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CPT 2008 Changes Impacting Emergency Physicians
Jeff Wajda, DO, MS, FACEP
Vice President, Clinical Services
Annually, the American Medical Association updates the Current Procedural Terminology (CPT®) Codes. The following summary focuses on the most relevant changes for emergency physicians.
Codes addressing alcohol abuse and smoking cessation counseling
These codes require face-to-face interaction with the patient and are time-based. In order to report these codes, an emergency physician (EP) should include the use of specific validated interventions including "motivational counseling", "suggesting actions", and "assessing readiness and barriers to change". The new codes include:
99406 Smoking and tobacco use cessation counseling visit; intermediate, longer than 3 minutes and up to 10 minutes duration
99407 Smoking and tobacco use cessation counseling visit; intensive, longer than 10 minutes
99408 Alcohol and/or substance abuse (other than tobacco) structured screening and brief intervention. Examples of this structured screening include the Alcohol Use Disorder Identification Test (AUDIT) and the Drug Use Questionnaire (DAST_10). Brief intervention services should also be performed. Do not report 99408 for fewer than 15 minutes of service.
99409 Intervention services longer than 30 minutes.
Please note that Centers for Medicare & Medicaid Services (CMS) will not pay for codes 99408 and 99409 in 2008. Check with other payers to determine the applicability of reporting these codes.
Increased specificity regarding procedure codes
2008 CPT code sets for the following procedures have been updated:
32020 Deleted. The longstanding code for chest tube insertion has been deleted.
32421 Thoracentesis for aspiration, initial or subsequent.
32422 Thoracentesis with placement of thoracostomy tube, includes water seal for pneumothorax when performed as a separate procedure.
32551 Tube thoracostomy, includes water seal (e.g. empyema, abscess, hemothorax) when performed as a separate procedure.
43760 Percutaneous gastrostomy tube replacement without imaging or fluoroscopic guidance.
49450 Replacement of gastrostomy or cecosstomy (or other colonic tube), percutaneous under fluoroscopic guidance including contrast injection(s), image documentation and report.
49451 Replacement of duodenostomy or jejunostomy tube, percutaneous under fluoroscopic guidance including contrast injection(s), image documentation and report.
49452 Replacement of gastro-jejunostomy tube, percutaneous under fluoroscopic guidance including contrast injection(s), image documentation and report.
51100 Aspiration of bladder with needle.
51101 Aspiration of bladder with trocar or intracatheter.
51102 Insertion of suprapubic tube.
Hydration/injection/infusion codes
In 2006, physicians were provided with a CPT code set that allowed EPs to report and bill for hydration, intravenous injection, and infusion services. Effective January 1, 2008, changes to this section limit reporting of these services to the hospital only. New 2008 CPT language states, "These codes (90760-90779) are not intended to be reported by the physician in the facility setting". The Emergency Department is defined as a facility setting.
Proper clinical compensation is directly related to compliance with documentation requirements. LYNX Medical Systems can provide your physician group with expert consulting to mitigate loss from CPT changes and to earn proper compensation.
The information contained herein is provided for informational and educational purposes only, and nothing contained herein should be construed as advice. All information contained herein is obtained by LYNX Medical Systems (LYNX) from sources believed by LYNX to be accurate and reliable. Because of the possibility of human and mechanical error as well as other factors, LYNX is not responsible for any errors or omissions. LYNX makes no representations and disclaims all expressed, implied, and statutory warranties of any kind to user and/or any third party including warranties as to accuracy, timeliness, completeness, merchantability or fitness for any particular purpose.