Code the More Complex Procedure With 69610-RT

In a particular situation, a physician assessed the patient's right ear and cleared the canal of all cerumen. The tympanic membrane was visualized, which had retained a tube. He removed a tube in the anterior superior aspect of the eardrum with a Rosen needle while ciprodex was applied. Post this, a paper patch was placed in an overlay technique and positioned using the operative microscope. After this, the physician went to the left ear and got rid of some dry debris. He also got rid of an extruded tube. There wasn't any perforation in situ; he debrided the canal and applied Ciprodex. As such, how do you report this?

Well, first of all you need to code the more complex procedure with 69610-RT.

Call off these choices: You can't code for the binocular microscope since it's a separate procedure and inclusive minus any other ear procedure carried out. Likewise, the removal of impacted cerumen is also a separate procedure, and insurers take it as inclusive with any other ear procedure. What's more, if the physician carried out this service in the operating room, you can't code 69990 because even though the physician used the operating microscope, coding 69990 requires the use of microsurgical technique. These procedures show no proof of microsurgery.

Next, you should code 69424-59-LT if the doctor carried out this procedure in the operating room under general anesthesia. If the doctor carried out this service under local anesthesia in the OR or in the office, you can code it 92504-59-LT for the use of the binocular microscope as you won't find any code for tube removal when the physician does not use general anesthesia.

Typically, if an otologic procedure requires a transcanal or endaural approach with incision of the tympanic membrane and access through the middle ear, you shouldn't report it separately. But then your physician carried out these services on two ears and should be paid for them as separate procedures. Your claim should look like this: 69610-RT, 69424-59-LT or 92504-59-LT depending on the type of anesthesia the physician used.

For further details on this and for other physician medical billing and coding tips, sign up for a one-stop medical coding guide like Supercoder. Such a site comes stocked with a physician coder's Powerpack that offers powerful physician medical billing and coding tools to provide you everything you need for denial-proof claims. It comes with codesets and tools, specialty coding library, SuperScrubber for physicians, CPT Assistant, and the like.

Standby: Take a Look at Documentation of 4 Areas before Submitting Claims

As we know, CPT's evaluation & management section includes only one code for standby time; however limited choices do not guarantee payment. Take a look at these four areas to see you get your well-deserved payments.

You should code based on availability and not care. Your first step in gearing up to submit a claim for standby service is to understand what you are reporting and what you are not. Code 99360 does not represent patient care, rather, it represents availability.

You need to document three important factors. Even though CPT includes a standby code, may payers don't reimburse for the service. Thorough documentation of your provider's service is paramount as you might be faced with an appeal. While coding 99360 for standby care, here are some key tips to keep in mind.

1. Yet another doctor must request that your anesthesiologist make himself available for standby time. You require this request in writing along with justification for why the other physician requests anesthesia standby.

2. The chart should cover a note by the anesthesiologist documenting that his service might be required.

3. Information about the anesthesiologist's involvement in the case.

You should also double check times and locations

Being able to report standby service hinges on a couple of important factors, which are time and location. You anesthesiologist must be in attendance for standby for at least 30 minutes and he must document that time. CPT indicates that if the time's less than 30 minutes, you do not report it separately. However, it is always a good idea to document patient care irrespective of whether it is billable or not.

Remember: Coding for standby time means your anesthesiologist doesn't have face to face contact with the patient. You should report his total time of availability, if it's 30 minutes or more. If your anesthesiologist is on standby for less than 30 minutes, document his availability, however do not charge for the time.

For more on this and for other anesthesia CPT codes, sign up for a one-stop medical coding guide like Supercoder. When you get onboard this, you'll have access to SuperCoder's Anesthesia Coder's PowerPack that comes with just the tools you need to code faster, ensure accuracy and stop denials. Some of the tools that'll help you stay away from denials are Anesthesia Analyst, Anesthesia Coding Alert, CPT Assistant, Stedman's Medical Dictionary, and lots more.

