New CPT Code for Coronavirus Testing

With over 576,859 cases worldwide and a startling 94,238 cases in the United States, it’s clear that Covid-19 has forced practically every facet of the economy to adjust for it. Businesses are being ordered to shut down, institutions are having difficulty working with the strict recommendations to observe social distancing.

The American Medical Association (AMA) has announced via a press release that there has been a new addition to the CPT code set rendered for the use of tracking and identifying novel coronavirus testing. Ordinarily, new codes are not released at this time and they are often subject to an activation period so all related parties who would utilize the code have time to update their employees and input the code into their EHR or health IT systems.

The category I CPT code and description is as follows:

87635 – Infection agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique.

How are CPT Codes Approved?

CPT stands for Current Procedural Terminology; the AMA publishes CPT codes. The CPT Editorial Panel which is comprised of 17 members are in charge of handling the code set for each year. This includes maintaining the code set, making revisions, updates, or modifications to the code set. Of the 17 members, 11 are physicians who are selected by the National Medical Specialty Societies and are subject to final approval by the AMA. As you can tell, this is a fairly rigorous selection process to be on the board.

Because it is a panel or board, a member of the panel can submit a request to changes to the existing codebase or rarely—add a new code. The code is then reviewed by the appropriate advisory committee. In general, a code change request must specify information such as:

  • A detailed description of the procedure or service which would elaborate on how much skill or time is required to complete (this is important for billing hours).
  • An overview of who this procedure would typically be performed for (patient profiles)
  • Medical literature or studies which sufficiently prove that reasonable safety and effectiveness of this procedure or service.

There are many more factors. Ultimately, they speak to the concept of the CPT code set which is meant to be comprehensive. Code changes are common, but new codes are not nearly as common as revisions or changes are. The prevailing attitude when the board is confronted with suggestions for new codes is to ask why the current code set is not adequate. As with any standardized information with near universal applicability, changing codes requires a lot of effort nationwide to abide by the new set. And so, adding a new code must always be done with skepticism to avoid unnecessary work.

For the AMA to convene for a special expedited meeting and declare a CPT code for novel coronavirus testing is just another glaring reminder of how dire the situation has become.

Remote Medical Billing and Office Support

The most we can do now is observe social distancing to limit the spread of the virus. For healthcare workers and medical administrative employees, this can be a difficult proposition as many clinics and offices provide essential services to patients who require monitoring or availability for conditions that can be life-threatening without aid.

One way to limit exposure in the coming months as we seek to flatten the curve of infection is to work remotely when possible, however possible.

If you are an office, clinic, or healthcare administration that wants to protect its employees and limit unnecessary interaction with patients, contact us at The Psych Biller to discuss how we can safely and securely handle the administrative and medical billing needs of your office so you can focus on safe patient interaction and managing the total amount of people allowed within at a time.

2020-05-01T20:43:04+00:00 March 13th, 2020|