Primary Care Coding Alert

Your practice could benefit from new patient self-management codes

Because your plate is full relearning affected CPT codes that are already on your superbill, you may have overlooked a new three-code series, which describes educational services you may provide.

These basics from the experts will help you determine whether you want to add this new series to your encounter sheet. CPT 2006 introduces a medicine sub-section titled -Education and Training for Patient Self-Management,- which includes these codes:

- 98960--Education and training for patient self-management by a qualified, nonphysician healthcare professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient

- 98961--- 2-4 patients
- 98962--- 5-8 patients.

Reserve Self-Management for Non-MD Education

As with the health and behavior assessment/intervention codes (96150-96155), CPT intends nonphysicians to use the patient self-management education and training codes.

The physician or a nurse practitioner would use the appropriate E/M code instead of 98960-98962 when she provides these services, says consultant Richard H. Tuck, MD, FAAP.

Before you order and perform services associated with 98960-98962,  be sure to meet CPT's requirements for the codes:

1. A physician must prescribe the education and training.

2. A qualified healthcare professional must provide the services using a standardized curriculum.

3. The nonphysician's qualifications and the program's contents -must be consistent with guidelines or standards established or recognized by a physician society, nonphysician healthcare professional society/association, or other appropriate source,- according to CPT's introductory notes for patient self-management education and training.

Consider Asthmatics, Diabetics Potential Candidates

Unlike the codes for counseling and/or risk-factor reduction intervention (99401-99412), the codes for patient self-management education and training require the individual to have an established condition. The educational and training services teach the patient -how to effectively self-manage the patient's illness(s)/disease(s) or delay disease comorbidity(s) in conjunction with the patient's professional healthcare team,- states CPT's introductory notes for 98960-98962.

Qualifying candidates for 98960-98962 could include patients with asthma or diabetes, Tuck says.
 
-The individual must be enrolled in a disease-management program that is specific in design with tools and schedules to follow up with the doctor, nurses and pharmacists,- he says.

Warning: Don't count nutrition counseling as education and training.

-Codes 97802-97804 are specifically for medical nutrition therapy (MNT),- says Anne Riehl, RD, with Mid Ohio Nutrition in Columbus. Codes 98960-98962 may encompass more medical education, such as insulin management, she says.

Remind Payers of Program's Savings

Although the National Physician Fee Schedule has not assigned any values to the patient self-management education and training codes, you may still be able to receive payment for 98960-98962 as part of the programs most major insurance companies promote. Many payers understand the value of disease-management programs, Tuck says:

-Insurers realize that these programs significantly improve patient's health and as a result decrease emergency department visits and hospitalizations.-