Primary Care Coding Alert

CPT 2004 answers your miscellaneous code concerns

 Were you uncertain as to when you could bill for after hours and special reports? CPT 2004 answers those questions and also updates several vaccine and lab codes.

Office Hours Determine 99050 Reporting

CPT finally clarifies that 99050 is for "services requested after posted office hours in addition to basic service." The addition of the word "posted" formalizes that you should use the adjunct code to describe services your FP provides after established office hours, says Daniel S. Fick, MD, assistant dean for clinical affairs at Carver College of Medicine and senior assistant hospital director at University of Iowa Hospitals and Clinics in Iowa City.
 
The revised language indicates that you may assign 99050 in several situations. For instance, an FP's office is closed on Wednesday afternoons. But, a patient requests a 3 p.m. appointment, and the FP opens the office to see the patient. In this instance, Fick recommends reporting 99050 because the FP provides a service outside posted hours, in addition to the E/M code you would report for the basic service (such as 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...).
 
You may also assign 99050 for evening appointments when the FP sees patients after posted hours. Suppose a family practice has posted hours of 8 a.m. to 5 p.m. At 5:15 p.m., the staff is still present because the doctors are running late. A patient calls and needs to be seen that evening. An FP agrees to stay and treat the patient at 5:30. In this situation, you now may tack on the extra 99050 service.
 
Prior to 99050's revision, CPT was unclear as to whether you should apply 99050 to an already open office. The change clarifies that you may assign the special service code as long as the patient requests an appointment after posted office hours.

Don't Report 99080 for WC Forms

If you've contemplated reporting 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form) for worker's compensation forms, CPT 2004 will halt your temptation. An editorial note following the special reports code specifies that you shouldn't report 99080 with 99455 (Work-related or medical disability examination by the treating physician that includes ... completion of necessary documentation/certificates and report) or 99456 (Work-related or medical disability examination by other than the treating physician ...) when the FP completes WC forms.
 
The revision, however, shouldn't affect FP practices that follow CPT, says Kent J. Moore, American Academy of Family Physicians healthcare financing and delivery systems manager in Leawood, Kan. "Most FPs never report 99080 with 99455-99456." Codes 99455-99456 have always included completing the forms.

Code 99024 Allows Postoperative E/M Tracking

For administrative purposes, you may continue to use revised code 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason[s] related to the original procedure). CPT's revision clarifies that you should use this code to report services that the surgical package includes and are thus not intended to be separately reimbursed, Moore says.

Vaccine Section Gets an Update

You won't be using 90659 (Influenza virus vaccine, whole virus, for intramuscular or jet injection use) in 2004 because CPT deletes it to reflect the fact that the influenza whole-virus vaccine is no longer manufactured. You should be reporting either 90657 (Influenza virus vaccine, split virus, for children 6-35 months of age, for intramuscular use) or 90658 (Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use) for the split-virus influenza vaccine. In addition, there are some new vaccine codes and a revision to established codes (90703-90708, 90718, 90727 and 90733) to delete references to "jet injection" as a delivery mode.
 
The Vaccines and Toxoids section also contains several new codes for 2004, including: