Primary Care Coding Alert

Question: I heard that there's a new code section coming in CPT 2004. What is it and how will we use it?

Florida Subscriber

Answer: You're correct, CPT 2004 introduces a new section - the Category II codes. Although you may be reporting more codes, you won't be seeing any additional reimbursement.
 
CPT's new Category II adds supplemental tracking codes for performance measurements. AMA adds this section to comply with ongoing changes being made as a result of Health Insurance Portability and Accountability Act of 1996 regulation. These codes will not affect reimbursement because they won't have relative value units assigned to them. Instead, AMA hopes that these codes will facilitate data collection about quality of care, and some of the codes may relate to healthcare professionals' compliance with state or federal law.
 
Using Category II codes is optional, and you may not substitute them for the regular Category I CPT codes. For example, suppose you're trying to track the use of Beta-blocker therapy in your practice and you don't have an electronic health record. Reporting the new Category II code 0007F (Beta-blocker therapy, prescribed) will allow you to do this through your claims data or practice management software rather than through chart reviews.
 
Or, perhaps you want to track what percentage of nurse visits are for blood pressure checks. In this case, you should assign supplemental code 0001F (Blood pressure, measured) in addition to reimbursement code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...).
 
If your office provides smoking cessation counseling, you may want to consider using 0004F (Tobacco use cessation intervention, counseling) or 0005F (Tobacco use cessation intervention, pharmacologic therapy). Make sure you still report the counseling Category I code, such as 99401 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes). Category II codes describe components that are typically included in an E/M service or test results that are part of the laboratory test/procedure.

The AMA will publish new Category II codes twice a year: Jan. 1 and July 1. For the most current listing, visit www.ama-assn.org/go/cpt.