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Monkeypox Declared a Public Health Emergency – Coding Guidelines and Health Plan Preparation   

On August 4, 2022, the USA declared monkeypox a public health emergency. On July 26, 2022, the American Medical Association (AMA) published the coding details for testing and the two current vaccines available for smallpox and monkeypox. This was based on the World Health Organization (WHO) declaring that this has become a global health emergency based on the daily increasing number of cases in multiple countries, including the United States.

Monkeypox is a type of orthopoxvirus that is responsible for causing cowpox and smallpox infections, which why the Food and Drug Administration (FDA) has expanded the indications of approval for use during the global emergency of monkeypox. There is much that still needs to be learned regarding how this is spread. This viral infection causes sores of the skin. Presently, there is no known treatment available for this disease.

Testing Code – 87593: infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (e.g., monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each

Diagnosis Code – B04: Monkeypox

Vaccine Codes

    • 90611: Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, nonreplicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous injection and requires two injections 28 days apart.
    • 90622: Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use single injection.

Administration Codes
Existing CPT vaccine administration codes (90460, 90461, 90471, 90472) should be used to report the administration of the vaccine products described by codes 90611 and 90622 depending on the age of the patient and the administration(s) provided during the encounter.

Data Points to Monitor Prior to July 2022 and Things to Consider Now
Existing CPT vaccine administration codes (90460, 90461, 90471, 90472) should be used to report the administration of the vaccine products described by codes 90611 and 90622 depending on the age of the patient and the administration(s) provided during the encounter.

    • Review your unspecified lab codes for increased volumes which may or may not be explainable based on the case volumes in your respective state and repeated testing patterns
    • Continue to monitor viral panels for inclusion of tests beyond smallpox that could be deemed as unsupported in the literature and beware of “customized panels” created for a single practice
    • Monitor your Pharmacy claims for increased use of antiviral medications, off-label, or unproven therapies for the treatment of monkeypox
    • Develop a coverage policy for testing and treatments of monkeypox, adding any maximum unit limitations or treatment exclusions

If you have questions regarding the volume of cases in your state, please see the links to the reference materials below. As of this writing, all but 3 states in the US have reported cases of monkeypox.  

References:
  1. American Medical Association, https://www.ama-assn.org/practice-management/cpt/orthopoxvirus-and-monkeypox-coding-guidance 
  2. Center for Disease Control, https://www.cdc.gov/poxvirus/monkeypox/index.html 
  3. World Health Organization, https://www.who.int/emergencies/situations/monkeypox-oubreak-2022
  4. Washington Post Press Release on US Monkeypox PHE Declaration, https://www.washingtonpost.com/health/2022/08/04/monkeypox-public-health-emergency-united-states-becerra/

If you are interested in learning more about Codoxo’s forensic AI platform or would like to speak to Codoxo team member, contact us via info@codoxo.com.

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