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Coding Corner: 2013 revisions of evaluation and management services



February 01, 2013
Area(s) of Interest: Emergency Services Hospitals and Health Facilities Payor Issues and Reimbursement 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 G. John Verhovshek, MA, CPC.


The American Medical Association made a number of CPT code changes in 2013. The changes are effective with January 1, 2013, dates of service and include 186 new codes, 119 deleted codes and 263 revised codes.


A few highlights of the changes include, but are not limited to:


Eighty-two evaluation and management (E/M) codes in the range 99201-99467 have been revised to allow a physician or other qualified health care professional to provide services. The revisions clarify that each state’s scope-of-practice laws (not CPT® descriptor language) determine the services an individual provider is qualified to perform.


For example, the revised descriptor for a level I, new outpatient visit (99201) specifies:



  • Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components:


    • A problem focused history;

    • A problem focused examination;

    • Straightforward medical decision making.




Counseling and/or coordination of care with other physicians, other providers qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self-limited or minor. Physicians typically spend Typically, 10 minutes are spent face-to-face with the patient and/or family.


New (underlined) text allows that counseling and/or coordination of care may be provided with other physicians or “other qualified health care professionals,” and deleted (strikethrough) text eliminates the reference to “physician” time. Coding requirements are otherwise unchanged.


CPT® 2013 adds three new categories of E/M services, for a total of seven new E/M codes:



  • Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient (99485-99486): These time-based codes report the non-face-to-face work performed by the control physician (the provider directing care) during an interfacility transport. The patient’s age, medical condition (critical illness or critical injury) and the total time must be documented.

  • Complex chronic care coordination services (99487-99489): These time-based services are provided to patients with complex chronic illnesses residing at home or in a domiciliary, rest home or assisted living facility, and typically involve implementing a care plan directed by the physician or other qualified health care professional.

  • Transitional care management services (99495-99496): These services, which include both face-to-face and non-face-to-face efforts, are provided to established patients “whose medical and/or psychosocial problems require moderate or high complexity medical decision making during transitions in care from an inpatient hospital setting … to the patient’s community setting.” 


The psychiatry category received a major overhaul with the creation of new codes (e.g., 90832 Psychotherapy, 30 minutes with patient and/or family member and 90839 Psychotherapy for crisis; first 60 minutes) and guidelines, as well as substantial code deletions. The revised code set more accurately reports the services behavioral health providers now perform.


Changes in Depo Provera Coding: HCPCS code J1055 (Injection, medroxyprogesterone acetate for contraceptive use, 150 mg) was deleted and replaced with new code J1050 (Injection, medroxyprogesterone acetate, 1 mg). With the change, offices now must bill for 150 units rather than 1.

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