Is it not crucial to stay up to date with Covid-19 coding changes and report on current and emerging healthcare issues? In fact, it’s not only important but very essential too! Covid-19 coding and description for testing came into existence from last year. Accepted at the March 2020 CPT Editorial Panel meeting, the Covid-19 coding is used as the industry standard for reporting of novel coronavirus tests across the nation’s health care system.

In a report during an announcement about its release, the American Medical Association (AMA) noted that the new CPT code will help hospitals, health systems and laboratories in the United States to efficiently report and track testing services related to SARS-CoV-2. Let’s look into the frequently asked questions for Covid-19 lab tests and specimen collection.

Can hospital labs bill for specimen collection using C9803 when lab personnel are collecting specimens and then performing the test?

  • For Covid-19 coding, HCPCS code C9803, Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus disease [COVID-19], is a conditionally packaged service under the Outpatient Prospective Payment System (OPPS). This means that C9803 will receive separate payment when it is billed without another primary covered hospital outpatient service. The OPPS will make separate payment for HCPCS code C9803 when it is billed with a clinical diagnostic laboratory test with a status indicator of “A” in the Addendum B file, which includes the lab tests for COVID-19 detection.

What’s the effective date for HCPCS code C9803 and can it be reported before effective date for any specimen collected prior to the effective date?

  • HCPCS code C9803, Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus disease [COVID-19], has been given a retroactive effective date of March 1, 2020. It can be reported for any procedures performed on or after that date which meets the code definition but cannot be reported prior to that date of service.

Can specimen collection be reported using HCPCS code C9803 while providing an E/M service?

  • In Covid-19 coding, specimen collection will not be included in the lab test and can therefore be separately reported. However, HCPCS code C9803, Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus disease [COVID-19], is a conditionally packaged service under the OPPS. It means that C9803 will not receive separate payment when billed with an Evaluation & Management (E/M) service. Rather, the payment will be packaged into the E/M service.

Can we report HCPCS code C9803 while collecting specimens for tests other than PCR Covid-19?

  • Though this question has not officially been addressed by CMS, HCPCS code C9803, Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus disease [COVID-19], specifies in the description that it should be used to report specimen collection for SARS-CoV-2, which does not include antibody testing. Vital ware would therefore recommend reporting an alternate code, such as 36415, Collection of venous blood by venipuncture, when collecting blood for a COVID-19 antibody test.

Can the HCPCS code C9803 be reported by respiratory therapists who collect specimen for Covid-19 testing?

  • For Covid-19 coding, HCPCS code C9803, Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus disease [COVID-19], is intended to be reported when hospital staff perform specimen collection for COVID-19 testing. There is no requirement or necessity that it must be collected specifically by laboratory personnel.

Should HCPCS code C9803 be used for Medicare patients and HCPCS code G2023 for commercial payers while billing for specimen collections in the hospital out-patient department?

  • CMS requires that HCPCS code C9803, Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus disease [COVID-19], be reported when specimen collection for COVID-19 testing is performed in a hospital outpatient department. Each commercial payer will have their own guidelines and reimbursement policies related to specimen collection. It will likely be necessary to check with each regarding their specific policies to ensure accurate reimbursement for these services.

Can HCPCS code C9803 be reported for specimen collection on an in-patient basis?

  • During Covid-19 coding, CPT and HCPCS codes are not reported on inpatient claims. Inpatient claims for Medicare beneficiaries are assigned a single MS-DRG based upon the ICD-10-CM and ICD-10-PCS codes reported for that encounter. All provided items and services, with some minor exceptions, are packaged into the MS-DRG reimbursement that is received. Even though HCPCS codes are not reported, it is important that hospitals accurately report their costs for all services that are provided during an inpatient encounter. Ultimately, it will be up to each individual hospital to determine which services are included in the typical inpatient room and board charge and which services should be separately billed on the inpatient claim.

What is the difference between HCPCS code C9803 and G2023?

  • HCPCS code G2023, Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), any specimen source, was created for use when a laboratory technician travels to a non-patient’s home (Bill Type 014X) and collects the specimen for COVID-19 testing.
  • HCPCS code C9803, Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus disease [COVID-19], was created for instances when a specimen is collected from a registered outpatient of a hospital, including specimen collection procedures that are performed at a temporarily relocated off-campus hospital departments or sites.

Explain the difference between U0002 and 87635.

  • CPT code 87635 for Covid-19 coding, 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, is specific to the amplified probe technique for detection of the virus by DNA or RNA. On the other hand, HCPCS code U0002, 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or sub-types, non-CDC, includes all techniques. The COVID-19 FAQ document published by CMS directs laboratories to assign 87635 when they use the methodology described by the code and to use U0002 when they use a method not described by code 87635.

What’s the Medicare reimbursement rate for 87635?

  • CMS has not formally released test pricing for CPT® code 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. However, several commercial payers, including UHC, Aetna, and Blue Cross, have announced that reimbursement for 87635 will be equivalent to the reimbursement rate for HCPCS code U0002, 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or sub-types (includes all targets), non-CDC, which is currently $51.31 or $51.33 depending upon the region.

 

Covid-19 coding is as difficult as billing. New codes appear and the old ones may not exist in the meantime. Switching to best outsourcing companies for billing and coding tasks would be a great idea as it will also ease the work of healthcare professionals.

 

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