Urology Coding Alert

Come January, you'll be faced with several new and revised E/M codes. Since much of your coding relies on E/M codes, save yourself a few headaches and dodge the potential denials by staying ahead of the coding curve.

Half the new E/M codes are replacements for codes removed from CPT 2008. For instance, medical team conferences codes 99361 and 99362 have been deleted and replaced by three all-new codes:

Codes 99366-99368 differ from their predecessors 99361 and 99362 in several ways. Most important, 99366 and 99368 apply to nonphysician healthcare professionals, such as nurse practitioners or physician assistants, says Susan E. Garrison, CHC, PCS, FCS, CCS P, CPAR, CPC, CPC H, executive vice president of Healthcare Consulting Services. Both code descriptors specify a minimum service time of 30 minutes or more, but 99366 also stipulates that the patient and/or family must be present during the conference.

Patient presence matters: Many payers, including Medicare, will not reimburse separately for non-face-to-face services -- which means insurers will likely not recognize 99368 (during which the patient and/or family are not present) as a payable service. Payers may choose, however, to accept 99366 if a nonphysician practitioner (NPP) in your practice takes part in a team conference for a patient under your care, as long as the patient and/or family is involved.

Code 99367 also requires a service time of 30 or more minutes, but applies when a physician also participates in the team conference. In this case, the patient and/or family is not present.

Previously, 99361 and 99362 also described physician participation in a team conference, but because those codes specified "patient not present," Medicare and other payers would not reimburse for the services. Because 99367 likewise is not a face-to-face service, payers will almost definitely not pay for it.

Documentation will be key when reporting team conferences, Garrison says. She suggests that for each service, NPP or physician notes should specify:

1. Who participates in the conference (the specific providers with credentials). Remember, only one same-specialty, same-practice professional may bill per conference.

2. Time of participation. This must begin at the start of the review for an individual patient, and ends when that review concludes. The service must deal with one patient at a time.

3. The patient's presence (or lack thereof).

4. Plan going forward, to include:

Caution: CPT 2008 does not contain a code for a team conference with both physician and patient and/or family involvement. In such a case (that is, when both a physician and patient are present for a counseling service), the physician should report a standard E/M code (such as established patient visit 99211-99215) based on counseling and coordination of care time, Garrison says.

"Be sure to alert your physicians," Garrison says, "that counseling and coordination of care time must be documented."

CPT 2008 will add reference times to several E/M code categories -- specifically nursing facility care (99304-99310) and annual nursing assessments (99318) -- that did not previously include them. The addition of a reference time means that, when necessary and supported by documentation, you may select an E/M service level using time, rather than the history, exam and medical decision-making key components, as the primary deciding factor.

Warning: You'll have to await CMS guidance to see if you can report these new codes simultaneously with prolonged service codes when time becomes prolonged and is also the primary coding factor for a visit in a nursing facility, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at State University of New York, Stony Brook.

Additionally: In the list of new 2008 E/M codes, two (99406 and 99407) will deal with counseling patients on how to quit smoking, while two others (99408 and 99409) will describe alcohol and/or substance (other than tobacco) abuse structured screenings and interventions. You likely won't be using these codes in the urology practice.

The final new E/M code in CPT 2008, 99477 (Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or less, who requires intensive observation, frequent interventions, and other intensive care services), describes services less intensive than those outlined by neonatal critical care code 99295 (Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less) but presumably more intensive than those services included in a standard initial inpatient care code (99221-99223). The AMA will likely provide more information on the exact circumstances under which you should apply 99477 when it officially unveils the CPT 2008 this fall.

More info: Read about the additional telephone and e-visit E/M CPT 2008 code changes in "Anticipate Easier Telephone Service Coding Come January" in Urology Coding Alert Vol. 9, No. 12.