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COVID-19 Guidance

COVID-19: Guidance for AANEM Members

AANEM has received numerous emails and calls from its physician members asking for guidance on how to best handle caring for their neuromuscular patients, many of whom may be immunocompromised, in light of the COVID-19 pandemic. Unfortunately, there is little evidence-based guidance on COVID-19 or how to handle these vulnerable patients. AANEM has reviewed the currently available resources and guidance published by the most reputable sources of healthcare information to put together some guidance for physicians. AANEM urges its members to adhere to information from public health officials, other government entities as listed below and on the CDC website. This webpage provides information regarding common questions we are receiving.
 

Rescheduling Patient Visits

One of the major questions facing our members is whether or not elective tests or visits or other procedures should be canceled at this time. According to the CDC:
 
“Patients should receive any interventions they would normally receive as standard of care. Patients with suspected or confirmed COVID-19 should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed. Healthcare personnel entering the room should use Standard and Transmission-based Precautions.” https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html

However, the Centers for Medicare & Medicaid Services recently announced that all elective and non-essential surgeries and procedures be postponed “until further notice.” We are seeing major institutions, including the Mayo Clinic, making the decision to postpone ALL elective or nonurgent tests/visits/procedures for at least 8 weeks (https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-deferring-elective-care/). Cleveland Clinic has decided to cancel all elective surgeries scheduled from March 19-27 (https://my.clevelandclinic.org/landing/preparing-for-coronavirus). Physicians are encouraged to discuss issues related to patient care with their hospitals and provide their recommendations regarding which patients need to be seen versus those that can be delayed without impact on patient care or outcomes. Physicians should carefully consider when to cancel non-urgent procedures or prioritize their more urgent patients in order to reduce potential exposure and to ensure judicious use of potentially limited supplies of personal protective equipment (PPE). Physicians should check the CDC website for updates to this recommendation given the evolving nature of this situation.

AANEM's Open Letter to Neuromuscular Patients

Telehealth Options: Please be aware that the Centers for Medicare & Medicaid Services have expanded their coverage of telehealth services so this may also be an option for some patient visits. If you do not currently have telehealth capabilities set up in your practice, the AMA has a Quick Start Guide.  For even more information on how to implement digital health in your practice, the AMA has an expanded Digital Health Playbook.

A summary of the key takeaways around CMS's expansion of Medicare telehealth coverage can be found here
 

Special Precautions While Performing EDX Testing

AANEM members have asked whether or not any special precautions should be taken when performing an EMG, such as wearing a mask or gloves. Given the current shortage of PPE and the diversion of available supplies to ICUs and ERs, AANEM cannot state that all physicians performing an EMG should wear protective gear. Each institution and/or practice will have to determine the allocation of PPE internally. As this situation continues to unfold, hopefully the supply chain can catch up to the current demands. AANEM will work with its physician leaders to update our recommendations as the availability of PPE changes.
For patient with known COVID-19 infection, suspected COVID-19 infection, or a patient who has had close contact with an infected individual, as with other systemic infections, non-urgent EMGs and NCSs should be postponed until the patient is no longer infectious or it is determined that they do not have COVID-19. (See CDC materials https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html). If a patient, needs an EMG or NCS in this circumstance than PPE is recommended for the physician and the patient. 
 

COVID-19 Coding

A new CPT code has been created that streamlines novel coronavirus testing offered by hospitals, health systems and laboratories. This code is effective March 13, 2020.
87635—Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique

The CDC also announced an ICD-10-CM diagnosis code to accurately document the COVID-19 diagnosis in patients. This code is effective April 1, 2020.
U07.1—COVID-19
 
The AMA has published a CPT Assistant article that provides guidance on the use of the new SARS-CoV-2 (COVID-19) CPT code.  The AMA has also released several resources to aid in correct coding for patients being assessed for COVID-19:
Quick reference flow chart for CPT reporting for COVID-19 testing
Coding scenarios and how to apply best coding practices
 

Latest Updates

CMS Offers Exemptions and Extensions for 2019 MIPS Submissions: https://www.cms.gov/newsroom/press-releases/cms-announces-relief-clinicians-providers-hospitals-and-facilities-participating-quality-reporting. If you or your practice is participating in MIPS, you now have until April 30, 2020 to submit your data. If you don’t report ANY data by April 30, 2020, then you/your practice will NOT receive any payment adjustment (i.e., if you are eligible but don’t want to participate, make sure you don’t report ANY data – if you report even one data point, you will be scored and receive the corresponding payment adjustment).
 

Additional Information/Resources

Centers for Disease Control - For more information about COVID-19, such as special cleaning, caring for ill family members at home, travel considerations, etc., please visit the CDC’s website: https://www.cdc.gov/coronavirus/2019-ncov/index.html.

Centers for Medicare & Medicaid Services COVID-19 Partner Toolkit: https://www.cms.gov/outreach-education/partner-resources/coronavirus-covid-19-partner-toolkit

White House task force can be found on CMS’s “Current Emergencies” website: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page

National Institutes of Health (NIH) - https://www.nih.gov/health-information/coronavirus

American Medical Association -  AMA COVID-19 Resource Center for Physicians

If you have specific questions about your practice or handling specific types of patients, please post your question to AANEM Connect: https://www.aanem.org/Membership/Member-Portal/AANEM-Connect. AANEM staff will monitor this site for trending issues or questions to help guide the development of future resources and will also allow for quicker, crowdsourced responses from leaders in NM and EDX medicine.

Please contact policy@aanem.org with questions. 
 

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