CPT 2013: Medicine section contains significant changes

Coders will find significant changes in the medicine section of the 2013 CPT® Manual, including changes to nerve conduction studies.

The guidelines for neurology and neuromuscular procedures now state:
 
EEG, autonomic function, evoked potential, reflex tests, EMG, NCV, and MEG services (95812–95829 and 95860–95967) include recording, interpretation, and report by a physician or other qualified healthcare professional
 
If the provider only interprets the test, append modifier -26 (professional component) to the code.
The guidelines also state that time for codes 9581295822, 9595095953, and 95956, is based on the recording time only. Do not count time for set-up and take down, says Denise Williams, RN, CPC-H, senior vice president of Health Revenue Assurance Associates in Plantation, Fla.
 
For codes 95961–95962, use physician or other qualified healthcare professional attendance time as a basis for code use.
 
The AMA established seven new nerve conduction codes (95907–95913) for 2013 and deleted nerve conduction study codes 95900, 95903, 95904, and H-reflex codes 95934 and 95936.
In the new coding structure, the unit of service in codes 95907–95913 is the number of nerve conduction studies performed, Williams says.
 
Nerve conduction tests are performed at multiple sites along a nerve, says Georgeann  Edford, RN, MBA, CCS-P, president and owner of Coding Compliance Solutions LLC, in Farmington Hills, Mich.
In the past, coders would report the specific points where the tests were performed. Now, they will count the number of nerves tested.
 
For the purposes of coding, a single conduction study is defined as a sensory conduction test, a motor conduction test with an F-wave or without an F-wave test, or an H-reflex test.
 
Proximal and distal nerves may be tested and each study is reported once for multiple sites along the nerve, Edford says.
 
Coders should add the numbers of these separate tests to determine which code to use, Williams says.
Also in this section, the AMA deleted add-on code 95920 and added two new add-on codes (95940 and 95941) for neurophysiology monitoring either inside or outside the operating room.
 
New code 95940 is reported per 15 minutes of service and requires reporting only the portion of time the monitoring professional was physically present in the operating room providing one-on-one patient monitoring. No other cases may be monitored at the same time.
 
New code 95941 is reported for all cases in which the monitoring professional was not physically present in the operating room during the monitoring time or when monitoring more than one case while in an operating room.
 
CMS also created a new G code, G0453, for continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes. (List separately in addition to code of primary procedure.)
 
This change could present a huge financial impact, Edford says. In the past a physician could monitor multiple patients during a one-hour stretch and bill for one hour of service for each because that was the time on the code, Edford says. Now, the physician must spend at least 15 minutes monitoring one patient exclusively in order to bill G0453.
 
Providers will now need to keep track of the actual time spent with each patient. Time can be added up when determining units, as long as the physician spent at least 15 minutes monitoring the patient in each block of time. If the procedure lasts for four hours and the physician monitors the patient for 15 minutes each hour, coders can report four units of G0453.
 
Note that the physician must spend the full 15 minutes monitoring the patient. The eight-minute rule for physical therapy does not apply to the G code, Edford says. Providers also cannot bill for more than one patient at a time because the code specifies individual attention.
 
Vaccine administration
The AMA added two new codes for influenza vaccinations:
  • 90653, influenza vaccine, inactivated, subunit, adjuvanted, for intramuscular use. Note that this service is not yet FDA-approved, Williams cautions. Watch the AMA and FDA websites to find out when it is approved.
  • 90672, influenza virus vaccine, quadrivalent, live, for intranasal use.
In addition, the AMA revised codes 90655, 90656, 90657, 90658, and 90660 to include “trivalent” in the description, meaning the vaccine covers three strains of the virus.
 
For an adult intramuscular Hepatitis B vaccine on a two-dose schedule, coders will report new code 90739 once the FDA approves the vaccine. Coders should also note that code 90746 now specifies a three-dose schedule in order to differentiate it from the two-dose schedule, Williams says.
 
Coders also need to read the parenthetical note for vaccine administration, Williams says. Prior to 2013, coders could not report 90460, which is vaccine administration with counseling and 90471-74, which are for vaccine administration without counseling.
 
The provider may counsel the patient on one vaccine, but may not provide counseling for all vaccines when he or she administers multiple vaccines, Williams says.
 
Ophthalmology
The AMA revised the new patient guidelines under ophthalmology to be consistent with the rest of the CPT Manual, Edford says. Coders should read the guidelines because they include definitions of intermediate and comprehensive services.
 
Note that a comprehensive service can cover more than one visit, Edford says.
 
Allergy and clinical immunology
A new instructional note under allergy testing instructs coders to report 96372 (therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular) for administration of medications (e.g., epinephrine, steroidal agents, antihistamines) for therapy for severe or intractable allergic reaction.
 
If the patient suffers an adverse reaction during an allergy, the time for the ingestion test stops and an evaluation and management (E/M) service begins, Edford says. The E/M service is not necessarily time-based.
 
New codes 95017 and 95018 describe the combination of percutaneous (scratch puncture, prick) and intracutaneous (intradermal) testing. Code 95017 involves venoms, while 95018 is used for drugs and biological. Report the number of tests performed.
 
New codes 95076 and 95079 are used to report ingestion challenge testing. Report 95076 for the initial 120 minutes of testing time (not physician face-to-face time). Report 95079 for each additional 60 minutes of testing time (not physician face-to-face time).
 
For total testing less than 61 minutes (e.g., positive challenge resulting in cessation of testing), report an E/M service, if appropriate, Williams says.
 
These tests include patient assessment/monitoring activities for allergic reaction (e.g., blood pressure testing, peak flow meter testing), so those services are not separately billable. However, coders may separately report Intervention therapy (e.g., injection of steroid or epinephrine) as appropriate.
 
Email your questions to Senior Managing Editor Michelle A. Leppert, CPC, at mleppert@hcpro.com.
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