Proposed CPT Code Edits Avoided

The wins -- big and small -- keep rolling in when it comes to the Academy's advocacy efforts on behalf of family physicians.

AAFP learned in mid-February that CMS would not implement proposed coding edits for urinalysis codes 81000, 81001 and 81002 that would have bundled those CPT codes with several obstetrical procedure codes.

In short, CMS was considering not paying physicians for those urinalysis codes if they were submitted with any of four delivery and postpartum care CPT codes: 59410, 59515, 59614 and 59622.

Time out, said AAFP in a December 2006 comment letter to the National Correct Coding Initiative, a program run by CMS that decides which CPT codes are bundled. Those changes are unnecessary and will take money out of family physicians' pockets, the Academy's letter stated. The change would have affected the nearly 17,000 AAFP members who, according to the "2006 Facts About Family Medicine," include obstetrical care as a clinical component of their practices.

How much money was at stake? According to Cynthia Hughes, AAFP's coding specialist, the current average Medicare or Medicaid payments for the CPT codes in question are

Although that may sound like small change, the cumulative effect over time for a physician's practice could add up, said Hughes. And given the fact that many private payers use CMS edits as a guide for their own physician payments, the proposed edits had possible implications beyond Medicare.

In the Academy's comment letter, signed by AAFP's CPT Advisor David Ellington, M.D., of Lexington, Va., AAFP argued that CPT does not include routine chemical urinalysis in delivery services or in postpartum care; therefore, the cost for necessary supplies -- such as specimen cups and glucose-protein test strips -- was not used to calculate the practice expense relative value units for CPT codes 59410, 59515, 59614 and 59622.

The Academy had no objections to similar proposed edits for CPT codes that apply to antepartum care because those codes already included routine chemical urinalysis.