Jan 2004 Table of Contents

GETTING PAID

CPT: What’s in Store for 2004?



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Multiple changes have been made to the vaccine codes.

Fam Pract Manag. 2004 Jan;11(1):18-21.

If you’re like me, you always open your new CPT book with a mixture of hope and dread: Hope that your questions from the past year have been addressed through new and revised codes, and dread that new changes have created new coding issues. Here is a peek at some of the changes for 2004 that may be relevant to your practice.

Vaccines and other medical services

Multiple changes have been made to the vaccine and toxoid codes. For instance, CPT has deleted code 90659 for whole virus influenza virus vaccine since this vaccine is no longer manufactured or used. It has added a new code, 90655, “Influenza virus vaccine, split virus, preservative free, for children 6-35 months of age, for intramuscular use.” A similar code, 90656, for use in individuals three years of age and older is also available but will not appear in the CPT book until 2005. For more information on the changes to the vaccine codes, visit http://www.ama-assn.org/ama/pub/category/10902.html.

CPT has revised code 99024 to read, “Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management (E/M) service was performed during a postoperative period for a reason(s) related to the original procedure.” The revision is intended to further clarify that this code is used to report services that are included in the surgical package (and therefore not meant to be separately reimbursed) that the physician wants to track for administrative purposes.

CPT has also revised code 99050 to read, “Services requested after posted office hours in addition to basic service.” The addition of the word “posted” is meant to help define office hours and, by extension, what constitutes after-hours care.

CATEGORY II CODES

CPT has added a whole new category of codes for 2004, called Category II codes, to help physicians track performance measures through their administrative systems. These codes are meant to facilitate data collection about quality of care and decrease the need for record abstraction and chart reviews. For example, let’s say that you are trying to track the use of beta-blocker therapy in your practice and you don’t have an electronic medical record system. Reporting Category II code 0007F, “Beta-blocker therapy, prescribed,” will allow you to do this through your billing software rather than through chart reviews.

Keep in mind that Category II codes are not reimbursable. Use them at your option, and don’t substitute them for Category I codes (i.e., standard CPT codes). The AMA will publish Category II codes twice a year: on Jan. 1 and July 1. For the most current listing, visit http://www.ama-assn.org/go/cpt.

Office procedures

CPT has deleted the “starred procedure” concept for 2004. Historically, a starred procedure was a minor surgical procedure with no associated pre- and postoperative services included in the service. Concurrent with this deletion, CPT has also deleted code 99025, “Initial (new patient) visit when starred (*) surgical procedure constitutes major service at that visit.”

CPT has added guidelines before the skin biopsy codes, 11100 and 11101, to clarify when it is appropriate to report a skin biopsy at the same encounter in which other skin procedures are done. The new guidelines specify that the use of a skin biopsy code “indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other procedures/services provided at that time.” Otherwise, obtaining tissue for pathology during the course of an integumentary procedure is considered a routine component of such procedure and is not separately reportable using 11100 and 11101.

CPT has once again revised codes 20550 and 20551 in another attempt to clarify their intent as they relate to multiple injections. For 2004, the codes read:

  • 20550, Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar “fascia”);

  • 20551, Injection(s); single tendon origin/insertion.

Based on these descriptors, you would use code 20550 once for multiple injections to a single tendon sheath, twice if you inject two tendon sheaths and so forth. Note that the subsequent codes for trigger point injections, 20552 and 20553, are still reported once per session, regardless of the number of injections, trigger points or muscles involved.

E/M services

There are very few changes this year in the E/M section. CPT has revised the guidelines for critical care services to explain that the pediatric and neonatal critical care codes (99293-99296) are for pediatric and neonatal critical care services in the inpatient setting only. In the outpatient setting, you should report the hourly critical care codes, 99291 and 99292, regardless of the patient’s age.

The only other change of note in this section is a new cross-reference following code 99456. This cross-reference specifies that you should not report code 99080, “Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form,” with 99455 and 99456, which describe work-related or medical disability evaluation services. Codes 99455 and 99456 include the completion of such forms by the physician. A similar cross-reference has been added after code 99080.

Laboratory

CPT has revised the codes for general health panel (80050) and obstetric panel (80055) to reflect changes made in 2003 to the Hematology subsection. CPT has also revised code 84155, “Protein, total, except by refractometry; serum,” to specify that this is for serum specimens only. New codes have been created for similar measurement of total protein from urine specimens (84156) and other sources (84157). Also, CPT has added a cross-reference after code 84160 to indicate that you should use 81000-81003 for urine total protein by dipstick method.

As always, the changes I’ve mentioned here are only some of those you will find in your new CPT book. A review of the others, which are summarized in Appendix B of CPT 2004, is always a good idea. You will find it helpful as you prepare your claims this year.

Kent Moore is the AAFP’s manager for health care financing and delivery systems and is a contributing editor to FPM.

Conflicts of interest: none reported.

Send comments to fpmedit@aafp.org.

Copyright © 2004 by the American Academy of Family Physicians.
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