Q and A: 2009 CPT code changes

Along with the many new CPT codes that come our way each winter, come many questions about how to handle them. Here are the answers to some common questions that coders may have as they work through the new codes for 2009.

Q: What is the extent of the CPT code changes for 2009? How would you compare the number of changes to those in past years?

A: The number of CPT code changes is higher overall than in the past. There are approximately 750 changes for 2009. In 2008 there were around 600. But it is important to consider that approximately 225 of the revisions were really only minor grammatical changes (e.g., the numbers included in some of the CPT code descriptions where changed to numerals instead of remaining spelled out).

Q: What section or sections of the CPT Manual were most heavily revised? Were there any surprises this year?

A: The category II codes had the most significant revisions for performance measures. Some coders may find that this is not a big deal for them because they don't routinely track performance measures. But for those who do, it may be a welcome addition to the CPT Manual.

One of the most widely used code series, and one that saw a fair number of revisions, would be in the Evaluation/Management (E/M) section. However, the changes only affect practices that evaluate pediatrics or neonates.

Another section that saw a wide array of additions was the Medicine section. Some new series were created to remedy the illogical placement of codes like injections and infusions. Injections and infusions were previously in the Medicine section, however they were interspersed throughout the chapter. This made it very difficult for coders to apply guidelines consistently.

There were some new codes for cardiology procedures added to the Medicine section to accurately identify the technology used for services like echocardiography.

All told, the AMA did not add many truly new codes for 2009, but rather they created new code series for codes that have existed in previous years but were in an illogical order.

Q: What method do you recommend for training coders on the annual code changes?

A: There is a variety of media that coders can use to learn about new code changes. For instance, consider listening to audio conferences that outline the changes. Training such as this is usually very helpful because an expert has already done the work for you, they've researched the changes and can summarize them for you in accompanying slides, which is always nice. All you have to do is sit back and listen.

You could also review Appendix B in the 2009 CPT Manual, which is a list of all the additions, deletions, and revisions for the current year. Also, the AMA published the text 2009 CPT Code Changes: An Insider's View, available through the AMA Press, outlining this year's code changes. The AMA text provides common clinical scenarios for when the new codes may be applicable.

Q: Why was modifier -21 deleted for 2009?

A: Per the AMA, modifier -21 was somewhat of a duplicate concept to the prolonged E/M codes. Although, modifier -21 was only for use on the highest level of a given category, the prolonged add-ons were more specific. Therefore, use of the modifier was somewhat confusing and redundant, especially when used on the highest level in a category.

Q: Can coders use the prolonged services codes with ED visit codes 99281-99285?

A: No. Per coding guidelines, coders may only use these add-on codes with codes that have established times listed. ED codes do not include established times.

Q: I understand that coders may not use the "remote real-time interactive video-conferenced critical care codes" (0188T, 0189T) for the same period of time as the neonatal or pediatric critical care codes. Does this also apply for the adult critical care codes?

A: Yes. This applies to the adult critical care codes according to the coding guidelines preceding codes 99291 and 99292. For more information, see the last sentence on the left-hand column of p. 19 in the 2009 CPT Manual, professional version.

Q: Considering the new stereotactic surgery codes, how should a coder report this procedure for two cranial lesions, one simple and one complex? Would it be appropriate to report codes 61796 and 61798?

A: Although the guidelines aren't crystal clear in the 2009 CPT manual, the 2009 CPT Changes; An Insider's View states that coders should use codes 61798 (complex) and 61797 (simple).

Shannon McCall, RHIA, CCS, CCS-P, CCS-I, director of HIM and Coding, HCPro, Inc. www.hcpro.com