Quick links for COVID-19 updates

 Both chambers of Congress passed and President Trump signed into law The Paycheck Protection and Health Care Enhancement Act, which allocates an additional $321 billion for Paycheck Protection Program (PPP) loans and an additional $60 billion for the Economic Injury Disaster Loan program. New applications can be submitted starting on Monday, April 27, 2020 at 10:30am. Any borrower that applied for a PPP loan prior to the issuance of this guidance and repays the loan in full by May 7, 2020 will be deemed by SBA to have made the required certification in good faith 

 The Academy believes that decisions regarding when and how elective surgery should begin are best decided on a local basis. To help members prepare for these conversations, they have developed clinical considerations for navigating COVID-19 and are recommending the following universally applied guiding principles:

1. All decisions should be locally based as resource availability is locally determined. These resources include: Hospital beds, ICU beds, Ventilators, PPE, and Healthcare workers.
2. Overall disease burden varies by location: Hot spots like New York City and New Orleans have high case rates.
3. Stage of pandemic varies by location. (Reproductive number*: greater, equal or less than one. Is the curve increasing, flattening or decreasing?)
4. Legal restrictions vary by location: We need to adhere to government mandates; however, these vary by state. 

Once the decision is made to resume elective surgery, other important issues that must be addressed include:

1. Velocity of return,
2. Location of return,
3. Prioritization of surgical cases, and
4. COVID-19 testing (for both patients and staff).

Again, decisions regarding these factors are best made on a local basis. For example, in areas of low disease burden, elective surgery may not need to be phased in and can start all at once. In other areas, where personnel and equipment have been repurposed, a more phased-in approach is necessary. The principles guiding velocity of return include:

1. Resource availability (repurposed staff and equipment)
2. Utilization of “COVID-19 free” hospitals or ASCs when possible
3. Ambulatory cases first (to avoid hospitalization and COVID-19 exposure)
4. Inpatient cases (ASA I and II)
5. Inpatient cases (ASA III and IV), once COVID exposure as inpatient is minimized and COVID-19 testing is perfected

There is much debate about the availability and utility of COVID-19 testing for patients and staff. Despite the debate, it is likely that perioperative patient testing and universal staff testing will be required.

 * Reproductive Number: It is the average number of secondary infections produced by a typical case of an infection in a population where everyone is susceptible. If the number is >1, then the case numbers increase. If it is <1, they decrease.  

A new CPT® code has been created that streamlines novel coronavirus testing offered by hospitals, health systems and laboratories in the United States. The code is effective March 13, 2020 for use as the industry standard for reporting of novel coronavirus tests across the nation’s health care system.

Please note that, per the standard early release delivery process for CPT codes, you will need to manually upload this code descriptor into your EHR system. This CPT code will arrive as part of the complete CPT code set in the data file for 2021 later this year. Review and download the full CPT code descriptor release. 

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 For the latest information and guidelines regarding telemedicine via telephone and video conferencing, download the AAOS Telemedicine Resource Guide

Access a comprehensive list of commercial health plan payers and their coverage policies for telemedicine services
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Find comprehensive telemedicine coding information for COVID-19: AAOS Coding Guide for COVID-19

For the latest information and guidelines regarding telemedicine via telephone and video conferencing: AAOS Telemedicine Resource Guide

> AMA Special Coding Advice During COVID-19 Public Health Emergency

 CDC

• CDC Website for Healthcare Professionals
• Preparing for and responding to community spread of COVID-19: CDC Interim Guidance
• CDC Free Patient Communication Resources  
• CDC Resources for Business and Employers
• CDC Travel Information

AMA

• AMA - A Physicians Quickstart Guide to COVID-19 (PDF) Website

ACS

• Recommendations for Management of Elective Surgical Procedures

ASCA

• Statement from the Ambulatory Surgery Center Association regarding Elective Surgery and COVID-19

CMS

• COVID-19 Emergency Declaration Health Care Providers Fact Sheet
• Coverage and payment related to COVID-19: CMS Medicare Fact Sheet
• Flexibilities for Medicare Advantage organizations and Part D sponsors: CMS Memo
• CMS Frequently Asked Questions: COVID-19 FAQs
• CMS information and updates about coronavirus: Current Emergencies
• Frequently Asked Questions (FAQs) on Essential Health Benefits (EHB) Coverage

HHS

• HIPAA status during national and public health emergencies: HHS FAQ

WHO

• World Health Organization - Coronavirus

EPA

• Environmental Protection Agency - Registered Antimicrobial Products for Use Against COVID-19

Additional Resources

• Johns Hopkins  COVID19 Mapping