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

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.