Primary Care Coding Alert

There are only six notable changes in this years CPT codes that affect family practitioners. These changes take effect in January 2000, although past experience shows that many insurance companies wait until well into the new year to load them into their systems. It is advised by coding experts that you prepare now.

1. Critical care services. While 99291 (critical care, evaluation and management) used to refer to unstable critically ill or unstable critically injured, requiring the constant attendance of the physician; first hour, it now requires only that the patient be critically ill or critically injured; first 30-74 minutes. Code 99292 still refers to each additional 30 minutes. The new instructions clarify that the patient must be critically ill, but removes the word unstable. In addition, the descriptions of appropriate scenarios for critical care have been expanded, as well as the types of services rendered. Also, the physician must devote his or her full attention to the patient during the time the critical care is rendered.


2. Revised codes for vaccine administration. Although codes 90471 and 90472 were new last year, the wording has been revised for 2000. Code 90471 refers to immunization administration and was formerly for single or combination vaccine/toxoid and now says one vaccine (single or combination/toxoid). Code 90472, in CPT 1999, was for two or more (i.e., whether you give two or four you can only use the 99472 code once), and that, when family practitioners are frequently administering three, four, or even five, was not fair. CPT 2000 redefines the second code to be for each subsequent vaccination. So now, the physician will be able to bill for each vaccine administered.

90472Immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections and/or intranasal or oral administration); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure).

3. New laboratory modifier -91. On occasion, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. For example, a family physician administers a glucose tolerance test (82951-82952) to a patient and detects abnormally high blood sugar. The physician gives the patient medication to lower their blood sugar, then tests it again in an hour to make sure the blood sugar is stabilized. The -91 modifier allows the physician to code for both tests performed. In such cases, the test can be billed again by its usual procedure number and by appending modifier -91. However, CPT 2000 cautions that modifier -91 is not to be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, [...]