CPT Code

The current procedural terminology (CPT) code has been published by an AMA update which includes new vaccine-specific codes to report immunizations for the new coronavirus, SARS-CoV-2, that are unique to the COVID-19 vaccine under development by Janssen Pharmaceutical, a division of Johnson & Johnson. 

There are two coronavirus vaccine CPT Codes approved by the American Medical Association, 91300 and 91301. These two codes are used to better track, report, and analyze data for coronavirus vaccine planning and distribution. They are made by Pfizer and Moderna and both require two doses.

The CPT Editorial panel has worked closely with the centers for Disease Control and Prevention and approved a unique CPT code for each of four coronavirus vaccines- others from Pfizer-BioNTech and Moderna that have been authorized in the U. S together with the vaccine candidates made by Johnson & Johnson and AstraZeneca- also administration codes are unique to such vaccine. 

Four vaccine administration codes have also been added: 0001A, 0002A, 0011A, and 0012A. These administration codes are specific to each of the two vaccines, and whether it is the first or second dose given to the patient.

Here we show category I CPT codes and long descriptors for the vaccine products;

CPT Codes for Corona Vaccine

• 91300: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosages, diluent reconstituted, for intramuscular use.
• 91301: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL dosages, for intramuscular use.
• 91302: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative-free, 5×1010 viral particles/0.5mL dosage, for intramuscular use.
• 91303: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative-free, 5×1010 viral particles/0.5mL dosage, for intramuscular use.

COVID-19 Vaccine Administration Codes 

The COVID-19 vaccine administration codes are specific to the coronavirus vaccine and dosage. These are responsible to report the work of administering the vaccine, counseling the patient or caregiver, and documenting the medical record. 

0001A

The 0001A COVID-19 vaccine administration CPT code is for the first dose of the Pfizer vaccine only. Administration of immunization by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosages, diluent reconstituted; first dose. 

0002A

The 0002A COVID-19 vaccine administration CPT code is for the second dose of the Pfizer vaccine only. Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosages, diluent reconstituted; second dose.

0011A

The 0011A COVID-19 vaccine administration CPT code is for the first dose of the Moderna vaccine only. Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease vaccine, mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL dosages; first dose.

0012A

The 0012A COVID-19 vaccine administration CPT code is for the second dose of the Moderna vaccine only. Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease vaccine, mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL dosages; second dose.

How To Bill For The COVID-19 Vaccine?

Just like billing of various specialties, proper medical billing for the Coronavirus vaccine also important for reimbursements and governmental reporting purposes. 

Every coronavirus vaccine has its own specific CPT code based on the vaccine manufacturer (Pfizer or Moderna). Moreover, the vaccine administration code highly depends on the manufacturer plus the number of doses. 

It is important to note that when you are submitting claims only vaccine administration codes are bill. You can’t include the vaccine CPT codes when the coronavirus vaccines are free. 

Thinking about how you can bill for the Pfizer COVID-19 vaccine? Here is an example 

For Pfizer First Dose:

To bill COVID-19 Vaccine first dose that is 91300 (Vaccine CPT), administrative 0001A, and ICD-10: Z23 is used.

For Pfizer 2nd Dose:

To bill COVID-19 Vaccine first dose that is 91300 (Vaccine CPT), administrative 0002A, and ICD-10: Z23 is used (only administrative code is changed).

For Moderna First Dose:

To bill Moderna first dose vaccine CPT: 91301, Administration: 0011A, and ICD-10: Z23 are used.

For Moderna 2nd Dose:

To bill Moderna first dose vaccine CPT: 91301, Administration: 0012A, and ICD-10: Z23 are used.

How will the COVID-19 vaccine be reimbursed?

The Coronavirus vaccine is provided by the Federal Government when it first comes out. As a result, there will be no reimbursement for the vaccines themselves. However, CMS has proposed reimbursement rates; for the first dose: $16.94 and $28.39 is for 2nd dose.

Need more updates about COVID-19 reimbursement? Then call our experts at +1 888-598-9181.

Radiology CPT coding changes for 2021 have been released. There are changes in radiology coding that the American Medical Association is prepared to make, as they do every year. Some codes are removed and some are added or revised to reflect current practices, technologies, and services. 

In 2021, there are very few changes to radiology coding. The new radiology codes assigned are also limited. The most significant change in CPT 2021 that affects radiology falls under the changes to the Evaluation and Management guidelines. Other changes affecting the practice of radiology are minimal.

