ED Coding and Reimbursement Alert

1. Who can deliver services: In the introduction section, a new line appears in the first paragraph. “In the CPT^® code set, the term “procedure” is used to describe services, including diagnostic tests.”  That section goes on to say that new techniques in medicine and surgery have evolved including new types of services that have challenged the traditional distinction of cognitive vs. procedural services. The idea is that the placement of a service or procedure in a specific section of the CPT^® book should not be interpreted as strictly classifying the service or procedure as “surgery” or “not surgery” for any purposes. Additionally, there is new language explaining that when advanced practice nurses and physician assistants are working with physicians, they are considered as working in the exact same specialty and exact same subspecialties as the physician.

Translation: This new language reinforces the CPT^® principal that any procedure or service in the book may be used by any qualified health care professional, says Michael Granovsky MD, CPC, President of LogixHealth, an ED billing company in Bedford MA.

2. Submitting code change requests: There is also new language in the introduction section about how to submit a request to update the CPT^® nomenclature, as well as a section on application submission requirements, including criteria for Category I and III codes.

3. New psych guidelines: The introduction also includes a new section on coding for psychiatric services, including a coding algorithm for use in choosing the correct E/M vs. psychiatric code for the service actually provided.