Wiki Antibody Testing E/M Coding

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What E&M service are your providers performing for this, and why? I guess a level would depend on what is documented. Ordering an antibody test for an asymptomatic patient doesn't require an evaluation of any kind that I'm aware of. And if the patient has no complaints, I'm not sure how you could support the medical necessity of an HPI, exam and MDM for an E&M service of any level. Are they being evaluated due to suspected exposure? That would be a different issue, but even so, the code would follow from the documentation, not from the reason for the encounter.
 
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Thomas your response is exactly how I am feeling about a topic that was brought up recently in the clinic I work for.

The question was raised of if we could bill for collecting a COVID19 sample for testing if the reason was strictly for peace of mind. There is no medical necessity for the test, just purely peace of mind.

My opinion is that no we can not since there is no medical necessity. It wouldn't fit to bill a 99211, and if you bill the 99000 for collection to be sent to an outside lab what would you use for a diagnosis?
From what I read recently the use of Z11.59 is inappropriate since we are currently in a health crisis. ICD-10-CM guidelines say that we should be using Z20.828 on all testing because the provider who ordered it must believes the patient must have been potentially exposed. In fact the new FY 2021 guidelines say this specifically.

So what would you use for a diagnosis for a visit that didn't have a medically necessary reason to occur? Z71.1? But again, it is all patient driven.
 
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Whether or not a service is medically necessary is going to be a matter of opinion on the part of the provider and/or the payer - it should not affect how you code. You wouldn't just not bill a service due to lack medical necessity, although there is a likelihood the payer may elect to deny it for that reason. So your code has to be chosen just based on the provider's documentation of the stated reason for the visit - you'll choose the code that best fits what was documented - the question of medical necessity question is a separate one that won't change the code choice.

The problem with assigning an E&M code though is that the standard office visit codes 99201-99215 require that there be a problem that is being evaluated. If the patient is presenting without symptoms or for evaluation of an existing condition, then these codes aren't really appropriate, because there is no 'problem' to drive the coding of the visit, to support a reason for taking a history or doing an exam. If the provider is insisting on offering an E&M service for which there was no reported problem (and which is not a routine physical, counseling visit or other preventive service that does have a code) then your best bet is probably the unlisted code 99499.

I agree with you on the use of Z20.828 - I have also seen guidance that testing for COVID-19 during a pandemic warrants this code rather than a screening code since there is a presumption of exposure in this unique situation. However, for antibody testing, I think Z01.84 is the most appropriate diagnosis since the aim is not to detect or rule out disease but rather to test for possible immunity.
 
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dcastellano said:
Can anyone tell me what your providers are coding for new patients e/m levels with no complaints. Thanks.
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Code Z01.84 is correct for the antibody testing as Thomas noted. For patients who have recovered from COVID-19 (including any diagnosed via telehealth when testing was not available), report follow-up (Z09) and history (Z86.19).
Best wishes,
Cindy
 
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