Evaluation and management codes change in CPT 2002
By Brett Baker
Q: How has the evaluation and management (E/M) services section of Current Procedural Terminology (CPT) 2002 changed?
A: For 2002, CPT has added several new codes covering patient transport, critical care, care plan oversight and preventive medicine. Here are the major changes that will affect internists:
CPT added two new codes to describe a physician's physical attendance and direct care of a critically ill or injured patient during interfacility transport:
- 99289—Physician constant attention to critically ill or injured patient during an interfacility transport, first 30-74 minutes.
- 99290—Each additional 30 minutes (list separately in addition to code for primary service); use 99290 in conjunction with 99289.
Face-to-face care begins when the physician assumes primary responsibility for the patient at the referring hospital/facility and ends when the receiving hospital/facility accepts responsibility for the patient's care. The physician can report only the direct, face-to-face time spent with the patient during the transport.
The physician can report other services performed during the transport that can be identified by a separate CPT code, with the exception of routine monitoring evaluations (heart rate, respiratory rate) and initiating mechanical ventilation.
For reporting purposes, physicians cannot:
- count the time performing separately reportable services and procedures toward billing 99289-99290;
- report services or procedures provided by another transport team member;
- report transport services that involve less than 30 minutes of face-to-face time (such services must be billed under another E/M service code); or
- report these codes for directing the transporting staff from a hospital/facility using two-way communication. (In such cases, use CPT 99288, physician direction of emergency medical services, EMS, emergency care, advanced life support.)
Other E/M services should be reported as appropriate after the patient is admitted at the receiving hospital/facility.
Note that Medicare does not pay for codes 99289-99290. Medicare requires physicians to use "G" codes to bill face-to-face time spent directing a beneficiary's transport between hospitals with the critical care service codes. The G codes are:
- G0240—Critical care service delivered by a physician, face-to-face, during interfacility transport of a critically ill or critically injured patient; first 30-74 minutes of active transport.
- G0241—Each additional 30 minutes.
Medicare created the G codes instead of using CPT 99289-99290 because the codes and corresponding notes do not require physicians to deliver any specific services. In addition, the codes fail to state that services bundled into CPT critical care codes (gastric intubation, temporary transcutaneous pacing, etc.) are also included in the new transport codes.
Medicare's payment rules for these G codes are the same as for its critical care codes, with two exceptions. All time counted toward transport must be face-to-face with the patient (as opposed to floor/unit time for inpatient critical care), and only face-to-face time during the actual transport can be counted toward G0240 and G0241.
For more on Medicare's payment policy for critical care (CPT codes 99291-99292), see the January 2001 ACP-ASIM Observer at www.acponline.org/journals/news/jan01/cpt.htm.
Critical care services
CPT added a paragraph to the critical care notes stating that 99291-99292 should not be reported for physician attendance when transporting a critically ill or injured patient between facilities. This service is now separately reportable using the new patient transport codes, 99289-99290.
CPT changed its notes to clarify that code 99292 should be used to report additional blocks of time of up to 30 minutes each beyond the first 74 minutes. The notes also reference a table that illustrates appropriate reporting of 99291-99292. That table now includes instructions on how to report a critical care service that is 194 minutes or longer.
Care plan oversight services
CPT modified the care plan oversight code descriptors to allow physicians to include the time they spend discussing care decisions with the patient's family or other decision-makers. Medicare, however, refuses to accept the CPT 2002 descriptors because they involve nonhealth professionals. Medicare continues to require physicians to use "G" codes to bill for care plan oversight for patients in home health and hospice settings.
Medicare does not pay separately for oversight services of less than 30 minutes a month. They are reimbursed through the payment for post-service work for the previous face-to-face E/M service. Additionally, Medicare does not recognize oversight services for nursing facility patients, because physicians frequently visit them face-to-face.
For more information on how to use G codes to document care plan oversight activities, see the Practice Management Center publication, "Care Plan Oversight Encounter Worksheet and Instructions" online at www.acponline.org/pmc/cpo.htm.
Preventive medicine services
In the preventive service notes, CPT clarified how a comprehensive preventive service differs from other comprehensive E/M exams. The revised text states (new text in bold):
The "comprehensive" nature of the Preventive Medicine Service codes, 99381-99397, reflects an age and gender appropriate history/exam and is NOT synonymous with the "comprehensive" examination requirements in E/M codes 99201-99350.
CPT slightly revised the comprehensive preventive medicine visit code descriptors to reflect the above change.
You should obtain the CPT 2002 to review all changes in the E/M and other sections. Many changes—including those in the pathology, laboratory and medicine sections—are relevant to internists.
Brett Baker is a third-party payment specialist in the College's Washington office. To ask a third-party payment or coding issue question, contact him at 202-261-4533 or firstname.lastname@example.org.
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