CPT® 2012 Update: Revisions Expand Your Prolonged Services Reporting Scope

2012 CPT® revision opens opportunity of using code by every specialty.

When your gastroenterologist examines a patient for a condition for instance protracted vomiting, ICD-9 code 787.03, necessitating in-office medication and observation or obstipation/ impaction (564.09, 560.3) needing in-office enema or disimpaction, you might be able reporting prolonged services codes +99354 and +99355 in order to capture the time and work. The good news is that a CPT® 2012 revision permits you even more bandwidth in using these codes. Read on for advice on correct reporting with this change.

Broaden Office or Outpatient Prolonged Services

In 2012, you’ll have more tractability as far as applying office or outpatient prolonged services code +99354 is concerned, credit goes to this provider-related CPT® 2012 revision:

Old way: +99354 – (Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service; first hour [List separately besides code for office or further outpatient Evaluation and Management service].

New way: +99354 (Prolonged service in the office or other outpatient setting requiring direct patient contact further than the usual service; first hour [List separately besides code for office or further outpatient Evaluation and Management service]).

Big change in 2012: As per CPT® 2012 revision, the latest descriptor removes the words "physician" and "face-to-face", which extends the scope for reporting prolonged services. The descriptor is now apt for use by a wider range of providers and is not restrained for face-to-face physician services offered in an outpatient or office setting.

Likewise, the additional 30-minute CPT codes follow the same revision removing face-to-face physician time.

New way: For every added 30 minutes of prolonged services, you’ll report +99355 (Prolonged service in the office or further outpatient setting requiring direct patient contact further than the usual service; each added 30 minutes [List separately besides code for prolonged service])

Old way: + 99355 in 2011 was Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service; each additional 30 minutes [List separately besides code for prolonged physician service].

Append to Appropriate E/M Codes

You must keep in mind that prolonged services are additional codes that you have to report with suitable evaluation and management codes. You can report prolonged services after your gastroenterologist spends a total of 30 minutes beyond the typical times (as mentioned in the CPT® guidelines) for a specific E/M code.

As per CPT® 2012 revision, while the level of service of a particular code is met, still, the time involved with the patient goes beyond the highest level of that code grouping, you would use the prolonged service codes. You will report prolonged services in the outpatient setting or office with +99354. You can report every added 30 minutes of direct patient contact with +99355.

CPT Codes: Stay current and get the reimbursements you deserve

Current Procedural Terminology (CPT) Codes have become the “currency” of healthcare, mandating all manner of payments to physicians be it the most complex surgical procedures or routine office visits.

CPT codes are five-digit numbers assigned to every service a medical practitioner provides to a patient after which they are used by insurers to determine the amount of reimbursement that a practitioner will receive. These codes ensure uniformity since everyone uses the same codes to convey the same thing. However, there are circumstances when the reimbursements don’t come in.

To ensure that you do not miss out on the reimbursements, you need to have a sound understanding of CPT codes, apart from having a thorough knowledge of the latest medical terminologies, procedures and diagnosis. What’s more, you need to develop careful observation because that is exactly what can help you avoid common coding goof-ups and compliance issues.

A very important part of getting the right CPT codes is staying current. Keep yourself up-to-date with the from CPT code list. The updates come every year in January, and it’s not a difficult proposition getting hold of it; but the key is to know their correct application. Keep track of what changed and what didn’t, which code deletion is likely to affect you, how you need to handle payers that do not accept the 2009 CPT codes, etc.

That apart, modifiers can also make your coding a lot easier, and bring you the reimbursement without much of a hassle. Be on the watch for them because they ease out the complexities when you have similar conditions to code in a given instance.

So stay abreast of the latest CPT codes and keep the cash flowing in, each time, every time!

CPT Codes Online: Reducing slip-ups and the time it takes to get paid

With so many Current Procedural Terminology (CPT) codes doing the rounds today, coding right have become a difficult proposition. The astounding number of available procedure codes often results in incorrect coding thus resulting in expensive billing and reimbursement follies.

If you want to get the coding right the very first time, research and careful considerations are the key. There are various sources of access for the Current Procedural Terminology codes, both online and offline.

Electronic CPT codes help; Electronic Medical Record (EMR) and practice management solutions now integrate CPT codes directly into their software to perk up the process. Offices have the option to choose frequently used CPT codes, incorporate them into their software and make use of this code set to make simple the correct-coding procedures. This does away with the goof-ups and saves time in the billing and reimbursement process.

Doctors and nurses can use CPT codes online to estimate patient payment portion correctly before finishing the patient visit. In addition, integrated CPT codes allow an office to use real-time electronic charge capture.

