|
Medicare covers anthrax testing when reasonable and necessary and ordered by a physician. Even if a Medicare patient shows no signs or symptoms of anthrax infection, the physician may decide, upon questioning and examination of the patient, that a nasal swab or other diagnostic test is warranted to ascertain whether the patient has been exposed to or is infected with anthrax.
In this specific clinical situation, Medicare will cover the test and related services. All usual rules apply regarding documentation of the reason for the test and the need for a written order. As always, Medicare covers only testing necessary to diagnose and treat the patient.
Follow these coding rules:
- Code the culture using current procedural terminology (CPT) code 87081 (culture, presumptive, pathogenic organisms, screening only). The payment for obtaining the specimen is included in the evaluation and management payment. Other medically necessary tests should be coded with the appropriate CPT codes.
- When the reason for performing the test is that the patient has had contact with or exposure to a communicable disease or biological agent, the appropriate ICD-9 code to use is V018 (contact with or exposure to a communicable disease, other communicable diseases), whether or not the patient has signs or symptoms of a disease.
- When submitting claims for a patient with a nasal swab positive for bacillus anthracis (anthrax) who will be treated with antibiotics, use code 7953 (nonspecific positive culture findings).
- Use code V0739 (other prophylactic chemotherapy) if prescribing prophylactic antibiotics.
- Use codes from the anthrax series (0221-0229) only if the patient is confirmed to have disease caused by anthrax.
Medicare coverage of anthrax testing (as with other public health-sponsored testing) does not extend to mass testing performed by public health officials in response to a confirmed anthrax exposure. However, Medicare will cover any subsequent medically appropriate and necessary diagnosis and treatment consistent with existing policy.
Medicare has published a list of frequently asked questions on anthrax testing in Medicare Part B newsletter No. 02-022 (PDF), Nov. 30, 2001, page 46.
For additional information on anthrax, visit the TMA Knowledge Center hot topic bibliography on bioterrorism.
TMA Practice E-tips main page
Last Published: 8/18/2009 Print this page
|