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Primary Care Coding Alert

Ring In the New Year With CPT 2003

Published on Wed Jan 01, 2003

The New Year brings new and revised codes that will significantly affect family practices. Follow our guide to CPT changes and make 2003 a year of dollars instead of denials.

1. Lesion Excision Codes: One of the most significant changes concerns coding of benign and malignant skin-lesion excisions. CPT revised 11400-11446 (benign-lesion excisions) and 11600-11646 (malignant-lesion excisions) to include the measurement of margins in the determination of the correct code. In 2002, you chose the code depending on the location and size of the lesion only; now, code based on location and size of lesion and the skin margin, i.e., the "excised diameter."

For example, says Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan., previously if the FP excised a 1.0-cm benign skin lesion from the patient's back with a margin of 0.2 cm on both sides, you would have reported 11401 (... lesion diameter 0.6 to 1.0 cm [2002 descriptor]). Now, you will use 11402 (... excised diameter 1.1 to 2.0 cm [2003 descriptor]) because the l.0-cm lesion size and 0.4-cm margin size (0.2 + 0.2) must be added together.

The measurements in the descriptors have not been changed, but the phrase "excised diameter" replaces "lesion diameter" to account for the margin measurement. Also, the words "including margins" were added to the root codes introducing each body location and to the preceding guidelines. As always, FPs should record the lesion size as the greatest clinical diameter. So, for example, if the lesion measures 2.0 cm x 1.0 cm, it is considered a lesion of 2.0 cm.

The same new rules apply to the excision of malignant lesions. CPT also added new language for reporting additional excisions performed as a result of inadequate margin excision. Sometimes, FPs do not excise the whole lesion, a problem revealed only after frozen pathology. In such a case, the physician performs an additional excision to extract the remainder of the lesion. Coders in 2002 may have reported two codes, but CPT 2003 directs you to bill for one procedure by adding the entire margin together.

So, for example, says Daniel Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City, the FP performs an elliptical incision around a black mole of 0.2 cm with a margin of 0.3 cm on each side. Frozen pathology reveals that he didn't get the whole tumor, so he makes another incision with a 0.1-cm margin on each side and excises the remainder of the lesion, which is an additional 0.2 cm. Add together the 0.6 (0.3 + 0.3) and 0.2 (0.1 + 0.1) for a total margin of 0.8, plus the entire size of the lesion (0.2 + 0.2 = 0.4). The preceding example would be coded 11602 (... excised diameter 1.1 to 2.0 cm) because the total excised diameter is 1.2 cm.

If the physician performs the re-excision during the postoperative period, append modifier -58 (Staged or related procedure or service by the same physician during the postoperative period), CPT says.

Note: CPT 2003 Professional Edition erroneously labeled the captions of the lesion diagrams on page 49. Your book should have a Notice of Correction inserted, indicating the correct captions. If not, go to www.ama-assn.org/ama/pub/category/3896.html for a complete list of errata, to be posted on Jan. 1, 2003.

2. Trigger Point Injections: Those pesky trigger point codes have been revised to clear up past confusion. Revisions are as follows:

  • 20550* Injection(s); tendon sheath, ligament
  • 20551 tendon origin/insertion
  • 20552 single or multiple trigger point(s), one or two muscle(s)
  • 20553 single or multiple trigger point(s), three or more muscles.

    First, note that an "(s)" has been added to the word "injection" in 20550. Report 20550 and 20551 once for multiple or single injections to a single tendon sheath, ligament, tendon origin or tendon insertion performed. For example, if the FP injects a tendon sheath three times, use 20550 once. CPT 2002 language made it seem as if you could bill the 20550 for each injection.

    And if the FP injects a tendon sheath and a tendon origin, report 20550 and 20551. However, if the FP injects different ligaments, tendon sheaths or origins, you can report the 20550 or 20551 for each injection. In that case, "You may want to add a modifier -51 (Multiple procedures) or -59 (Distinct procedural service) to clue the payer in that you're not inappropriately billing for injecting the same site more than once," Moore says.

    The "(s)" also clarifies the fact that you can report 20552 and 20553 only once per session, regardless of the number of injections or muscles. To further prevent coders from billing these codes more than once, CPT replaced the words "muscle groups" with "muscle(s)."