CPT 2011 Codes Help Solve Your 'Middle Day' Code Dilemma

While reporting the middle day observations, this year you have new options to choose from. If you want to find out how CPT additions will have a say on your orthopedist's observation care services, read on and find out:

New codes bring clarity with them. Before the start of this year, coding for the 'middle days' of an observation service was a pain in the neck. Even though, it's not the norm, there are situation where a patient is admitted to observation and remains in that status for three or more days. The E/M section of CPT 2011 addresses these middle days with new codes. The three codes that parallel the hospital subsequent care series in terms of component requirements and time frames are 99224, 99225 and 99226.

There has been some confusion on ways to report the middle day for those cases when an observation period transcends three calendar days. The new CPT codes

99224-99226 stamp out insurer variances. There has been some uncertainty about how to report the middle day for those cases when an observation period transcends three calendar days. The new codes however solve the problem.

Prior guidance for these 'extended' observation and middle day observation stays created some confusion and led to different policies such as the Spring 1993 edition of CPT Assistant, which instructed coders to “use the unlisted evaluation and management service code to report these services."

However, when setting policy on 'middle day' observation coding, payers often took their own path. They would often call for 99499; but then some carriers preferred 99231-99233 or 99211-99215. Technically speaking, observation codes are outpatient codes.

But be ready for disappointing reimbursement. Physicians and coders who were excited about the new subsequent care observation codes will not be too happy when they hear the accepted payments for these codes. The Relative Value Update Committee had compared this year's codes 99224-99226 for subsequent observation care to subsequent hospital care and had requested the same work value. However, the Center for Medicare disagreed with the proposal.

You should focus this time clarification in your CPT 2011 manual. All that fine green print on time in your evaluation & management CPT 2011 manual comes down to one thing: you can round to the closest time code. However that advice from CPT is quite opposed to Medicare's threshold time guideline. This year's CPT tells you that you can use the code closest to the documented time. This advice is nothing new. In choosing time, the doctor must have spent a time closest to the chosen code, according to CPT Assistant, Aug 2004.

For further CPT details and for other information relating to CPT Assistant, sign up for a one-stop medical coding guide like Supercoder. This site comes with a CPT Assistant Code Connect for just $199.95 to help your understanding. In fact, the site offers 20 years of CPT Assistant articles and reader questions linked to every applicable CPT code.  Source URL :- http://www.supercoder.com/coding-newsletters/my-orthopedic-coding-alert/cpt-2011-99224-99225-99226-solve-middle-day-code-dilemma-103938-article

Colon Motility & Manometric Studies: You've Got New CPT Codes

As a gastroenterology coder, there are a lot of changes you need to sort through this year.

This year, CPT put an end to your search for a code on colon motility by coming up with a new code for manometric study in addition to two revised codes for esophageal pH monitoring.

The new manometric study codes are 91117 and 91013. Code 91117 is just for the study itself, not for the same session with catheter placement. The radiologist may place the catheter in a procedure before and the gastroenterologist may come in and out to supervise the testing and any provocations that are carried out. Therefore, you should include the provocations in the study and report 97117 only once no matter how many times the testing is done.

You can go for 91013 in cases like assessment of the effect on the measured esophageal motility when the patient's esophagus is exposed to different stimulant liquids. This code is also applicable when intravenous medications are administered to try to produce symptoms. CPT 91010 is included in 91013 and wouldn't be billed separately.

Change the way you use 91034, 91035: Apart from 91117 and 91013, this year CPT revised esophageal pH monitoring codes to describe the site of attachment:

91034 -- Esophagus, gastroesophageal reflux test, with nasal catheter pH electrode[s] placement, recording, analysis and interpretation

91035 -- with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation

As per the revisions, 91034 is for the nasal approach where the catheter goes through the nose and down the patient's neck to the monitor. The patient walks around for 24 hours wearing the device and recording her symptoms of belching, pain, and the like. The device manufacturers figured a way to directly attach the device into the nose without having to have a catheter through the nose.

Apart from these, there are other revisions pertaining to your gastroenterology coding. For more on these and for other updates relating to your gastroenterology coding, sign up for a one-stop medical coding guide like Supercoder.

Onboard Supercoder, you can choose to opt for SuperCoder's Physician coding bundle which combines the most powerful coding tools to give you everything you need for denial-proof claims – codesets & tools deluxe, specialty coding library, SuperScrubber for Physicians and CPT Assistant ( Source "http://www.supercoder.com/coding-references/code-connect"). Simply put, all you need to do is simplify your code-search and boost accuracy with LCDs, RVUs, HCPCS, ICD-9, & CPT® all on one page.

