Otolaryngology Coding Alert

New CPT® manual will feature 186 new codes and 119 deletions, AMA reveals.

Although the 2013 edition of the CPT® Manual is still being printed, the Otolaryngology Coding Alert has had a sneak peek at the codes that you'll use next year -- and uncovered allergy changes and deletions that could help your practice.

Among the changes effective Jan. 1, you'll find 119 deletions, 186 new codes, 263 revisions, and adjustments to 18 CPT® modifiers, the AMA announced in an Aug. 16 article published in its American Medical News.

For example, you'll find two new codes for intraoperative neurophysiology monitoring (IONM): 95940 (Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes [List separately in addition to code for primary procedure]) and 95941 (Continuous intraoperative neurophysiology monitoring, from outside the operating room [remote or nearby] or for monitoring of more than one case while in the operating room, per hour [List separately in addition to code for primary procedure]). These two codes replace 95920 (Intraoperative neurophysiology testing, per hour [List separately in addition to code for primary procedure]), which CPT® 2013 deletes. Like 95920, these two new codes are add-on codes, so you should not use modifier 51 (Multiple procedures) with them. Additionally, you won't apply a multiple surgery discount. Physicians use this CPT® code when performing nerve monitoring during complex surgical procedures involving cranial nerves.

Watch out: You cannot report these codes without first reporting the ENG codes for setting up the monitoring: 95867-26 (Needle electromyography; cranial nerve supplied muscle[s], unilateral; professional component) for ear or parotid or 92868-26 (Needle electromyography; cranial nerve supplied muscles, bilateral; professional component) for the thyroid. The new codes differentiate between monitoring that is done on site in the OR and monitoring that is being performed offsite (remote monitoring).

Don't Miss These Allergy Revisions, Deletions, and Additions

Most of the allergy CPT® 2013 changes you'll need to adopt relate to revisions, deletions, and additions. So if you miss these subtle differences, then you may be setting yourself up for lost reimbursement or a denial.

Note: The new wording is underlined, and you'll see the deleted wording via the strikethroughs.

Revisions: For instance, you'll see that 95004 (Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests) deletes the phrase "by a physician."

You'll find a similar revision to 95024 (Intracutaneous [intradermal] tests with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests) and 95027 (Intracutaneous [intradermal] tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report by a physician, specify number of tests).

CPT® clarifies who can perform allergen immunotherapy by adding the following revision to 95120-95134 (Professional services for allergen immunotherapy in prescribing physiciansthe office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract ...).

These wording deletions fall in line to how most operations are set up, with the testing usually performed by an allergy nurse and the immunotherapy also administered by an allergy nurse, says Barbara Cobuzzi, MBA, CPC, CENTC, CPCH, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. The practice, however still has to be concerned with following the diagnostic supervisory guidelines for allergy testing and incident to guidelines for providing immunotherapy when these services are provided by someone other than the physician.

Deletions: Meanwhile, you should delete 95010 (Percutaneous tests (scratch, puncture, prick) sequential and incremental, with drugs, biologicals or venoms, immediate type reaction, including test interpretation and report by a physician, specify number of tests) and 95015 (Intracutaneous (intradermal) tests, sequential and incremental, with drugs, biologicals, or venoms, immediate type reaction, including test interpretation and report by a physician, specify number of tests) from your coding cache.

Also, you will no longer use 95075 (Ingestion challenge test [sequential and incremental ingestion of test items, eg, food, drug or other substance such as metabisulfite]).

Additions: Then, you should add 95017 (Allergy testing, any combination of percutaneous [scratch, puncture, prick] and intracutaneous [intradermal], sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests) and 95018 (Allergy testing, any combination of percutaneous [scratch, puncture, prick] and intracutaneous [intradermal], sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests).

You should also add 95076 (Ingestion challenge test [sequential and incremental ingestion of test items, e.g., food, drug or other substance]; initial 120 minutes of testing) and +95079 (...each additional 60 minutes of testing [List separately in addition to code for primary procedure]).

CPT® Tweaks E/M Verbiage

Many practices use E/M codes more often than any other code series in CPT®, and you'll find revised descriptors for these codes in 2013.

Whereas most E/M codes previously referred to "physicians" and "providers" in their descriptors, that will change effective Jan.1, when the descriptors will instead say "qualified health care professionals."

Taking 99213 as an example, the code changes are indicated with the strikethroughs (indicating deleted text) and underlining (indicating new text) as follows: "Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other providersqualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spendTypically, 15 minutes are spent face-to-face with the patient and/or family."

What this means: "They are clarifying that all E/M codes can be reported by physicians or other qualified health care providers and changed the wording with regard to time in each of the codes--which really has no bearing on how the codes are used, just that the typical time is spent by all qualified providers who bill these codes," says Melanie Witt, RN, COBGC, MA, an independent coding consultant in Guadalupita, N.M. "In other words, if a payer allows someone other than a physician to provide and bill for a service, the CPT® E/M codes are used by all providers who qualify."

Time assignment: In addition, CPT® will add typical times to the same-day ordered and discharged observation codes 99235-99236, assigning a typical reference time of 50 minutes to 99235 and a typical reference time of 55 minutes to 99236. Previously, these codes did not have typical times associated with them, so this change could be helpful to physicians who are at the patient's bedside or on the unit counseling or coordinating care for more than half of the visit, which would allow them to select a code based on time.