New codes for COVID-19 testing and services

Recent updates to coding changes for COVID-19.

Q: Can you please update us on the recent changes for COVID-19?

In addition to the changes that were made at the beginning of 2021, there are several new codes that have been developed by the American Medical Association (AMA) to help facilitate the need for specific COVID-19 testing and services.All of the new codes listed below are effective immediately.

Under the Immunology section of the CPT codebook, a new code 86413 was established to report quantitative antibody detection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2):

  • 86413 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative

New code 99072 was established to report additional practice expenses incurred during a Public Health Emergency (PHE), including supplies and additional clinical staff time.It accounts for additional supplies, materials, and clinical staff time required for patient symptom checks over the phone and upon arrival, the time spent putting on and removing personal protective equipment (PPE), and increased sanitation measures to prevent the spread of communicable disease. The new parenthetical note for 99072 reiterates this information.

Also, 99072 can be billed for an in-person patient encounter (office visit or other non-facility service) when mitigating the transmission of the PHE respiratory disease is required. Use of this code is not dependent on a specific patient diagnosis. Check with your payers to see what documentation they might require to support 99072:

  • 99072 Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease

According to the special November edition of the AMA CPT Assistant, a new code was developed a much-needed single test that measures antigens for severe acute respiratory syndrome (SARS) coronavirus (CoV) (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) as well as influenza virus types A and B.This test was given the code 87428, in the Microbiology subsection of the Pathology and Laboratory section of the CPT code set.The AMA made this new code effective immediately.

  • 87301 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; adenovirus enteric types 40/41
  • 87426 severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])
  • 87428 severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B

In October, the AMA also added the following laboratory testing CPT codes for SARS-CoV-2.

  • 87471 Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, amplified probe technique
  • 87635 severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
  • 87636 severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique
  • 87637 severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique

Be aware that CPT codes 86317, 87250, 87255 in addition to the new codes listed above have parenthetical notes and guidelines to correct and clarify how to report infectious agent antigen studies.

Additionally, another CPT code was created to use when a provider directly observes the antigen.

  • 87802 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group B
  • 87811 severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19])

There are also revisions made to codes in this section.Note that this clarification only applies to primary source infectious disease codes, and it does not apply to drug testing codes.

All of the changes and additions to this section (new and revised codes) will continue to be valid and active after the Public Health Emergency declaration is lifted.

Renee Dowling is compliance auditor at Sansum Clinic, LLC, in Santa Barbara, California.