How To Use HCPCS Code C9803

HCPCS code C9803 describes a hospital outpatient clinic visit for the collection of a specimen for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as coronavirus disease (COVID-19). This code is used when a healthcare provider collects a specimen from a patient for testing or diagnostic purposes related to COVID-19. It is important for medical coders to understand the specific meaning and usage of this code to ensure accurate billing and reimbursement.

1. What is HCPCS C9803?

HCPCS code C9803 is used to identify a hospital outpatient clinic visit for the collection of a specimen for COVID-19 testing. This code is specific to the collection of specimens related to SARS-CoV-2, the virus that causes COVID-19. It is important to note that this code is not used for other types of specimen collection or for general outpatient clinic visits.

2. Official Description

The official description of HCPCS code C9803 is “Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), any specimen source.” The short description is “Enteral supp not otherwise c.”

3. Procedure

1. The healthcare provider schedules an outpatient clinic visit for the patient.
2. During the visit, the provider collects a specimen from the patient for COVID-19 testing.
3. The specimen can be collected from any source, such as nasal swab, saliva, or blood.
4. The provider follows the appropriate guidelines and protocols for specimen collection to ensure accuracy and patient safety.
5. The collected specimen is then sent to a laboratory for testing and analysis.

4. When to use HCPCS code C9803

HCPCS code C9803 should be used when a healthcare provider collects a specimen from a patient for COVID-19 testing during a hospital outpatient clinic visit. It is important to use this code only when the specimen collection is specifically related to SARS-CoV-2 and COVID-19. If the specimen collection is for other purposes or unrelated to COVID-19, a different HCPCS code should be used.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9803, healthcare providers need to document the following information:

• Date of the outpatient clinic visit
• Type of specimen collected
• Reason for the specimen collection (COVID-19 testing)
• Any additional relevant information, such as patient symptoms or exposure history

Providers should also ensure that the documentation supports the medical necessity of the specimen collection and the use of HCPCS code C9803.

6. Historical Information and Code Maintenance

HCPCS code C9803 was added to the Healthcare Common Procedure Coding System on January 1, 1985. It has an effective date of January 1, 1996. This code is currently active and has not been terminated. The action code N indicates that no maintenance actions have been taken for this code.

7. Medicare and Insurance Coverage

HCPCS code C9803 is covered by Medicare. The pricing indicator code 57 indicates that this code is priced by other carriers. The multiple pricing indicator code A means that it is not applicable as HCPCS priced under one methodology. Healthcare providers should consult the Medicare Carriers Manual Reference Section Number 2130 for specific guidelines and instructions related to billing and reimbursement for HCPCS code C9803.

8. Examples

Here are five examples of when HCPCS code C9803 should be billed:

1. A patient visits a hospital outpatient clinic for COVID-19 testing. The healthcare provider collects a nasal swab specimen for SARS-CoV-2 testing. HCPCS code C9803 should be used to bill for the specimen collection.
2. During a hospital outpatient clinic visit, a healthcare provider collects a blood specimen from a patient for COVID-19 antibody testing. HCPCS code C9803 should be used to bill for the specimen collection.
3. A patient presents to a hospital outpatient clinic with COVID-19 symptoms. The healthcare provider collects a saliva specimen for SARS-CoV-2 testing. HCPCS code C9803 should be used to bill for the specimen collection.
4. During a hospital outpatient clinic visit, a healthcare provider collects a sputum specimen from a patient with suspected COVID-19. HCPCS code C9803 should be used to bill for the specimen collection.
5. A patient undergoes a hospital outpatient clinic visit for COVID-19 testing. The healthcare provider collects a throat swab specimen for SARS-CoV-2 testing. HCPCS code C9803 should be used to bill for the specimen collection.