Wiki Pre-op COVID swab coding

[shayla22]

We are aware of the guidance from Medicare to bill CPT 99211. However, I posed the question to my supervisor about commercial payers. She does not like billing the CPT 99211 for the swab at all because the documentation does not support an e/m service. She states, "If you do not take vitals, you do not document any elements of history, you do not do an exam, you do not provide medical advice (counseling/education), what are you documenting for E/M 99211?" I say due to the pandemic there is a lack of available codes to bill for the circumstance and I believe that is why Medicare has also advised this. The documentation we have in the encounter note is as follows:
Provider: Dr. A
Chief Complaint: Established Patient
Covid swab. Having surgery by Dr. B on Monday.
HPI: COVID preop testing
Assesment/ Plan: COVID preop testing, tonsillectomy and adenoidectomy scheduled for next week
1. Hypertrophy of tonsils
J35.1: Hypertrophy of tonsils
PRE-SURGERY SCREENING
Signed by Provider A

Please provide some references and advice on what would be best to bill in the circumstance.
Thank you.

 

[Kristen Bensel]

99211 does not have the same documentation restrictions that the 99212-99215 have. It does not require the HPI, Exam and MDM like the others.

 

[imeza]

We are aware of the guidance from Medicare to bill CPT 99211. However, I posed the question to my supervisor about commercial payers. She does not like billing the CPT 99211 for the swab at all because the documentation does not support an e/m service. She states, "If you do not take vitals, you do not document any elements of history, you do not do an exam, you do not provide medical advice (counseling/education), what are you documenting for E/M 99211?" I say due to the pandemic there is a lack of available codes to bill for the circumstance and I believe that is why Medicare has also advised this. The documentation we have in the encounter note is as follows:
Provider: Dr. A
Chief Complaint: Established Patient
Covid swab. Having surgery by Dr. B on Monday.
HPI: COVID preop testing
Assesment/ Plan: COVID preop testing, tonsillectomy and adenoidectomy scheduled for next week
1. Hypertrophy of tonsils
J35.1: Hypertrophy of tonsils
PRE-SURGERY SCREENING
Signed by Provider A

Please provide some references and advice on what would be best to bill in the circumstance.
Thank you.

Who are you using as the billing provider for the specimen collection? Is it the provider who will do the surgery or a prover overseeing the department? Any information would help.