ED Coding and Reimbursement Alert

And see how new rib fracture treatment alters your closed rib fracture coding. 

CPT® 2015 goes into effect in January. Take a look at our expert overview of your top ED-relevant changes that are in the works for next year.  

Joint Arthrocentesis Codes Now Reflect With Or Without Ultrasound Guidance

Three new codes join revised codes in the family of ultrasound guided arthrocentesis of small, intermediate, and large joints.  The previously existing codes, 20600, 20605 and 20610 now include the phrase “without ultrasound guidance” and each is now partnered with a new code (20604, 20606, and 20611 that reads “with ultrasound guidance, with permanent recording and reporting”, says Michael Granovsky, MD, FACEP, CPC, President of Logixhealth a national coding and billing company based in Bedford, MA.

See below for specifics on the changes for each revised code followed by a new code describing the procedure with ultrasound guidance: 

20600 (Arthrocentesis, aspiration and/or injection, small joint or bursa [e.g., fingers, toes]; without ultrasound guidance)

20604 Code added (with ultrasound guidance, with permanent recording and reporting)

20605 (Arthrocentesis, aspiration and/or injection, intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]; without ultrasound guidance)

20606 Code added (with ultrasound guidance, with permanent recording and reporting)

20610 (Arthrocentesis, aspiration and/or injection, major joint or bursa [e.g., shoulder, hip, knee, subacromial bursa]; major joint or bursa] without ultrasound guidance)

20611 Code Added (With ultrasound guidance, with permanent recording and reporting)

ED Connection: Here’s Why Care Management E/M Language Changes Matter

 As you’ve noticed, over the past few years, the AMA has engaged in an extensive rewrite of what is now known as the care management services section of the evaluation and management code chapter.  This section includes chronic care management, complex chronic care management, the transitional care management series and advance care planning.  

ED relevance: While ED physicians are unlikely to report the care management codes,  because they can only be reported once per month, and only by a single provider, typically the primary care physicians or whoever is running the medical home for that patient, knowing about them can enhance your payment savvy.  

The skinny: As payment methodologies continue to evolve towards episodes of care, ED coders  need to be aware of these specific code descriptors to gain a big picture understanding of the code sets and how they may impact larger payment methodologies, says Michael Granovsky, MD, FACEP, CPC, President of Logixhealth a national coding and billing company based in Bedford, MA.

Don’t Look for Uncomplicated Rib Fracture Treatment Code 

The rib fracture code 21800 (Closed treatment of rib fracture, uncomplicated, each) has been deleted from CPT® because of changes in the standard of care for rib fractures, so that is no longer separately reportable. 

Rationale: Historic strapping and support are no longer typically performed to the extent that CPT® felt the treatment is separately identifiable from an E/M service. As such, this code was deleted from the book starting in 2015, Granovsky explains.

Stay Abreast of These Additional Ultrasound Changes 

A rewrite of the codes describing ultrasound of the breast results in one code being deleted and replaced by two new codes starting January 1 2015.

• 76645 (2014 code for US breast unilateral or bilateral) has been deleted
• 76641 is a 2015 new code (Ultrasound breast unilateral complete)
• 76642 is a 2015 new code (Ultrasound breast unilateral limited)

Prick Up Your Ears For Vaccine And Immunization Changes

Many influenza vaccine codes already are present in CPT®, but new for 2015 is 90630 (Influenza vaccine quadrivalent, split virus, preservative free, for intradermal use)

The FDA has approved an additional influenza vaccine formulation which has its own unique CPT® code

90651 (Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (HPV), 3 dose schedule, for intramuscular use)

Revised codes in the vaccine section include these three, which have been updated to reflect the most current strains or minor rephrasing of prior language as shown below using underline for new language and strikethrough for deleted terms, Granovsky explains.

90654 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, for intradermal use

90721 Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Hemophilus influenza B vaccine (DtaP-HIB) for intramuscular use 

90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and inactivated poliovirus vaccine, inactivated (DtaP-HepB-IPV) for intramuscular use

90734 Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), quadrivalent, for intramuscular use

Do you Have A Pediatric ED? Brush Up on the Coding Continuum for Very Sick Kids

You may be interested in changes in the Inpatient Neonatal and Pediatric Critical Care code preamble. 

Details: The new language clarifies the code choice is based on the initial or subsequent day of treatment, the age of the patients (28 days or under, 29 days to 6 years) and the site of service (neonatal or pediatric critical care unit). There is also new language limiting the code use to only one provider and only once per day. 

Remember that children age 6 years or older requiring critical are service would have those services reported using the regular critical care codes, 99291 and 99292, as needed, Granovsky warns.

Resource note: ED coders are encouraged to review the new CPT® book to make note of major or even subtle changes to codes or code language that can alter accurate code assignment. To order your book, go to http://www.codinginstitute.com/2015-ama-cptr-professional.html.