Pediatric Coding Alert

Question: I heard that a new code section is coming in CPT Codes 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 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 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 what percentage of nurse visits are for blood pressure checks, and you don't have an electronic health record. Reporting the new Category II code 0001F (Blood pressure, measured) in addition to reimbursement code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...) will allow you to do this through your claims data or practice-management software rather than through chart reviews.
 
If your office provides smoking-cessation counseling, you should consider using 0004F (Tobacco use cessation intervention, counseling) or 0005F (Tobacco use cessation intervention, pharmacologic therapy). 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). 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 each year: Jan. 1 and July 1. For the most current listing, visit www.ama-assn.org/go/cpt.

- Information for Reader Questions and You Be the Coder provided by Richard A. Molteni, MD, FAAP, a neonatologist and medical director at Children's Hospital and Regional Medical Center in Seattle; Peter Rappo, MD, FAAP, a practicing pediatrician and assistant clinical professor of pediatrics at Harvard University School of Medicine; Teresa Thompson, CPC, CCC, a nationally recognized coding, compliance and reimbursement speaker and president of TM Consulting in Carlsburg, Wash.; Richard H. Tuck, MD, FAAP, medical director of Quality Care Partners in Zanesville, Ohio; and Linda J. Walsh, MAB, division of healthcare finance & practice senior health policy analyst manager for the American Academy of Pediatrics committee on coding and nomenclature in Elk Grove Village, Ill.