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How to bill covid-19 specimen collection

Posted By Sandy B on 04-09-2020, 09:55:48 in Ob-Gyn

Our office doesn't normally do testing such as this so I'm not sure if/how to bill for the specimen collection, however the facility we use for delivery is requiring our 39wk-40wk pregnant patients to be tested for coronavirus.
Our physicians/nurses are collecting the covid-19 sample via swab then sending the specimen to an outside lab for processing.
#1- What CPT code and Dx should I use? I was thinking CPT code 99211 or 87635? For dx code, I was thinking O98.513 then weeks of gestation secondary...??
#2- We are bringing some patients in specifically for the testing which I believe should be separately billable, however if we do this test during a scheduled ob visit, would it then be considered part of their ob care even though this isn't a routine test?

Any help would be great!

Comments (1)

Posted By Melanie Witt on 04-09-2020, 15:43:03

First, only Medicare has created a collection code for the covid-19: G2023, Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source, and it is unclear if other payers will accept this code (although Medicaid programs might). However, these codes were created specifically for diagnostic laboratories, not physician offices. In most states, the collection and test are being performed at assigned sites so I would be sure you are following your state's guidance on this. If you are permitted to collect and test, you should know that while CPT has created a new code for testing (87635, Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique), they have not developed any codes for the collection. The code 89220, Sputum, obtaining specimen, aerosol induced technique (separate procedure), does not apply here as you are doing a swab, not an aerosol technique. Under CPT guidelines, collection of a specimen is not separately billable unless there is a specific code for it (and there is not for respiratory secretion collection). However, you might be able to bill 99000 for the handling/conveyance of the specimen if you are incurring extra costs for this purpose. 99211 should not be reported and this code represents an E/M service, not specimen collection. If you are performing the test in-house, you can certainly bill for it (if your state regulations are allowing it) and it would not be part of normal ob testing. DO NOT report O98.513 for any unconfirmed case of covid-19. This ICD10 guidelines state: During pregnancy, childbirth or the puerperium, a patient admitted (or presenting for a health care encounter) because of COVID-19 should receive a principal diagnosis code of O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, followed by de U07.1, COVID-19, and the appropriate codes for associated manifestation(s). Codes from Chapter 15 always take sequencing priority. This code indicates she has a viral disease that is complicating pregnancy which would not be the case if you are testing and do not have a confirmed or presumptive confirmed result. If you are screening them for covid-19 in absence of symptoms, you report Z11.59. If she has symptoms of a respiratory illness I would code her symptoms such as: • R05 Cough, • R06.02 Shortness of breath, • R50.9 Fever, unspecified along with Z33.1 (pregnancy incidental) or possibly O99.51__ if the respiratory symptoms are complicating the management of the pregnancy. Remember that this is all new to all of us and written guidance is sparce right now. So this would be my best advice given my experience with ob/gyn coding and guiding principles. We can but try.

First, only Medicare has created a collection code for the covid-19: G2023, Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source, and it is unclear if other payers will accept this code (although Medicaid programs might).  However, these codes were created specifically for diagnostic laboratories, not physician offices.  In most states, the collection and test are being performed at assigned sites so I would be sure you are following your state's guidance on this.  If you are permitted to collect and test, you should know that while CPT has created a new code for testing (87635, Infectious agent detection by nucleic acid (DNA or  RNA); severe acute respiratory syndrome coronavirus  2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique), they have not developed any codes for the collection.  The code 89220, Sputum, obtaining specimen, aerosol induced technique (separate procedure), does not apply here as you are doing a swab, not an aerosol technique.  Under CPT guidelines, collection of a specimen is not separately billable unless there is a specific code for it (and there is not for respiratory secretion collection). However, you might be able to bill 99000 for the handling/conveyance of the specimen if you are incurring extra costs for this purpose.  99211 should not be reported and this code represents an E/M service, not specimen collection.  If you are performing the test in-house, you can certainly bill for it (if your state regulations are allowing it) and it would not be part of normal ob testing.  DO NOT report O98.513 for any unconfirmed case of covid-19.  This ICD10 guidelines state: During pregnancy, childbirth or the puerperium, a patient admitted (or presenting for a health care encounter) because of COVID-19 should receive a principal diagnosis code of O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, followed by de U07.1, COVID-19, and the appropriate codes for associated manifestation(s). Codes from Chapter 15 always take sequencing priority. This code indicates she has a viral disease that is complicating pregnancy which would not be the case if you are testing and do not have a confirmed or presumptive confirmed result.  If you are screening them for covid-19 in absence of symptoms, you report Z11.59.  If she has symptoms of a respiratory illness I would code her symptoms such as: • R05 Cough, • R06.02 Shortness of breath, • R50.9 Fever, unspecified along with Z33.1 (pregnancy incidental) or possibly O99.51__ if the respiratory symptoms are complicating the management of the pregnancy.  Remember that this is all new to all of us and written guidance is sparce right now.  So this would be my best advice given my experience with ob/gyn coding and guiding principles.  We can but try.