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You should be aware of changes in E/M, integumentary, musculoskeletal and lab codes.

Fam Pract Manag. 2002;9(1):16

The short answer to the question posed in the title is “Not much,” at least as it relates to family physicians. But there are some changes you’ll need to know about to ensure that you’re reimbursed promptly for the care you provide. Here is a summary of those changes.

Evaluation and management

For family physicians who attend to critically ill or injured patients during transportation from one facility to another (e.g., from a rural hospital to an urban trauma center), CPT has two new codes, 99289 and 99290, to describe “Physician constant attention of the critically ill or injured patient during an interfacility transport.” Use 99289 to report the first 30 to 74 minutes of face-to-face time with the transport patient, and use 99290 for each additional 30 minutes.

Note that Medicare decided not to recognize these codes. Instead, it has created two codes of its own to describe these services:

  • G0240, Critical care service delivered by a physician; face-to-face, during interfacility transport of a critically ill or critically injured patient: first 30 to 74 minutes of active transport;

  • G0241, Each additional 30 minutes (list separately with G0240).

Medicare believes that these G codes will facilitate more accurate reporting of these services.

Also, CPT has revised the language of the preventive medicine codes to clarify that the “comprehensive” nature of these services “reflects an age and gender appropriate history/exam.” Previously, CPT only stated that the “comprehensive” exam of the preventive services codes was not synonymous to the “comprehensive” exam required for other E/M codes (e.g., 99215). This revision, which affects codes 99381-99397, clarifies that the comprehensive nature of the service is not limited to the exam (i.e., it includes the history, too) and that it is a function of the patient’s age and gender, rather than, for example, the number of organ systems and body areas examined. The CPT Editorial Panel indicated that this revision is more editorial than substantive, because it doesn’t affect the amount of work these services require.

Integumentary services

CPT has renumbered the fine-needle aspiration codes and moved them from the Pathology/Laboratory section of CPT to the integumentary portion of the Surgery section. “Fine-needle aspiration; without imaging guidance” is now code 10021, and the same procedure with imaging guidance is now 10022.

Musculoskeletal services

CPT has a new code to describe a therapeutic injection into the carpal tunnel: 20526 describes “Injection, therapeutic (e.g., local anesthetic, corticosteroid), carpal tunnel.”

Also, CPT has revised a frequently used injection code, 20550, to read, “Injection; tendon sheath, ligament, ganglion cyst.” A new code, 20551, describes the therapeutic injection of a tendon at its origin or insertion.

Previously, 20550 included a reference to “trigger points,” but CPT now includes two new codes to describe trigger-point injections. Code 20552 describes “Injection; single or multiple trigger point(s), one or two muscle group(s),” and 20553 describes “Injection; single or multiple trigger point(s), three or more muscle groups.” These codes are intended to differentiate the techniques associated with multiple muscle group injections for trigger points.

Laboratory services

CPT deleted the arthritis panel code, 80072. To report this service in 2002, you need to report the individual tests that previously made up the panel:

  • 84550, Uric acid, blood, chemical;

  • 85651, Sedimentation rate, erythrocyte, non-automated;

  • 86255, Fluorescent noninfectious agent/antibody, screen, each antibody;

  • 86430, Rheumatoid factor, qualitative.


CPT has revised the immunization administration codes and added new codes that distinguish different routes of administration. Revised codes 90471 and 90472 describe “percutaneous, intradermal, subcutaneous, intramuscular and jet injections.” New codes 90473 and 90474 describe vaccines administered by an “intranasal or oral route.” Remember to use these codes in conjunction with the corresponding CPT codes for the vaccine(s) administered.

As always, this represents only a portion of the annual changes in CPT. Please consult your 2002 CPT book for other changes that may be relevant to your practice.

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Copyright © 2002 by the American Academy of Family Physicians.

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