* The 2008 CPT Codes Are Here!

* Complete ROS Requires Double Digit Reviews

* Modifier Lingo Changes in 2008

The AMA has released the list of changes in CPT 2008. Here are some of the new codes you’ll have to work with effective Jan. 1:

You’ll have new codes for smoking and tobacco cessation counseling (99406-99407), alcohol and/or substance abuse screening (99408-99409), telephone-based evaluation and management services (99441-99443) and online evaluation and management services (99444).

Cardiology: In addition, CPT 2008 deletes cardiac Magnetic Resonance Imaging codes 75552-75556 and replaces them with eight new codes (75557-75564).

Gastro: CPT 2008 deletes 43750 (Percutaneous placement of gastrostomy tube, without imaging or endoscopic guidance), and introduces three new codes that cover insertion of gastrostomy (49440), duodenostomy or jejunostomy (49441), or cecostomy or other colonic (49442) tubes. You’ll use three other new codes when your physician replaces a gastrostomy or cecostomy (or other colonic) tube (49450), a duodenostomy or jejunostomy tube (49451), or a gastro-jejunostomy tube (49452). In addition, new code 49446 will come in handy when your physician converts a gastrostomy tube to a gastro-jejunostomy tube. Another new code (49460) covers the mechanical removal of obstructive material from a gastrostomy or any other type of tube. And finally, 49465 covers contrast injection(s) for radiological evaluation of an existing tube, including image documentation and report.

Specimen collection: New CPT code 36591 covers blood specimen collection from a completely implantable Venous Access Device (VAD), while 36592 covers collection from an established central or peripheral venous catheter, which is “not otherwise specified.”

Infusion: New codes 90769-90771 cover subcutaneous infusion for “therapy or prophylaxis.” Another code, 90776, covers each additional sequential IV push of a therapeutic, prophylactic or diagnostic injection which your physician provides in a facility. You’ll use this as an add-on code with existing code 90774. The main difference between 90776 and existing code 90775 is that 90775 covers additional pushes of a new drug, while 90776 covers more pushes of the same drug.

Ob-Gyn: You’ll have new codes for paravaginal repair via vaginal approach (57285) and laparoscopic approach (57423). You’ll also have four new codes for laparoscopic hysterectomy (58570-57573).

Team conferences: CPT 2008 also includes three new codes for medical team conferences with an interdisciplinary team of health care professionals (93366-99368). These cover participation by a Non-Physician Practitioner (NPP) (99366), participation by a physician (99367), and participation by an NPP lasting 30 minutes or more (93368).

Want the scoop on the dozens of additional new CPT Codes? Check out one our LIVE audioconferences with specialty-specific 2008 code updates. http://www.audioeducator.com/search.php?search--criteria=2008

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CPT 2008 has changed the descriptors for some of your most frequently-used modifiers. For example, modifier 22, formerly described as, “Unusual Procedural Services,” will now hold the descriptor, “Increased Procedural Services” to denote that the work to provide a procedure is substantially greater than the typical work required of a particular code.

In addition, modifier 76 is now defined as, “Repeat procedure or service by same physician.” (The bolded and underlined phrase is new for 2008).

Get the modifier scoop with the Nov. 20 LIVE audioconference, “Modifiers 25 and 59 Myths and Misuse: Is an Audit in Your Future?” http://www.audioeducator.com/industry--conference.php?id=76 Use the coupon code 10%PRIMESAVINGS and get 10% off the price!

Question: What is the difference between problem-pertinent, extended and complete review of systems (ROS) on an E/M service?

Answer: You’ll need to know the difference between the three ROS levels because ROS is a vital component to determining your level of history, which, in turn, determines the level of E/M service.

Problem-pertinent: The physician performs a problem-pertinent ROS when he reviews a single system for the patient during the encounter. A problem-pertinent ROS can support up to an expanded problem-focused level of history, which can support up to a level-three established patient E/M service (99213) or level-two new patient E/M service (99202) -- but be sure to choose your E/M code based on your FP’s entire set of encounter notes, not just the ROS level.    

Extended: When the physician conducts an extended ROS, there must be evidence that he checked the system directly related to the patient’s problem and a “limited” number of additional systems. According to Medicare, “limited” can be anywhere from two to nine systems, depending on the service your physician provides. An extended ROS can support up to a detailed level of history, which can support a level-four established patient E/M service (99214) or level-three new patient E/M service (99203).   

Complete: The physician must review 10 or more systems to qualify for a complete ROS and must individually document those systems with positive or pertinent negative responses. For the remaining systems, a notation that all other systems are negative is permissible. In the absence of such a notation, the physician must individually document at least 10 systems.

A complete ROS can support a comprehensive level of history, which can support a level-five established patient E/M service (99215) or a level-four or -five new patient E/M service (99204 or 99205).

We’ve got the secret to optimal E/M coding! Check out the Oct. 30 audioconference, “Self-Audit Secrets to Optimize Your E/M Reimbursements.”  http://www.audioeducator.com/industry--conference.php?id=586 Use the coupon code 10%PRIMESAVINGS and get 10% off the price!