Primary Care Coding Alert

The American Medical Association made its annual announcement about additions, deletions and modifications last month in Chicago.

Coders reviewing the new manuals will see that the majority of changes for next year affect other specialties like surgery, radiology and pathology, says Daniel S. Fick, MD, associate professor, residency director and medical director for the department of family medicine at the University of Iowa College of Medicine in Iowa City, Iowa. But there are some changes that will apply to family physicians.

Care Plan Oversight Changes

Noteworthy among changes to evaluation and management (E/M) service coding are the revisions made to care plan oversight services (99374-99380), and the addition of codes to describe certification and recertification for Medicare-covered home health services. Revisions to care plan oversight services were made to reflect more clearly the range of settings in which the services may be provided, according to Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. The new wording specifically notes care provided by a home health agency in the home, domiciliary or equivalent environment like an Alzheimers facility.

In addition, CPT has added language that includes the involvement by other caregivers like nonphysician professionals, she says.

However, the Health Care Financing Agency (HCFA) disagrees with the new descriptors and has implemented new HCPCS codes that describe care plan oversight for Medicare beneficiaries. HCFA preferred to stick with the existing definitions and so added two G codes that will be used for services covered by Medicare, Callaway explains.

These new HCPCS codes are G0181 (physician supervision under care of home health agency [patient not present] requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication [including telephone calls] with other health care professionals involved in patients care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes) and G0182 (... 30 minutes or more), which carry the same definitions as the 2000 version of 99375 and 99378.

HCFA also added two more G codes to describe services provided by family physicians as they certify and recertify patients eligible to receive Medicare-covered home health services:

G0180 physician services for initial certification of Medicare-covered home health services, billable once for a patients home health certification period.

G0179 physician services for recertification of Medicare-covered home health services, billable once for a patients home health certification period.

The first code will be assigned when a patient has not received these service for at least 60 days, Callaway explains, while the second code applies in situations where the patient has received home health services for at least 60 days.

Another significant change to the E/M section includes language to tighten up instances in which critical care services are provided (99291-99292). The revisions are intended to redefine the specific types of injuries and illnesses when critical care codes are appropriately applied, Callaway says. Medicare felt that the most recent descriptions were too broad, and the language changes for 2001 are intended to modify that.

For instance, critical care codes can no longer be assigned with patients experiencing organ system failure simply because of the failure. That condition must contribute to imminent or life-threatening deterioration of the patients status to be considered for critical care services, she says. Family practice coders should carefully review the introductory notes to the critical care section of the 2001 CPT manual to ensure they are assigning these codes properly.

CPT 2001 also clarifies E/M coding for new versus established patients by noting that professional services rendered within the previous three years must have been face-to-face and have been assigned their own specific CPT codes to qualify a patient as established.

Wound Management

CPT 2001 also adds two new codes to describe active wound care management:

97601 removal of devitalized tissue from wound; selective debridement, without anesthesia (e.g., high pressure waterjet, sharp selective debridement with scissors, scalpel and tweezers), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session.

97602 removal of devitalized tissue from wound; non-selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session.

According to Fick, these codes would usually be reported by nonphysician practitioners (NPPs), including physical therapists, occupational therapists, and wound care and enterostomal nurses who often remove tissue and apply topical medicines without an anesthesia. These dont replace codes 11040-11044, which typically describe wound debridement done by a physician using sterile technique, he says. Nor should they be reported in addition to these codes.

However, he adds, there are occasions when family physicians may perform these services and the lower-level 97601 and 97602 codes would be most appropriate to assign. They are not exclusively for nonphysician professionals. Physicians should follow the spirit of these codes, which describes the type of service provided, and report them if appropriate.

Medical Nutritional Therapy

CPT has added codes to describe medical nutritional therapy provided by dietitians and other staff members in either an individual session or a group setting:

97802 medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes

97803 re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes

97804 group (two or more individual[s]), each 30 minutes.

This series of codes addresses interdisciplinary collaboration and treatment of family practice patients who have nutritional needs. While the code is not intended to cover services like patient feeding through tubes or intravenous parenteral nutrition, it describes a wide range of services. These include evaluation of nutritional intake, identification of nutritional problems, calculations of body size, physical measurements, current body weight and goal weight, exercise patterns, psychosocial factors, and the patients willingness and ability to undergo nutritional therapy.

Coders should note that, per CPT 2001, medical nutrition therapy assessment and/or intervention by a physician is to be coded using the appropriate-level E/M or preventive medicine code.

Immunization Codes

Callaway notes that CPT 2001 also revises or adds several immunization codes to reflect new medications and formulas developed over the past few months. These include:

90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DtaP-HepB-IPV), for intramuscular use;

90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use;

90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use;

90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use; and

90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use.

Coders should note that 90740 and 90747 describe separate vaccine products now available for immunosuppressed patients. Code 90743 represents a new two-dose schedule product for adolescents 11-15 years old, while CPT revised 90744 to specify its original intent as a three-dose product.

Other revisions to immunization codes include 90378 (respiratory syncytial virus immune globulin), 90669 and 90732 (pneumococcal vaccine), 90702 (DT) and 90718 (Td).

Other Noteworthy Changes

A new prostate specific antigen (PSA) testing code, 84152, has been added for complex PSA testing, and another new code, 89321 (semen analysis, presence and/or motility of sperm) describes the limited semen analysis commonly done to confirm the success of a vasectomy.