CPT 2012: Don't Skip These Explanations About New Patients plus 'Qualified Healthcare Professional'

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.

Prepare Yourself With Novel Codes To Report Neurolysis in 2012

While reporting the paravertebral facet joint nerve injections in 2012, you will no more be counting nerves that your surgeon targeted. Till now, you have been reporting injections for each nerve at a distinct vertebral level. Effective Jan. 1, you'll require adjusting your technique to look for the particular anatomical site involved along with the work that your surgeon did. Read this expert medical coding article for more on what changes does CPT 2012 brings for these injections in: what goes obsolete and what new comes in.

CPT 2012: Know the Deletions

Here are four CPT codes that will be deleted in 2012:

64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level)

+64623 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level [List separately in addition to code for primary procedure])

64626 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level)

+64627 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level [List separately in addition to code for primary procedure])

CPT 2102: Look at Novel Codes

You will find four new CPT codes in 2012. These include the following:

64633 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single facet joint)

+64634 (Destruction by neurolytic agent, paravertebral facet joint nerve [s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, each additional facet joint [List separately in addition to code for primary procedure])

64635 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single facet joint)

+64636 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, each additional facet joint [List separately in addition to code for primary procedure])

Don't Distinctly Report Image Guidance

When reporting neurolysis described by new CPT codes 64633-64636, ensure that your surgeon has used and documented the image guidance used to carry out the paravertebral facet joint nerve destruction. The CPT 2012 codes are inclusive of the image guidance, so you do not individually report the fluoroscopy or CT guidance used for the paravertebral nerve localization. Keep in mind that image guidance with either fluoroscopy or CT is both required and is bundled into the new CPT codes.
 

CPT 2012 Tip: You do not report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) for fluoroscopic guidance and 77012 (Computed tomography guidance for needle placement [eg, biopsy, aspiration, injection, localization device], radiological supervision and interpretation) for CT guidance with 64633-64636.

CPT® 2012 Clarifications: Pediatric Hospital Rounds Will Be Stress-free to Code

Distinguish the common types of pediatric hospital visits and you'll be on the road to correct medical coding.

Though most pediatricians assess newborn inpatients as part of their fixed weekly work, some practices struggle with how to code such services. However once you break it down into the below listed most common categories of inpatient E/M rounds, you could be sending claims out the door sooner and more competently. Read this article for correct medical coding and know what CPT codes apply in this situation.

Check NICU Changes for CPT 2012

Two of the most severe types of infant hospital visits include time with intensive care or critical care. In both of such cases, the pediatrician has to go above and beyond what's needed when seeing a healthy newborn--and coding such visits can be a challenge.

The issue of level of care delivered is not specific to the site of service. Though, neonatal critical and intensive care services are normally provided in a NICU.

Intensive care: Assume that a baby is tachypneic with a fever as a newborn and is worked up and is getting treatment for sepsis. The pediatrician gives a neonatal intensive level of care, carrying out daily intensive care services. In these situations you'll report a code from the 99477-99480 series of CPT codes.

Critical care: After the pediatrician examines a patient for more austere issues—for instance organ system failure or serious respiratory distress--he might decide that the patient is in need of critical care, which you'll code using the 99468-99469 series of CPT codes. In a lot of cases, critical care would be administered by a neonatologist.

Changes for CPT 2012: Earlier, in case a patient was transferred from neonatal intensive to critical care--or vice versa--the coding rules were blurred. But, CPT 2012 clarifies that issue with parenthetical notes to guide you in making the correct CPT codes decision.

What CPT® now makes clear is that in case an infant recovers after the initial day and is transferred to a lower level of care, the transferring physician does not report a per-day intensive care service. In its place, the transferring doctor will report a code from the subsequent hospital care section (99231-99233) of CPT®. The receiving physician will report subsequent intensive care (99478-99480) or subsequent hospital care (99231-99233) as suitable based on the condition of the neonate or child.

In case the physician provides intensive care services but then the patient becomes critically ill and then is transferred to a dissimilar physician, the transferring physician reports either the critical hourly care service (99291-99292) or the daily intensive care service carried out , but not both.

Welcome Car Seat Testing Codes Effective Jan. 1

Plus: You'll find explanation on developmental testing codes 96110-96111.

Previous year, coders got a good dose of updates--and confusion--with the inclusion of numerous new vaccine administration codes. CPT 2012 goes lenient on pediatric practices with a few modifications to the code set which will generate the necessity for updates, but not overhauls. Read this article for stress-free and accurate medical coding.

