AMA publishes CPT guidance on reporting COVID-19 visits

Monday, March 30, 2020

The American Medical Association (AMA) announced on March 26  new CPT coding and reporting guidance for physicians and medical practices, intended to simplify reporting of in-person and online visit services for novel coronavirus (COVID-19) patients.

The new guidance includes 11 scenarios to help healthcare professionals select the most specific CPT codes for services administered to patients diagnosed with COVID-19 and patients suspected of having the virus. Notably, the last two scenarios address CPT coding for telehealth encounters unrelated to COVID-19.

Specifically, the AMA includes step-by-step instructions for reporting the following scenarios:

  • Scenario one: Patient comes to the office for an E/M visit and is tested for COVID-19 during the visit
  • Scenario two: Patient comes to the office for an E/M visit for COVID-19 and is directed to a testing site
  • Scenario three: Patient received a telehealth visit for COVID-19 and is directed to come to a physician office or a physician’s group practice site for testing
  • Scenario four: Patient received a telehealth visit for COVID-19 and is directed to unaffiliated testing site
  • Scenario five: Patient receives a virtual check-in or an online visit for COVID-19 (not related to an E/M visit) and is directed to come to the physician office for testing
  • Scenario six: Patient receives a virtual check-in or an online visit for COVID-19 (not related to E/M visit) and is directed to an unaffiliated testing site
  • Scenario seven: Telehealth visit for a COVID-19 diagnosed patient
  • Scenario eight: Patient with COVID-19 receives a virtual check-in,  an online visit via a patient portal or email (not related to an E/M visit), or a telephone call from qualified nonphysician (those who may not report E/M)
  • Scenario nine: Physician orders remote physiologic monitoring following patient quarantined at home after receiving COVID-19 diagnosis
  • Scenario 10 (non-COVID-19 case): Telehealth visit for a non-COVID-19 patient
  • Scenario 11 (non-COVID-19 case): Patient receives a virtual check-in or online visit via patient portal/email (not related to E/M visit) or a telephone call from qualified nonphysician (those who may not report E/M)

The AMA also published a quick-reference flowchart that outlines CPT reporting for COVID-19 testing and created a webpage devoted to information on CMS payment policies and regulatory flexibilities related to COVID-19.

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