CPT Code Changes You Need to Know
The AMA CPT Editorial Panel made a number of changes to CPT coding for 2006 that are relevant to psychiatrists, according to Becky Yowell, deputy director of APA's Office of Healthcare Systems and Financing. “We encourage all psychiatrists,” she said, “to purchase a copy of the AMA CPT coding manual each year to remain current with procedure coding and documentation requirements.” A copy can be ordered by calling the AMA at (800) 621-8335.
Psychiatry and Neurology Codes
The code for multiple seizure ECT, 90871, was eliminated at APA's request because current evidence does not indicate that multiple seizure ECT is more effective than single seizure ECT. All visits for ECT should now be coded 90870.
The Editorial Panel approved coding for vagus nerve stimulation (VNS) for treatment-resistant depression after VNS received FDA approval for this indication. Clinicians who perform VNS therapy are directed to use codes 95970, 95974, and 95975 for the procedure, based on how long it takes. A parenthetical to this effect will appear in the 2007 CPT manual.
For the delivery of repetitive transcranial magnetic stimulation (rTMS), clinicians should use code 0018T, a Category III code. A parenthetical note, which will appear in the 2007 CPT manual, was added regarding coding rTMS when used for the treatment of clinical depression.
Consultation Codes
The 2006 CPT manual added new descriptive language for the consultation codes in the Evaluation and Management Section to better define how these codes are to be used.
Consultations requested by a physician or other appropriate source are to be noted in the patient's record, and the consulting physician should provide a written report of findings to the requesting party. The appropriate consultation code should be used in this case. | |||||
A consultation initiated by the patient or the patient's family should not be reported using a consultation code, but rather the appropriate office visit code. | |||||
Mandated consultations (for example, from third-party payers) should be reported using the appropriate consultation code with a modifier 32. | |||||
If, following the consultation, the clinician assumes responsibility for the management of all or a portion of the patient's condition, the appropriate evaluation and management services code should be used after the initial consult. | |||||
Follow-Up Inpatient Consult Codes
Codes 99261 to 99263 were eliminated from the CPT manual. Clinicians are directed to use the appropriate code from one of the following groups:
For follow-up inpatient consultations, refer to codes 99231 to 99233, in the Subsequent Hospital Care section. | |||||
For follow-up consultations in nursing facilities, refer to codes 99307 to 99310 in the Subsequent Nursing Facility Care section. | |||||
Codes 99311 and 99312 were also deleted from the CPT manual. These codes were replaced by the new codes 99307 to 99310 in the Subsequent Nursing Facility Care section. There are now four levels of care rather than the previous three levels. Note that there are currently no typical unit times listed for the new codes. The AMA CPT Editorial Panel has sent these codes to the AMA RVS Update Committee to be valued and have times assigned. APA has asked the CPT panel for a status report and for recommendations about what codes to use when time is supposed to drive the choice (when more than 50 percent of the visit is spent on counseling and coordination of care). When this information is received, it will be posted on APA's Web site at<www.psych.org>.
More discussion of these changes can be found on APA's Web site at<www.psych.org/psych_pract/2006UpdateonCPTCoding.pdf>.
APA members with CPT coding questions may send them to APA's Office of Healthcare Systems and Financing by e-mail to [email protected] or by fax to (703) 907-1089. They will be reviewed by APA's CPT Coding Network. ▪
