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Ready for CPT® 2012? Not Until You Read the AMA Errata

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  • In Coding
  • December 15, 2011
  • Comments Off on Ready for CPT® 2012? Not Until You Read the AMA Errata

Before your begin using your 2012 CPT® codebook on Jan. 1, be sure to check the American Medical Association’s (AMA) official errata, which include corrections and other information related to CPT® 2012.
Especially interesting is a new instruction defining “other qualified health care professional,” as used in CPT®. For example, CPT® instructs that prolonged services codes 99354-99357 may be used “when a physician or other qualified health care professional provides prolonged services involving direct patient contacted that is provided beyond the usual service in either the inpatient or outpatient setting.”
New errata now specify:

“A ‘physician or other qualified health care professional’ is an individual who by education, training, licensure/regulation, and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports a 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 specified professional service. Other policies may also affect who may report specified services.”

Registered nurses (RNs) and licensed practical nurses (LPNs) are not included in the definition of “physician or other qualified health care professional,” and will be unable to independently report certain services, such as prolonged evaluation and management (E/M) services, immunization administration (90460-90461), and neuropsychological and cognitive testing (96120 and 96125, respectively).
The AMA also adds a note reminding physicians, coders, and payers that services listed in CPT® are not limited to use by any particular specialty:

“… the listing of a service or procedure and its code number in a specific section of this book does not restrict its use to a specific specialty group. Any procedure or service in any section of this book may be used to designate the services rendered by any qualified physician or other qualified health care professional or entity (eg, hospital, clinical laboratory, home health agency).”

Those professionals reporting cardiovascular systems codes describing vascular injection procedures should review the errata for new language and coding instruction. For example, one of four substantial additional instructions for this section specifies:

“For the purposes of coding interventional procedures in arteriovenous (AV) shunts created for dialysis (both arteriovenous fistulae [AVF] and arteriovenous grafts [AVG]), the AV shunt is artificially divided into two vessel segments. The first segment is peripheral and extends from the peri-arterial anastomosis through the axillary vein (or entire cephalic vein in the case of cephalic venous outflow). The second segment includes the veins central to the axillary and cephalic veins, including the subclavian and innominate veins through the vena cava. Interventions performed in a single segment, regardless of the number of lesions treated, are coded as a single intervention.”

Instructions for proper use of molecular pathology codes (81200-81408) have been added, as well.
The errata contain additional corrections to Level 1, 2, and 3 CPT® codes and coding instructions (e.g., the descriptor to 64479 Injections(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level has been changed to specify “injections(s)” (plural) rather than “injection” (singular).
To download the complete CPT® errata, visit the AMA website.

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