Internal Medicine Coding Alert

Published on Fri Dec 01, 2000 PDF

CPT Redefines New Patient. To help distinguish between new and established patients, the latest edition of CPT adds explanatory text to define the term professional services. CPT 2001 states that solely for the purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by a physician and reported by specific CPT code(s). A new patient is one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.

This means that telephone calls and nurse visits do not fall into the category of professional services and would not qualify a person as an established patient, according to comments made by Celeste G. Kirschner, director of the American Medical Associations (AMA) CPT Editorial and Information Services, at the recent associations CPT 2001 Coding Symposium.

CPT Makes Changes to Critical Care. CPT 2001 also makes some minor revisions in its introductory remarks about critical care. The most noteworthy changes include:

Critical care and other evaluation and management (E/M) services may be provided to the same patient on the same date by the same physician.

The list of services that are components of critical care services and are not separately reportable has been expanded to include 71015 (chest x-rays), 94760-94762 (pulse oximetry), 43752 (naso-gastric tube placement) and 36540 (vascular access).

Time spent performing separately reportable procedures or services should not be included in the time reported as critical care time.

Medicare RVU Update. The 2001 Medicare conversion factor, which when multiplied by a procedures relative value unit (RVU) yields the unadjusted Medicare payment for a procedure, has been raised 4.49 percent to $38.2581 from last years $36.6137.

The RVUs for critical care codes reverted to their 1999 levels. The 2001 transitioned facility RVU for 99291 (critical care; first 30-74 minutes) was raised to 5.52 from 5.09, and for 99292 (critical care; each additional 30 minutes) it was raised to 2.73 from 2.51.