CPT Provides you An Assist on Multi-arthroscopy Encounters

In a particular situation, my orthopedist carried out a medial and lateral meniscectomy on a patient, and also performed a synovectomy in the patellofemoral compartment. Because the arthroscopic procedures were carried out in separate knee compartments, is it possible to code for their procedures or do I have to select one? Well, you should be able to report both procedures. You should report the following on the claim:

29880 (Arthroscopy, knee, surgical; with meniscectomy [medial AND lateral, including any meniscal shaving])

29875 (… synovectomy, limited [example, plica or shelf resection [separate procedure]]) for the synovectomy

modifier 59 (Distinct procedural service) added to 29875 to show that the synovectomy and meniscectomy were different services. Explanation: In case the payer challenges the appropriateness of this coding, note this guidance from the August 2001 CPT Assistant: Arthroscopic synovectomy is reported using 29875 and 29876. Limited synovectomy (29875) involves resection of the synovium and may cover partial resection of the plica of one knee compartment… 29875 is designated as a "separate procedure". Normally, codes with the 'separate procedure' designation would not be additionally reported when the procedure or service is carried out as an integral component of another procedure or service. But then when a procedure or service designated as a separate procedure is carried out independently or is thought of as unrelated or distinct from the other procedure(s) or service(s) provided at the time, then it would be proper to report the code in combination with the other procedure(s) or service(s). Modifier -59, Distinct Procedural Service should be added to the separate procedure code to indicate that the procedure was distinct from the overall procedure. For instance, if the knee arthroscopy with limited synovectomy were carried out in a different knee compartment than another knee procedure, modifier 59 would be added to code 29875 to show that a different compartment was involved. For more on this and for other medical coding updates regarding orthopedic coding, sign up for a one-stop medical coding guide like Supercoder.

Article Source :- http://www.supercoder.com/coding-newsletters/my-orthopedic-coding-alert/you-be-the-coder-cpt-gives-you-an-assist-on-multi-arthroscopy-encounters-article

Mild Coding: Turning to 63030, 63047 Could Trip You Up

Properly reporting minimally invasive lumbar decompression (MILD) procedures with open and endoscopic techniques just got a bit easier. Follow this scenario and coding advice when your neurosurgeon performs a MILD.

Scenario: Through a small incision and using fluoroscopic guidance, the surgeon performs an epidurogram to identify the specific lumbar stenosis location, followed by a small laminotomy and decompressive resection of the ligamentum flavum to treat the patient's central canal spinal stenosis. As a result, should you go for 63030 or 63047 for this procedure?

The answer is no. You would report these services with 'unlisted spine code, or 22899 or 64999, unlisted procedure, nervous system, according to CPT Assistant. The rationale is that the MILD procedure involves a fluoroscopic, needle-based procedure without direct visualization of critical neural structures. MILD procedure devices "aren't intended for disc procedures" but should be used for "tissue resection at the perilaminar space inside the interlaminar space, and at the ventral aspect of the lamina. These devices aren't intended for use near the lateral neutral elements and remain dorsal to the dura using image guidance and anatomical landmarks, states the CPT Assistant.

As such, you wouldn't use code 63030, (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically-aided approaches; 1 interspace, lumbar), "as the MILD procedure is a needle-based approach and isn't intended for removal of disc material versus an open surgical or open with endoscopic-assisted approach (code 63030)," CPT Assistant says.

You'd report 63030 "only when an open surgical technique is used and the intrinsic vital components of this code are carried out; namely, a resection of the vertebral component, spinous processes, and lamina, which must cover a discectomy, for decompression of the nerve root(s), as well as any laminotomy or laminectomy foraminotomy along with partial facetectomy, as required for decompression of the nerves or needed as part of the surgical approach.

Further, CPT Assistant explains that you would not use 63047 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [example, spinal or lateral recess stenosis]), single vertebral segment: lumbar) when your surgeon carries out a MILD procedure as code 63047 is only reported if anopen surgical technique is used when the intrinsic components of this code's key elements are carried out, namely a resection of the vertebral component, spinous processes which includes a laminotomy, laminectomy or hemilaminectomy (unilateral or bilateral) lamina, along with foraminotomy with partial facetectomy."

