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New COVID-19 CPT codesDifficulty: Simple // COVID-19
Why run this play?
This play will help you proactively identify SARS-CoV-2 testing cases using new CMS CPT/HCPCS codes, and show you how to prepare proper bills for reimbursement from payers. It also recommends that you monitor and track patients and cases who are admitted to the hospital following these procedures.
Background
Besides presenting a large-scale challenge to every hospital's clinical operations, COVID-19 can cause revenue leakage if the tests you administer aren't properly coded and/or billed correctly. CMS has just issued new codes for testing, and it's important to begin using them immediately, since the number of tests you administer is likely to increase.
In addition to protecting your revenue stream, this new CPT code will support a data-driven response to the COVID-19 disease outbreak in the United States. According to AMA President Patrice A. Harris, MD, MA, “By streamlining the flow of information on novel coronavirus testing, a new CPT code facilitates the reporting, measuring, analyzing, researching and benchmarking that is necessary to help guide the nation’s response to the public health emergency.”
Take Action
Query all charges from the hospital or physicians billing system starting in March 2020.
At the detailed charge level, identify HCPCS code U0002 for all non-CDC labs reporting SARS-CoV-2 testing.
Additionally, use CPT code 87635 for the detection of SARS-CoV-2 (COVID-19) and any pan-coronavirus types or subtypes. Note that this is separate and distinct from existing CPT code sets that already contain codes for coronavirus testing.
We recommend that you monitor the daily instances of these tests to prepare coding and billing for the volume of these new cases.
Per CMS and AMA, it will be important to check with local payers to determine your specific reporting guidelines prior to the April 1, 2020 date when CMS will begin accepting these new codes.
Additionally, we recommend that you draw the connection between patients who test for the virus and those who are admitted to the hospital.
Want to see how to run this play in VisiQuate?
Request a demoHow to Calculate This Play's Value
Follow this block of claims through the billing cycle to confirm that they are clean and going out to the payers on time. Delays in billing or an increase in DNFB as a result of these tests will significantly impact the timeliness and completeness of payments.
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