How To Use CPT Code 99072

CPT 99072 refers to the additional supplies, materials, and clinical staff time that are utilized beyond what is typically included in an office visit or other non-facility services during a Public Health Emergency (PHE) related to respiratory-transmitted infectious diseases. This code is particularly relevant in the context of the COVID-19 pandemic, where healthcare providers have had to implement extra measures to ensure patient safety and minimize the risk of disease transmission during in-person visits.

1. What is CPT code 99072?

CPT code 99072 represents the additional resources required by healthcare providers during a Public Health Emergency, specifically when dealing with respiratory-transmitted infectious diseases. This code was introduced to address the unique challenges posed by situations like the COVID-19 pandemic, where standard office visit protocols were insufficient to ensure patient and staff safety. The purpose of this code is to account for the extra supplies, materials, and clinical staff time that are necessary to facilitate safe in-person encounters while reducing the risk of transmitting infectious diseases. It highlights the importance of adapting healthcare practices to meet the demands of public health crises.

2. Qualifying Circumstances

This CPT code can be used specifically during a Public Health Emergency as defined by law, particularly in response to respiratory-transmitted infectious diseases. The criteria for using this code include the necessity for additional supplies and clinical staff time that exceed what is typically required for standard office visits. Appropriate scenarios for using this code include instances where providers must implement enhanced safety measures, such as using personal protective equipment (PPE), conducting symptom checks prior to visits, and employing additional cleaning protocols. Inappropriate use of this code would occur outside of a declared Public Health Emergency or when the additional resources do not directly contribute to minimizing disease transmission.

3. When To Use CPT 99072

CPT code 99072 should be used when a healthcare provider encounters a situation that necessitates additional resources during an in-person visit due to a Public Health Emergency related to respiratory-transmitted infectious diseases. This code can be reported alongside the appropriate service codes that describe the actual medical services rendered during the visit. However, it is important to note that this code should only be reported once per encounter per provider number, regardless of the number of services performed during that visit. This restriction ensures that the code accurately reflects the additional resources utilized without duplicating claims for multiple services.

4. Official Description of CPT 99072

Official Descriptor: Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease.

5. Clinical Application

The clinical context for CPT code 99072 is rooted in the need for enhanced safety measures during in-person healthcare encounters amid a Public Health Emergency. The application of this code is crucial for ensuring that healthcare providers can adequately protect both patients and staff from the risks associated with respiratory-transmitted infectious diseases. By utilizing this code, providers can account for the additional resources required to maintain a safe environment, which may include increased cleaning protocols, PPE usage, and patient education regarding safety measures such as social distancing.

5.1 Provider Responsibilities

During the procedure or service, the provider is responsible for implementing various safety measures to reduce the risk of disease transmission. This includes preparing the office environment with adequate cleaning supplies, ensuring that PPE is available and properly used, and conducting pre-visit symptom checks via phone. The provider must also educate patients about safety protocols, such as maintaining social distancing during the visit. Additionally, the provider must document the use of extra supplies and time spent on these safety measures to justify the use of CPT code 99072.

5.2 Unique Challenges

One of the unique challenges associated with the use of CPT code 99072 is the need for healthcare providers to adapt quickly to evolving public health guidelines and recommendations. This may involve sourcing additional supplies on short notice, training staff on new protocols, and managing patient expectations regarding safety measures. Furthermore, providers must navigate the complexities of billing and coding accurately to ensure that they are compensated for the additional resources utilized during these encounters, all while maintaining a high standard of care.

5.3 Pre-Procedure Preparations

Before the procedure, providers must conduct thorough evaluations to determine the necessary additional supplies and materials required for a safe in-person visit. This may involve assessing the current inventory of PPE, cleaning supplies, and other materials. Providers should also review public health guidelines to ensure compliance with safety protocols. Additionally, staff training may be necessary to prepare for the implementation of new procedures aimed at minimizing the risk of disease transmission during patient encounters.

5.4 Post-Procedure Considerations

After the procedure, providers must continue to monitor the effectiveness of the safety measures implemented during the visit. This includes evaluating the use of additional supplies and materials, as well as gathering feedback from patients regarding their experience. Follow-up care may also involve ensuring that patients are informed about any ongoing safety protocols and that they understand the importance of adhering to these measures in future visits. Documentation of the encounter, including the use of CPT code 99072, should be completed to support billing and coding accuracy.

6. Relevant Terminology

COVID-19: Coronavirus Disease 2019 (COVID-19) is a disease caused by a novel coronavirus, SARS–CoV–2, that resulted in the declaration of a global pandemic beginning in March 2020.

SARS–CoV–2: Severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) is the virus that causes COVID-19 and is a member of the coronavirus family responsible for past outbreaks such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).

Virus: An infectious agent that can reproduce only inside other living cells, generally invisible even with a microscope.

7. Clinical Examples

1. A healthcare provider conducts a routine check-up but must implement additional cleaning protocols and use PPE due to the ongoing COVID-19 pandemic.

2. A patient presents with respiratory symptoms, and the provider conducts a pre-visit symptom check over the phone, requiring extra time and resources for the in-person visit.

3. During a flu season marked by heightened public health concerns, a provider uses additional supplies to ensure patient safety during a routine vaccination appointment.

4. A clinic implements social distancing measures in the waiting area, requiring additional staff time to manage patient flow and ensure compliance.

5. A provider educates patients about the importance of wearing masks during their visit, necessitating extra time and resources for patient education.

6. A healthcare facility purchases additional cleaning supplies to maintain a safe environment during a respiratory disease outbreak.

7. A provider must don and doff PPE multiple times during a single patient encounter, requiring additional time and resources.

8. A telehealth visit is followed by an in-person visit, where the provider must ensure that all safety protocols are in place, requiring extra preparation time.

9. A patient with a known respiratory condition requires a longer visit to ensure that all safety measures are adhered to, necessitating additional clinical staff time.

10. A healthcare provider conducts a follow-up visit for a patient who had COVID-19, requiring extra precautions and resources to ensure a safe encounter.