Urology coding Q&A: Is CPT code 99072 being paid?

Jonathan Rubenstein, MD
Jonathan Rubenstein, MD

Rubenstein is compliance officer and medical director of coding and reimbursement, United Urology Group and Chesapeake Urology, in Towson, Maryland.

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Mark Painter
Mark Painter

Mark Painter is CEO of PRS Urology SC in Denver.

"Unfortunately, we have found that most if not all insurers do not pay for this code and additionally often have policies against charging patients for extra supplies, and balance billing would be a violation of their contract," write Jonathan Rubenstein, MD, and Mark Painter.

In your article “What to know about COVID-19 CPT code 99072 for your urology practice”1, you stated, “You do not need to link the code to a particular diagnosis code such as ICD-10-CM U07.” Would you expound on that?

CPT code 99072’s description reads, “Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s), when performed during a public health emergency, as defined by law, due to respiratory-transmitted infectious disease.” As of the writing of this article, the current coronavirus disease 2019 (COVID-19) public health emergency is set to expire on April 21, 2021. CPT code 99072 can be linked to any international classification of diseases (ICD)-10 code used for the office or other outpatient evaluation and management service or other urology CPT code; it does not have to

be linked to an ICD-10 code specific for a virus. The code was developed to help physicians offset the costs of supplies, time, and overhead required for all patients coming to the office during the pandemic.

Unfortunately, we have found that most if not all insurers do not pay for this code and additionally often have policies against charging patients for extra supplies, and balance billing would be a violation of their contract. You may attempt to report the code if your office is taking extra steps and purchasing extra supplies to maintain COVID-19-safe protocols; however, you may find that payers not only will not pay but may not process claims with this code reported. If you have already attempted to report the code and have not been reimbursed or seen rejections of claims outright, the problem is not diagnosis code-related but related to the status of the code for the payer, usually bundled.

Reference

1. Rubenstein J, Painter M. What to know about COVID-19 CPT code 99072 for your urology practice. Urology Times®. October 14, 2020. Accessed January 12, 2021. http://bit.ly/3bAsxbQ

Send coding and reimbursement questions to Rubenstein and Painter c/o Urology Times®, at urology_times@mmhgroup.com.

Questions of general interest will be chosen for publication. The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.