Oncology & Hematology Coding Alert

Question: I-m confused about whether I should report Category II CPT codes. Would you please explain these codes?

Kansas Subscriber 
 
Answer: Reporting Category II codes may contribute to the development of future Category I codes, but you aren't required to use Category II codes, and Medicare won't reimburse you for them.

The American Medical Association uses Category II codes to help data mining, keeping track of certain services that contribute to positive health outcomes and quality patient care.
 
You should report Category IIs secondary to the primary procedure code, and doing so may help tell the patient's story. Example: You report 1000F (Tobacco use assessment) with an E/M service when your practice helps lung-cancer patients stop smoking.
 
Note: Only use the composite-measures codes added in 2006 if you meet all the individual component measures for that specific composite measure, state CPT 2006 guidelines.
 
For example, 0001F (Heart failure assessment) includes blood pressure measurement (2000F), level of activity assessment (1003F), clinical symptoms assessment (1004F), weight measurement (2001F), and an auscultation of the heart (2003F). You provide all of the components, so you only report 0001F.
 
Watch for: Category II codes received their own modifiers in CPT 2006 -- and you shouldn't report them with Category I or III codes unless noted special guidelines instruct you to, says CPT Changes 2006.
 
Modifiers 1P (Performance measure exclusion modifier due to medical reasons) and 2P (Performance measure exclusion modifier due to patient choice) show that the physician considered the associate measures but didn't provide them because of medical or patient circumstances (such as when a patient refuses to accept treatment).

 -- The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the American Academy of Professional Coders National Advisory Board.