CPT code 99072 was created in response to extra medical practice expenses associated with patient care during the pandemic.
What is the story with the new CPT code 99072?
Jonathan Rubenstein, MD
Payment for the typical resources, supplies, and clinical staff time and effort is included in the value of evaluation and management (E/M) visits and other medical visits. However, up until now there was no code available that could be used to report the additional expenses incurred by practices for the extra supplies, materials, and clinical staff time needed to mitigate the transmission of coronavirus disease 2019 (COVID-19).
CPT code 99072 was created by the CPT Editorial Panel in response to these extra practice expenses associated with patient care during the Public Health Emergency (PHE). Practices can use CPT 99072 to report the additional materials, such as extra cleaning supplies; face masks; personal protective equipment; thermometers; and clinical staff time, including, but not limited to, previsit instructions and office arrival symptom checks, that support the safe provision of
evaluation, treatment, or procedural service during this unprecedented time. Practices may use this code in conjunction with office visits and other nonfacility services when the office visit or other nonfacility services are rendered during the PHE, as defined by law, if the practice itself incurs such expenses. Unless extended, the current PHE for COVID-19 is scheduled to expire on October 25, 2020.
When reporting CPT code 99072, practices should report the code only once per in-person patient encounter per day regardless of the number of services rendered at that encounter. Code 99072 may be reported during a PHE when the additional clinical staff duties as described are performed by the physician or other qualified health care professional in lieu of clinical staff.
Use CPT 99072 only when safety measures are over and above those usually included during an office visit or service, as opposed to CPT code 99070, which covers supplies, materials, and time used during a typical office visit.
Additional coding guidelines for 99072 include the following:
• The time counted in any other time-based visit or service during the same encounter cannot be counted twice to report this code.
• You do not need to link the code to a particular diagnosis code such as ICD-10-CM U07.1 COVID-19.
• You may report 99072 with an E/M service or procedure even if it is not PHE-related.
• You may report 99072 only once per in-person patient encounter per Provider Identification Number (PIN).
Note that, as of this writing, there has been no definitive payment for CPT code 99072, so it is important that physicians check with their Medicare contractors and insurance carriers.
Send coding and reimbursement questions to Rubenstein and Painter c/o Urology Times®, at firstname.lastname@example.org.
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.