Anesthesia Coding Alert

You could also be reporting 31500 quite often.

With many aspects of healthcare adopting an “all hands on deck” approach during the coronavirus (COVID-19) pandemic, some anesthesia providers have found themselves dealing with scenarios that are traditionally out of their norm: helping evaluate and treat patients in the emergency room or other locations. That means anesthesia providers and coders need to be familiar with any codes or modifiers related to COVID-19.

Here’s your quick primer on codes you might see and when you should report them (as of press time).

Learn the New Testing Codes

A new CPT^® Category I code for testing patients for coronavirus went into effect March 13, 2020: 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).

Caution: Keep in mind that this is an early release code, which means you might need to manually upload the code descriptor into your electronic health record system.

In addition, two new HCPCS Level II codes for specimen collection were introduced on March 31, 2020:

• G2023 (Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source)
• G2024 (Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source)

Pay attention: Note that both code descriptors refer to ”any source.” The codes can apply to nasal swabs as well as other means of collection.

Reimbursement: Code G2023 has an associated Medicare payment rate of approximately $23.46, based on the national Medicare conversion factor (CF). The Medicare payment for G2024 is approximately $25.46, also based on the national CF.

Know the Antibody Test Codes

New and revised codes are in place for antibody tests used to verify whether a patient had COVID-19 previously.

• 86318 (Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip))
• 86328 (…severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]))
• 86769 (Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]))

Code 86318 has a revised descriptor to encompass both single and multiple antibodies. Codes 86328 and 86769 are newly introduced, as of April 10, 2020.

Don’t Forget Intubations

Anesthesiologists are frequently being called upon to perform emergency intubations due to respiratory distress associated with COVID-19, says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida.

Report the emergency intubation with 31500 (Intubation, endotracheal, emergency procedure) and diagnosis code U07.1 (COVID-19) along with additional codes for respiratory disease (such as J12.8, Other viral pneumonia) or signs or symptoms of respiratory disease (such as R06.0, Dyspnea) when the virus is identified.

Always include supporting documentation for any reported diagnoses.

Remember: The American Society of Anesthesiologists (ASA) defines an emergency as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body part. COVID-19 patients fall under this description since they should all be considered emergencies, Dennis says.

“For other patients, if no anesthesia was provided, a ‘non-emergency intubation’ will depend on the documentation and situation,” Dennis says. “I have not seen anything to change that guideline since COVID-19 began.”

Disclaimer: Information related to COVID-19 is changing rapidly. This information was accurate at the time of writing. Be sure to stay tuned to future issues of Anesthesia Coding Alert for more information. You can also refer to payer websites, CMS (cms.gov), CDC (cdc.gov), and AAPC’s blog (www.aapc.com/blog) for the most up-to-date information.