News Alert: Two New CPT® Codes Effective Immediately

Reimbursement has not been established at this time.

The American Medical Association (AMA) CPT® Editorial Panel has revised one code and created two new codes to provide more specificity for serology laboratory testing.  

The codes, which were published on April 10, are effective immediately. Reimbursement has not been established for the Centers for Medicare & Medicaid Services (CMS), and providers should contact commercial carriers regarding their reimbursement.

CPT 86318 has been revised to include testing for multiple infectious agent antibodies, single-step method (e.g. reagent strip). The two new codes are 86328 and 86769. CPT 86328 is a child code of 86318. The description for this code is severe acute respiratory distress coronavirus (SARS-CoV2) (COVID-19). There is an instructional note that for COVID-19 testing using the multiple-step method, use 86769, which is the second new code. This code has an instructional note that if you are performing COVID-19 antibody testing using a single-step method, use 86328.

A clinical example for 86328 is a 67-year old woman with a history of diabetes and hypertension, presenting to the emergency department with a five-day history of a non-productive cough and a low-grade fever. A COVID-19 antibody test using reagent strip was ordered. The patient’s blood or serum is collected.

A clinical example for 86769 is a 68-year old male with coronary artery disease, previous aortic valve replacement, and lymphoma, who presents to the emergency department with a six-day history of malaise, a non-productive cough, and low-grade fever. COVID-19 IgG and IgM antibody tests were ordered. Serum and plasma are collected. 

Questions and answers published with these new codes include the following:

• What is the difference between 87635 (another recently created CPT) and these new codes? 87635 was created for respiratory specimens, while the new codes are used for serology testing.
• What if the reagent strip provides analysis for two antibody classes on a single-step method; does 86328 get reported twice? No, 86328 should be reported per reagent strip.
• If two reagent strips are used in two separate single-step assays, would 86365 be reported for each assay? Yes, 86328 is reported for each reagent strip. Modifier -59 may be appended to the second code to communicate that separate tests were performed.

There are more questions published on the AMA website, and the link is listed in the resources.

Providers have an opportunity to ask questions about COVID-19 by listening to the CMS Office Hours on COVID-19; this conference call will be conducted on April 14 from 5-6 p.m. at 833-614-0820, with passcode 2395745.

Resources: 

https://www.ama-assn.org/press-center/press-releases/ama-announces-expedited-updates-cpt-covid-19-antibody-tests 

For all matters related to COVID-19, you can use this URL: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page. This page contains coding advice, updates to regulations, and pricing information.