Otolaryngology Coding Alert

Get clear on ‘qualified health care professional’ definition.

CPT® 2014 has barely hit coders’ desks, but the American Medical Association (AMA) has already released explanatory notes and corrections. Every coder needs to be clear on what “qualified health care professional” means, and you might also find some chemodenervation updates of interest.

Starting point: Some updates are classified as errata (E) and others as technical corrections (T). An errata shows information that was approved by the CPT® Editorial Panel but inadvertently left out of the current CPT® book. Technical corrections clarify the Editorial Panel’s intent for the current code structure.

Let Facilities Count as ‘Health Care Professional’

CPT® 2013 introduced the use of “qualified health care professional” throughout the book when codes distinguish who is able to provide the service. The introduction to CPT® 2014 now includes an important clarification regarding this terminology.

Errata posted to the AMA website on Nov. 11, 2013, stated, “Throughout the CPT® code set the use of terms such as ‘physician,’ ‘qualified health care professional,’ or ‘individual’ is not intended to indicate that other entities may not report the service. In selected instances, specific instructions may define a service as limited to professionals or limited to other entities (e.g., hospital or home health agency). Revise the instructions for use of the CPT® codebook guidelines to include missing content “define a service as limited to professionals or limited to other entities (e.g., hospital or home health agency).”

Bottom line: If you code for services rendered in a facility setting, you can still report codes that include “qualified health care professional” in the descriptor, when appropriate. For example, even if a service does not include an NPP in the description, but the service is within the scope of a NPP, such as an admission into the hospital by a nurse practitioner, the NP may provide and code for this service. The NP’s NPI must be used for the claim since a NP cannot provide incident to services in an inpatient place of service.

Correct Chemodenervation Parenthetical Note

Chemodenervation code 64620 (Destruction by neurolytic agent, intercostal nerve) includes three parenthetical notes to clarify the code’s use. The first note states that imaging guidance (including fluoroscopy or CT) is included in certain chemodenervation codes.

Correction: Mark in your CPT® book that the applicable code range should be 64633-64636 because the original version included transposed codes.