ED Coding and Reimbursement Alert

Emergency department coders must pay close attention to language changes in the front matter of CPT 2002, according to Michael Beebe of the AMA. He notes that the modification represents a "subtle, but major change" in how ED physicians and coders report services that are not precisely described by an existing code. Beebe provided this information during the AMA's CPT 2002 Coding Symposium in Chicago, Nov. 15 and 16, 2001.
 
Instructions about coding these services may be found in the Introduction section of the CPT 2002 manual (page x), under the heading "Instructions for Use of CPT." The new directions read (revisions appear in italics):
 
Select the name of the procedure or service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service provided. If no such procedure or service exists, then report the service using the appropriate unlisted procedure or service code. In surgery, it may be an operation; in medicine, a diagnostic or therapeutic procedure; in radiology, a radiograph. Other additional procedures performed or pertinent special services are also listed. When necessary, any modifying or exten-uating circumstances are added. Any service or procedure should be adequately documented in the medical record.
 
It is important to recognize that the listing of a service or procedure and its code number in a specific section of this book does not restrict its use to a specific specialty group. Any procedure or service in any section of this book may be used to designate the services rendered by any qualified physician or other qualified health care professional.

Emphasis on Unlisted-Procedure, Category III Codes
According to David A. McKenzie, director of reimbursement for the American College of Emergency Physicians in Irving, Texas, in the past, directions simply noted that coders should "select the name of the procedure or service that most accurately identifies the service performed," without giving further instructions to use unlisted-procedure codes.
 
Beebe notes that the AMA's primary objective in implementing the modification is to help prevent miscoding of new services. To accommodate this shift in policy, additional unlisted-procedure codes have been added to various sections and subsections of CPT, and more are anticipated in future years. In addition, CPT 2002 contains 22 Category III codes, developed to track the use of new and emerging technologies and services. (Codes now in place are considered Category I codes.) Placed in the CPT manual between the Medicine section and Appendix A, the temporary Category III codes are alphanumeric (e.g., 0021T, insertion of transcervical or transvaginal fetal oximetry sensor) and their use is optional, Beebe says. However, CPT 2002 instructions indicate that, if available, a Category III should be reported instead of an unlisted-procedure Category I code. No relative value units [...]