General Surgery Coding Alert

Also watch for modifier 33.

When CPT® 2011 debuted the subsequent observation care codes 99224-99226, many coders were left scratching their heads. Those new codes featured typical times associated, even though the initial observation care codes 99218-99220 don't have typical times.

Get a New Outlook on E/M Time

The new 2012 edition of your CPT® manual, which takes effect on Jan. 1, will remedy that problem, with the addition of the following typical time guidelines:

• 99218 -- ...Physicians typically spend 30 minutes at the bedside and on the patient's hospital floor or unit
• 99219 -- ...Physicians typically spend 50 minutes at the bedside and on the patient's hospital floor or unit
• 99220 -- ...Physicians typically spend 70 minutes at the bedside and on the patient's hospital floor or unit

Although the specific reasons for the CPT® committee's inclusion of these codes won't be crystal clear until the AMA's November CPT® Symposium, it looks like the addition of typical times could open the door for coding based on time.

"There are only two ways that you can use time as a basis for selecting an E/M code," says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. "If counseling/coordination of care takes up 50 percent or more of the visit, and if the code has a typical time associated with it. So by these codes now having a time reference, it sounds like we may have a way to reference time used if counseling or coordination of care takes up at least 50 percent of a visit. In addition, this could open the door to collecting for prolonged service times if the time the doctor spends exceeds 30 minutes more than the allotted time, and the visit notes are documented as such," Cobuzzi adds.

New 2012 Modifier May Not Mean Extra Pay

It isn't every year that CPT® adds new modifiers for your coding and billing needs, so when you see a new one gracing the pages of your 2012 manual, you might get excited -- but don't rejoice just yet.

Modifier 33 (Preventive service) went into effect on Jan. 1, 2011, but it didn't make it into the 2011 CPT® book due to publishing deadlines, so the modifier will be making its first appearance in the 2012 manual. According to CPT®, you should append the modifier "when the primary purpose of the service is the delivery of an evidence based service in accordance with a US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates."

Medicare won't pay: Unfortunately, you're not likely to get any love from your MACs with this new modifier. According to a Q&A on WPS Medicare's Web site, Medicare does not recognize modifier 33 (www.wpsmedicare.com/part_b/resources/provider_types/awv-faq.shtml).

General surgery outlook: The most likely reason a general surgeon would look to modifier 33 is for performing a screening colonoscopy. Not recognizing the modifier shouldn't be a problem, however, because Medicare expects a HCPCS Level II code without a modifier for this procedure, such as G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk).