CPT: What's new for 2006

December 2, 2005

Don't risk denials by using outdated codes. Here's a rundown of the changes.

Here we go again. The new year is fast approaching, bringing with it CPT revisions galore. As you should know by now, you'll need to update your charge sheets and encounter forms to reflect the changes that take effect Jan. 1. If you don't, you could end up over-or undercoding your services, and having your claims denied.

This year, there are 277 new CPT codes, 71 revised codes, and 110 deleted ones. You can find the full list in Appendix B of your 2006 CPT book, available in hard copy, on CD-ROM, or electronic software from the AMA at http://www.amapress.com.

"We tried to make the codes more specific, which in turn should make them clearer," says Tracy R. Gordy, chair of the AMA's CPT Editorial Panel. There's also been an effort to delete codes for procedures that are no longer used.

Evaluation and management. There are an equal number of additions and deletions in E&M codes this year-20 of each.

A notable revision is the deletion of the follow-up inpatient consult codes (99261-99263), which Gordy says were a source of confusion. Beginning in January, if after the initial consult, you assume responsibility for all or part of the patient's care, you'd code the subsequent visits using the appropriate E&M code (99231-99233 for subsequent hospital care or 99211-99215 for established patient care if you see the patient in your office). If the follow-up consult takes place in a nursing facility, use one of the new subsequent nursing facility care codes (99307-99310).

But if you return when asked to see the patient in the hospital and render an opinion only, you'd report a low-level consultation code. Although this last point isn't stated in the new CPT book, Gordy says it will be clarified in an upcoming issue of the AMA's CPT Assistant.

The confirmatory consultation codes (99271-99275) have also been deleted because other, more-specific E&M consult codes are available, says Gordy. For example, when the patient comes to your office, use the office consultation codes (99241-99245).

Other important changes are in the nursing facility service section. Six codes have been deleted (99301-99303 and 99311-99313), and seven have been added (99304-99310) to address initial and subsequent nursing facility care. The new codes create three levels of service for admissions (99304-99306) consistent with the levels for hospital care admissions. The subsequent care codes have been replaced with new codes 99307-99309. Another new code-99310-allows the reporting of a comprehensive level of care, which is a new level of service. You can now also report a comprehensive annual assessment using the new code 99318, which appears in a new subsection (other nursing facility services).

More E&M changes: The explanatory text of modifier –25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), found in Appendix A, has been revised. Gordy hopes the new language will clarify the modifier's use and reinforce what doctors should have been doing all along. The added language stresses the importance of documentation to support that the E&M service is significant and separate from the same-day procedure, or service.

Medicine. There are 57 new codes, 22 revised codes, and 38 deleted ones. Eleven of the new codes and seven of the deleted ones are part of the revised subsection on hydration and therapeutic, prophylactic, and diagnostic intravenous injections and infusions. Six new codes have been added to report moderate (conscious) sedation.