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New changes to CPT codes that will affect internists

From the January/February ACP Observer, copyright © 2004 by the American College of Physicians.

By Brett Baker and Carol McKenzie

Q: What changes to the "Current Procedural Terminology (CPT) 2004" will affect internists?

A: The AMA committee that updates CPT made several changes to the 2004 edition. Internists will be most affected by changes to: evaluation and management (E/M) codes; the designation for a minor, stand-alone procedure; laboratory test/panel codes; and vaccine codes.

E/M services

  • Disability evaluation. CPT added a note to its codes for work-related or medical disability evaluation services (99455-99456). When physicians complete workers' compensation forms, CPT says it is inappropriate to report the above codes with code 99080, which refers to "special reports such as insurance forms" that ask for information beyond what is required in "usual medical communications or standard reporting forms." CPT says the work related/medical disability codes already cover physicians' efforts to complete forms.

    Each Medicare carrier has the discretion to decide whether to pay separately for these services and determine payment amounts if it decides to cover them.

  • Critical care. CPT revised its pediatric critical care codes (99293-99294) and its neonatal critical care codes (99295-99296) to specify that they are to be used only for patients in the inpatient setting. These codes were previously used to report pediatric and neonatal critical care in both inpatient and outpatient settings.

    CPT now tells physicians to use codes 99291-99292 for critical care provided to pediatric and neonatal patients in the outpatient setting. While this change isn't likely to affect internists' reporting of critical care services, CPT says they should nonetheless be aware of the change.

Minor stand-alone procedures

  • Starred procedure designation. CPT deleted the starred procedure designation (noted with an "*"). The goal is to eliminate a duplicate method of reporting minor procedures performed on the same date as an E/M service.

    In the past, CPT assigned the starred procedure designation to indicate that a surgical procedure code described only the surgical procedure. Physicians used the designation to indicate that all services should be reported separately and that a global period did not apply.

    If you're performing an E/M service on the same date as a minor procedure and want to indicate that you should be paid separately for both, use modifier -25. CPT says that physicians may need to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided-or beyond the usual preoperative and postoperative care associated with the performed procedure.

    CPT also says that the E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. Different diagnoses are not required to report an E/M service on the same date.

    (Note: Do not use modifier -25 to report an E/M service that results in a decision to perform surgery. Use modifier -57 instead.)

    CPT hopes that eliminating the starred procedure designation will result in more consistent use of modifier -25. CPT also deleted the designation to eliminate conflicts with the Medicare global period assignments (0, 10 or 90 days) that apply to procedures in the physician fee schedule. In the past, Medicare has assigned a global period to codes that CPT designated as a starred procedure.

Pathology/laboratory

  • Organ- or disease-oriented panels. CPT revised the description of its general health panel (CPT 80050) to incorporate CPT 2003 revisions to hematology and coagulation codes. The general health panel descriptor now correctly identifies the codes for the individual tests that comprise the panel.

    The new description for the general health panel says the panel must include the following services:

  • comprehensive metabolic panel (80053);

  • blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) or blood count complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009); and

  • thyroid stimulating hormone (TSH) (84443).

    Be aware that CPT maintains organ- or disease-oriented laboratory panels as a convenient way for physicians to order tests. Typically, a single diagnosis code is sufficient to justify the medical necessity of ordering a panel. To bill a panel code, you must perform all tests included on each panel.

    If you order tests outside of the panel, you must justify each procedure separately.

  • Chemistry. CPT revised code 83716 to clarify that it can be used to describe the quantitation of lipoprotein subclasses. CPT also removed the word "cholesterol" from the descriptor. The new description of CPT 83716 code reads:

    "Lipoprotein, blood; electrophoretic separation and quantitation: high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (e.g. electrophoresis, nuclear magnetic resonance, ultracentrifugation)"

    CPT revised the series of codes for measuring total protein (84155, 84160 and 84165), and added two codes (84156-84157) to differentiate total protein testing by specimen and methodology. The new and revised codes are:

  • 84155: (revised) protein, total, expect by refractometry; serum.

  • 84156: (new) urine.

  • 84157: (new) other source (synovial fluid, cerebrospinal fluid).

  • 84160: (revised) protein, total by refractometry, any source.

  • 84165: (revised) protein, electrophoretic fractionation and quantitation.

    In addition to these changes, CPT made significant changes to the following pathology and laboratory subsections: hematology and coagulation; microbiology; cytopathology; surgical pathology; other procedures; and reproductive medicine procedures.

Vaccines/toxoids

CPT made several changes to the vaccine/ toxoid subsection of the medicine section.

(Changes were also made to the following subsections of the medicine section: dialysis; gastroenterology; special otorhinolaryngologic services; cardiovascular; neurology and neuromuscular procedures; physical medicine and rehabilitation; special services, procedures and reports; and home health procedures/services.)

  • CPT established a new code, 90656, to describe a preservative-free influenza virus vaccine for injection in patients older than 3. CPT created the code to distinguish between a vaccine product that contains preservatives.

    The new description for CPT 90656 is: "Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years of age and above, for intramuscular use."

    The new code has been available for use since Nov. 15, 2003. CPT took the unusual step of releasing the code early so physicians could use it during the entire flu season.

  • CPT deleted code 90659 (influenza virus vaccine, whole virus), for intramuscular or jet injection use. That vaccine product is no longer manufactured or used, and the presence of the code resulted in coding errors.

  • CPT established a new code, 90698, to describe a single vaccine that uniquely combines diphtheria toxoid, tetanus toxoid, acellular pertussis, hemophilus influenza type B and poliomyelitis types 1, 2, 3 inactivated. The descriptor states that 90698 is for intramuscular use.

  • CPT deleted the phrase "or jet injection" from vaccine/toxoid codes 90703-90708; 90718; 90727; and 90733. This method of administration is seldom performed.

  • CPT established a new code, 90715, to identify tetanus, diphtheria toxoids and acellular pertussis vaccine (TdaP), for use in individuals 7 and older. The current code for this combination of antigens, 90700, identifies the formulation for individuals 6 years and younger. The description states that 90715 is for intramuscular use.

  • CPT established a new code, 90734, to distinguish a tetravalent conjugated meningococcal vaccine from an existing meningococcal vaccine code, 90733, that describes a polysaccharide formulation.

    The descriptor for new CPT 90734 is: "Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for intramuscular use."

Q: What new sections in CPT 2004 should I know about?

A: CPT released a section containing category II codes in the 2004 edition. These codes are supplemental tracking codes that can be used for performance measurement. Listing 0007F to indicate that you had prescribed beta-blocker therapy is an example of a category II code.

CPT established category II codes to minimize the administrative burden that collecting performance data imposes on physicians. Category II codes represent services and/or test results that support performance measures. Those services or results have been agreed upon as contributing to good patient care or involve compliance with state or federal laws.

Use of these codes is optional. They are not required for correct coding and are not to be used as a substitute for the five-numerical-digit, category I CPT codes. Category II codes will be published every Jan. 1 and July 1. You can view the current listing at the AMA Web site. (Look in the column on the right side of the page.)

Q: Are there any changes to the CPT category III codes?

A: The CPT category III section contains temporary codes for emerging technology, services and procedures, primarily to allow for data collection. CPT has added 17 category III codes. (It deleted two because they were converted to category I codes.)

Although internists are unlikely to use the new category III codes, a complete listing of the codes appears in CPT 2004. You should obtain a copy of CPT 2004 to review these and other changes and ensure reporting of the most recent codes. (To order a copy from the AMA, call 800-621-8335.)

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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