ED Coding and Reimbursement Alert

Get the Inside Scoop On New Codes And Subtle Changes In The Preamble Language To Several ED Relevant Sections

You’ll have some adjustments to make in your reporting of some key E/M services, thanks to CPT^® 2014. Code changes in chronic care coordination, transition of care and new telephone or internet consultations may alter the way you interact with other providers.  And new language in portions of the CPT^® manual introduction could affect who delivers and receives care for certain services. Read on for can’t-miss advice on what’s in the works for next year.

Review Updates to Complex Chronic Care Coordination Codes

New language in the introduction to the complex chronic care coordination codes provides additional detail on those services, including patient characteristics, the typical process of requiring substantial revision of the care plan, and more extensive staff monitoring.

The text:  “Patients who require complex care coordination may be identified by practice specific or other published algorithms that recognize multiple illnesses, multiple medication uses, inability to perform activities of daily living, requirement for a caregiver, and/or repeat admission or emergency department visits.”

ED relevance: What this text clarifies is who the typical adult and pediatric patient is and what is involved in the monthly service described by the code. The new language reinforces that these codes should not typically be reported in the ED setting because that level of ongoing long-term staff and patient monitoring is unlikely to be provided as a component of typical ED services supervision, says Granovsky.

Factor in These New Telephone or Internet Consultation Codes

Although there is no new language pertaining directly to ED E/M or critical care codes, the E/M section does contain a new parenthetical instruction following the Hospital Discharge Services section. This instruction reminds coders that codes 99238 and 99239 include all E/M services on that date and that the discharged services are included in observation codes 99234-99236, so no additional discharge codes could be assigned.

The biggest change in this section of CPT^® covers the Interprofessional Telephone /Internet Consultations. These new codes, 99446-99449, describe a scenario when the patient’s treating provider requests the opinion and /or treatment advice of a physician with specific specialty expertise to assist in the diagnosis and/or management of the patient, without the need for face-to-face contact with the consultant. The request for the consultation must be documented in the patient’s chart by the requesting provider and the encounter also involves a verbal and written report to the requesting provider.

Application: The expectation is that these codes will be used in complex and/or urgent situations where a timely face-to-face service with the consultant may not be feasible, such as the ED.

Bear in mind: The codes are for reporting by the consultant, not by the ED provider who requests the consult. The consultant cannot have seen the patient in the prior 14 days. The telephone/internet consultation codes should not be reported by a consultant who agrees to accept transfer of care or when the sole purpose of the communication is to arrange transfer of care, states Granovsky.

The codes are ranked based on the amount of time involved in providing the service.

• 99446 (Interprofessional telephone/internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review.)
• 99447 (…11-20 minutes of medical consultative discussion and review.)
• 99448 (…21-30 minutes of medical consultative discussion and review.)
• 99449 (…31 minutes or more of medical consultative discussion and review.)

Add a New Code For Fluid Drainage In Surgical Section

A new code appears in the skin, subcutaneous and accessory structures section in the surgical section of CPT^®.

• 10030 (Image-guided fluid collection drainage by catheter [e.g., abscess, hematoma, seroma, lymphocele, cyst], soft tissue [e.g., extremity, abdominal wall, neck], percutaneous) (Report 10030 for each individual collection drained with a separate catheter.)

Remember: In CPT^®, the red dot indicates it is a new code and the target symbol indicates that the code includes moderate sedation.

Rethink the Way You Report Complex Repairs of Less Than
1 Centimeters

A review of the Complex Repair code section shows the following code has been deleted:  13150 (Complex repair of eyelids, nose, ears and/or lips for 1.0 cm or less). For complex repairs of less than 1.0 cm, see simple or intermediate repairs.

Rationale: The thought was that so few of these codes were reported annually, only about 2500, that the code was not necessary. A complex repair so small would be hard pressed to meet the CPT^® definition of a layered closure requiring debridement and extensive undermining, says Granovsky.

Note New Language in the Preamble to Appendix C

CPT^® has long contained a list of brief clinical examples of patient presentations for most of the E/M codes, found in Appendix C in the back of the book. These examples were crafted with input from various medical specialties that use the code in question to assist in understanding the clinical differences as codes within the same family become more complex. New language in 2014 stresses that the same problem, when seen by different physicians in different specialties, may involve different amounts of work. Because of this, the appropriate level of encounter should be reported using the descriptors rather than the examples.

Addressing concerns from specialties that auditors could use the clinical examples to down code claims with similar presentations, CPT^® has made a point to say that the examples should not be used for any review of correct coding or estimating physician work and that they do not encompass the entire scope of physician work. It is emphasized in the preamble of this section that these are examples and the specific circumstances of a patient encounter must be considered. Simply because a patient’s complaints, symptoms or diagnoses do not match those of a particular clinical example, it does not preclude the provider from reporting that level of service, says Granovsky.