Special COVID Laboratory Specimen Coding Information

April 21st, 2020 - Wyn Staheli, Director of Research
Categories:   HCPCS Coding   Documentation Guidelines   Covid-19  
0 Votes - Sign in to vote or comment.

With all the new laboratory test codes that have been added due to the current public health emergency (PHE), there are a few additional guidelines CMS has released about collecting samples to perform the testing. Please keep in mind that these guidelines are by CMS and may or may not apply to other commercial payer policies.

Specimen Collection Coding

During this PHE, for their own safety or the safety of others, patients are confined to their homes to minimize the risk of exposure. Therefore, in order to obtain testing, new codes and methodologies have been put into place.

To report the collection of a specimen for COVID-19 testing, report one of the following codes (as applicable):

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

G2023 - any specimen source

G2024 - from an individual in an SNF or by a laboratory on behalf of an HHA, any specimen source

Additionally, if a patient is homebound (see definition below), a healthcare provider will need to travel in order to obtain the specimen. To report travel incurred obtaining a specimen, report one of the following codes (as applicable):

Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; 

P9603 - prorated miles actually travelled

P9604 - prorated trip charge

CMS Definition of Homebound

According to the “Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency” Final Rule, “the definition of ‘confined to the home’ (that is, ‘homebound’) allows patients to be considered 'homebound' if it is medically contraindicated for the patient to leave the home.” They gave the following examples during this PHE:

  1. A physician has determined that it is medically contraindicated for a beneficiary to leave the home because he or she has a confirmed or suspected diagnosis of COVID-19
  2. A physician has determined that it is medically contraindicated for a beneficiary to leave the home because the patient has a condition that may make the patient more susceptible to contracting COVID-19.

It should be noted that CDC guidelines specifically advise older individuals to stay at home, except for getting medical care. So older adults who are self-quarantining on their own — meaning that they have not been instructed by a healthcare provider to do so — would not be considered homebound for Medicare purposes unless “...there exists a normal inability for an individual to leave home and leaving home would require a considerable and taxing effort.” 

Documentation of Laboratory Specimen Collection of Homebound Patient

It is necessary that the documentation clearly identifies how the patient meets the “homebound” requirement; however, CMS has noted “that paper documentation of miles traveled is not required and laboratories can maintain electronic logs with that information.” 

###

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)

How to Combat COVID-Related Risk Adjustment Losses with the Medicare Annual Wellness Exam
April 12th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Identifying new ways to encourage Medicare beneficiaries to schedule and attend their Annual Wellness Exam (AWE) can be difficult, but the Open Enrollment period is a prime time for every payer to identify new beneficiaries and provide a reminder to both new and existing patients that this preventive service does ...
Failure to Follow Payer’s Clinical Staff Rules Costs Provider $273K
April 12th, 2021 - Wyn Staheli, Director of Research
Clinical staff (e.g., LPN, RN, MA) provide essential services which allow providers to leverage their time and improve reimbursement opportunities and run their practices more efficiently. There is, however, an ongoing question of how to appropriately bill for clinical staff time. This is really a complex question which comes down to code descriptions, federal or state licensure, AND payer policies. Failure to understand licensing and payer policies led a Connecticut provider organization down a path that ended in a $273,000 settlement with both federal and state governments.
Properly Reporting Imaging Overreads (Including X-Rays)
April 8th, 2021 - Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research
hile many provider groups offer some imaging services in their offices, others may rely on external imaging centers. When the provider reviews images performed by an external source (e.g., independent imaging center), that is typically referred to as an overread or a re-read. Properly reporting that work depends on a variety of factors as discussed in this article.
How Social Determinants of Health (SDOH) Data Enhances Risk Adjustment
March 31st, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
The role of SDOH in overall patient care and outcomes has become a more common topic of discussion among healthcare providers, payers, and policymakers alike. All are attempting to identify and collect SDOH and correlate the data to patient management which is increasingly seen as necessary to address certain health disparities and identify exactly how SDOH affects patient health outcomes. Learn how to address this important subject.
Understanding Skin Biopsy Codes
March 23rd, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
A biopsy is a procedure to obtain only a portion of a lesion for a pathologic exam. According to the AMA, "The use of a biopsy procedure code (e.g., 11102, 11103) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other ...
How Reporting E/M Based on Time May Lose Money
March 18th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...
COVID-19 Vaccines
March 10th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
To accommodate the new COVID-19 immunizations the CPT editorial panel has approved 11 Category I codes. Watch for new and revised guidelines and parenthetical notes with these codes. For example; which administration codes should be used with the vaccine codes and the NCD codes applicable to the dose being administered. These ...



Home About Contact Terms Privacy

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

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association