Updated guidelines, clarifications featured
By Margie S. Vaught, CPC, CCS-P, MCS-P
In several sections of CTP 2002, the American Medical Association (AMA) has provided updated guidelines and clarification as well as further guidance in regard to correct coding.
In the Introduction Section, added clarification regarding the appropriate use of Unlisted Procedure Codes states:
"Do not select a CPT code that merely approximates the service provided. If no such procedure or service exists, then report the service using the appropriate unlisted procedure or service code."
Prior to this clarification, surgeons and coders did the best they could to locate a "close" code and possibly apply a modifier. CPT is now stating that this is not correct coding, as "merely approximates" as stated above does not justify using a given CPT code. There are still many procedures that Orthopedic Surgeons perform that have NO corresponding CPT codes, such as:
In order to obtain reimbursement for these procedures, the appropriate unlisted CPT codes need to be reported along with supporting documentation and a cover letter. CPT has added the new Category III Codes and currently there are three codes that reflect some of the procedures listed above:
The reporting of the above noted codes is for "data collection" or "informational" purposes only. Offices will need to check with their carriers to see if they will need to report the unlisted procedure CPT code in addition to these "T" codes to obtain reimbursement and to support the "data" to obtain a new CPT code status.
Another guideline change that appeared in CPT is the long awaited AMA description of "Surgical Package." The Surgery Guidelines Section of CPT now states that the following is included in a given procedure:
This definition closely resembles what Medicare has stated in its Global Surgery Package. It provides some standardization as outlined under HIPAA and should, hopefully, help with areas of confusion regarding surgical package coding.
New motion analysis codes
A new section that might affect some Orthopaedic offices is the addition of "Motion Analysis", codes 96000-96004. These codes "describe services performed as part of a major therapeutic or diagnostic decision making process." CPT is clear that in order to report these codes the services must be "performed in a dedicated motion analysis laboratory (ie, facility capable of performing videotaping from the front, back and both sides, computerized 3-D kinematics, 3-D kinetics, and dynamic electromyography)."
These new codes are NOT to be reported with codes 95860-95875. Further guidelines are given that physicians reviewing and interpreting these studies (96004) are to report the code ONLY ONCE, regardless of the number of test/studies reviewed or interpreted.
Athletic training evaluations and re-evaluations were given their own CPT codes for 2002 97005 and 97006. Offices can find the guidelines given for the appropriate use and reporting of these codes in the manual "CPT Changes 2002, An Insiders View."
Some of these guidelines state that evaluations should include:
There is a notation that physical therapy procedures performed above and beyond these evaluations can be separately reported. Examples provided indicate that a licensed athletic trainer performs these services.
Reporting code 95920
Surgeons and coders were also given insight into the correct reporting of CPT code 95920 Intraoperative neurophysiology testing, per hour. The notes under this code states, "Code 95920 describes ongoing electrophysiologic testing and monitoring performed during surgical procedures [this] code is reported per hour of service, and includes only the ongoing electrophysiologic monitoring time distinct from performance of specific type(s) of baseline electrophysiologic study(ies) or interpretation of specific type(s) of baseline electrophysiologic study(ies) should not be counted as intraoperative monitoring, but represent separately reportable procedures. Code 95920 should be used once per hour even if multiple electrophysiologic studies are performed. The baseline electrophysiologic study(ies) should be used once per operative session."
Throughout the Musculoskeletal section of CPT 2002 changes have been made in regards to terminology. Surgeons and coders will find the replacement of "No Mans Land" with the correct anatomic location stated as "Zone 2." In the upper extremity section there is now a reference to reflect that the correct coding of codes 26390-26392 and 26415-26416 should be "per rod." As well as coding for "each finger" is reflected in codes 26426 and 26428 and coding for each tendon is reflected in codes 26445 and 26510.
More changes in terminology, as well as the addition of new codes, are expected for 2003. In the original proposal of changes for 2002, there was an initial request for 250 changes of which 59 were accepted (26 new codes, 30 revisions and 3 deleted codes).
Margie S. Vaught, CPC, CCS-P, MCS-P, is an independent coding specialist in Ellensburg, Wash. She is also a member of the American Academy of Professional Coders National Advisory Board.
Answers to common coding questions may be addressed in future editions of the Bulletin. Fax (847) 823-8026.