Practice Management Alert

Get a glimpse of the codes you'll be using in January so you can prepare now.

January is just around the corner, so there's no time like the present to start easing your practice into the CPT 2011 changes that will be in effect on the first day of the year. Have you been searching for a code to reflect the evaluation and management service your physician performs during a subsequent visit with a patient in observation care? If so, CPT 2011 brings welcome relief in the form of 99224-99226. These codes are among a handful of new codes that could solve tricky claims you may be facing now. Be the first biller to glean what else is potentially newfor your practice, so that you can be proficient when Jan. 1 hits.

Brace For New Observation Additions

One of the biggest changes for next year is that CPT adds to your E/M coding options with the introduction of three new observation codes, as follows:

99224 -- Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/ or family's needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient's hospital floor or unit

99225 -- Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and thepatient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit

99226 -- Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit.

Before 2011, coding for the "middle days" of an observation service was a problem, says Jill Young, CPC, CEDC, CIMC, principle with Young Medical Consulting LLC in East Lansing,Mich.

"Although not the norm, there are situations where a patient is admitted to observation and remains in that status for three or more days," Young explains.

When to use: "If you had a patient admitted to observation on July 1 and discharged from observation on July 3, the problem for coders was how to bill for July 2," Young says. In 2011, you'll use 99224-99226 for July 2.

Get Specific With Debridement, Flu Codes

You'll also find that CPT has revised debridement codes to include the size of the area debrided, and will introduce new codes three new codes to describe additional areas that the physician debrides. The changes are as follows:

11042 (Revised) -- Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less

11043 (Revised) -- Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less

11044 (Revised) -- Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less

11045 (New) -- Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

11046 (New) -- Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

11047 (New) -- Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure).

Flu: Your CPT 2011 book will feature the new pandemic formulation flu vaccine codes 90664-90668 (Influenza virus vaccine, pandemic formulation ...) that went into effect July 1, 2010 (following the six month implementation period which began Jan. 1, 2010). You should use these codes not for the regular flu, but for widespread illness, says Carol Pohlig, BSN, RN,CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia. The new codes were created to reflect vaccines that "differ in both formulation and cost, which requires differentiation of products," Pohlig says.

More information: Stay tuned to Medical Office Billing & Collections Alert for future articles that will delve into specialty-specific code changes for 2011.