Reader Question: Track E/M Components With New Category II Codes

Question: What is the new Category II section in CPT, and how should we use it?

Florida Subscriber

Answer: CPT 2004 introduces the Category II code section, but these codes will not add anything to your reimbursement.

AMA adds this new section to comply with ongoing changes being made as a result of Health Insurance Portability and Accountability Act (HIPAA) regulations. These codes will not affect reimbursement because they won't have relative value units assigned to them. Instead,
AMA hopes that these codes will facilitate data collection about quality of care, and some of the codes may relate to healthcare professionals' compliance with state or federal law.

Using Category II codes is optional, and you may not substitute them for the regular Category I CPT codes. Suppose, for example, you're trying to track the use of smoking-cessation counseling on a group of your patients and you don't have an electronic health record. Reporting one of the new smoking-cessation Category II codes, such as 0004F (Tobacco use cessation intervention, counseling) or 0005F (Tobacco use cessation intervention, pharmacologic therapy), will allow you to do this through your claims data or practice management software rather than through chart reviews.

Make sure you still report the counseling Category I code, such as 99401 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes) linked to ICD-9 code 989.84 (Toxic effect of other substances, chiefly nonmedicinal as to source; tobacco).

The AMA will publish new Category II codes twice a year: Jan. 1 and July 1. The Category II codes that became effective Jan. 1, 2004, are: