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The American Medical Association (AMA) changes in Current Procedural Terminology (CPT) coding from year to year can have an enormous effect on any practice.
Coding-related changes for 2010 can be grouped into several categories:
• CPT changes
• Non-CPT changes
Two main questions surround this transition:
1. How will specialists be compensated for the additional time and effort it takes to evaluate patients they never have seen for problems complex enough that the patients' primary care physicians have asked for evaluations and opinions?
Levels of evaluation and management (E/M) service in an outpatient or hospital setting do not always contain the typical time constraints of the previous consultation codes (see "Time constraints").
CMS representatives at the AMA CPT and RBRVS [Resource-Based Relative Value Scale] 2010 Annual Symposium; Amy Bassano, MA, director of the Hospital and Ambulatory Policy Group; and Kenneth Simon, MD, MBA, FACS, senior medical officer of that group, indicated that inpatient consultations should be reported with an initial level of hospital care. To differentiate between the admitting physician and consultant, a new modifier will be established. Although it was not final, discussion was that, presumably, the A1 modifier code would be used to define the admitting physician from the consultant physician.
2. How will Medicare treat the new patient definition that would adversely affect certain multispecialty groups?
For instance, certain specialties, such as ophthalmology, although having subspecialty providers in areas such as cornea, glaucoma, neuro-ophthalmology, pediatrics, and retinology, are not recognized by Medicare as having subspecialists, and, therefore, do not have separate taxonomy codes representing these subspecialties. All ophthalmologists, therefore, are considered to be part of the same specialty. An evaluation by any one of the ophthalmology subspecialists will be billed at an established patient level of service if another provider first saw the patient. Established patient codes 99214 at 25 minutes or 99215 at 40 minutes do not equate to consultation codes 99244 at 60 minutes and 99245 at 80 minutes in terms of time.
• Re-sequencing of codes
The requirement for additional definitions and more space within CPT definitions created the need to re-sequence codes, many times putting them out of order within the code hierarchy. A new symbol, #, was established for use in CPT 2010 to assist users in recognizing the out-of-sequence codes.
• Greater transparency in the CPT process
Changes include internal and external review of the CPT processes, including Relative Value Scale Update Committee recommendations by non-members of the committees through printed materials and access to activities of the various committees via the Web site.
• Category II codes
Ninety-eight Category II codes for quality improvement measures are new, nine Category II codes for clinical conditions are new, and 46 Category II codes for clinical conditions have been revised.
• Category III codes
Eleven Category III codes are new, and 22 Category III codes have been deleted. Of the deleted codes, seven have been converted to Category I CPT codes. The remaining deleted codes have been archived, not meeting the criteria for conversion to Category I codes.