Changes in critical care, care plan oversight, lab services and vaccines are most likely to affect family physicians.
Fam Pract Manag. 2001;8(1):14-16
Once again it’s that time of year when we joyfully (groan!) put to use all the CPT gifts that Santa and the AMA, not to mention HCFA, have given us. Here’s a sample of this year’s goodies. Use them, or you may find your claims “returned to sender.”
Evaluation and management
According to CPT, a new patient is “one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years.” While that definition hasn’t changed, the CPT editorial panel has added the following sentence to help clarify what is meant by “professional services”: “Solely for the purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by a physician and reported by a specific CPT code(s).”
Critical care. The CPT editorial panel has further revised the introductory notes accompanying the critical care codes (99291 and 99292). The purpose is to assure accurate reporting of these services and to ensure that there is a clear delineation between critical care codes and other evaluation and management (E/M) services, such as emergency services and subsequent hospital care. The revisions are too numerous to enumerate here, but if you provide critical care services, you would be wise to read the introductory notes to these codes.
Care plan oversight. There is good news and bad news with respect to care plan oversight codes (99374 through 99380). The good news is that the CPT editorial panel revised the codes to better reflect the range of settings in which these services are applicable and to reflect the full scope of work associated with these services. The bad news is that HCFA did not like the revised descriptors, so they implemented HCPCS codes to be used in place of the care plan oversight CPT codes when billing Medicare. Specifically, HCFA is implementing codes G0181 and G0182. Until HCFA decides otherwise, these two codes will carry the same definitions that CPT codes 99375 and 99378 did in 2000. Medicare policy related to care plan oversight remains unchanged.
On a related note, HCFA has also established two new HCPCS codes to describe the services involved in physician certification and recertification and the development of a plan of care for a patient for whom the physician has prescribed Medicare-covered home health services. The first code is G0180, “Physician services for initial certification of Medicare-covered home health services, billable once for a patient’s home health certification period.” This code should be used when the patient has not received Medicare-covered home health services for at least 60 days. The other code is G0179, “Physician services for recertification of Medicare-covered home health services, billable once for a patient’s home health certification period.” This code should be used after a patient has received services for at least 60 days (i.e., one certification period), when the physician signs the certification after the initial certification period.
If your office provides laboratory services, you may want to be aware of some of the following changes:
Drug testing. First, the CPT editorial panel has revised the guidelines and some of the descriptors for drug testing codes (80100–80103) to clarify the procedures and methods inherent in them. Specifically, code 80100 has been revised to specify that this test is “qualitative” and done using a “chromatographic method.” The descriptor for code 80101 also has been changed to include the word “qualitative” and that the test is done using a single drug class method, such as immunoassay or enzyme assay.
Urinalysis. Code 81007 has been revised to read: “Urinalysis; bacteriuria screen, except by culture or dipstick.” This revision will distinguish this type of urinalysis from that done with culture (87086–87088) or dipstick methods (81000 or 81002). CPT 2001 includes two cross-references after 81007 directing users to the appropriate codes for urinalysis by culture or dipstick.
Chemistry. The CPT editorial panel has also made changes in the chemistry portion of its laboratory codes, including the following:
Albumin. 82042 now reads, “Albumin; urine or other source, quantitative, each specimen,” to include specimen sources other than urine.
Bilirubin. 82251 “Bilirubin; total and direct” has been deleted. To report this service, you will need to use codes 82247, “Bilirubin; total,” and 82248, “Bilirubin; direct.” On a related note, CPT 2001 includes a new code, 88400, for “Bilirubin, total, transcutaneous.” This describes a non-invasive procedure for the detection of hyperbilirubinemia using transcutaneous bilirubinometers.
Occult blood. 82270 now reads, “Blood, occult, by peroxidase activity (e.g., guaiac); feces, 1–3 simultaneous determinations.” This allows reporting of assays for the determination of peroxidase activity in hemoglobin. Additionally, a cross-reference has been added to direct users to code 86683 for fecal hemoglobin detection by immunoassay.
