We are in a new year, but will see the impact of code changes from 2020 for months to come. There are many new codes directly related to COVID-19, in addition to the normal code changes. One code we want to focus on for this article, is Current Procedural Terminology (CPT) code 99072 (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 (PHE), as defined by law, due to respiratory-transmitted infectious disease)1. This code became effective September 8, 2020.
There is a similar code, CPT 99070, (Supplies and materials,except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided); however, in the CPT Assistant Special Edition2, the AMA clarifies the difference between 99070 and 99072. CPT 99072 is used only during a PHE and only for supplies supporting a safe environment. CPT 99072 also accounts for additional time needed by the clinical staff in order to provide a safe environment. This potentially could include the use of masks or sanitizing supplies.
What to look for:
- Since CPT 99072 is to be billed once per in-person visit, look for anyone billing it more than once or excessively per patient.
- Look for providers billing for other time-based codes in an attempt to bill for the time spent related to CPT 99072. The time spent for the services related to CPT 99072 should not be calculated in any other time-based service during the same visit.
Check your respective plan policies for information regarding reimbursement and documentation requirements as they may vary. In addition, the PHE is currently set to expire on January 20, 2021, however, be on the lookout for additional extensions. Once the PHE has ended, the code will no longer be accepted for reimbursement.
If you have any questions, please do not hesitate to reach out to SIU@hcfraudshield.com.
REFERENCES:
2. https://www.ama-assn.org/system/files/2020-09/cpt-assistant-guide-coronavirus-september-2020.pdf
Healthcare Fraud Shield 