Otolaryngology Coding Alert

Question: I heard that a new code section is coming in CPT 2004. What is it and how will we use it?

Florida Subscriber

Answer: You're correct, CPT 2004 introduces a new section - the Category II codes. Although you may be reporting more codes, you won't be seeing any additional reimbursement.
 
CPT's new Category II adds supplemental tracking codes for performance measurements. AMA adds this section to comply with ongoing changes being made as a result of Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulation. These codes will not affect reimbursement because they won't have relative value units assigned to them. Instead, AMA hopes that these codes will facilitate data collection about quality of care and that some of the codes may relate to healthcare professionals' compliance with state or federal law.
 
Using Category II codes is optional, and you may not substitute them for the regular Category I CPT codes. For example, suppose you're trying to track the use of smoking-cessation counseling in your practice and you don't have an electronic health record. Reporting one of the new smoking-cessation Category II codes, such as 0004F (Tobacco use cessation intervention, counseling) or 0005F (Tobacco use cessation intervention, pharmacologic therapy), will allow you to do this through your claims data or practice management software rather than through chart reviews.
 
Make sure you still report the counseling Category I code, such as 99401 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes) linked to ICD-9 code 989.84 (Toxic effect of other substances, chiefly nonmedicinal as to source; tobacco).
 
Because otolaryngology physician assistants usually provide assessment, therapy or counseling for the toxic effects tobacco has on a patient's body, such as cough (491.0, Chronic bronchitis; simple chronic bronchitis [smokers' cough]), lip cancer (140.9, Malignant neoplasm of lip; lip, unspecified, vermilion border) and laryngeal cancer (161.9, Malignant neoplasm of larynx; larynx, unspecified), rather than addressing the patient's psychological disorder, you should use 989.84, not 305.1 (Nondependent abuse of drugs; tobacco use disorder). Category II codes describe components that are typically included in an E/M service or test results that are part of the laboratory test/procedure.
 
The AMA will publish new Category II codes twice a year: Jan. 1 and July 1. For the most current listing, visit www.ama-assn.org/go/cpt.