Urology Coding Alert

Nearly every E/M code descriptor gets a facelift on January 1.

Evaluation and management codes are a part of nearly every practice's billing, whether you're billing office visit codes, inpatient hospital codes, consultation codes, or any of the other many E/M codes. CPT® 2013 will revise nearly every code descriptor in the E/M code section.

We'll review the changes to both sections so you'll be ready as soon as Jan. 1, 2013 rolls around.

Eliminate 'Physician' Limitations From Your E/M Code Thinking

Whereas most E/M codes previously referred to "physicians" and "providers" in their descriptors, that will change effective Jan.1, when the descriptors will instead say "qualified health care professionals."

Using 99213 as an example, the code changes are indicated with the strikethroughs (indicating deleted text) and underlining (indicating new text) as follows: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other providers qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend Typically, 15 minutes are spent face-to-face with the patient and/or family

This really isn't a change per se, as much as it is a clarification, says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla.

What this means: "They are clarifying that all E/M codes can be reported by physicians or other qualified health care providers and changed the wording with regard to time in each of the codes -- which really has no bearing on how the codes are used, just that the typical time is spent by all qualified providers who bill these codes," says Melanie Witt, RN, COBGC, MA, an independent coding consultant in Guadalupita, N.M. "In other words, if a payer allows someone other than a physician to provide and bill for a service, the CPT® E/M codes are used by all providers who qualify."

"I believe that there are a lot of physician extenders out there," says Christy Shanley, CPC, department administrator for the University of California, Irvine department of urology. "This further clarifies what they can and or cannot perform on their own."

This change clarifies things in two ways, Mac says: First, the change makes it clear that you can use E/M codes for NPPs. Second, it clarifies that "you have to have that counseling with someone who is certified or technically licensed to provide that type of service; it can't be your office administrator, so to speak," she explains. "It is just a clarification, and I think it was understood before but it could have been abused in some way."

Apply the Change to Your PA/NP Billing

"In urology, apply these changes for services provided by your physician assistants (PAs) and nurse practitioners (NPs)," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, University Hospital, State University of New York, Stony Brook. "E/M service changes indicate nonphysician providers (NPPs), especially PAs and NPs, can provide E/M services on their own, can bill on time alone, and can do counseling and coordination of care on their own," he explains.

Impact: "The description changes I feel are a benefit if RVUs do not go down," Hines says. "Allowing PAs to bill these E/M services on their own and bill for services based on time including the counseling and coordination of care services is a positive move. It is important to recognize that these changes will mean that you will need to train your PAs and NPs to document properly if they are not used to doing this. It is always a good idea to review E/M coding each year with your physicians/NPPS and staff."

Time assignment: In addition, CPT® will add typical times to the same-day observation or inpatient admission and discharge codes 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date ...), assigning 40 minutes to 99234, 50 minutes to 99235, and 55 minutes to 99236. Previously, these codes did not have typical times associated with them, so this change could be helpful to physicians who are at the patient's bedside or on the unit counseling or coordinating care for more than half of the visit, which would allow them to select a code based on time.

Take Note of 76000, 77001 Descriptor Changes, Too

The code descriptor revisions are not limited to the E/M section either. You'll find that the additional NPP clarification applies to two radiology codes you will likely use in your urology practice:

• 76000 -- Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 (eg, cardiac fluoroscopy)
• 77001 -- Fluoroscopy, physician or other qualified health care professional time more than 1 hour, assisting a nonradiologic physician or other qualified health care professional (eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy).

The underlined sections are the additional text you'll find in CPT® 2013. "This means your NPPs can perform and report fluoroscopy represented by 76000 and 77001," Ferragamo says.