Click here to see a replay of the 2013 CPT Changes Overview webinar.
This webinar will give you a better understanding of 2013 CPT changes, on this program we will cover the following topics:
- Overview of changes in CPT for 2013
- Review of each CPT change by section of CPT to include:
o Medicine and Category II & III codes
- Rationale for change
NOTE – The replay is not eligible for CEU credits
Questions and Answers:
Question: Which date of service should we report for the Chronic Conditions Management codes and the Transitional Care Management codes .... the date of the face-to-face visit or the last day of the 30-day period?
Answer: CPT doesn't specify but does state that the codes can be reported separately. For the Complex Chronic Care Coordination, because these codes are time based, it would seem that following the first face to face, and the first time hurdle had been met, the service could be billed. Thereafter each time the time requirements were met, the service could be billed. For Transitional Care, it would be the date in which the encounter occurred that involved either the moderate or high complexity medical decision making.
Question: Does "qualified health professional" include non prescriptive providers? (e.g. Psychologist)
Answer: Definition of a Qualified Health Professional: "A "physician or other qualified healthcare professional" is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/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 healthcare professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. Other policies may also affect who may report specific services."
Question: Should a pericardium repair procedure be billed separately during a CABG and if so with what code? To clarify, the repair is done is xenographt and would that be separately billed with CPT 15777 or 15271.
Answer: The 15777 code is for soft tissue and the 15271 is a wound surface code are in the skin graft section of CPT and would only be used if the patient required a skin graft to close the surgical site but otherwise, these codes have no relationship to a CABG.
Question: Is Pub 100-04 Medicare Claims Processing Transmittal 2596 for hospitals to add to the UB 04 or is this for physician therapy billing on a HIC?
Answer: The transmittal is applicable to anyone who bills for a non-covered service and does not obtain an advance beneficiary notice.
- R2596CP Annual Update to the Therapy Code List - 2012-11-23
- MM8126 [PDF, 102KB] Annual Update to the Therapy Code List - 2012-11-23
Question: Will these changes to the CPT affect the relative value units?
Question: In the E&M section - the "usually" statement has removed the word "physician". Do you believe this means that total staff time can be used to calculate a score based on time? (Example: if a genetic counselor and physician see a patient, can we count in total time the time the genetic counselor worked with the patient without the physician in the room?
Answer: No. A genetic counselor cannot perform an E&M service. The time that is counted as part of an E&M is for a licensed provider functioning within their scope of medical practice. There are multiple codes for genetic counseling including 96040, The parenthetical following the 96040 specifies that the genetic counseling is provided by a physician or other qualified health professional can use an E&M.
Question: What CPT code is replacing CPT 88386?
Answer: According to the AMA, Code 81479 was developed to allow reporting of services formerly identified by deleted codes 83890-83914 and 88384-88386.
Question: Is there a crosswalk available for the Molecular Pathology codes?
Answer: The Molecular pathology code revisions relate to the addition specific analytes for testing in the tier 2 codes. For the Multianalyte Assays with Algorithmic Analyses the MAAA codes have specific parentheticals that preclude billing with the individual test. E.g. 81500 Oncology (Ovarian) biochemical assays of two proteins CA-125 and HE4) preclude billing with CPT 86304 (CA-125) and 86305 (HE4).
Question: When would there be a scenario where an E&M could be billed in addition to psychotherapy?
Answer: Psychotherapy for an adult suffering from co-morbid medical conditions, depression, anxiety and agitation. The patient is seen for psychotherapy and the physician or qualified healthcare professional. The physician evaluates the patients current medication regime and performs a psychiatric exam consistent with the 1997 E&M guidelines, orders a drug assay to determine the patient's therapeutic level and adds a new medication to the treatment regime.
Question: What CPT code is replacing CPT 90718?
Answer: According to AMA, "Code 90714 is appropriate for reporting all available Td vaccines."
Question: If I have MD's, PhD's and LCSW's, does this affect the subspecialty provision for New Patient Guidelines?
Question: Can you please repeat the new codes under the Nuclear Imaging that replace the 78000-78011 codes. Thank you
Answer: (78000-78011 have been deleted. To report, see 78012-78014)
Question: Which E&M should be used with code 90792?
Answer: Code 90792 includes medical services. An E&M code would not be used with either the 90791 or the 90792 AN E&M is only appended to 90833, 90836 and 90838. AN E&M code would not be appended to 90792 as it already includes "medical service". AN E&M is only appended to the psychotherapy codes 90833, 90836 or 90838.
According to the 2013 CPT Changes, "Codes 90791, 90792 may be reported once per day and not on the same day as an evaluation and management service performed by the same individual for the same patient."
(Watch for related NCCI edits in January.)
Question: Could you please explain the difference between 90791 and 90792? Who would be performing the "medical services" to correctly used 90792? Thank you.
Answer: According to the OPPS Rule, Effective January 1, 2013, CPT codes 90801 and 90802 will be deleted and the E/M services will be billed using the following CPT codes: CPT code 90791 (Psychiatric diagnostic evaluation (no medical services) when completed by a non-physician) and CPT code 90792 (Psychiatric diagnostic evaluation (with medical services) when completed by a physician). The 90782 is provided by a physician or licensed professional practicing within their scope of practice. A psychologist and social worker are not licensed to provided medical care so they would use the 90791.
Question: Would a clinical psychologist ever use these E&M codes?
Question: Please elaborate on use of new modifiers RI and LM for Medicine section on cardiology.
