Learn how changes influence your use of 99201-99205, 99460-99461, and more.
Medical coding guidelines can at times seem puzzling when you're trying to decide whether to categorize a patient as new or established. For instance when an established patient comes to your practice to see a new physician, would you report a new patient office visit code?
CPT 2012 tries to clarify this question and one other E/M question: Who counts as a "qualified healthcare professional" to administer that vaccine or deliver prolonged service?
'New Patient' Classification Goes to a New Level
At present, CPT® indicates that a "new patient" refers to a patient who has not received any professional services, for instance an E/M or other face-to-face service, from the physician or another physician of the same specialty in the similar group practice in the past three years.
Clarification: CPT 2012 takes that definition a step further, by stating, "A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years." The parts of the description that are novel for 2012 are underlined.
What it means: In case your practice employs several subspecialists, CPT® now clarifies that claims for patients who see dissimilar doctors with different subspecialties can be billed using a novel patient code (such as 99201-99205).
RN Doesn't Fit 'Other Qualified Healthcare Professional'
In case your payer follows CPT® rules, you can now eliminate registered nurses from the list of professionals who can administer vaccinations or offer prolonged services for patients.
At the demand of many physicians, CPT 2012 now describes the term "other qualified healthcare professional." Although this definition didn't make it into the 2012 manual, the AMA lists it as part of the "CPT 2012 Errata" on its Web site.
The definition("A 'physician or other qualified health care professional' is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. These professionals are distinct from 'clinical staff.' A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. Other policies may also affect who may report specified services.)
Result: RNs and LPNs are excluded in the definition, as they cannot individually report the professional services that they offer. RNs and LPNs suit the CPT® definition of "clinical staff," as their professional services are normally reported under a physician or other qualified health care professional's identification number (e.g., under Medicare's "incident to" rule). This implies that when certain CPT codes refer to 'other qualified health care professionals' they are not including RNs and LPNs.
Medical coding guidelines can at times seem puzzling when you're trying to decide whether to categorize a patient as new or established. For instance when an established patient comes to your practice to see a new physician, would you report a new patient office visit code?
CPT 2012 tries to clarify this question and one other E/M question: Who counts as a "qualified healthcare professional" to administer that vaccine or deliver prolonged service?
'New Patient' Classification Goes to a New Level
At present, CPT® indicates that a "new patient" refers to a patient who has not received any professional services, for instance an E/M or other face-to-face service, from the physician or another physician of the same specialty in the similar group practice in the past three years.
Clarification: CPT 2012 takes that definition a step further, by stating, "A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years." The parts of the description that are novel for 2012 are underlined.
What it means: In case your practice employs several subspecialists, CPT® now clarifies that claims for patients who see dissimilar doctors with different subspecialties can be billed using a novel patient code (such as 99201-99205).
RN Doesn't Fit 'Other Qualified Healthcare Professional'
In case your payer follows CPT® rules, you can now eliminate registered nurses from the list of professionals who can administer vaccinations or offer prolonged services for patients.
At the demand of many physicians, CPT 2012 now describes the term "other qualified healthcare professional." Although this definition didn't make it into the 2012 manual, the AMA lists it as part of the "CPT 2012 Errata" on its Web site.
The definition("A 'physician or other qualified health care professional' is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. These professionals are distinct from 'clinical staff.' A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. Other policies may also affect who may report specified services.)
Result: RNs and LPNs are excluded in the definition, as they cannot individually report the professional services that they offer. RNs and LPNs suit the CPT® definition of "clinical staff," as their professional services are normally reported under a physician or other qualified health care professional's identification number (e.g., under Medicare's "incident to" rule). This implies that when certain CPT codes refer to 'other qualified health care professionals' they are not including RNs and LPNs.
No comments:
Post a Comment