Tammie Posted Thu 11th of June, 2020 09:18:48 AM
How should we bill for patients being pre screened for Covid-19 with a nasal swab? Is it okay to bill a 99211 in conjunction with the 99000 and submit the specimen to the outside lab ?
SuperCoder Answered Fri 12th of June, 2020 03:19:17 AM
Thank you for your question.
There is more appropriate code to bill for Covid-19 test. Please check with CPT C9803 if it matches as per the documentation available. Also, there are more codes to bill for coronavirus related test which are lab, technique and POS specific.
For clinical staff symptoms review and specimen collection for SARS–CoV–2 testing, see 99211.
The Centers for Medicare & Medicaid Services (CMS) announced the creation of C9803 in interim final rule with comment period CMS–5531–IFC.
Medicare expects to retire this code once the public health emergency (PHE) due to COVID–19 concludes.
Medicare’s Hospital Outpatient Prospective Payment System (OPPS) will make separate payment to a hospital for C9803 only when the code is billed without another primary covered hospital outpatient service, such as a clinic or emergency room visit, observation service, or critical care services.
For lab technician specimen collection for SARS–CoV–2 testing, see G2023 and G2024.
C codes represent items and services for outpatient use, including pass through devices, pass through drugs and biologicals, brachytherapy sources, new technology, and certain other services.
Feel free to ask for any further query.
Tammie Posted Fri 12th of June, 2020 08:07:28 AM
Just to be clear, we are a pediatric specialist office performing the test and sending to the lab. Does that mean, we are okay to bill the 99211? Do we need to bill it in conjunction to the 99000? I do realize the 99000 is bundled with the 99211.
SuperCoder Answered Mon 15th of June, 2020 14:02:03 PM
NCCI edit do not show bundling between these codes. These codes can be billed together. CPT 99000 is an informational code and there is zero fee schedule attached to this code. It is paid by the private payer when the physician's office centrifuges the specimen, separates the serum and labels, and packages the specimens for transport to the laboratory - according to CPT's clarification comment.
However, if the specimen is picked up by laboratory staff at no additional cost to the physician, it would not be appropriate to report CPT® code 99000. It would not be appropriate to report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional ...) simply for the collection alone.
Also, Code 99000 is also intended to reflect the work involved in the preparation of a specimen prior to sending it to the laboratory. Typical work involved in this preparation may include: Centrifuging a specimen, separating serum, labeling tubes, packing the specimens for transport, filling out lab forms and, supplying necessary insurance information and other documentation.
Do Not Report 99000 to Medicare Carrier
Medicare considers 99000 a bundled service and makes no separate payment for it. Some commercial payers may pay for the service.