Cardiology Coding Alert

Code language will better reflect current practice.

CPT® 2013 will revise nearly every code descriptor in the E/M code section. Fortunately, once you identify the common theme, the long list of revisions becomes a lot less overwhelming.

The revisions won't be finalized until later in the fall, but we'll review the changes now to get your preparations for Jan. 1, 2013, implementation rolling.

Remove 'Physician' Limitations From E/M

Most E/M codes refer only to "physicians" in their descriptors, but that will change effective January 1, when the descriptors will add "qualified health care professionals."

Using 99213 as an example, the code changes are indicated with the strikethroughs (indicating deleted text) and underlining (indicating new text) as follows: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other providers qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend Typically, 15 minutes are spent face-to-face with the patient and/or family.

This really isn't a change per se, as much as it is a clarification, says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, president of Maggie Mac-Medical Practice Consulting.

What this means: "They are clarifying that all E/M codes can be reported by physicians or other qualified health care providers and changed the wording with regard to time in each of the codes -- which really has no bearing on how the codes are used, just that the typical time is spent by all qualified providers who bill these codes," says Melanie Witt, RN, COBGC, MA, an independent coding consultant in Guadalupita, N.M.

"In other words, if a payer allows someone other than a physician to provide and bill for a service, the CPT® E/M codes are used by all providers who qualify," says Witt.

Qualified defined: CPT® guidelines state: "A 'physician or other qualified health care 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 or her scope of practice and independently reports that professional services. 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 specific professional service, but does not individually report that professional service."

So the language change clarifies things in two ways. First, the "E/M service changes indicate nonphysician providers (NPPs), especially PAs and NPs, can provide E/M services on their own, can bill on time alone, and can do counseling and coordination of care on their own," says Michael A. Ferragamo, MD, FACS, clinical assistant professor, University Hospital, State University of New York, Stony Brook.

Second, it clarifies that "you have to have that counseling with someone who is certified or technically licensed to provide that type of service; it can't be your office administrator, so to speak," Mac explains. "It is just a clarification, and I think it was understood before, but it could have been abused in some way."

Hospital Care Takes on Typical Times

In one more change for E/M, CPT® will add typical times to the same-day observation or inpatient admission and discharge codes 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date ...), assigning 40 minutes to 99234, 50 minutes to 99235, and 55 minutes to 99236.

Previously, these codes did not have typical times associated with them. This change could be helpful to providers who are at the patient's bedside or on the unit counseling or coordinating care for more than half of the visit, allowing them to select a code based on time.