Asymptomatic but wants a COVID test? Press for medical necessity in notes, use Z-code, Part B News, ft. Abbye Alexander
Abbye Alexander, partner and co-chair of the KD Health Care/Managed Care practice group, was quoted in a Part B News article – page 8 Ask Part B News – published on October 5, 2020.
Question: My patient is visiting aged relatives and wants a COVID test before she goes to reduce the chance of infecting them. How should I code this? And will Medicare deny the charge for lack of medical necessity, as my patient lacks any symptoms?
Answer: Despite the public health emergency (PHE) enduring for more than six months, a lack of clarity around testing — and whether the testing will get reimbursed — remains.
“CMS has not established a national policy, either through rulemaking or a national coverage determination, regarding when COVID-19 testing is necessary and therefore the medically necessary standard is applicable for coverage,” says Abbye E. Alexander, co-chair of the health care/managed care practice group at Kaufman Dolowich & Voluck in Orlando, Fla. “Absent national policy, coverage of these tests is determined by the Medicare administrative contractors [MACs] themselves.”
But there are diagnosis codes and CPT codes that you will want to make sure you apply, and your providers should make the best possible case for necessity.
Read more at the full article.