Cholesterol. 82465 now reads, “Cholesterol, serum or whole blood, total.” This expands the use of this code to include whole blood specimen in addition to the serum specimen that code originally described. Note that this code’s intent is to report both the collection of the specimen and the subsequent analysis.
Glucose. 82945 has been added to describe “Glucose, body fluid, other than blood.” Because the indications for the test are different for the different specimen types, laboratories have to be able to report the services with identification of specimen type. Additionally, CPT added the phrase “(except reagent strip)” to code 82947 to better distinguish it from code 82948, which is “Glucose; blood, reagent strip.”
PSA testing. If you provide prostate specific antigen (PSA) testing, be aware that there is a new code, 84152, for complexed PSA. The existing codes for total PSA (84153) and free PSA (84154) are unchanged.
Fine-needle aspiration. Note that the relevant codes, 88170 and 88171, no longer include the phrase “with or without preparation of smears.” The logic is that smear preparation is always part of fine-needle aspiration. The phrase has been deleted from the corresponding evaluation codes, 88172 and 88173, for the same reason.
Vasectomy. There is a new code, 89321, for “Semen analysis, presence and/or motility of sperm.” This code describes the limited semen analysis commonly done to confirm the success of a vasectomy. It does not include the Huhner test described in CPT code 89300.
Vaccines and toxoids
A number of commonly used vaccine codes have been revised, including the following:
RSV-IgIM. CPT has revised the code for respiratory syncytial virus immune globulin (RSV-IgIM), for intramuscular use, 90378, to include the phrase “50 mg, each.” This change reflects the fact that smaller dose vials containing 50 mg of the product are available for the first time. Beginning in 2001, if a patient receives a 100 mg dose, you should code 90378 twice or put two units of service on the claim form.
Pneumococcal vaccine. The CPT editorial panel has also revised the pneumococcal vaccine codes. Code 90669 now includes the phrase “for children under five years,” and code 90732 now references adult “or immunosuppressed patient” dosage. The intent of these changes is to more accurately describe recipient populations.
Other vaccines. Some of the other vaccine codes have been revised for the same reason, including the following:
90702, “Diphtheria and tetanus toxoids (DT) adsorbed for use in individuals younger than seven years, for intramuscular use,”
90718, “Tetanus and diphtheria toxoids (Td) adsorbed for use in individuals seven years or older, for intramuscular or jet injection,”
90723, “Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DtaP-HepB-IPV), for intramuscular use.”
Also, there are new and revised CPT codes for the Hepatitis B vaccine. These include:
90740, “Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use,”
90743, “Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use,”
90744, “Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use,”
90747, “Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use.”
Codes 90740 and 90747 describe separate vaccine products currently available for immunosuppressed patients. Code 90743 represents a new product for adolescents 11–15 years that follows a two-dose schedule, while the CPT editorial panel revised 90744 to specify its original intent as a three-dose product.
Wound care. Two new codes have been added to describe active wound care management:
97601, “Removal of devitalized tissue from wound; selective debridement, without anesthesia (e.g., high pressure water jet, sharp selective debridement with scissors, scalpel and tweezers), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session,” and
97602, “Removal of devitalized tissue from wound; non-selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session.”
These codes provide a mechanism for reporting interventions associated with active wound care as done by physical therapists, occupational therapists and enterostomal nurses. Do not report either of these codes in addition to codes 11040–11044, which describe wound debridement done by physicians.
Nutrition therapy. Finally, practices that employ staff, such as a dietitian, to provide medical nutrition therapy, will now find new codes for that service: 97802 and 97803 describe such therapy provided to an individual, while 97804 describes medical nutrition therapy in a group setting. Note that these codes are not intended to report the service of patient feeding through tubes or administration of intravenous parenteral nutrition. Also note that, per CPT, medical nutrition therapy assessment and/or intervention done by a physician should be coded using a preventive medicine or other E/M code.
This represents only a partial listing of the new, revised and deleted codes in CPT and HCPCS, and you should review all of the codes that you commonly use to identify any other changes relevant to your practice. The result should be fewer denied claims, and with any luck, a happy new year!