Pulmonology Coding Alert

Good news: TCM services can now be applied to new patients too. 

The earlier you’re up to speed on the coming CPT^® changes, such as new codes for inter-professional consultations, influenza vaccines and chest wall oscillation, the more likely you are to see fewer payment delays for those services next year.  While official CPT^® changes have not been released, take a look at what you can expect, come Jan. 1, 2014.

Reminder: Although the potential revisions are listed as “accepted” in the CPT^® editorial panel meeting summaries, it is not given that all these changes will appear in CPT^® 2014. Also, the actual codes, descriptors, and guidelines won’t be finalized until closer to the time of CPT^® 2014’s official publication later this year.

Look for New E/M Codes For Consults

You are likely to see new codes to report the work of two medical professionals who discuss a patient’s condition via phone or internet. So, beginning Jan.1, 2014, look for four new codes using the code range 9944X to describe this work, depending on the time spent for this consultative service.

Caveat: “These new codes are intended to be used only by the consultant physician,” notes Kent Moore, senior manager for physician payment at the American Academy of Family Physicians. “The patient’s treating physician, which is typically the attending or primary care physician, who is seeking the consultant’s opinion or advice with respect to diagnosis and/or management of the patient will not be able to use these codes for his or her portion of the conversation. That said, if a family physician is consulted by another physician or other qualified health care professional in this way, there is nothing to preclude the family physician from reporting these codes,” adds Moore

However, it isn’t clear whether Medicare or any other payer will include payment for these codes, since they are non-face-to-face consultations, so keep an eye on future issues of the Pulmonology Coding Alert for more on whether these are payable once the final 2014 Medicare Physician Fee Schedule is released.

TCM Guidelines Will Match CMS in 2014

CPT^® 2014 promises to work some of the kinks out of the new-in-2013 transitional care management (TCM) codes 99495 (Transitional care management services with the following required elements: Communication [direct contact, telephone, electronic] with the patient and/or caregiver within two business days of discharge, medical decision-making of at least moderate complexity during the service period, and face-to-face visit within 14 calendar days of discharge) and 99496 (…within seven calendar days of discharge).

The Editorial Panel’s accepted guideline revisions will indicate that TCM services can now also apply to new patients. The 2013 guidelines limited the codes to established patients, but payers such as Medicare already allow the use of the codes for new patients, too. You’ll also get clarifications about reporting discharge services and other E/M services in addition to TCM.

Observe Changes to Vaccination Codes

CPT^® 2014 is also likely to include vaccine code changes. One of these is 90673 (Influenza virus vaccine, trivalent, derived from recombinant DNA [RIV3], hemagglutnin [HA] protein only, preservative and antibiotic free, for intramuscular use). “This code, which was FDA approved in January 2013, was released on July 1, 2013, for implementation on January 1, 2014,” says Moore.  Be sure that you always identify the actual influenza vaccine supply being administered by your office before selecting the appropriate CPT^® code.

The other influenza vaccine codes that CPT^® announced will make their way into CPT^® 2014 may not be in the code book yet, but have already been valid to report since Jan. 1, and include the following:

• 90685 — Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
• 90686 — ...when administered to individuals 3 years of age and older, for intramuscular use
• 90687 — Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
• 90688 — ...when administered to individuals 3 years of age and older, for intramuscular use

Note: The codes 90687 and 90688 carry a lightning bolt sign which means that these codes are still awaiting FDA approval. These two codes carried the symbol in CPT^® 2013 and are still carrying the same status in CPT^® 2014.

To read about the new vaccine codes, visit www.ama-assn.org/resources/doc/cpt/vaccine-codes.pdf.

Don’t Overlook New Chest Wall Oscillation Code

If the recommendations for 2014 are accepted, you will soon be able to add one more new code to your pulmonary diagnostic testing and therapy series 94010-94799. This new code will help you capture mechanical chest wall oscillation to facilitate lung function.

You’ll report this procedure when your pulmonologist or a respiratory therapist performs chest physical therapy in order to clear the airways and to help in lung function. This code is likely to be in the same code range (9466X) as the codes for demonstration and evaluation of other chest wall manipulation techniques such as cupping, percussing and vibration that your pulmonologist or a respiratory therapist will perform to facilitate lung function.