New CPT® Codes Approved for COVID-19 Antibody Identification

April 15th, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Categories:   CPT® Coding   Billing   Cardiology|Vascular   Emergency Medicine   ENT|Otolaryngology   Gastroenterology   Home Health|Hospice   Internal Medicine   Laboratory|Pathology   Oncology|Hematology   Pulmonology   Skilled Nursing   Reimbursement   Covid-19  
0 Votes - Sign in to vote or comment.

On April 10, 2020, the American Medical Association approved and published a revision of code 86318 and added two new codes 86328 and 86769 for reporting Coronavirus [COVID-19] antibody testing. The descriptions for these codes are as follows: 

86318  Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip);

86328        ; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)(Coronavirus disease [COVID-19])

86769   Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)(Coronavirus disease [COVID-19])

The revision changes 86318 to a parent code describing single-step antibody testing (e.g., reagent strip). It then lists beneath it 86328 to identify single-step antibody testing (e.g., reagent strip) specific to SARS-CoV-2 or the Coronavirus [COVID-19] antibodies. Code 86769 was added to report a multi-step, more in-depth test for the same antibodies. 

To clarify, antigens are the unique molecules of pathogens (e.g., bacteria, viruses). When a virus enters the body the immune system signals antibodies (a protein produced mostly by plasma cells) to attach themselves to the antigens and systematically destroy them. Immunoglobulin G (IgG) and immunoglobulin M (IgM) are two known antibodies that when present in testing provide information on what is occurring in the body. IgG is found in all bodily fluids and protects against infections while IgM is found mostly in lymphatic fluids and blood serum or plasma and is the first antibody made by the body to fight off a new infection. The presence of these antibodies helps identify a positive COVID-19 result. 

The two most recent codes the AMA approved for this type of testing include: 

86328, which uses a blood serum or plasma sample that is placed into a single well on a reagent strip with controls for IgG and IgM. The result is read optically (visually) and recorded in the patient’s medical record.

86769, which uses a blood serum or plasma sample that is placed into a multi-well plate that is incubated and washed. It then has IgG and IgM antibodies added, and is incubated again before finally being measured using a microtiter plate reader. The results of this test are measured and require interpretation and a separate report by a physician.

Antibody testing is not the only method used for identifying a patient infected with SARS-CoV-2. Another new code that was approved for reporting and became effective on March 13, 2020, is:

87635  Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

This type of testing includes reverse transcription quantitative polymerase chain reaction (RT-qPCR) or amplified probe technique. In order to perform the test, a sample from the nasopharyngeal or oropharyngeal area must be collected, which is done by inserting a long cotton swab into the area where the nose meets the throat (nasopharyngeal space) and swabbing the area to collect viral RNA cells for testing. This method, although noninvasive (not cutting into the body), is very uncomfortable for the patient. 

Due to the virus’ atypically long incubation period (the time from exposure to becoming symptomatic), nasopharyngeal swab testing hasn’t necessarily been the best testing method. Consequently, a number of “false negative” test results have occurred due to:

  • the timing of the test (start of the infection vs. onset of symptoms)
  • the sampling technique used (which varies from nurse to nurse), and 
  • whether or not enough viral RNA was collected for the test

While these testing methods (87635, 86328, 86769) are all different, sometimes a combination of them is required to ensure accurate test results. As with any new codes added during the year, they will not be included in the current (2020) CPT® codebook but will be in the 2021 edition. Please note that code 87635 was effective as of March 13, 2020, but revised code 86318 and new codes 86328 and 86769 are effective as of  April 10, 2020. 

The AMA has provided clinical examples for the use of these codes in their “CPT Assistant Special Edition” and “CPT Assistant Special Edition: April Update,” which are useful in ensuring proper code assignment. Also, don’t forget to assign the proper ICD-10-CM codes as well, which is discussed in the article “Understanding the New Codes for Testing & Reporting COVID-19 Coronavirus (SARS-CoV-2)” and “ICD-10-CM Official Coding and Reporting Guidelines UPdated for COVID-19.”

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Important Podcast on Dental to Medical Billing
September 21st, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Be sure and check out this discussion with LaMont Leavitt (CEO of innoviHealth) and Christine Taxin (Adjunct professor at New York University, President of Dental Medical Billing, and Links2Success).  Some of the resources and tools they discuss will help you with your dental coding/billing and education. Do You Have All the Right ...
More COVID-19 Codes Added as of September 8, 2020
September 15th, 2020 - Wyn Staheli, Director of Research
The American Medical Association (AMA) recently announced the addition of two more CPT codes in relation to COVID and the Public Health Emergency (PHE). Codes 99702 and 86413 were posted to the AMA website on Tuesday, September 8, 2020 and new guidelines have been added as well.
Not Following the Rules Costs Chiropractor $5 Million
September 1st, 2020 - Wyn Staheli, Director of Research
Every healthcare office needs to know and understand the rules that apply to billing services and supplies. What lessons can we learn from the mistakes of others? What if we have made the same mistake?
New Value-Based Payment Models for Primary Care (Primary Care First and Direct Contracting)
August 28th, 2020 - Jared Staheli
This article summarizes the new Medicare value-based payment models: Primary Care First and Direct Contracting.
Podcast - Do you have all the right Dental resources needed to succeed in Dental Medical Billing and Coding?
August 27th, 2020 - Innoventrum
Discussion between innoviHealth CEO, LaMont Leavitt and Guest speaker, Christine Taxin who is an Adjunct professor at New York University, and President of Dental Medical Billing and Links2Success about making sure you have all the right Dental resources needed to succeed in Dental Medical Billing and Coding. ...
Is COVID-19 Causing Risk Adjustment “Gotcha’s”?
August 27th, 2020 - Wyn Staheli, Director of Research
The COVID-19 public health emergency (PHE) has created some possible problems when it comes to risk adjustment. Be sure your organization has implemented policies and procedures to try and overcome these new hurdles.
New and Exciting Changes in the Dental Industry
August 26th, 2020 - Christine Taxin - Links 2 Success
My colleagues and I are nerds for information on all things billable—or not billable—in the worlds of dental and medical insurance. One of the most puzzling challenges for me over the past 15 years of teaching has been to understand why we on the dental side are segregated out of ...



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2020 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association