Also considered part of 63047 services are repairs of small dural "lacerations or leaks, and harvesting and placement of soft tissue graft, muscle, or fat when got from within the primary surgical incision" and wouldn't be reported separately.

Count Post-Op Brace Fitting and Education Separate?

Is it feasible that my physician bill for a fitting and education of a brace during the postoperative period for an anterior cruciate ligament (ACL) surgery? I found 97760, but can I use this separately or is it considered a part of the ACL surgery's global period?

Answer: The CCI edits do not bundle 97760 (Orthotic[s] management and training [including assessent and fitting when not otherwise reported], upper extremity[s], lower extremity[s] and/or trunk, each 15 minutes) into any of the ACL repair codes, for instance, 27407 (Repair, primary, torn ligament and/or capsule, knee; cruciate). However, this does not automatically mean you can report 97760 in the situation outlined in the question above.

As per the December 2005 CPT Assistant, 97760 includes the provider's time associated with determining the proper orthotic design in relation to the patient's skin integrity, sensibility and healing of tissues with or without surgical repair.(for example static versus dynamic, pre-fabricated versus custom designed, choice of materials such as thermoplastic, pulleys, and elastic tendon). The code also includes the fitting of the orthotic, training in use, care and wearing time of the orthotic, and brief instructions in exercises that are to be carried out while the orthotic is in place."

When settling on whether to report 97760, examine your physician's documentation to ensure he has noted each of these decision-making processes. Most national and local Medicare coverage determinations note that physical therapists report this code most often and this service should take no longer than 30 minutes. As a result, you might run into frequency edits if you attempt to report more than two units of 97760.

Article  Source :- http://www.supercoder.com/coding-newsletters/my-orthopedic-coding-alert/you-be-the-coder-97760-count-post-op-brace-fitting-and-education-separate-article 

Know How to Differentiate Between the Two Codes for Pulmonary Stress Test

Finding it difficult to differentiate between the two codes for pulmonary stress test? The key is to look for clues in their descriptions.

A doctor orders pulmonary stress testing on patients who complain of shortness of breath. The test allows the doctor to determine if the underlying cause is heart disease or lung disease. If you would have to code this test, there are two codes to choose from:

94620 -- Pulmonary stress testing; simple [example., six-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry]

94621 -- Pulmonary stress testing; complex (including measurements of CO2 production, O2 uptake, and electrocardiographic recordings).

'Simple' and 'complex:

When you are coding 94620 and 94621, you would find that the words 'simple' and 'complex' differentiate one from the other. But then these words are not enough to look for hints. If you understood what the descriptors imply in detail, you could differentiate 94620 from 94621 more easily. For example, if documentation supports it, most six-minute walk tests can be coded as 94620 - a test performed for pulmonary assessment.

CPT Assistant indicates documentation should include heart rate, blood pressure, oxygen saturation, and liter flow of supplemental oxygen. Each of these should be recorded at rest, during exercise, and during recovery. CPT code 94620 also includes physician analysis of data, interpretation of the test, and a written report.

94621 constitutes a series of metabolic test

94621 involves measuring the integration of cardiac and pulmonology function, and the status of physical fitness. This includes measuring CO2 production, O2 uptake, and electrocardiographic recordings of the patient's response to the stress.

 Article Source "http://www.supercoder.com/coding-newsletters/my-pulmonology-coding-alert/pulmonary-stress-test-94620-94621-take-the-stress-out-of-walk-test-coding-article"

CPT 2011 Asks for CMS re-Examination of Time as Averages or Thresholds

CPT 2011: The doctor must have spent a time closest to the chosen code, according to CPT Assistant

All that fine green print on time in your E/M CPT 2011 manual comes down to one thing: you can round to the closest time code. However, that advice from CPT contradicts Medicare's threshold time guideline.

CPT treats times as averages

CPT 2011 indicates that you can use the code closest to the documented time. That piece of advice is nothing new. In choosing time, the doctor must have spent a time closest to the chosen code, according to CPT Assistant, Aug. 2004.

Your documented time must be equal to or cross the average time given to bill that level. For a 35-minutes spent on a medically necessary counseling-dominated visit is a 99214, according to CPT you could report 99215.

