Coding Corner: Other providers now acknowledged throughout CPT®

December 01, 2012
Area(s) of Interest: Emergency Medicine Hospitals and Health Facilities Practice Management 

CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from AAPC’s Brad Ericson, MPC, CPC, COSC.

The most significant change to CPT® in 2013 isn’t restricted to one code or to physicians themselves. More than 200 codes now include “other qualified health care professional” with “physician” in their descriptions to indicate who may perform the service.

Most of the Evaluation and Management (E/M) codes were changed to acknowledge that E/M services may be provided by physicians or “other qualified health care professionals.” E/M section guidelines also have been modified to allow non-physician providers to report services.

For example, the descriptors for critical care services (99291-99292, 99468-99469, and 99471-99476) have not been revised, but section guidelines now stipulate, “Critical care is the direct delivery by a physician(s) or other qualified health care professional of medical care for a critically ill or critically injured patient.”

Revisions including “other qualified health care providers” were made so that the type of provider (e.g., physician, nurse practitioners, physician assistants, outpatient hospital facilities) does not dictate which codes may be reported. CPT® codes describe the services performed, not the provider who performs the service. Consult California’s scope-of-practice laws to determine the services an individual provider is qualified to perform. Providers typically considered to be “other qualified health care professionals” are ARNPs, PAs, midwives and others.

Descriptor changes throughout the E/M chapter are consistent with this example. A summary of the affected codes includes:

  • Outpatient visits: 99201-99215

  • Observation: 99217-99226

  • Inpatient care (initial and subsequent): 99221-99233

  • Observation or initial hospital care: 99234-99236

  • Office consultations: 99241-99245

  • Inpatient consultations: 99251-99255

  • Emergency department visits: 99281-99285

  • Direction of emergency medical services: 99288

  • Nursing facility care (initial and subsequent): 99304-99310

  • Annual nursing facility assessment: 99318

  • Domiciliary or rest home visits: 99324-99337

  • Home visits: 99341-99350

  • Standby services: 99360

  • Supervision of patient care: 99374-99380

  • Telephone E/M services: 99441-99443

  • Online E/M services: 99444-99464

  • Critical care during interfacility transport, critically ill or critically injured patient, 24 months of age or younger: 99466-99467.

Many codes in the Medicine section of CPT® 2013 have seen descriptor revisions similar to those found in the E/M chapter (and less frequently, throughout the Surgery and Radiology chapters), which now specifically allow the reporting of services by “other, qualified non-physician practitioners.”

This also includes modifiers. CPT® 2013 contains no new modifiers; however, complete descriptors for 16 modifiers in Appendix B have undergone revisions to include “other qualified health care professional” language, to specify that these modifiers may be appended to non-physician services.


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