Answer: . Appendix A of the CPT book lists the coronary modifiers as LC, LD but not the RI or LM which are HCPCS modifiers. CMS lists them effective 1/2013. The new Coronary intervention codes have a base code of a single vessel and an add on code for each additional vessel. I would append the appropriate modifier to the base code for the major vessel and then code each subsequent vessel using the applicable modifier for the vessel. CPT has established new coronary therapeutic services and procedures section. The modifiers are used with the new codes that define the interventions in terms of major coronary artery or branch and then each additional (separate code). The modifiers are appended to define which vessel was involved.
Also, refer to R1136OTN National Correct Coding Initiative (NCCI) Associated Modifier Changes (Additions) - 11/01/2012 for more details
- R1136OTN National Correct Coding Initiative (NCCI) Associated Modifier Changes (Additions) - 11/01/2012
- Pub. 100.04, Chapter 23, Section 20.9.1 and 18.104.22.168 when the update is published this month.
- Modifier -LC Left circumflex coronary artery
- Modifier -LD Left anterior descending coronary artery
- Modifier -LM Left main coronary artery
- Modifier -RC Right coronary artery
- Modifier -RI Ramus intermedius
New Modifier Instructions 01/2013
Additional modifiers shall be added to the list of NCCI-associated modifiers that will allow an edit with modifier indicator of “1” to be bypassed when the modifier is utilized correctly.
- Modifier -LM left main coronary artery
- Modifier -RI ramus intermedius
- Modifier -24 unrelated evaluation and management service by the same physician during a postoperative period
- Modifier -57 decision for surgery
Question: These codes are all effective 1/1/13??
Answer: Yes. All CPT codes are effective 1-1-2013
Question: Does 90792 apply to ED patients also?
Answer: : The ED physician would do an E&M. If a psychiatrist or psychiatric Nurse Practitioner saw the patient, then they would perform. I don't see an ER physician making a psychiatric diagnosis or developing a plan of care involving the patient and family. I would suggest you look at the Final Rule section "VIII. Payment for Partial Hospitalization Services". Also, for 2013, 90792 has an OPPS Status Indicator Q3. And APC 0323 (Extended Individual Psychotherapy). In Addendum M, it groups to Composite APC 0034 (Mental Health Services Composite). I cannot find a specific ED Reference at this time.
Question: If a physician is monitoring 1 medicare patient and 1 bcbs patient can medicare get billed for the entire time of monitoring because the other patient is a BCBS patient?
Answer: The only amount of time that can be billed for the Medicare patient is the amount of one-on-one time spent exclusively on that patient.
Question: If both a motor and sensory NCV are performed on right median and right ulnar how many studies is this and which code will apply in 2013?
Answer: The 95908 would be correct for after January 1 because it would be 2 nerves on the sensory and 2 for the motor.
Question: 95920-intraoperative monitoring is not for the surgeon to report while rendering the surgical procedure, correct? So, will the same rule apply to 95940?
Answer: The official description includes language to report the surgical procedure separately: Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure)
Question: Can you clarify what is a rest home?
Answer: When AMA references "Rest Home" in the CPT book, they typically provide the example: eg, assisted living facility. Medicare does not use the term "Rest Home". Old terminology but there must be some still out there. Essentially, it is the place a patient calls "home"
Question: Reagarding codes 99487-99489 - I Was Under The Impression That Medicare Has These Codes On Their Fee Schedule For 2013
Answer: RVU13A assigns these codes the Status Code: B - Bundled. Payment bundled into payment for other services not specified. and the OPPS Status Indicator: N - Paid under OPPS; payment is packaged into payment for other services. Therefore, there is no separate APC payment.
Question: For the TCM what is the date of service that should be billed, is it the 29th day after discharge, or is it the date of the face to face?
Answer: The date on which the physician encounter occurred that required the moderate or high complexity medical decision making,
Question: For the TCM what would be the documentation guidelines for coordination of care that happens via telephone?
Answer: CPT does not specify the details however, one would expect to see the date, who was present on the call, a summary of the discussion and the amount of time spent.
Question: Can there be a facility charge for transitional care management code, a TC component?
Answer: No. The RVU13A file does not break out codes 99495-99496 into 26/TC components.
Question: If a psychiatrist does a H&P for a facility and also does 90791, can they bill for both?
Answer: No it would be the 90792 and the H&P is typically done by internal medicine or family medicine.
Where to find 2013 Updates on MediRegs
2013 Information is "Pre-Released"
- Guidance for Coders Library
- First folder - 2013 Pre-Release CodeBook
Important Documents in the 2013 CodeBook
- AMA - Appendix Files folder...Appendix B - lists changes
- Bottom of book...Updates & Changes Report - provides deeper detail
- Any Chapter....Code Details Page for any code - has latest Medicare payment logic
- Printable Guide: HCPCS & CPT Procedure CodeBook (PDF)
CPT Changes - An Insider's View
- Available only in CRRC, ARRC & CRSP
- AMA publication that details changes to the CPT Professional Edition each year.
- Search by code
- Printable Guide: CPT Changes - An Insider's View (PDF)
Guidance for Coders Library
- CRS - Go to Browse by Category
- CRRC/ARRC - Go to CodeBooks & Guidance
- Provides transmittals, Final Rules, key CMS Manuals, Crosswalks and more
- Search by code or key word
Browse Content Folder View
- Provides complete list of content, including MAC LCDs
- Search and store the search for automatic e-mail alerts
- How to Store a Search
Downloads - Coding Comply Tool
- Available only in CRRC, ARRC & CRSP
- Lookup & Payment Tools... Coding Comply...Search Codes
- Create a custom export of added, modified, deleted codes by date.
Important Note about 2013 Pre-Release book
Don't bookmark in this page. Content is available for a short period until it becomes effecive 01/01/2013.
When it becomes effective, the 2013 data is moved to the "regular" codebook.
Expect Updates to RVU and OPPS Payment rates!