Primary Care Coding Alert

Get ready for the new edition, effective Jan. 1

If you-ve been wondering how you should report ventilation assist and management in the hospital or nursing facility, look no further. CPT 2007 rings in the new year with several new codes that will help family practice physicians bill these claims more accurately.

Break Down Vent Management by Site

In the past, coders may recall reporting 94656 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; first day) and 94657 (-subsequent days) for ventilation management. But CPT has deleted those codes, and now you can bill based on where the physician administered the ventilation management, as follows:

- 94002 -- Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day

- 94003 -- ... hospital inpatient/observation, each subsequent day

- 94004 -- ... nursing facility, per day

- 94005 --  Home ventilator management care plan oversight of a patient (patient  not present) in home, domiciliary or rest home (e.g., assisted living) requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan (as appropriate), within a calendar month, 30 minutes 
or more.

Streamline Coumadin Management Coding

CPT 2007 also introduces two new codes that will help physicians who perform warfarin sodium management:

- 99363 -- Anticoagulant management for an outpatient taking warfarin,  physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR  measurements)

- 99364 -- Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; each subsequent 90 days of therapy (must include a minimum of 3 INR measurements).   

Family physicians use Coumadin, or warfarin sodium, to thin a patient's blood to prevent heart attacks (410.xx), strokes (431-436), and complications from other disorders, such as deep venous thrombosis (451.1x). Because too much Coumadin can lead to fatal bleeding, the physician uses a finger stick to monitor the patient's blood clotting speed, which provides him with almost instant results.

Breakthrough: Coders normally report 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]) for the finger stick and 85610-QW (Prothrombin time; CLIA waived test) for the lab test. But family medicine practices faced problems when trying to report 99211 along with the visits. This new code might help eliminate those problems.

-I am delighted to see that we now have codes to capture anticoagulant management,- says Sheldrian Leflore, revenue management educator with The Coding Group in Carlsbad, Calif.

-This will be a welcome addition for practices with protime or coumadin clinics. There has not been a CPT code to effectively describe this service. Also, there was so much controversy in the past about the appropriateness of assigning code 99211 for anticoagulant management.-

CPT 2007 Updates Lesion Destruction Codes

Family medicine coders can now distinguish between destruction of premalignant or benign lesions. The update revises the descriptors for 17000 and 17004 to make them only apply to premalignant lesions, and now 17110 is only for benign lesions other than skin tags or cutaneous vascular proliferate lesions:

- 17000 -- Destruction (e.g., laser surgery, electro surgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (e.g., actinic  keratoses); first lesion

- 17004 -- Destruction (e.g., laser surgery, electro surgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (e.g., actinic keratoses), 15 or more lesions

- 17110 -- Destruction (e.g., laser surgery, electro surgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or  cutaneous vascular lesions; up to 14 lesions.

CPT Cleans Up Inpatient Consult Language

Coders struggling to report subsequent inpatient consultations can rest easy. The codes have been in CPT all along, and thanks to CPT 2007's revisions, now it's easy to see which codes you should report for these services.

Family physicians may recall that CPT 2006 deleted follow-up inpatient consult codes (99261-99263) but left the descriptors of the remaining codes the same.

CPT 2007 will clean up the descriptors to eliminate the word -initial- and simply refer to these services as -Inpatient consultation for a new or established patient --

This change shouldn't effect the way that family physicians report their inpatient consult services. -This descriptor change for 99251-99255 was necessary because CPT previously deleted the follow-up consult codes,- says Pat Strubberg, CPC, coder at Patients First Health Care in Washington, Mo. -The word -initial- would be unnecessary and could be confusing for some.-

As in 2006, the physician should report only one consultation per admission. Subsequent services during the same admission are reported using subsequent hospital care codes (99231-99233) or subsequent nursing facility care codes (99307-99310), depending on the site of service. These subsequent services include services to complete the initial consultation, monitor progress, revise recommendations, or address a new problem. 

West Nile Antibody Gets a Code

As of Jan. 1, family physicians finally have the following codes for detecting the antibody to the West Nile virus:

- 86788 -- Antibody; West Nile virus, IgM

- 86789 -- Antibody; West Nile virus.

As with last year, there is no grace period for using both the old and new codes. You should start using the new codes on Jan. 1, or you could face denials across the board.

Keep in mind: Just because CPT introduces a new code, you aren't guaranteed payment. Family Practice Coding Alert will keep you up to date on coverage guidelines and fee schedule figures for these new and revised codes.