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E&M Code Utilization ?

Victoria Posted Wed 29th of April, 2020 09:53:31 AM
Would a ordering provider be able to Utilize a low level E&M code for COVID-19 testing and resulting out to a referring provider?
SuperCoder Answered Thu 30th of April, 2020 11:44:39 AM


Thanks for your question.

The utilization of low-level E/M codes depends on the reason for visit and key components (history, physical exam and MDM) of the visit.

The code ranges that can be applied for new patients are 99201-99205, and code range 99212-99215 for established patients.

Please find below some scenarios shared on AMA special coding advice during COVID-19 health emergency where office visit codes 99201-99205 and 99212-99215 can be utilized with other CPT codes:

  1. Patient comes to office for E/M visit, is tested for COVID-19 during the visit, test conducted at laboratory not in physician’s office
  2. Patient comes to office for E/M visit, is tested for COVID-19 in office during the visit, test conducted in office
  3. Patient comes to office for E/M visit re: COVID-19 and is directed to an external testing site (not affiliated with physician)

Hope this helps.


Victoria Posted Thu 30th of April, 2020 12:17:19 PM
Okay thank you! So if the patient is just coming in to the office and is not seeing a provider they are just having test done for the covid-19 we would not be able to an E&M code, Just for testing?
SuperCoder Answered Fri 01st of May, 2020 12:17:29 PM


If the patients came for COVID-19 testing and no provider perform E/M of the patient, then code for COVID-19 testing can only be billed.

Hope this helps.


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