At the top of the list this year, you'll find the following new CPT codes for car seat testing:

94780 – (Car seat/bed testing for airway integrity, neonate, with continual nursing observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; 60 minutes)

+94781 – {...each additional full 30 minutes (List separately in addition to code for primary procedure)}

The car seat testing services will mainly be done in facility settings; however will be valued with facility and non-facility payment amounts. These tests are usually essential before premature or at-risk babies (with conditions such as heart disease or congenital malformations) are discharged home from NICU settings.

There are occasions where follow-up testing may be indicated. "This would normally be provided in a neonatal follow-up clinic, however could be carried out in the office setting, in case the setup is complete to offer all the necessities for the code. As more services shift to the medical home, this could happen more in the future. Having the CPT codes and the anticipated relative value payments should facilitate the process.

For More Information :- http://isupercoder.blogspot.in/2011/12/welcome-car-seat-testing-codes.html

Developmental 'Testing' Modifies to 'Screening'

New CPT codes are always great to find in CPT®, however occasionally you'll find changes that make significant explanations to present codes. Such is the case with existing developmental testing CPT codes 96110-96111. The new descriptors for these codes are listed below:

96110 – (Developmental screening, with interpretation and report, per standardized instrument form)

96111 – (Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments), with interpretation and report)

Medical Coding Tip: Take Note of Vaccine Revisions

Last year, in pediatric medical coding, CPT® threw many practices for a loop with the adding of several new vaccine administration codes, which most payers finally began processing efficiently within the last few months. Luckily, such a main overhaul has not taken place this year. Instead, CPT® makes slight adjustments to how you'll report your vaccines for accurate medical coding.

For instance: CPT® will change meningococcal conjugate vaccine code 90644 to get rid of mention of "Hib-MenCY-TT." In its place, the new code descriptor reads "Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine (Hib-MenCY), 4-dose schedule, when administered to children 2-15 months of age, for intramuscular use.

CPT® 2012 Contains Intradermal Flu Vaccine Option With 90654

Don't overlook revisions to other vaccine, E/M codes.

CPT® 2012 will go into effect in a few weeks, so you must prepare yourself now for new and revised choices associated with vaccine administration and prolonged E/M service to make sure your claims stay correct. Read this article for an ICD-9 and CPT 2012 expert insight for accurate claims and maximized ethical reimbursement.

Official Addition of 90654

CPT® 2012 adds a different option to your flu vaccine coding by adding 90654 (Influenza virus vaccine, split virus, preservative-free, for intradermal use). The inclusion expands on the code family 90655-90668 that at present addressed influenza vaccines.

A couple of factors separate 90654 from a lot of of the other flu vaccine codes:

Code 90654 is not age specific, while codes 90655-90658 do identify the patient's age (either 6 to 35 months of age, or age 3 years and older).

Code 90654 denotes an intradermal injection (administered to the dermal layer of skin), however additional codes (e.g. 90655-90658 and 90662) describe intramuscular injections (administered to muscle tissue) as well as intranasal administration (e.g. 90660).

ICD-9 and CPT Tip: Code 90654 signifies just the vaccine product. Include the fitting administration code (90460-90474) on your claim. In case your physician delivers a noteworthy, distinctly identifiable E/M service in the encounter for the vaccine, also report the suitable E/M code (99201-99205 for a new patient or 99211-99215 for an established patient).

Though 2012 will be the first time 90654 is covered in the CPT® book, the code has been present for more than a year.

Ace ICD-9 and CPT 2012: Note Extra Specificity of 90460-90461

A number of additional vaccine as well as vaccine administration codes go through revision for CPT® 2012. Revised codes involve (underline indicates change):

90460 -- Immunization administration over 18 years of age through any route of administration, including counseling by a physician or added qualified health care professional; first or only component of each vaccine or toxoidadministered.

+90461 -- ... every single additional vaccine or toxoid component which is administered (List separately in addition to code for primary procedure)

90581 -- Anthrax vaccine, meant for subcutaneous or intramuscular use

90644 -- Meningococcal conjugate vaccine, as well as serogroups C & Y along with Hemophilus influenza B vaccine (Hib-MenCY), a 4 dose schedule, while administered to children who are 2-15 months of age, for intramuscular use.

ICD-9 and CPT Expert Tip: CPT 2012 removes vaccine codes 90470 (H1N1 immunization administration [intramuscular, intranasal [including counseling when performed) and 90663 (Influenza virus vaccine, pandemic formulation, H1N1). These codes were possibly considered no longer required, particularly with the inclusion of codes 90664-90668 in 2011.

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