ED Coding and Reimbursement Alert

These codes were approved by the AMA on April 10 and went into effect immediately.

Emergency departments have two new coronavirus testing codes to use, thanks to an emergency meeting that the American Medical Association (AMA) held in early April. These two codes allow you to accurately code the performance of blood tests that detect antibodies associated with coronavirus.

“Antibody testing that identifies patients that have been exposed to the novel coronavirus (SARS-CoV-2) and developed an immune response is likely to have important public health implications by providing a clearer picture of the prevalence of the disease in the US,” said AMA President Patrice A. Harris, MD, MA, in a news release about the new codes.

The new codes are:

• 86328 (Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); 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))

Here’s the difference: The first new code, 86328, describes antibody tests using a single-step method immunoassay. This often includes a strip with all the critical components for the assay, and is appropriate for a point of care platform, according to the AMA. If you perform antibody tests using a multiple-step method, you’ll instead report 86769.

Check These Examples

Consider the following two clinical examples that can show you exactly which situations suit the two new codes.

Example 1: A 72-year-old male patient with a history congestive heart failure and colon cancer presents to the ED with a six-day history of a dry cough, a “constantly exhausted” feeling, and a fever that has not exceeded 101 degrees. The ED physician orders a SARS-CoV-2 IgG/IgM reagent strip antibody test and collects the patient’s blood for testing. For this encounter, you’d report 86328.

Example 2: A 67-year-old female with a history of diabetic neuropathy and Parkinson’s Disease presents to the ED complaining of a one-week history of a dry cough, malaise, and an elevated temperature, which she says exceeded 102 at one point. On examination, her temperature is currently 98.6. The physician orders SARS-CoV-2 IgG and IgM antibody tests to determine whether the patient may be recovering from COVID-19. The physician also collects serum for testing. You’ll report 86769 for this encounter.

Don’t Forget 87635

The two new codes above arrive on the heels of 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), which was approved for dates of service on or after March 13, 2020.

“Use of code 87635 will help to efficiently report and track testing services related to SARS-CoV-2 and will streamline the reporting and reimbursement for this test in the United States,” according to a special edition of CPT® Assistant, Vol. 30.

Coding example: The physician sees a patient in the ED and performs an E/M service, which includes a detailed history, a detailed exam, and moderate complexity medical decision making (MDM). The patient reports a fever and a cough with a high community prevalence of coronavirus infection. The physician tests the patient for COVID-19 during this encounter. A nurse in the ED collects the patient’s swab sample. The lab in ED then conducts the COVID-19 test where agent detection by DNA is performed, using the amplified probe technique. For this encounter, you’d report 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components…) and 87635.