Part B Insider (Multispecialty) Coding Alert

Caution: Missing primary care designation could wreck your Medicare pay.

Primary care physicians, take note: You can look forward to a continued cash flow from the primary care incentive program, more inclusive language in CPT® codes, and new codes for transitional care.

So said speakers at the American Medical Association's (AMA) annual CPT® and RBRVS Symposium, held Nov. 14 to 16 in Chicago, with presenters sharing the latest news on fee schedules, new codes for 2013, and more.

The most widespread changes throughout CPT® 2013 -- the switch to more inclusive or provider-neutral language -- shouldn't be difficult for physician practices to put into place.

"The concepts are pretty straightforward," said Richard Duszak, Jr., M.D., an AMA CPT® Editorial Panel member and practicing radiologist. "There's been an evolution in CPT® for how codes report services by non-physicians."

Result: Hundreds of codes were revised for 2013 to include "provider neutral language." Codes throughout the book have replaced designations of "physician" with "individual" or "qualified health care provider."

Exception: A few codes retained the "physician" language, such as those related to skilled nursing facility admissions, because regulations require that a physician admit the patient.

"CPT® is not the turf police," Duszak said. "We're focusing on the services provided and recognize that sometimes professionals other than physicians are qualified to provide some services. As a nationally recognized reporting system, it's important for CPT® to maintain provider neutrality."

CMS will continue the primary care incentive program (PCIP) through 2015. The agency distributed approximately $560 million to providers in 2011 through the PCIP, according to Kathy Bryant, deputy director of the department of physician services at CMS.

Bonus: Providers don't need to apply for participation. CMS reviews providers' records and automatically sends payments to those who qualify.

Big caution: "The main thing you need to worry about is your physician's Medicare specialty designation," Bryant cautioned. "He must have the primary care specialty designation in CMS records, or he won't receive payments. He may have switched from ER to primary care years ago, but he won't get paid if his CMS designation still says ER."

CPT® 2013 introduced the following two new codes for transitional care management (TCM) services:

• 99495 -- Transitional care management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; medical decision making of at least moderate complexity during the service period; face-to-face visit, within 14 calendar days of discharge
• 99496 -- ... medical decision making of high complexity during the service period; face-to-face visit, within 7 calendar days of discharge.