Otolaryngology Coding Alert

Question: If a provider has a telehealth visit with a patient and the patient is then instructed to come to the office for a COVID-19 swab, does that qualify for 99211 or just the prep and handling code for a send-out specimen?

New York Subscriber

Answer: Per the flow chart at www.ama-assn.org/system/files/2020-05/cpt-reporting-covid-19-testing.pdf, here’s how the American Medical Association (AMA) says you should report this encounter using CPT^® codes:

First, report the telehealth visit, adding modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) and the place of service (POS) for the location where the visit would have occurred otherwise (e.g. POS 11 for “Office”) for Medicare claims. Note that you can do this for the duration of the public health emergency (PHE); pre-pandemic, Medicare required you to report a telehealth visit with POS 2 (Telehealth). This could change back once the PHE is lifted.

Next, report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. …) for the swab collection, appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) if the collection occurs on the same day as the telehealth visit.

Finally, report 99000 (Handling and/or conveyance of specimen for transfer from the office to a laboratory) if you incur any costs in preparing or delivering the specimen to the lab.

Note that Medicare doesn’t separately pay for 99000, considering payment for it to be bundled in with the payment made for other services. Also note that commercial payers may not follow these reporting procedures.