Q&A: Reporting an E/M visit for a patient exposed to COVID-19

Monday, April 20, 2020

Q: How would you report an E/M visit for a new patient who was exposed to COVID-19 and sent to a diagnostic testing site?

A: If the E/M visit was provided in-person, the physician or qualified healthcare professional would report the appropriate E/M code within the range 99201-99205 for new patient visits. The provider would also report ICD-10-CM code Z20.828 (contact with and [suspected] exposure to other viral communicable diseases).

The testing site would report CPT code 99001 (handling and/or conveyance of specimen for transfer from the patient in other than an office to a laboratory [distance may be indicated]) for the handling of the specimen and the laboratory would bill CPT code 87635 (infectious agent detection by nucleic acid [DNA or RNA]; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [COVID-19]), amplified probe technique) for laboratory testing.

The appropriate place of service (POS) code would depend on the setting in which the services were administered. If the setting was a physician office, the POS code would be 11 (physician office).

Office visits for COVID-19 may also be performed virtually and reported using E/M codes 99201-99205 for new patients and 99212-99215 for established patients. For visits performed through telemedicine, coders would append modifier -95 (synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system) to the E/M code to indicate that the visit was rendered using interactive audio and video. If the provider only interacted with the patient over the phone, the coder should instead report a CPT code for a telephone evaluation (i.e., codes 99441-99443).

Notably, because there has been such an expansion of reimbursable telehealth services due to the COVID-19 pandemic, CMS has advised providers who bill virtual E/M visits for COVID-19 to bill the location as if the service was provided in-person. 

According to CMS, providers may continue to use POS code 02 (telehealth services) on claims for COVID-19 telehealth visits and be paid under the Medicare Physician Fee Schedule, at the facility rate. If the provider were to report a location (i.e., where the service would be performed if the visit was administered in-person) and append modifier -95 to the E/M code, the services would be reimbursed as if they were performed in-person.

For more information on correct CPT reporting and billing for COVID-19, coders can review the American Medical Association’s COVID-19 CPT reporting guidance for physicians and medical practices. This guidance is intended to simplify reporting of in-person and online visit services for 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.

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.

Editor’s note: This question was answered by Yvette DeVay, MHA, CPC, CPMA, CIC, CPC-I, lead instructor for HCPro’s Medicare Boot Camp®—Physician Services Version, and by Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D, director of HIM and coding for HCPro in Middleton, Massachusetts, during the HCPro webinar, “COVID-19 Coding: The Latest on ICD-10-CM, CPT Reporting.”

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

This answer was originally published in Revenue Cycle Advisor.