Get Well-Versed With CPT® Updates

Updates to vaccine, E/M, Dermatology procedures.

CPT® 2012 will go into effect in a few weeks, thus you must get ready for novel and revised choices linked with vaccine administration and prolonged E/M service to make certain your claims stay correct. Read on this article for expert ICD and CPT tip for accurate claims.

Look for Official Addition of 90654

CPT® 2012 adds a different option to your flu vaccine coding with the addition of 90654 (Influenza virus vaccine, split virus, preservative-free, for intradermal use). The inclusion expands on the code family 90655-90657 that previously addressed influenza vaccines.

Two aspects distinguish 90654 from the other flu vaccine codes:

Code 90654 is not age specific, however 90655-90657 identify the patient's age (either 6 to 35 months of age, or age 3 years and older).

Code 90654 signifies an intradermal injection (administered to the dermal layer of skin), however 90655-90657 define intramuscular injections (administered to muscle tissue).

ICD and CPT Tip: Code 90654 signifies the vaccine product only. Include the suitable administration code (90460-90474) on your claim. In case your physician offers a noteworthy, distinctly identifiable E/M service in the encounter for the vaccine, you must also report the suitable E/ M code (99201-99205 for a new patient or 99211-99215 for an established patient).

Though 2012 will be the first time 90654 is incorporated in the CPT® book, the code has been in existence for more than a year.

Note Extra Specificity of 90460-90464

A number of other vaccine administration codes go through revision for CPT 2012. Revised codes invlove (underline indicates change):

90460 - i.e. Immunization administration ; 18 years of age through any route of administration, including counseling by a physician or other qualified health care professional; first or only component of each vaccine or toxoid which is administered

+90461 -- -- i.e. each additional vaccine or toxoid component which os administered (List separately in addition to code for primary procedure)

90581 -- i.e. Anthrax vaccine, for subcutaneous or intramuscular use

990644 -- i.e. Meningococcal conjugate vaccine, along with serogroups C & Y as well as Hemophilus influenza B vaccine (Hib-MenCY), 4 dose schedule, while administered to children 2-15 months of age, meant for intramuscular use.

Furthermore, CPT® 2012 removes vaccine codes 90470 (H1N1 immunization administration [intramuscular, intranasal [including counseling when performed) and 90663 (Influenza virus vaccine, pandemic formulation, H1N1).

Study Timeframes for Observation, Prolonged Care

E/M codes meant for observation services as well as prolonged care explain timeframes and providers with CPT® 2012 revisions.

ICD and CPT Tip: Effective Jan. 1, 2012, every code for initial observation care (99218-99220) identifies the amount of time an internist normally spends at the patient's bedside or on the patient's hospital floor. Code 99218 (Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components ...) signifies 30 minutes, code 99219 represents 50 minutes, and 99220 represents 70 minutes.

Management Strategies: Master Facet Joint Injection Essentials With These Tips

Count every level and also check for your payers' first choices.

While reporting facet joint injections, ensure that you already know the spinal levels that the pain management specialist treated as well as what your payers' first choices are for the maximum number and frequency of the injections that can be presented. Whether the facet injections are diagnostic or they are therapeutic, you must count each level and/or both sides. Read on for further advice on how you must report these common procedures and what codes for CPT you should use.

Don't Let Intent Throw You

You'll find that the terms 'diagnostic' and 'therapeutic' are already in facet joint injection codes for CPT descriptors, as follows, but don't be too overzealous about those descriptors:

64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] including image guidance [fluoroscopy or CT], cervical or thoracic; single level)

64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] including image guidance [fluoroscopy or CT], lumbar or sacral; single level).

The purpose why the injection was given is not significant while billing the procedure. You report the same codes for CPT regardless of the fact whether the injection was given for diagnosis or therapy.

Reckon Each Level and Side

You must count every spinal level the pain management physician treats. You report 64490 while the physician is injecting at the cervical or thoracic level and then 64493 when the injection includes the lumbar or sacral level. You do not distinctly code for several injections at the same spinal level.

Tip: Append modifier 50 (Bilateral procedure) when the injections are given bilaterally. You should count two units for bilateral injections at a level. Few carriers require it 64490-50; on the other hands, other carriers want 2 line items 64490 on the first line 64490-50 on the second. You do not normally bill bilateral injections as 2 units. Rather, you would bill them as either the single line item along with modifier 50 and 1 unit of service or 2 line items -- 1 line item including modifier RT and 1 unit of service AND 1 line item with modifier LT and 1 unit of service.

For coding purposes, a par vertebral facet (zygapophyseal) joint level is the joint and the two medial nerve branches that originate from two different spinal segments. The injection coding is the similar unrelatedly in case the physician injected intra-articularly into the facet joint itself or injected the two medial nerve branches.

For an added level in the cervical or thoracic area, you must report these Codes for CPT : +64491 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; second level [List separately in addition to code for primary procedure]) bedies 64490. As far as third level and beyond are concerned, you must report +64492 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; third and any additional level[s] [List separately in addition to code for primary procedure]) along with 64490.