing the CS modifier on our E/M service since we are ordering the COVID test? I'm having a hard time finding a clear answer if it is OK to use this modifier for the above reason or is it just when ordering a COVID test for a patient with symptoms? Any input is appreciated. Thanks!
 
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We are an ortho group that does screening pre op and had the same question. We have been using 99211 with CS modifier and some carriers (such as Horizon and United) do apply to patients deductible/ coinsurance. They have medical policies stating that unless you use a certain dx such as exposure to covid, they will not waive cost sharing. We bill with screening ICD 10 which is not listed on their policies so we cant change just to waive cost share. The guidelines seem to have been put out by CMS so not all carriers follow.


 
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For our patients that are required to have the COVID test prior to surgery we report on claim:

99211-CS Dx: Z01.812 (Encounter for pre-op lab exam) and additional ICD-10-CM code, Z20.822 (Contact with and suspected exposure to COVID-19)

We do not apply the CS Modifier to any patients with WellCare Insurance because they do not accept the CS and/or CR Modifiers.

We got this guidance from AHIMA. Here is the link (QUESTION #38) - https://journal.ahima.org/ahima-and-aha-faq-on-icd-10-cm-coding-for-covid-19/

Hope this helps some.
 
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