The new year brings new and revised CPT codes. TMA’s Payment Advocacy staff highlighted the changes most likely to affect the most practices in 2013:
Eighty-two evaluation and management (E&M) codes were revised to include “other qualified health care professionals.” This phrase also was added to several non-E&M services in various sections of the guidelines.
CPT defines “physician or other qualified health care professional” as
an individual qualified by education, training, licensure/registration (when applicable), and facility privileging (when applicable) who performs a professional service within his or her scope of practice and independently reports that professional service. These professionals are distinct from “clinical staff.” A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional, and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specific professional service, but does not individually report that professional service. Other policies may also affect who may report specific services.
Check carrier payment/credentialing policies, facility policies, and state scope-of-practice rules for any qualified health care professionals that may bill for the applicable CPT codes.
- Also in the E&M section are new complex chronic care coordination services (99487-99489) and transitional care management services (99495, 99496) codes. These codes have very specific criteria, and some include a non-face-to-face component. Check with the carriers you contract with regarding coverage and payment for these codes.
- Getting paid for time-based codes now requires passing the midpoint of the time specified in the code. For example, for a code that requires one hour, 31 minutes must be met to bill the time-based code, and it must be documented.
- Cardiology codes (33010-37799 and 92920-93799) have many changes for 2013. Watch for new combination codes that include services that previously may have been listed as separately reportable.
- Multiple new laboratory and pathology (81400-81408 and 81500-81599) codes have been added and coding descriptions for Tier II procedures revised. Check the patient’s benefits and carrier medical policies for coverage, as some of the new codes are for screening a patient for the potential of developing specific conditions.
- Psychiatric codes (90785-90899): Several codes have been deleted and new codes added.
- Nerve conduction codes (95905-95913): Several codes have been deleted and new codes added.
These are only portion of the changes for 2013. Be sure to review the CPT 2013 guidelines for the above sections carefully and the sections with codes you use most often. In addition, check with carriers for coverage requirements of the new codes and the patient’s benefits.
Also note, the American Medical Association’s Corrections Document — CPT 2013 (PDF) is now available. Review this for corrections made to 2013 codes and guidelines.
If you have questions about billing and coding, contact the specialists at firstname.lastname@example.org for help, or call TMA Knowledge Center at (800) 880-7955.
Published Jan. 22, 2013
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