New, Revised, Deleted Codes for 2013

New, Revised, Deleted CPT®, ICD9 and HCPCS Codes for 2013

 Since ICD-10 implementation has been postponed until October 1, 2014, there is a code freeze at this time.  Therefore, there have been no new, revised or deleted ICD-9 codes released on October 1, 2012.  There will be limited code updates to both ICD-9-CM and ICD-10-CM code sets to capture new technologies and diseases on October 1, 2013.  

 Effective January 1, 2013, HCPCS codes G8447 (patient encounter was documented using an EHR system has been certified by an authorized testing and certification body (ATCB)) and G8448 (patient encounter was documented using a PQRI qualified EHR or other acceptable systems) are no longer valid codes. 

 NOTE:  G8553 (Prescription(s) generated and transmitted via a qualified ERX system) should be used to report eRx measures.

 In order to receive the EHR incentive payment, eligible professionals must register and attest that he or she is using EHR technology in a meaningful way such as eprescribing.  In addition, eligible professionals should report the appropriate Category II CPT® codes to report PQRS (Physician Quality Reporting System) measures in order to qualify for PQRS incentive payments. 

REMINDER:  YOUR EHR TECHNOLOGY MUST BE CERTIFIED BY THE OFFICE OF THE NATIONAL COORDINATOR (ONC).  For a list of certified EHR systems, go to ONC’s website, www.healthhit.gov.

There are updates to the CPT® codes that reflect new care advancements.  These codes will go into effect on January 1, 2013.  The list below is not a complete list of all new, revised and deleted codes, but only codes found to be pertinent to endocrinologists.  The complete list of new, revised and deleted codes can be found in the CPT® book published by the AMA. 

  1. Throughout the CPT® book the term physician now includes “other qualified health care professionals” as well.  The CPT® book states the following,

“When advanced practice nurses and physician assistants are working with physicians they are considered as working in the exact same specialty and the exact same sub specialty as the physician.  A “physician or other qualified health care professional” is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his or her scope of practice and independently reports that professional services.  These professionals are distinct from “clinical staff”.  A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional, and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specific professional service, but does not individually report that professional service.”   

   The following are new CPT® codes:

 78012 Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression or discharge, when performed))

 78013 Thyroid imaging (including vascular flow, when performed);

 78014 Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)

 NOTE:  Effective January 1, 2013, CPT® codes 78000-78011 are no longer valid codes.

 81506 Endocrinology (type 2 diabetes), biochemical assays of seven analytes (glucose, HbA1C, insulin, hs-CRP, adoponectin, ferritin, interleukin 2-receptor alpha), utilizing serum or plasma, algorithm reporting a risk

90653 Influenza vaccine, inactivated, subunit, adjuvanted, for IM use (FDA approval pending)

90672 Influenza virus vaccine, quadrivalent, live, for intranasal use

90739 Hepatitis B vaccine, adult dosage 92 dose schedule), for IM use (FDA approval pending)

99487 Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with non-face-to-face visit, per calendar month (at present not paid by Medicare) 

99488 Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with one face-to-face visit, per calendar month (at present not paid by Medicare) 

99489 Complex chronic care coordination services; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure) (at present not paid by Medicare) 

99495 Transitional Care Management Services with the following required elements:

  • Communication (direct contact, telephone, electronic) with patient and/or caregiver within 2 business days of discharge
  • Medical decision making of at least moderate complexity during the service period
  • Face-to-face visit, within 14 calendar days of discharge 

99496 Transitional Care Management Services with the following required elements:

  • Communication (direct contact, telephone, electronic) with patient and/or caregiver within 2 business days of discharge
  • Medical decision making of high complexity during the service period
  • Face-to-face visit, within 7 calendar days of discharge 

NOTE:  In order to be reimbursed for transitional care management services, the physician or other qualified health care professional must be the primary care provider for a given patient. 

  1.  The following are revised CPT® codes: 

90655 Influenza virus vaccine, trivalent, split virus, preservative free, when administered to children 6-35 months of age, for IM use 

90656 Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for IM use 

90657 Influenza virus vaccine, trivalent, split virus, when administered to children 6-35 months of age, for IM use 

90658 Influenza virus vaccine, trivalent, split virus, when administered to individuals 3 years of age and older, for IM use

90660 Influenza virus vaccine, trivalent, live for intranasal use 

90746 Hepatitis B vaccine, adult dosage (3 does schedule), for IM use 

  1.  Category II CPT® codes are used to report performance measurements and are currently optional.  These codes are better known as the PQRS (physician quality reporting system) codes and are one of the Medicare Incentive programs.  Eligible professionals who decide not to report these measures will begin to see penalties taken in 2012.  Under the Category II codes the following codes have a revision for the description. 

5010F (Findings of dilated macular or fundus exam communicated to the physician or other qualified health care professional managing the diabetes care) 

5100F (Potential risk for fracture communicated to the referring physician or other qualified health care professional within 24 hours of completion of the imaging  study

 

All medical coding must be supported with documentation and medical necessity.  **While this document represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will recognize and accept the coding and documentation recommendations.  As CPT®, ICD-9-CM and HCPCS codes change annually, you should reference the current CPT®, ICD-9-CM and HCPCS manuals and follow the "Documentation Guidelines for Evaluation and Management Services" for the most detailed and up-to-date information.  This information is taken from publicly available sources.  The American Association of Clinical Endocrinologists cannot guarantee reimbursement for services as an outcome of the information and/or data used and disclaims any responsibility for denial of reimbursement.  This information is intended for informational purposes only and should not be deemed as legal advice, which should be obtained from competent local counsel.  Current Procedural Terminology (CPT©) is copyright and trademark of the 2012 American Medical Association (AMA).  All Rights Reserved.  No fee schedules, basic units, relative values, or related listings are included in CPT©.  The AMA assumes no liability for the data contained herein.  Applicable FARS/DFARS restrictions apply to government use. 

 

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