How To Use CPT Code 0223U

CPT 0223U describes the pathogen-specific nucleic acid test for infectious respiratory tract infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0223U?

CPT 0223U can be used to describe a specific laboratory test that detects and differentiates nucleic acid of various respiratory pathogens, including SARS-CoV-2, the virus responsible for COVID-19. This test is performed on a nasopharyngeal swab specimen using an automated PCR analyzer called QIAstat-Dx® Respiratory SARS CoV-2 Panel.

2. Official Description

The official description of CPT code 0223U is: ‘Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected.’

3. Procedure

1. The laboratory analyst receives a nasopharyngeal swab specimen in transport media.
2. The specimen is processed using the QIAstat-Dx® Respiratory SARS CoV-2 Panel, an automated multiplex PCR analyzer.
3. The analyzer performs sample preparation, nucleic acid amplification, target detection, analysis, and reporting in a single platform.
4. The test detects and reports the presence or absence of 22 respiratory pathogens, including SARS-CoV-2.

4. Qualifying circumstances

CPT 0223U is used for patients with respiratory infection symptoms who require testing to detect and differentiate nucleic acid of SARS-CoV-2 and other common respiratory viral and bacterial pathogens. The test is authorized by the FDA under the Emergency Use Authorization (EUA) for use in authorized laboratories during the COVID-19 emergency declaration.

5. When to use CPT code 0223U

CPT code 0223U should be used when ordering the QIAstat-Dx® Respiratory SARS CoV-2 Panel test for patients with respiratory infection symptoms. It is important to use this specific code only for the proprietary test described and not to report the test using any other CPT code.

6. Documentation requirements

To support a claim for CPT 0223U, the documentation should include:

• Indication for the test, such as respiratory infection symptoms
• Specific test performed, including the QIAstat-Dx® Respiratory SARS CoV-2 Panel
• Date of service
• Results of the test, indicating whether each pathogen was detected or not detected
• Signature of the laboratory analyst performing the test

7. Billing guidelines

When billing for CPT 0223U, ensure that the test performed is the QIAstat-Dx® Respiratory SARS CoV-2 Panel. Report one unit of this code for a single specimen analyzed on a single date of service. Some payers may separately reimburse for specimen collection using a different code, such as 36415. It is important to review payer guidelines for specific billing requirements and modifiers, if applicable.

8. Historical information

CPT 0223U was added to the Current Procedural Terminology system on June 25, 2020. There have been no updates to the code since its addition.

9. Examples

1. A patient presents with respiratory infection symptoms, and the QIAstat-Dx® Respiratory SARS CoV-2 Panel test is ordered to detect and differentiate nucleic acid of various respiratory pathogens, including SARS-CoV-2.
2. A healthcare provider suspects a bacterial or viral respiratory tract infection in a patient and requests the QIAstat-Dx® Respiratory SARS CoV-2 Panel test to identify the specific pathogen causing the infection.
3. A patient with COVID-19 symptoms undergoes the QIAstat-Dx® Respiratory SARS CoV-2 Panel test to confirm the presence of SARS-CoV-2 and rule out other respiratory pathogens.
4. A healthcare facility performs routine testing using the QIAstat-Dx® Respiratory SARS CoV-2 Panel to monitor the prevalence of respiratory pathogens, including SARS-CoV-2, in their community.
5. A patient with a suspected respiratory infection is tested using the QIAstat-Dx® Respiratory SARS CoV-2 Panel to guide appropriate treatment decisions.
6. A laboratory analyzes a nasopharyngeal swab specimen using the QIAstat-Dx® Respiratory SARS CoV-2 Panel to determine the presence or absence of 22 respiratory pathogens, including SARS-CoV-2.
7. A healthcare provider orders the QIAstat-Dx® Respiratory SARS CoV-2 Panel test for a patient with respiratory symptoms to differentiate between viral and bacterial causes of the infection.
8. A patient with a history of respiratory infections undergoes the QIAstat-Dx® Respiratory SARS CoV-2 Panel test to identify any recurrent pathogens, including SARS-CoV-2.
9. A healthcare facility uses the QIAstat-Dx® Respiratory SARS CoV-2 Panel test to screen individuals for SARS-CoV-2 as part of their infection control measures.
10. A patient with respiratory symptoms is tested using the QIAstat-Dx® Respiratory SARS CoV-2 Panel to determine the need for isolation and appropriate treatment.