Oncology & Hematology Coding Alert

Question: What do you know about the new CPT^® code for reporting additional practice expenses during the COVID-19 Public Health Emergency (PHE) that was released on September 8? What does it include, and how and when can we use it?

Delaware Subscriber

Answer: The American Medical Association (AMA) introduced 99072 (Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease) “in response to the significant additional practice expenses related to activities required to safely provide medical services to patients in person during a PHE over and above those usually included in a medical visit or service,” according to the 2020 Special Edition September Update of CPT^® Assistant (Source: https://www.ama-assn.org/system/files/2020-09/cpt-assistant-guide-coronavirus-september-2020.pdf).

The AMA goes on to say that the code “accounts for additional supplies, materials, and clinical staff time required for patient symptom checks over the phone and upon arrival, donning and removing personal protective equipment (PPE), and increased sanitation measures to prevent the spread of communicable disease.” The code, which can only be used in a “non-facility place of service (POS) setting,” will enable you to document such expenses as:

• Any time beyond the time for the primary service spent by clinical staff (such as registered nurses [RNs], licensed practical nurses [LPNs], or medical technical assistants [MTAs]) in screening the patient for symptoms, both over the phone before the visit and/or at the beginning of the visit, instructing the patient on office PHE protocols, applying and removing PPE, and sanitizing the visit room and any equipment or supplies used after the patient’s departure;
• Three surgical masks; and
• Any supplies used in the sanitizing process, “including additional quantities of hand sanitizer and disinfecting wipes, sprays, and cleansers.”

The CPT^® Assistant Special Edition is vague regarding the code’s documentation requirements, stating only that they “may vary among third-party payers and insurers,” and that those payers “should be contacted to determine their specifications.” The AMA also makes no mention of the code’s relative value units (RVUs) or whether it has a dollar value. Note, however, that Cigna and many Blue Cross/Blue Shield plans have stated they will not reimburse for this new code. For instance, Cigna states “Cigna does not provide additional reimbursement for PPE-related costs, including supplies, materials, and additional staff time (e.g. CPT^® code 99072), because office visit (E&M) codes include overhead expenses, such as necessary personal protective equipment (PPE). Separate codes providers may use to bill for supplies are generally considered incidental to the overall primary service and are not reimbursed separately. Contracted providers can’t balance bill customers for non-reimbursable codes.”

Finally, the CPT® Assistant Special Edition notes the code may only be used:

• During a PHE, such as the current COVID-19 PHE, which is “in effect when declared by law by the officially designated relevant public health authority(ies)”; and

“With an in-person patient encounter for an office visit or other nonfacility service in which the implemented guidelines related to mitigating the transmission of the respiratory disease for which the PHE was declared are required.”