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Coding Consult: New codes for 2002


Unless you're up on all the new coding rules, reimbursements will slide.


Coding Consult

New codes for 2002

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Choose article section...New codes for 2002 Diagnosis codes E&M codes Surgery codes Medicine codes Medicare changes

Unless you're up on all the new coding rules, reimbursements will slide.

By Susan Callaway, CPC

It just wouldn't feel like New Year's without new procedure and diagnosis codes. Here are the most important changes you need to know about.

Diagnosis codes

There are approximately 150 additions, changes, or deletions to the ICD-9-CM codes. Although these codes were official as of last October, many carriers didn't begin to use them until Jan. 1. Check with your local carriers to make sure they've implemented the new rules. The most notable new or revised codes for primary care are:

• 256.31—Premature menopause.

• 256.39—Other ovarian failure.

• 277.7—Dysmetabolic syndrome X.

• 530.12—Acute esophagitis.

• 564.00—Constipation, unspecified.

• 564.01—Slow transit constipation.

• 564.02—Outlet dysfunction constipation.

• 564.09—Other constipation.

• 602.3—Dysplasia of prostate.

• 608.82—Hematospermia.

• 692.76—Sunburn of second degree.

• 692.77—Sunburn of third degree.

• V49.81—Postmenopausal status (asymptomatic).

E&M codes

New CPT codes and descriptions became effective Jan. 1. But most carriers allow a phase-in period through the first quarter of the year. The important changes for evaluation and management services:

• 99289 and 99290—New codes for the supervision of patient transport. Physicians should no longer use critical care codes 99291-99292 for these services. Medicare doesn't recognize the new supervision codes, but offers G0240 and G0241 with slightly different descriptors that meet Medicare policy restrictions.

• 99381 through 99397—These preventive medicine codes now indicate that a patient's age and gender determine the elements included in the comprehensive history and exam. That should eliminate the uncertainty doctors have had when trying to code for these services.

Surgery codes

There's a long list of much-needed new surgery codes, but most of them apply to orthopedists and urologists. Of interest to primary care doctors are the codes for trigger point injections, which received an overhaul. Instead of a single code, there are now four, all of which require specific documentation concerning which part of the body was injected and how many muscle groups were involved. The new codes:

• 20550—Injection; tendon sheath, ligament, ganglion cyst.

• 20551—Injection; tendon origin/insertion.

• 20552—Injection; single or multiple trigger point(s) of one or two muscle groups.

• 20553—Injection; single or multiple trigger point(s), three or more muscle groups.

Medicine codes

The most important new codes:

• 90473 and 90474—Administration of intranasal or oral immunizations.

• 91123—Pulsed irrigation of fecal impaction. (Manual disimpaction is still recorded by using an E&M code.)

Medicare changes

CMS (Centers for Medicare & Medicaid Services, formerly HCFA) issued new rules allowing reimbursement when nurse practitioners, physician assistants, and clinical nurse specialists perform screening flexible sigmoidoscopies. Use the regular flex sig code (G0104); reimbursement will be 85 percent of a physician's fee.

Also, the agency reminded physicians who order and supervise home health services that they should be reimbursed even if they coordinate the care during a surgical global period (use G0179 and G0180).

Other changes:

• G0101 and Q0091—Preventive breast and pelvic exams. Effective last July, these services are covered for all non-high-risk females every other year.

• G0121—Screening colonoscopies. These are covered for non-high-risk patients every 10 years, also effective last July.

• 97802-97804—Medical nutrition therapy provided by a registered dietitian or nutrition professional. These services will be covered for patients with renal disease or diabetes, when referred by the patient's treating physician.

• -GY and -GZ—These two new modifiers were added to the HCPCS list this year. The first, -GY, is for services that are statutorily excluded or not a Medicare benefit, and the second, -GZ, is for services expected to be denied. Modifier -GX (service not covered by Medicare) has been deleted.

When services are provided that might require an advance beneficiary notice, such as 99397 (preventive medicine), use -GZ if you don't have a waiver from the patient, -GA if you do. Use these modifiers with standard CPT codes for services.


The author, a certified professional coder, is a consultant and seminar leader for McVey Associates (mcveyseminars.com), an insurance reimbursement consulting company in Novato, CA. This department answers common coding questions. Since coding rules frequently change and are subject to interpretation by insurance carriers, decisions should be made in light of individual circumstances, local conditions, payer policies, contracts, and new or pending governmental policies. We welcome your questions for future columns. Please submit them to mecode@medec.com. Sorry, but we're not able to answer readers individually.


Susan Callaway. Coding Consult: New codes for 2002.

Medical Economics


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