Primary Care Coding Alert

Family physicians will find few changes when new CPT 2002 codes are implemented Jan. 1, 2002. This was not a year of significant changes for family physicians, says Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy Family Physicians. Most of what well see in the new manual are simple language changes to make some of the codes easier to understand.
 
Among the new codes FPs will encounter are 90473 (immunization administration by intranasal or oral route; one vaccine [single or combination vaccine toxoid]) and 90474 ( each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]). CPT implemented new codes in an unusual midyear move in July 2001 to describe the administration of oral or intranasal vaccines.
 
Codes 90473 and 90474 provide greater specificity for reporting and follow the same guidelines as 90471 (immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]) and 90472 ( each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]), which were simultaneously revised to remove references to intranasal and oral administration. Although these codes do clarify immunization administration, I dont expect that family physicians will use them frequently since most vaccines are delivered in a subcutaneous or intramuscular fashion, Moore says.
 
As a result of  family practices seeing substantial numbers of diabetic patients, a second relevant new code is 95250 (glucose monitoring for up to 72 hours by continuous recording and storage of glucose values from interstitial tissue fluid via a subcutaneous sensor [includes hook-up, calibration, patient initiation and training, recording, disconnection, downloading with printout of data). This type of monitoring will entail placement of a subcutaneous sensor to collect information about glucose levels, he says. The data are used to determine the most effective and safest intervention in the care of the patient.
 
The AMA notes that 95250 may not be reported with 99091 (collection and interpretation of physiologic data [e.g., ECG, blood pressure, glucose monitoring] digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, requiring a minimum of 30 minutes of time), another code introduced for 2002. However, FPs should assign the appropriate E/M code for physician review, interpretation and written report associated with 95250.
 
Family physicians may occasionally use new codes 99289 (physician constant attention of the critically ill or injured patient during an interfacility transport; first 30-74 minutes) and 99290 ( each additional 30 minutes [list separately in addition to code for primary service]) for patient transport services. These wont be used very often by family physicians, Moore says. However, in some rural areas, the physician may be required to ride with a patient who is being transferred to a specialty- or tertiary-care center.
 
These two codes are only for direct, face-to-face care by a physician while a patient is being transported from one facility to another. The first 30 minutes of care cant  be reported with these codes. Physician direction of emergency care to the transporting staff is not covered and will continue to be reported with 99288 (physician direction of emergency medical systems [EMS] emergency care, advanced life support).
 
Services provided and procedures performed during transport may be reported in addition to 99289 and 99290, with the exception of routine monitoring and initiation of mechanical ventilation.