Online CPT codes enable point-of-service charge capture which accelerates the reimbursement process, reduces coding slip-ups and eliminates lost charge slips. Industry averages indicate that medical offices misplace 2-4 charge slips per week, resulting in loss. Electronic charge slips used with online CPT codes can get rid of lost charge slips and the overlooked revenue, all this while minimizing mistakes and the time it takes to get paid.

Therefore it goes without saying that the whole process of medical coding and billing becomes easy with the online access.

CPT Codes: Know the three categories

Maintained by American Medical Association (AMA), Current Procedural Terminology (CPT) codes can be found in various paperwork and documentation as we make the transition through any healthcare experience.

When you do a CPT code search, you’ll find that there are three types of CPT codes:

Category I CPT Code

Category II CPT Code - Performance Measurement

Category III CPT Code – Emerging Technology

Category I CPT codes

These types of codes describe a procedure or service identifiable with a five-digit CPT code and descriptor nomenclature. Category I CPT codes are restricted to clinically-recognized and generally accepted services. These codes are the permanent CPT codes

AMA offers free online CPT code searches as well

Current Procedural Terminology (CPT) codes are used in various paperwork as we transition through any healthcare experience. The American Medical Association (AMA) strives to provide you the latest CPT codes to assist you with correct reporting of procedures and services. Each year an annual publication is prepared that makes changes to the tune of significant updates in medical terminology and practice.

The association, through its department of CPT Editorial Research and Development, gives staff support to the process of addition, modification and deletion of CPT codes. The editorial panel comprises 17 members and conducts meetings thrice a year to consider proposals for changes to CPT. It has eleven physicians who are nominated by the National Medical Specialty Societies and approved by the AMA Board of Trustees.

The CPT Advisory Committee supports the panel in its efforts. The advisory committee is made up of representatives of over 100 medical specialty societies and other health care organizations. In order to establish new CPT codes, one can submit a coding request form; the CPT Advisory Committee then reviews the proposed code.

Apart from all these, the AMA comes up with a monthly newsletter, an annual publication, an educational primer, an annual CPT coding symposium, and an online service.

Despite controversy, AMA offers free CPT code searches online. Since February 2002, the association has been offering free searches of its online CPT coding manual. The AMA believes that patients should have as much information as possible when taking health care decisions. No one should put off reporting a condition or symptom to the physician just because of the cost.

CPT III codes: Temporary codes for emerging technologies

Developed by the American Medical Association (AMA), CPT coding is a standard code that is applied to procedures and services for the purpose of patient records. There are three types of CPT codes: Category I, II and III.

Category III codes are temporary codes for new and emerging technologies. The idea behind this category of codes is to aid researchers track emerging technology and services to substantiate extensive usage and clinical efficiency. So if you are someone who embraces new technology, there’s quite a possibility that you are familiar with Category III CPT codes.

This category of CPT codes has been created to allow for data collection and utilization tracking for new procedures that do not meet the criteria for Category I CPT codes. Category III codes comprise five digits, with four digits followed by the letter ‘T’ in the last field. These codes are temporary in nature and will make an exit if the procedure or service does not get accepted as Category I code within five years.

Few things to keep in mind about Category III codes:

• As per AMA, it’s not right to use a CPT I code or an unlisted procedure if Category III code exists
• Identify a base code that’s quite like the Category III code
• Determine the fee schedule for the Category III code using the same methodology as for unlisted procedures
• Watch the reimbursements closely

The AMA updates these codes twice a year, in January and July. So if you need to get hold of the most current listing of CPT III codes, you can check out the AMA website.

Right CPT Modifier Will Bring in the Right Cash Flow

Current Procedural Terminology (CPT) codes consist of five-digit numbers that represent individual services and procedures. The CPT is currently identified by the CMS as level I of Healthcare Common Procedure Coding System (HCPCS).
CPT codes may be further defined by starred designations for certain minor surgical procedures and by modifiers to explain an unusual circumstance associated with a service or procedure.
What is a CPT modifier?
CPT modifier is an added feature of the CPT to indicate that certain circumstances have changed the performance service.
To cite an example - 51: When several surgeries are performed during the same operative session. Normally, most payers pay 100 percent for the first procedure, but decrease the reimbursement on the second, third, and fourth procedures.
There are three ways to ensure that you are using modifiers correctly:

Firstly, there are software technologies available that will prompt physicians to select the right modifiers at the time of service.

Secondly if the modifier is likely to reduce the amount of payment, leave the amount as it is and let the payer reduce it when he receives the claim. And if there’s likelihood of the modifier increasing the payment, increase the payment on the claim before you file it; don’t expect the payer to do it for you.

Thirdly, you’ll do well to know the payers’ policies regarding the use of modifiers. Remember that rules may differ among the payers.

Keeping pace with the CPT code list and modifiers can be a daunting challenge. This year saw around 700 CPT code changes and with just a few months to go before the year comes to an end, you’ll do well to gear yourself up for additional changes in the coming year.