COVID-19 is costing us time and money. Supply prices are inflated, we are seeing less patients to socially distance, we are disinfecting frequently, providing masks daily to staff and patients and have to take temps of staff, patients and reps. It would be great if we could be compensated for the extra expense that our practice is spending on creating a safe environment for our patients and staff. In early September, the AMA created new CPT code 99072 to reimburse us under these circumstances.
How to protect our practice’s bottom line from COVID by correctly using new CPT code 99072.
What does 99072 pay for? To compensate us for the additional supplies, materials, and clinical staff time we spend on the following COVID-related activities:
Performing patient symptom checks over the phone and upon arrival (i.e. taking temperatures, asking questions, and providing distancing instructions)
Putting on and removing personal protective equipment (PPE)
Increased sanitation measures to prevent COVID spread, including cleaning supplies like hand sanitizer, disinfecting wipes, and more.
“Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease.” “Additional” means over and above what you usually include in a patient visit or service to ensure a safe in person visit and reduce the risk of the communicable disease for which the Public Health Emergency (PHE) was declared. For example, if providers do not typically wear masks during patient visits, and now, due to the pandemic, they do, that meets the definition of “additional.” CPT 99702 includes up to three surgical masks per encounter per encounter per provider.
Is a COVID Diagnosis Needed to Report 99072? Because this code is related to actions we take to reduce the risk of COVID transmission, the patient does not need a COVID diagnosis — or test — to report code 99072. CPT code 99072 isn’t specialty-specific — any specialty can use the code as long as the patient encounter meets the code’s requirements. But we can only report 99072 for services provided in an office or other non-facility setting. Remember that 99072 is used per encounter, not per service. We may report 99072 only once per encounter per provider, no matter how many services are performed during the encounter.
What about documentation? Documentation requirements for 99072 will vary among insurers, so be sure to check with your payers . ALSO: Our documentation must include information that supports the requirements for 99072. Include a statement that notes “Due to COVID-19 …” and then document what steps you took or supplies you used.
Since this code is so new, it’s tough to predict its prospects for payment. First, we’ll have to manually upload the new CPT code to your system — and it may take payers some time to update their own systems and policies. To avoid denials, confirm with the payers if they are accepting 99072 yet, and if not, when.
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As always, the PMCOE team is available to answer any questions, talk through your challenges and help you arrive at the best solution for your situation. Thank you for your consideration, Stay healthy and safe, Pat and team Patricia M. Morris, C.O.E www.4PMCOE1.com 1-888-476-2631 Expertise & Excellence with Enthusiasm since 1992
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