Otolaryngology Coding Alert

Question: We have an existing patient presenting to our office for a COVID-19 nasal swab test. She has an upcoming functional endoscopic sinus surgery (FESS) and the facility requests that we rule out a COVID-19 diagnosis prior to her scheduled date. What ICD-10-CM and CPT® codes need to be reported?

Tennessee Subscriber

Answer: You’d need more information in order to code the diagnosis portion of this encounter correctly. Assuming the patient has no symptoms and has no known exposure to COVID-19, you’d report Z11.59 (Encounter for screening for other viral diseases) as the primary diagnosis and Z01.818 (Encounter for other preprocedural examination) as a secondary diagnosis. Assuming there were no evaluation and management (E/M) services performed outside of the nasal swab, you will report code 99211 ((Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician…)), as per AMA guidelines.

You can access a helpful AMA flow chart on how to handle the coding processes for COVID-19 nasal swab and testing claims here: https://www.ama-assn.org/system/files/2020-05/cpt-reporting-covid-19-testing.pdf.