CPT Medical Coding Updates: New Restructuring Scheme and Ob-Gyn Code Changes


CPT decided that they have to renumber codes when new codes are added because there was never enough space in the book to put everything where it needs to be belonging. And this is why we got renumbered codes few years back for all of the injection codes and every time another one is added, then we have another flurry of renumbering. And they finally decided that this was a little bit much for everybody to take in every year. And it made it harder to track code numbers and it made for more mistakes in processing medical coding claims.

So, they decided what they will do is something called resequencing. They have decided that the new code should be placed as close as possible to the heading of the type of procedure that it is. So if it's an excisional procedure and say it was of the bladder, they want to make that it's in that family of code somewhere. But if there's no room for sequential number, then they will put it at the very end.

And when they do that, they will begin using the pound sign symbol to indicate that this code is out of sequence. So, it's not a mistake. You're not looking at your medical coding and billing book. And there's a typo in here. It says, “Hello, hello, this code is in the right family but it's out of sequence.” Therefore, this year, we're going to see this happen in your book.

You'll have 51729 being listed as a new code. And after that, you will have 51797. And the code after that will be 51741. As you'll notice, the 51797 is totally out of sequence. And so, that's how they're going to identify that.

And then when the code is code number comes to its actual place in the book where it is a numeric sequence, they will give you the code number. And then they will have a note that said, “Code is out of numeric sequence. See.” And then they'll give you a code range to go back to.

So they're hoping that this will solve the renumbering problem that has been plaguing is for some quite some time and allow again the code to stay in the section of books that it belongs in.

There will also be a symbol of a zero. So it's not the dot. It's not the field in dot but an actual, like a zero. And this one’s is going to represent any recycled or reinstated codes because if you're resequencing codes, you're going to pick old numbers as well.

So previously deleted CPT codes will be brought out, dusted off and used again. When that happens, you will see that symbol next to the code. And basically, the only reason you need to know this for most of us particularly if the code has not been used for ten years is if we were doing research on what did the code mean before and we were trying to do old crosswalks for old payments, old data processing, all of that kind of stuff. That's really the only time you would need to use it.

They also made a few adjustments to the appendices at the back of the book. It's really a lot of information and a quick way to obtain information you might need.

Appendix M is still there. It's always been there. But it's been revised and it'll include a citation that mentioned any former references that applied to that old code that now apply to the new code. So for instance, we have a reference to the old code 90772 which said, you know, you shouldn't report it with 99211. And then we got a new code renumbered 9396 – whatever. The renumbered code was for the IM injection – brain dead here for a moment.

And then in the back of the book, on Appendix M, it'll reference you that that rule still applies so that way, you'll know what's happening with the rule systems when you have these CPT codes that are being changed.

Then there is a new appendix N. And this will be the list of resequenced CPT codes. So the resequenced code 51797 will appear in appendix N this year. So take a look at those so you'll know what's going on there.

The other issue and it was a real biggie because it involves not just CPT but also Medicare was the CPT consultation medical coding guidelines and revisions and clarifications. We'll talk about what Medicare did in a minute.

What they’ve basically said is we can have a consultation for one of two reasons: to recommend care for specific condition or problem or two, to determine whether to accept responsibility for ongoing management for a specific problem or the entire care.

Written or Verbal Request for A Consult

The other change in CPT is they said the written or verbal request for a consult may be made by the physician who asks for the consult or the physician who receives the consult, either one. Again, that was contrary to the old Medicare rule which said it had to be documented in both places.

You may in fact find some payers out there who like the Medicare guideline and feel will not buy off on this one either. So again, for those of you, who are currently applying the Medicare guidelines, take a strong look at those and see what if anything might change based on what Medicare is proposing to do.

You still need to have it documented in the record as to why the service was being requested. And even those CPT does not say this specifically and if you don’t have a clear reason for the consult when you are audited, the payer will just simply take it back because there's no clear indication of why it was medically necessary. And of course the consultant still has to communicate that opinion back to the requesting physician via a written report. That has not changed in CPT.

Hospital Consult versus an Outpatient Consult

CPT medical coding rules also clarified when you would bill a hospital consult versus an outpatient consult. So you're going to bill an outpatient consultation if the patient is admitted after the outpatient consult. But the physician doesn’t see the patient in the hospital on the date of admission. So the only thing you bill is the outpatient consultation.

You bill an inpatient consult on the other hand if the patient is seen by the consulting physician in the outpatient or ER setting on that same date as that date of admission. And then physician then sees the patient in the hospital.

What they said is you can choose to bill it as an admission, an initial hospital visit in other words or as an inpatient consultation, either one your choice. But you're never going to be able to bill an outpatient an inpatient consult on the same date for the same patient.

And then all of the remaining rules are the same since we get away with the follow-up consults. Once the physician sees the patient again in the hospital setting, it's simply subsequent hospital care. So that was kind of a welcome thing.

Concurrent and Transfer Of Care Situations

The other thing they did was to clarify what they call concurrent and transfer of care situations. You'll find the explanation for this in the E/M services guidelines not at the part where you've got your E/M codes listed. So make sure you go back to that section of the book and read it carefully.

Under their new definition, concurrent care means that same patient is being seen by one or more physicians on the same day. And when that occurs, there's no special reporting. Each physician simply reports the service they provided that day. And you use your diagnosis code.

Concurrent care does not always mean you will get paid for it. Some payers do not allow concurrent care. And so, you need to be aware of that. And if the concurrent care has to do with two different diagnoses, make sure that the diagnosis that your OB-GYN is seeing them for which is different say than the general surgeon or the internal medicine guy is clearly marked on that claim form.

The transfer of care according to CPT means that the physician who's providing management for some or all of the patient’s problem gives up that responsibility to another physician who then explicitly agrees to accept the patient. This is what ties in with their rule on the consult that the consultation could be the doctor seen the patient for the first time and deciding he wanted to accept the patient, not necessarily giving an opinion or advice at the time of that visit.

And so, at the first encounter, in other words, once you explicitly accepted it, then the patient is not having a consultative service but a regular patient evaluation, a new patient or an established patient visit. And they also added that the physician who transferred the care is no longer providing any care for these problems, okay.

To keep yourself updated with the ob-gyn medical coding guidelines, visit our CPT medical coding training online page.