CPT changes codes for patient transport, labs and call
By Brett Baker and Carol McKenzie
Q: What changes to the Current Procedural Terminology for 2003 will affect internists?
A: The AMA committee that updates Current Procedural Terminology (CPT) made numerous changes in the 2003 edition. Internists will be most affected by changes to codes for patient transport, blood collection and special services. Here is an overview of those revisions listed by CPT category and Medicare's payment policy for each:
Evaluation and management
Patient transport. CPT has revised transport codes 99289 and 99290 so that they pertain to pediatric care only. CPT has also revised the introductory text to the two critical care codes to accommodate this change.
Here is a description of the revised codes:
99289—Critical care services delivered by a physician, face to face during an interfacility transport of pediatric patient 24 months of age or less, first 30-74 minutes of hands-on care during transport.
99290—Each additional 30 minutes. (List separately in addition to code for primary service.)
Medicare has accepted the new CPT codes and will pay for 99289 and 99290 for the transportation of pediatric patients.
To report your attendance during the transport of a critically ill or injured patient over 24 months of age, use CPT codes 99291 and 99292. CPT modified the introductory text to the two critical care codes to state that those codes should be used to report physician attendance during transport of a critically ill or injured patient over 24 months of age.
Last year, Medicare required physicians to bill using G0240 and G0241 for care they gave during the transport of all critically ill or injured patients, regardless of the patient's age. Medicare used these "G" codes because the 2002 CPT transport codes did not require physicians to perform any specific services. The old CPT transport codes also failed to state that critical care services such as gastric intubation performed during transport are bundled into the transport codes.
Medicare has discontinued using codes G0240 and G0241 for transport services.
Blood collection. The codes for reporting blood collection have been changed to distinguish venipuncture from stick method. (Last year, CPT used 36415 to report either method.) Here are the revised codes:
36415—Collection of venous blood by venipuncture. (Do not report modifier -63 in conjunction with this code.)
36416—Collection of capillary blood specimen (finger, ear, heel stick.)
Medicare has not accepted these new CPT codes and requires physicians to use G0001, routine venipuncture for collection of specimens, for both venipuncture and stick method. Private insurers, however, typically require CPT codes to report blood collection. Check with your payers to see if they want you to use the new CPT codes or Medicare's G codes.
Special services, procedures and reports. CPT includes two new codes for physicians to report call time that hospitals require physicians to work. Although Medicare does not pay physicians for hospital call time, you can use the new codes to bill your hospitals for mandatory call.
Here are the new codes:
99026—Hospital mandated on-call service; in-hospital, each hour.
99027—Hospital mandated on-call service; out-of-hospital, each hour.
For physician standby service that requires physician attendance for a prolonged period, use 99360 (physician requested standby service by other physician) when appropriate. Time spent performing separately billable procedures or services should not be included in the time reported as mandatory on-call service.
Emerging technology codes
New services and procedures. CPT established 18 new codes in 2003 for Category III services. These temporary codes (four digits plus T) apply to emerging technology, services and procedures and allow payers to collect data about them. (For more information, consult CPT 2003.)
The codes do meet the usual requirements for CPT Category I codes, and the inclusion of services in the Category III code list does not imply or endorse clinical efficacy, safety or applicability to clinical practice.
Pathology and laboratory
- Hematology. CPT reorganized its hematology section, creating new codes and revising and deleting existing codes.
CPT established the following new codes:
85004—Blood count; automated differential WBC count.
85032—Manual cell count (erythrocyte, leukocyte or platelet) each. (This code replaces 85590, which has been deleted.)
85049—Platelet, automated. (This code replaces code 85595, which has been deleted.)
CPT updated the following three microscopic evaluation codes to recognize that laboratory nonphysician manual microscopic review of peripheral blood falls into three basic categories:
85007—Blood smear, microscopic examination with manual differential WBC count.
85008—Blood smear, microscopic examination without manual differential WBC count.
85009—Manual differential WBC count, buffy coat.
CPT made minor editorial changes to CPT 85014 and 85018 to clarify their use. The revised codes are:
CPT revised 85025 and 85027. Here are the new codes with an explanation of how to use them appropriately:
85025—Complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count. Laboratories like large reference facilities that routinely perform only automated differentials can use the revised code 85025 to report an automated CBC (i.e., Hgb, Hct, RBC, WBC, and platelet count) with automated differential WBC count.
85027—Complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count). Practices that reflect the appropriate WBC differential counting technique, depending on results of the automated CBC, can use revised code 85027 as the base code for the CBC, then add the most appropriate differential code (85007, 85008 or 85009).
CPT revised 85041 to specify that it should be used only to report automated red blood cell count. Here is the revised code:
85041—Red blood cell count (RBC) automated. (Do not report 85025 or 85027 in conjunction with this code.)
CPT made minor editorial changes to CPT 85044, 85045 and 85048 to clarify their use. The revised codes are:
85048—Leukocyte (WBC) automated.
CPT also deleted a number of codes. Here is an overview of deleted codes that are pertinent to internists:
CPT deleted 85021, 85022, 85023, and 85024 because it determined that it is no longer necessary to distinguish between partial and complete automated WBC differential counts.
CPT deleted 85031 because complete manual CBC has become virtually nonexistent.
CPT replaced 85585, 85590 and 85595 with the revised codes, which are described below:
A platelet estimation, which was previously reported using CPT 85585, should now be reported with revised code 85008.
A manual platelet count, previously reported using CPT 85590, should now be reported with code 85032.
An automated platelet count, previously reported with 85595, should now be reported with new code 85049.
Q: Should I use these new and revised codes before Medicare implements its 2003 payment rates on March 1, 2003?
A: The new and revised CPT codes, as well as the new and revised Medicare-created codes, took effect on Jan. 1 of this year. Medicare officials have said, however, that they will hold claims that include new codes until the 2003 rates are implemented on March 1, 2003.
You should bill services using new/revised procedure codes on a separate claim form, whether electronic or paper. If you list CPT codes from both 2002 and 2003 on the same claim, your carrier may hold the entire claim until March.
Q: Do I have to wait until March to bill for services using CPT codes that haven't changed?
A: No. To receive the maximum reimbursement, bill all Medicare services you perform in January and February before March 1 if possible. Medicare will pay its 2002 rates until the 2003 rates are implemented on March 1.
Unless a legislative remedy is enacted, the 2003 Medicare rates will fall 4.4% because of the flawed formula for updating payments. ACP-ASIM has been pressing Congress to fix the problem for more than a year.
Information on how Medicare is implementing the 2003 payment rates and on changing your participation in Medicare is available online. For more on ACP-ASIM's efforts to avert the 4.4% cut, go to Physician Payment, Coding & Billing.
Brett Baker is a third-party payment specialist and Carol McKenzie is an administrative coordinator in the College's Washington office.
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