AMA Releases Two New CPT Codes for COVID-19 Antibody Detection

AMA Releases Two New CPT Codes for COVID-19 Antibody Detection

Perhaps the most important upcoming development in the fight against COVID-19 is detecting antibodies to the infection. Researchers are developing new tests for this purpose. As these are new tests, existing codes do not reflect these antibody studies. To assist, the CPT Editorial Board has fast-tracked the approval of two new CPT codes for the COVID-19 antibody blood testing (AMA, 2020).

AMA President Patrice A. Harris, M.D., MA noted: “Antibody testing that identifies patients that have been exposed to the novel coronavirus (SARS-CoV-2) and developed an immune response is likely to have important public health implications by providing a clearer picture of the prevalence of the disease in the U.S. The expedited approval of new CPT codes for COVID-19 antibody tests is an important step that enhances the reporting of innovative tools now available to advance medicine’s overarching goals of reducing the COVID-19 disease burden, improving health outcomes and reducing long-term care costs” (AMA, 2020).

Need assistance with the new 86328 and 86769 CPT codes? Let our team of skilled coders and auditors provide coding support and education training to help navigate COVID-19 documentation updates.\

How to Use COPT Codes 86328 and 86769

The new codes were published April 10, 2020, and are effective immediately. Use of the 86328 and 86769 CPT codes will allow for tracking and reporting of antibody tests specifically for COVID-19. Located in the Immunology subsection of the Pathology and Laboratory section of CPT, the distinction between the codes is whether this is a single-step or multiple-step method. Existing code 86318 was revised to include antibody/antibodies for single-step method. Below are the long descriptions of the two new codes:

• 86328 Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
• 86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

A special edition of CPT Assistant includes details on the new codes, clinical examples and descriptions (AMA, 2020). The article includes the guidelines added to the Immunology subsection with parenthetical notes and three cross references to the new codes as appropriate. For example, 86328 is the code for the single-step test, and there is a cross-reference after this code to use code 86769 for the multiple-step method. Conversely, after code 86769 for the multiple-step method, there is a cross-reference to 86328 for the single-step method.

Refer to the CPT Assistant for clinical examples and descriptions of the procedures for the new codes. It is noted that these clinical examples and descriptions may be updated as new knowledge about COVID-19 emerges.

Q&A for New Codes

Also included in the CPT Assistant are questions and answers about the codes. One question asked the date that coders can report these dates these codes. The answer is that the codes are available immediately for reporting; however, coders should consult third-party payers regarding reimbursement for the testing.

Another question asks if coders should report code 86328 twice for two separate single-step assays. The answer is that coders should report the code once for each reagent strip tested, with the 59 modifier appended to indicate a distinct service.

The difference between the new 86328 and 86769 CPT codes and the recently released code 87635 for COVID-19 laboratory testing is the subject of another question. Additionally, the answer notes that the 87635 code is for testing of respiratory specimens to detect the virus; by contrast, the two new codes are for testing for the presence of antibodies to the virus.

Additional Information

See our previous article that references the CPT Assistant to review all of the questions and other information. Stay tuned for updates to these codes and other information for COVID-19 testing and reporting.

Need assistance with the new 86328 and 86769 CPT codes? Let our team of skilled coders and auditors provide coding support and education training to help navigate COVID-19 documentation updates.

Lastly, do you need to learn how to code the COVID-19 vaccines or telehealth services? Enroll in the latest CPT Hot Topics learning series from YES HIM Education. This series dives into the HCPCS/CPT codes and guidelines for COVID-19 monoclonal antibodies, COVID-19 vaccines, and telehealth. We also discuss payment policies for all three topics.