Medicare has considered times thresholds

Medicare has always considered the times indicated in CPT's code descriptors to represent minimums. The doctor would choose the lower code (for example 99214… physicians typically spend 25 minutes face-to-face with the patient and/or family …) unless the time was greater or equal to the higher-level code's required time (such as 40 minutes for 99215).

Will Medicare alter its position?

When questioned on whether Medicare would change the allotments from thresholds to averages at the CPT® and RBRVS 2011 Annual Symposium, medical directors were hesitant to give a definitive answer. "I do not want to say one way either 'yes' or 'no' at this juncture," said E/M expert Deborah Patterson, MD, clinical medical director for Trailblazer Health Enterprises, LLC in Dallas.

For more on CPT 2011 , sign up for a medical coding guide like Supercoder!

Choose 43255 for control-of-bleeding situations

43255 is a good choice for control-of-bleeding situations

When coding for excessive blood loss, modifier 22 may not be that ally you are looking for. The answer may lie on more proper CPTs such as 43255 and critical care codes. Take cue from these two scenarios:

Think about endoscopy with injection as option

First Scenario: The doctor injects epinephrine into a duodenal ulcer to control active bleeding during endoscopy with biopsy.

Code it: Earlier, you may opt to use 43239 appended with modifier 22 if the physician required significant effort to control the patient's bleeding.

However, the option would need you to submit additional paper documentation to support your modifier 22 claim. In place of submitting yourself to potential hassles, you can accurately describe the session by reporting 43239 for the biopsy and 43255 for the control of bleeding provided that the bleeding was not caused by the biopsy.

As evident from 43255's descriptor, this procedure describes control of bleeding by any method, including injection.

Requirement: On your claim, you should append modifier 59 to 43255, and then report 43239. Omitting the modifier would give payers the feeling that the biopsy (or physician) caused the bleeding and bundle 43255 into 43239.

Extraordinary bleeding will require critical care coding

Second scenario: When the gastroenterologist is about to carry out an upper GI endoscopy, the patient experiences gastrointestinal bleeding so severe that the physician must suspend the endoscopy and spend 40 minutes lavaging blood from gastro-intestinal tract before continuing.

Code it: Here, the critical code 99291 is your best choice.

Here's why? If the gastroenterologist caused the bleeding, you can't bill for the control of bleeding procedure. You should call on control-of- bleeding codes only when treatment is required to control bleeding that takes place spontaneously or as a consequence of traumatic injury (noniatrogenic), and not as a result of another type of operative intervention," states CPT Assistant.

Remember, the time spent at the bedside carrying out services including lavage of gastric blood is not included in the performance of a subsequent endoscopic procedure and is not part of the E&M service that might be carried out on the same day.

Nevertheless, you should not report a critical care code carelessly for an excessive bleeding situation that's not out of the ordinary. Additional time for emergency bedside services less that 30 minutes does not count as billable critical care service. For prolonged critical care services, the doctor should specifically note the amount of time in his notes.

43255 Good Bet for Coding for Excessive Blood Loss

Coding for Excessive blood loss, modifier 22 may not be what you are looking for. The answer may depend on more appropriate CPTs such as 43255 and critical care codes.

When you are coding for excessive blood loss, modifier 22 may not be what you are looking for. The answer may depend on more appropriate CPTs such as 43255 and critical care codes.

Think about endoscopy with injection as option

Scenario 1:

The physician injects epinephrine into a duodenal ulcer to control active bleeding during endoscopy with biopsy. 43239, Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as apt; with biopsy, single or multiple).

Previously, you may opt to use 43239 appended with modifier 22 (Increased procedural services) if the doctor required effort to control the patient's bleeding.

However this option would need you to submit additional paper documentation to support your modifier 22 claim. Instead of submitting yourself to potential hassles, you can accurately describe the session by reporting 43239 for the biopsy and 43255 for the control of bleeding provided that the bleeding was not caused by the biopsy.

As is obvious from 43255's descriptor, this procedure describes control of bleeding by any method including injection.

Requirement: On your claim, you should append modifier 59 to 43255, and then report 43239. Omitting the modifier would give payers the impression that the biopsy (or physician) caused the bleeding and bundle 43255 into 43239.