    CPT removed the words "ganglion cyst" from 20550, 20600* and 20605* (Arthrocentesis, aspiration and/or injection ...). Now use new code 20612 (Aspiration and/or injection of ganglion cyst[s] any location) for a ganglion cyst injection or aspiration.

    3. Venipuncture Code: The ever-popular venipuncture code has been split in two. CPT revised 36415* (Collection of venous blood by venipuncture), removing the words "finger/heel/ear stick." Now, you should report those specimen collections with new code 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]).

    "This change in CPT should facilitate deletion of the HCPCS code G0001 (Routine venipuncture for collection of specimen[s]) so physicians can code 36415 for both Medicare and private payers," Moore says.

    4. Evaluation and Management (E/M) Services: Family practices that administer pediatric and neonatal critical care should make some coding adjustments come January. CPT 2003 added two new codes: 99293 (Initial pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child) and 99294 (Subsequent pediatric critical care ). Previously, critical care for patients of this age was coded with 99291 and 99292. The new codes will account for the additional work involved in treating these young patients due to their small size and more complex needs. "Their critical care and nutrition needs are more complicated than that for an adult, and the addition of these codes recognizes that," Fick says.

    CPT 2003 also revised the neonatal critical care codes 99295 (Initial neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 days of age or less) and 99296 (Subsequent neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 days of age or less). The revised definitions now describe "critical care" services rather than "intensive care" services, and they remove ambiguity associated with the previous terms of "stable" and "unstable."

    "This change implies that the neonates do not have to be in the intensive care unit," Fick says. Also, 99297, which described subsequent neonatal intensive care for a "critically ill though stable" neonate, has been deleted.

    The addition of 99299 (Subsequent intensive care, per day, for the evaluation and management of the recovering low birth weight infant [present body weight of 1500-2500 grams]) finally gives physicians a code for infants between 1,500 and 2,500 grams who are not critically ill but still require intensive-care monitoring. "There used to be a code only for those patients under 1,500 grams, and this new code accounts for the fact that there are sick infants at this weight that shouldn't be coded the same as well newborns," Fick says.

    5. Colposcopy Codes: Family practices that perform colposcopies should pay attention to revisions of 57452* (Colposcopy of the cervix including upper/adjacent vagina;), 57454* ( with biopsy[s] of the cervix and endocervical curettage) and 57460 ( with loop electrode biopsy[s] of the cervix), all of which CPT moved from the Vagina section to the Cervix Uteri section because descriptor language now specifies the cervix. "These codes do a better job of describing the actual procedure," Fick says. In 2002, these were the only codes for pelvic endoscopy, but CPT added several new colposcopy codes to indicate specific sites:

  • 57420 Colposcopy of the entire vagina, with cervix if present
  • 57421 with biopsy(s)
  • 56820 Colposcopy of the vulva
  • 56821 with biopsy(s).

    6. Pathology Codes: CPT 2003 deleted 80090 (TORCH antibody panel) because more-detailed tests have been developed, rendering the panel obsolete. Physicians used the TORCH panel to screen for serologic response to toxoplasmosis, rubella, cytomegalovirus and herpes simplex virus. Now you should code for each individual test.

    CPT also revised and added new codes to the Hematology and Coagulation section of pathology, mainly for organizational reasons.

    7. Special Services Codes: Physicians now have codes to report on-call services to the hospital. Use new codes 99026 (Hospital mandated on-call service; in-hospital, each hour) and 99027 (Hospital mandated on-call service; out-of-hospital, each hour). You can use these codes to report time that the physician is on-call but does not provide any services, since the time spent providing separately reportable services is not included in these codes.

    8. HCPCS Codes: CMS added three new HCPCS codes for Hepatitis B vaccine:

  • Q3021 Injection, hepatitis B vaccine, pediatric or adolescent, per dose
  • Q3022 Injection, hepatitis B vaccine, adult, per dose
  • Q3023 Injection, hepatitis B vaccine, immuno-suppressed patients (including renal dialysis patients), per dose.

    For Medicare purposes, you should use these codes rather than the existing CPT codes for hepatitis B vaccine, 90740, 90743, 90744, 90746 and 90747.

     

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