AMA Updated Coding Guidelines

Late last year, the American Medical Association (AMA) released an updated version of its document, ‘Special coding advice during COVID-19 public health emergency.’

This updated version, labeled v3.2, provides a broader list of coding scenarios, now 26 from the original 11, primarily for various telehealth scenarios. Other changes include an expansion of the medical services and the Qualified Healthcare Professionals eligible for telehealth through Medicare and/or private payors (CPT codes for these have also been added to the CMS Telehealth List).

The Current Procedural Terminology (CPT) code set, created and maintained by the AMA, is the most widely accepted system of terminology for medical nomenclature, used to report medical procedures and services under public and private health insurance programs, as well as for administrative management purposes such as claims processing.

The scenarios provided by the AMA offer best coding practices that can assist payors in applying the best flexibility to physicians in providing patient care during this public health crisis. Information provided for each scenario is based on who is performing the service, applicable CPT codes, COVID-19 focused ICD-10 CM codes, the place of service, and other additional data. Be advised that this guide does not dictate payer reimbursement policy and does not substitute for the professional judgment of the practitioner performing a procedure, who remains responsible for correct coding.

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