Primary Care Coding Alert

CPT 2006 introduces new 993xx codes, modifier 25 language

If you-re unsure how to bill monthly Internet communication and plan revisions for patients not in a home health agency, hospice, or nursing facility's care, CPT 2006 will clear up any confusion--and also introduce new modifier 25 instructions.

The AMA has released the tentative agenda for its CPT 2006 Coding Symposium, to be held Nov. 17 and 18 in Chicago. The agenda gives the first official clues as to which areas next year's coding changes will address.

When the 2006 CPT updates take effect Jan. 1, family physicians will face three major E/M changes:

- two new care plan oversight (CPO) codes that do not stipulate the patient must be under the care of a home health agency, hospice or nursing home

- modifier 25 explanatory text that will specify that documentation must support the significant and separate E/M claim

- deletion of the follow-up inpatient consultation codes (99261-99263, Follow-up inpatient consultation for an established patient -) and confirmatory consultation codes (99271-99275, Confirmatory consultation for a new or established patient -). For more information on consultation code changes, see -Rejoice Over New Foolproof Routine Hospital Care Coding - later in this issue.
 
Count Non-Agency Coordination as 993xx

CPT 2006 will expand CPO services by adding two new codes to describe CPO services that are not specifically performed for patients under the care of a home health agency, hospice or nursing facility.
 
Current method: You may now only report CPO services when the patient is:

- under the care of a home health agency--99374 or 99375 (G0181 for Medicare).

- on hospice--99377or 99378 (G0182 for Medicare)

- a nursing facility patient--99379 or 99380.

Benefit: The two new codes will make additional patients eligible for CPO services. If insurance companies agree to pay for these new codes, family physicians will finally get reimbursed for these currently unpaid services, says Ku-Lang Chang, MD, FAAFP, MRO, CPC, CPC-H, compliance officer for the Department of Community Health & Family Medicine Clinics at the University of Florida in Gainesville.

Physicians will be able to use the new codes to report telephone calls, Internet communication, treatment plan revisions, and lab review for these patients. To capture CPO services, include a time and work type worksheet in each patient's chart. -Each service that is provided to the patient needs to be documented and timed,- Chang says.

Tip: Paperless offices can put this documentation in electronic form or in a dictation, says Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City.

Important: The AMA still has to determine the codes- last two digits. The panel now refers to the codes  as 993xx.

Be Sure Your Documentation Includes This Info

Even though you should already know that you should append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) only when the FP's documentation supports a significant and separate service, CPT 2006 will reinforce this requirement.

The new explanation will state that a -significant, separately identifiable E/M service- should have documentation that meets the requirements for the E/M service being reported.

Translation: Modifier 25 claims do not have to contain any new documentation criteria, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Shrewsbury, N.J. -CPT is just clarifying that documentation must show the E/M service is significant and separate from the same-day procedure, preventive medicine or other service.-

-Physicians should have been documenting modifier 25 services this way all along,- says Victoria S. Jackson, owner of OMNI Management Inc. in California. -I always tell physicians that their documentation must support the E/M components of history, examination and medical decision-making as a stand-alone service from the procedure billed.-

Action: Use a separate written note for the E/M code with modifier 25 appended. In the entry, include the additional history, physical and medical decision-making. You may refer to the other service and other documentation as well.