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This month's question focuses on the Current Procedural Terminology code changes in 2013. Find out the answer to this pressing coding question.
Q: Would you please explain the Current Procedural Terminology (CPT) code changes for 2013 that will affect primary care physicians?
A: There are several 2013 CPT coding changes; however, only two pertain to primary care.
EVALUATION AND MANAGEMENT (E/M) CODE CHANGES
In the 2013 CPT code book, 82 E/M code descriptions were revised to include “other qualified healthcare professionals” instead of the term “physicians.”
The rationale is that providers other than physicians-including nurse practitioners, physician assistants, and physical and occupational therapists-use these codes but not registered nurses, licensed practical nurses, or medical assistants.
Although some CPT code descriptors (that is, critical care codes) were not revised to include the new terminology, the E/M section guidelines were modified to allow nonphysician providers to report services.
If you are unsure whether a provider can use a specific E/M code, check the:
COMPLEX CHRONIC CARE COORDNIATION SERVICES
These codes are reported for licensed clinical staff time (directed by a physician or other qualified healthcare provider) to report the coordination of services (medical and psychosocial). These services are reported once per calendar month and are based on whether a patient has a face-to-face encounter during the month.
Three new CPT codes were added for these services:
99487-Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified healthcare professional with no face-to-face visit, per calendar month.
99488-First hour of clinical staff time directed by a physician or other qualified healthcare professional with one face-to-face visit, per calendar month.
+ 99489-Each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month (list separately in addition to the code for the primary procedure).
Clinical indications that qualify for these codes:
TRANSITIONAL CARE MANAGEMENT SERVICES
These codes are used for transitional care management services (TCM) of an established patient whose medical and/or psychosocial problems require moderate or high complexity MDM during transitions in care from an inpatient hospital setting (acute hospital, rehabilitation hospital, or long-term acute care hospital); partial hospital; observation status in a hospital; skilled nursing or nursing facility to the patient’s community setting (home, domiciliary, rest home, or assisted living).
The CPT codes used to report these services:
99495-TCM with communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; MDM of at least moderate complexity during the service period; and a face-to-face visit within 14 calendar days of discharge.
99496-TCM with communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; MDM of high complexity during the service period; and a face-to-face visit within 7 calendar days of discharge.
PEDIATRIC CRITICAL CARE TRANSPORT CODES
Two new CPT codes were added to report the non-face-to-face work of a control physician directing care during interfacility transport:
99485-Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, aged 24 months or younger, includes two-way communication with transport team before transport, at the referring facility, and during the transport, including data interpretation and report; first 30 minutes.
+ 99486-Each additional 30 minutes (list separately in addition to code for primary procedure).
Do not report:
See the TCM code notes section for a listing of codes that cannot be reported by the same individual who bills TCM codes, as well as a listing of the types of face-to-face and non-face-to-face services that these codes could include.
The author is a billing and coding consultant for VEI Consulting Services, Indianapolis, Indiana. Do you have a primary care-related coding question you would like to have our experts answer in this column? Send it to firstname.lastname@example.org. Also engage at: www.twitter.com/MedEconomics and www.facebook.com/MedicalEconomics.