b'month. You could then divide this amount by the averagetime over and above those usually included in an office number of patient visits per month and use that as a basis forvisit or other non-facility service(s), when performed during your charge. You could also make similar calculations baseda Public Health Emergency (PHE) as defined by law, due on additional staff time needed to review the new protocolsto respiratory-transmitted infectious disease). However, with patients, perform temperature checks, ask COVIDsubmitted code (99072) was changed by Insurance related questions and/or file forms with such questions thatCarrier XYZ to CPT code 99199 and subsequently patients fill out as well as larger expenditures such as new denied. CPT 99199 (defined as: unlisted special service, or updated air filtration systems, new plexiglass or otherprocedure or report) is not the code that was billed by barriers, etc.our office and does not accurately reflect the services performedAdditional coding guidelines for 99072: 4. Provide as much referenced data as possible to back upThe time counted in any other time-based visit or service your appeal. Include authorities such as the AMA and during the same encounter cannot be counted twice toCMS in your response. For example: According to The report this code. American Medical Association (AMA), the Current Proce- You may report 99072 only once per in-person patientdural Terminology (CPT) Editorial panel on Septemberencounter per Provider Identification Number (PIN). 8, 2020 approved and released CPT code 99072 inYou do not need to link the code to a particular diagnosisresponse to the COVID-19 pandemic. New code 99072 was established to report additional practice expenses code such as ICD-10-CM U07.1 COVID-19. incurred during a Public Health Emergency (PHE),You may report 99072 with an evaluation and management including supplies and additional clinical staff time. (E/M) service or procedure even if it is not PHE-related.If you can, include specific citations, including page (although a PHE must be declared in effect at the time ofnumbers, etc. For your reference, here is the AMAs CPT service) Assistant Special Edition on 99072: www.ama- For more detailed information regarding this new code pleaseassn.org/system/files/2020-09/cpt-assistant-guide- see the AMA-CPT Assistants September Special Editioncoronavirus-september-2020.pdfUpdate:www.ama-assn.org/system/files/2020-09/cpt-5. You can also point out that CPT codes, HCPCS codes assistant-guide-coronavirus-september-2020.pdf and ICD-10 codes have all been adopted as federal We have received many inquiries regarding how to bestlaw and the codes and their definitions must be appeal denials of the new CPT code 99072 which wasacknowledged by all HIPAA covered entities, which established to account for additional supplies and staff timeof course include insurance companies. For example: needed due to a public health emergency.Under the HIPAA Transaction and Code Set standards, ANJCs Coding and Compliance Consultant Dave Klein hasInsurance Carrier XYZ is obligated to utilize the AMAs put together the following tips for preparing an appeal on thisCurrent Procedural Terminology (CPT) codes when code.adjusting health care service claims of its insureds. See, 45 C.F.R.162.925(c)(1) which requires health plans Depending on the type of appeal I would include such as Insurance Carrier XYZ to accept and promptly these key points: process standard transactions containing the restricted 1. Make sure to include the following information:code sets. RE: Denial CPT Code 99072 6. Always provide a conclusion that outlines your request,Claim Number for example: Based on the above, please reprocess claim# ___ dated __/__/2020 for the above namedPatient Name patient with the correctly submitted CPT code 99072. DOS: __/__/202_ 7. Make sure to leave your contact information andProvider Name telephone number where someone can reach you withNPI Number questions or follow-up.2.Include language that identifies the specific reason/issuePersistence is key, and you will not win all appeals. for appeal, for example: Please accept this as a formalRemember, while payers must follow coding rules, they are appeal for the denial of CPT code 99072 regarding claim#at liberty to make up their own reimbursement policies. For 12345, date of service __/__/2020. this reason, you might want to warn your patients that they will be responsible for any fees not covered by the payer 3. Provide an overview of the argument and why you feeland get this in writing, similar to a Medicare ABN form.the code should not be denied, for example: For dateAlso, be sure to check the details of your participating of service, __/__/2020 our office billed CPT code 99072provider agreement if you are in-network with the patients (defined as: Additional supplies, material, and clinical staffcarrier to see if charging the patient is allowed. www.njchiropractors.com I 11'