The procedure of medical billing is heavily dependent on CPT codes. These codes elaborate on the type of care that was given before. CPT codes are for everything that a certified medical provider is capable of doing, and new codes arrive every year.
The American Medical Association (AMA) assigns a unique code of 5 digits based on CPT to every special medical treatment or service a doctor provides to patients. CPT is part of all US medical systems.
The emergence of COVID-19 augmented the demand for medical treatment and the urge to take necessary actions regarding people’s health. AMA generates CPT codes regarding COVID-19 to operate and report medical procedures and services in the high hour of need.
Different medical Associations of the United States designed CPT codes for rapid Covid tests with specific instructions. In this article, multiple categories of CPT codes and different CPT codes for Covid 19 will be explained.
CPT codes for COVID Test
CPT codes are created for reporting the immunizations for COVID-19. Every CPT code is unique for reaching the Covid vaccine. The new CPT codes distinguish every Covid vaccine for better tracking and analysis, enabling better allocation of limited medical resources.
CPT codes for rapid Covid tests are there to facilitate the process of medical billing in an immediate Covid emergency.
Effective from 1st April 2020, the new ICD-10-CM diagnosis chapter, Chapter 22 Special Purposes Code (U00-U85), and a novel code U07.1 Covid 19 were there to report Covid diagnosis.
Coding Rules for U07.1
- This code can only be used for the confirmed coronavirus cases with positive results.
- The code can be different for patients involved in other medical problems like obstetric patients.
- Obstetric patients with positive COVID-19 results in pregnancy or childbirth will have code O98.5.
- If there are negative results of COVID, then the following Encounter codes will be used:
| Z11.59: Encounter for Screening for other fatal ailments | Asymptotic, unknown, or negative |
| Z03.818: Encounter for observation for assumed exposure to other biotic agents ruled out | Possible Covid 19 exposure, infection ruled out |
| Z20.828: Suspected for other viral diseases | Infected by Covid 19, suspected exposure |
These diagnosis codes may be effective as associated manifestations, irrespective of positive Covid 19.
- R05: Cough
- R06.02: Breath issue
- R50.9: Temperature, unspecified
- J12.89: Viral pneumonia
- J20.8: Acute bronchitis because of different definite organisms
- J22: Indefinite acute lower respiratory infection
- J40: Bronchitis, nor stated as acute or chronic
- J80: Acute respiratory distress syndrome
- J96.01: Failure of Acute respiratory with hypoxia
- J98.8: Other specified respiratory syndromes.
Swab Collection
No specific code is associated with swabbing the enduring Covid. It’s included in the E/M service. However, if it is collected in the office and shifted towards the laboratory, then CPT code 99000 can be billed.
- 99000: The transfer of a specimen from the office to the laboratory.
Laboratory
There are three codes for Covid 19 testing, including 87635, established to detect coronavirus and effective from 13th March 2020. 86328 and 86769 are used to identify any antibodies regarding Covid 19 and have been effective since 10th April 2020.
Antigen Testing
CPT code for rapid antigen Covid test is also designed for ensuring effectiveness in medical billing services.
- 87426: Through the immunoassay technique, the detection of infectious agent antigen like enzyme immunoassay, qualitative or semiquantitative method.
- 87811: The detection of infectious agent antigen through immunoassay with optical observation.
Specimen Collection
If there is no E/M code on the claim, specimen collection should be reported. The approved reporting code by CMS for specimen collection for new patients is 99211.
Monoclonal Antibody COVID Infusion
The Food and Drug Administration (FDA) legalized the usage of monoclonal antibody therapies for treating Covid patients when they are facing high risks of heath due to Covid. Moreover, their chances of getting hospitalized are high.
Therapies that are authorized as an emergency are:
- Casirivimab and imdevimab managed together
- Bamlanivimab and etesevimab directed together, and
- Tocilizumab is only used in the hospital setting
The first two products are delivered free of cost by the Health and Human Services Department (HHS), and there is only one bill for administration.
CPT Codes Categories
Category 1
Medical providers use this category for describing specific services and operations. As it’s the most important category, medical providers mostly use these codes. The following sections are included in this category:
- Evaluation and management
- Laboratory and Pathology
- Anesthesiology
- Radiology
- Surgery
- Medicine
Smaller details and services are also documented and coded. Moreover, extra services acquired are also included in the coding. For instance, modifiers are used in combination with codes.
Modifiers are also important for accurate billing as they provide all the necessary information required by insurance companies for authorizing claims.
Category 2
This category includes any additional information that you submit. These codes are designed to provide further information. It can consist of extra information about the patient, like medical history and treatment.
You can include a lot of information under this category CPT codes. The codes in Category 2 always finish with the letter “F.” Their classification is done in very particular ways and is based on the information provided by providers.
Category 3
The codes in this category are for innovative technology services. These CPT codes help government and health providers track and pursue the best medical techniques.
Most of the category three codes are reclassified as Category 1 codes after the approval of the CPT Editorial Panel. The CPT codes under this category include the word “T” at the end.
CPT codes in these categories are altered and even discarded if they are of no use to medical services. Medical providers must check if anything is changed or altered in codes to ensure smoothness in their market operations.
Conclusion
With the emergence of the pandemic, the need to release CPT code for rapid Covid test and other possibilities increased. The health care organizations and the US government proposed and approved several CPT codes for Covid to smoothen the process of medical billing and reporting.
This article mentions different CPT codes for Covid and the various categories of CPT codes. It will provide you with adequate knowledge about CPT codes and their usage in the pandemic.
A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.
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