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Newly Released CPT Code for Coronavirus Lab Test Helps Track the Virus

The sudden appearance of the novel coronavirus SARS-CoV-2 and rapid spread of the disease it causes in humans, COVID-19, required the immediate development of a test to confirm the presence of the coronavirus—which of course means modifications have to be made throughout the medical documentation system, including how hospitals and labs get reimbursed for performing the tests.

In early February, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for a test panel so that testing could immediately begin. The Centers for Medicare & Medicaid Services (CMS) created a medical billing code in the Healthcare Common Procedure Coding System (HCPCS).

Effective March 13, 2020, the AMA Current Procedural Terminology (CPT) Editorial Panel has adopted a new code for the SARS-CoV-2 tests.

The New CPT Code Must Be Added Manually

Healthcare facilities providing testing will need to manually add the new code to their EHR systems immediately, though it will be part of the official CPT code set for 2021.

The CPT code is 87635 and the three different descriptors can be found at these links on the AMA website:

An AMA Fact Sheet, Reporting Severe Acute Respiratory Syndrome Coronavirus SARS-CoV-2) Laboratory Testing, provides a description of how the test is to be done and the reporting that goes along with the use of the test.

The fact sheet also answers questions about the difference between existing CPT codes for coronavirus and the use of HCPCS codes versus the new CPT code.

The CPT Code Facilitates Reporting

In a pandemic, such as the one currently being caused by SARS-CoV-2, fast action is necessary to control the spread of disease and provide medical care for those afflicted. This means that when lab test panel results are positive, or even inconclusive, authorities need to know right away.

In a press release, the president of the AMA, Patrice A. Harris, M.D., M.A., described its importance this way: “By streamlining the flow of information on novel coronavirus testing, a new CPT code facilitates the reporting, measuring, analyzing, researching, and benchmarking that is necessary to help guide the nation’s response to the public health emergency.”

Fast Action Minimizes Spread of Disease

COVID-19 is extremely contagious and typically has an incubation period of about 5 days. Since the symptoms are mild initially, it may be another week before the person goes to the doctor. The virus is highly communicable during that period, so an infected person is likely to be spreading the virus to everyone they are in close contact with for up to two weeks before they seek medical care.

The simplest example of how reporting can help is that when a positive test result is reported, it lets authorities know that the virus has entered the area, so they can isolate the carrier and find out who they may have spread it to. By contacting those people and having them self-isolate, the cycle can be broken and the exponential increase in the number of affected people can be slowed down.

Asking general populations to isolate as much as possible is a protective measure that has been put in place across the country, but when test results indicate that the spread is rapid, mandatory isolation may need to be put in place. Having immediately accessible test results can help reduce the number of people infected in the area and keep the coronavirus disease to a minimum.

If you have questions about medical billing, give us a call at 800-640-6409. Medcare MSO has a large staff of experienced medical billers and we are happy to help.

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