Extraordinary bleeding requires critical care coding

Scenario 2: When the gastroenterologist is about to carry out an upper GI endoscopy, the patient experiences gastrointestinal bleeding so severe that the doctor must suspend the endoscopy and spend 40 minutes lavaging blood from the gastro-intestinal tract before continuing.

Code it: This time, the critical code 99291 is your best choice.

Here's why" If the gastroenterologist caused the bleeding, you cannot bill for the control of bleeding procedure. You should call on control-of- bleeding codes only when treatment is required to control bleeding that occurs spontaneously, or as a consequence of traumatic injury (noniatrogenic), and not as a result of another type of operative intervention, the CPT Assistant states.

Remember that the time spent at the bedside carrying out services including lavage of gastric blood isn't included in the performance of a subsequent endoscopic procedure and is not part of the E&M service that might be carried out on the same day.

Nevertheless, you should not report a critical care code carelessly for an excessive bleeding situation that's not out of the ordinary. Additional time for emergency bedside services less than 30 minutes does not count as billable critical care service. For prolonged critical care services, the physician should specifically note the amount of time in his notes.

Do and Don't of Unlisted Procedure Coding

Keep this CPT instruction in mind: "Don't choose a CPT code that merely approximates the service provided." This rule is key for compliant coding, however it leaves you with tough job of submitting a claim without a procedure-specific code. Here are some do's and don'ts to increase your chances of getting the payment your practice earned.

Explain the procedure in Layman's Terms

If CPT does not offer a code specific to the service provided, then you should report the appropriate unlisted-procedure code like 37799 (Unlisted procedure, vascular surgery) for vascular sclerotherapy.

When you file a claim using an unlisted procedure code you should include a cover letter stating why you are using the unlisted code. This separate report should explain in simple straightforward language exactly what the physician did.

According to CPT Assistant (http://www.supercoder.com/coding-references/code-connect)(April 2001), you need to submit reporting documentation identifying the specifics of the procedure such as the procedure report when you file the claim. The supplemental documentation should define the service (nature, extent, need) and the time, effort and equipment required. According to CPT Assistant, you may also include the following factors:

Whether the doctor required help to carry out the service

Whether the procedure was independent of other services

Whether the doctor carried out additional procedures at the same site

Number of times the doctor carried out the service at the encounter

Extenuating circumstances that complicated the service.

You may even want to include diagrams or photographs to facilitate the person reviewing your claim better understand the procedure.

Do not try to use modifiers or multiple units

You shouldn't append modifiers to unlisted-procedure codes or try to report them more than once per encounter.

Suggest an appropriate fee for the service

Unlisted procedure codes don't appear in the Medicare Physician fee Schedule, so they don't have assigned fees or global periods. Your payers will generally determine payment for unlisted procedure claims based on the documentation you provide.

You can suggest a fee by comparing the unlisted procedure to a similar listed procedure with an established reimbursement value.

93270 Calls for Minimum Transimission

As per CPT Assistant if you going to report 93270 you should have check some conditions.


Often, you may be confused over questions such as this: Question: Should you report 93270 even when the only transmission was the test transmission?


The answer is that you should be able to report 93270 in the situation you describe, assuming you meet certain conditions.



As per CPT Assistant (August 2010), prior to reporting 93270, you should check for the following:

The patient got the monitor from the office or facility, or through mail, such as from a monitoring center.

The doctor or facility instructed the patient on proper monitor use (including hookup, recording, and transmission).

The patient sent at least one transmission; the reason being: Patients must send a test transmission when the monitoring period starts to ensure the device is working.
Lesson learned: According to CPT Assistant, when the patient (1) gets both the device and instructions in the mail and (2) the physician or facility staff never instructed the patient directly, you shouldn't report 93270.


You also shouldn't report 93270 if the patient sends no transmissions. CPT Assistant states, “If no tracing is sent, then there can be no report and no reportable service has been provided although the patient received a monitor for a month.

For more updates on this, sign up for a one-stop medical coding website. Onboard such a site, you can even subscribe to a CPT Assistant to get hands on information that can help you bring in the reimbursements. Here, you'll get the annual CPT Assistant newsletter, along with access to CPT assistant back issues (1990 to 2009), at a good discount.