It is crucial to understand the new codes in to get efficient reporting and proper reimbursements. For this reason, most radiology practices prefer to outsource their medical billing and coding to an experienced and skilled medical service provider.

In this blog, we’ve covered the major changes that most often affect the practice of radiology. Let’s have a look!

Evaluation & Management

There are significant changes that occurred to the Evaluation and Management codes for and other outpatient visits. 

These revisions are the result of burdensome documentation and administrative complexities with previous CPT coding guidelines and code descriptions.  

These revised codes and coding guidelines should reduce unnecessary documentation requirements and allow for resource management in reporting these visits.

Both the and exam portions of the visit should be documented as “medically appropriate” while not involved in the calculation of code selection. As a result, we see a consistency between the documented level of care and the patient’s documented . 

Moreover, it is important to know that CPT 99201, the lowest level new patient visit option has been deleted for 2021. All the new patients should be stated under 99202-99205 and the patient who is established would be reported with 99211-99215. 

Revised

99202 – For Evaluation and management of a new patient ( or another outpatient visit), which requires a medically appropriate and examination or straightforward medical decision making. Especially using time for code selection, 15-29 minutes of the total time is spent on the date of the encounter.

99203 – Not so much change in it. Same as code 99202. However, there’s been an addition of 30-44 minutes of total time spent on the date of the encounter.

99204 – Again no significant change in it. An addition of 45-59 minutes of the total time is spent on the date of the encounter. 

99205 – Once again not so much change, Just an addition of 60-74 minutes total time is spent on the date of the encounter.  

Moreover, the 99211 code is used for the evaluation and management of an established patient ( or another outpatient visit). This is for those who may not need the presence of a physician or any other qualified healthcare professional. Mostly, their presenting problems are minimal 

On contrary to those established patients who require a medically appropriate or examination and straightforward medical decision making. When using time for code selection for an established patient; 

99212, for 10-19 minutes of time spent on the date of the encounter. 

99213, for 20-29 minutes of time spent on the date of the encounter. 

99214, for 30-39 minutes of total time spent on the date of the encounter.

99215, for 40-54 minutes of the total time is spent on the date of the encounter. 

New

A new code has been developed to state the additional time spent. It is important to note that this code would not be commonly reported for radiology groups 

99417, this code would be reported for a prolonged or other outpatient evaluation and management services that are used beyond the minimum required time of the primary procedure.

Diagnostic Radiology Coding Changes

For Screening CT of the Thorax

The diagnostic codes used are 71250, 71260, and 71270. Also, a new CT of the thorax code is available for describing low-dose lung cancer screening.

G0297 is the current HCPCS code identified by the CMS (Centers for Medicare and Medicaid Services) used to report as a high-value growth screen.  

This has later been submitted to the editorial board to create a Category CT code to report low-dose CT for lung cancer screening.

Urography

Diagnostic Radiology Procedures of the Urinary Tract code 74425 will be revised and reciprocal parenthetical will be added. It can be reported with codes 50390, 50396, 50684, and 50690. 

Fluoroscopic Guidance

Radiology Codes 64400-64450 and 64455 is added in the inclusionary parenthetical notes by following codes 77002 and 77003

Ultrasound Follow-Up Study

Other diagnostic Ultrasound Procedure code 76970 has been referred to the CPT Editorial Panel for deletion due to low volume. 

Interventional Radiology Coding Changes

Percutaneous Core Needle Lung Biopsy

For this procedure, code 32405 under excision procedures of the lungs and pleura is deleted and replaced with a new code that bundles percutaneous core needle lung biopsy.

The codes 32405 and 77012 were specifically mentioned by the editorial panel as code pairs that usually perform 75% of the time. Moreover, they were identified as bundled. 

Medical  

Medical dose Evaluation

The new category I radiology code includes Diagnostic Radiology, Diagnostic Imaging, and other procedures subsection of the CPT to report the assessment and calculation of radiation dose. 

Also, the potential adverse iatrogenic effects received by the patients may require a follow-up observation or treatment. It is considered as the most technical component since a medical physicist performs this actual service. 

We have provided a brief overview of the many changes in radiology coding that will take effect in 2021. Practices in radiology should carefully consider those codes that will impact their practice and make adjustments to their templates and EHR systems accordingly. 

This year’s reporting guidelines have not changed significantly, but nevertheless should be reviewed to determine where practice documentation may need to be changed.