2003 CPT codes affect several critical areas

Changes take effect April 1

The 2003 Physician’s Current Procedural Terminology (CPT) code set released Dec. 31, 2002, contained over 500 additions, revisions, and deletions. Getting updated by April 1 is no easy task, but should be a priority, as mistakes could result in lost reimbursement, says coding expert Glenda Schuler, RHIT, CPC, CPC-H, senior health care consultant at Ingenix in Salt Lake City.

The list of changes includes 189 additions — 107 in surgery, 27 in medicine, and 18 in Category III, which covers emerging technologies. Also, there are 281 revisions, including 124 in surgery, 55 in radiology, and 48 in medicine, as well as 34 deletions, including 14 in pathology and laboratory, 10 in medicine, and eight in surgery.

The goal between now and April should be to update the chargemaster and educate coders. Coders need to make sure all additions have been added to the chargemaster and all deletions have been removed from it, says Nelly Leon-Chisen, RHIA, director of coding and classification at the American Hospital Association in Chicago.

Additionally, she cautions, it is very important to pay close attention to revisions. "There may be an increase in services with the same code numbers," she says. "Delete or revise the existing charge or combine into one." Leon-Chisen stressed that coders should understand what the code does and what is represented by the code.

For example, there were significant revisions made to the surgical codes for 2003. Knee arthroscopy procedures may require both a CPT code assignment as well as Medicare’s HCPCS code G0289/arthro, loose body + chrondoplasty. CPT code selections are still reportable from 29870-29889, and when documentation indicates, HCPCS code G0289 may be appropriate.

Category III codes, which cover emerging technologies, have been available for hospital reporting since January 2001, though hospitals are still not recognizing their importance and availability for reporting services provided, says Schuler.

Category III codes can be reported for services provided in laboratory, radiology, rehabilitation, labor/delivery, and surgical departments. Eighteen Category III codes are new for 2003 and include antiprothrombin antibody, Dexa body composition study, magnetic treatment for incontinence, CT perfusion with contrast, and whole body photography.

HIM coders are challenged to assign CPT/ HCPCS codes and ICD-9-CM diagnoses codes consistently for all types of services, for all payers. However, with the drastic difference in code requirements evidenced between Medicare and commercial payers, coders are beginning to see how code selection often is based on payer requirements and cannot be based solely on departmentally established procedures or coding guidelines.

It does not matter whether the CPT code originates from the chargemaster or is assigned by HIM coders, says Schuler, as long as the code reported on the UB-92 claim form for which the facility will receive reimbursement represents the procedure performed and documented in the medical record.

"Many hospitals use a combined approach by having some clinical areas contain hard-coded CPT codes, originating from the chargemaster, while other facilities have all surgical CPT codes assigned by HIM coders," she explains.

"Health care providers sometimes feel they need to wear roller skates to remain current with constant changing reporting requirements, CPT revisions, coverage rules, reimbursement and APC updates, staffing shortages, and increased demands on facility resources," Schuler says. "In spite of all the demands, however, it’s very important to remember update your chargemaster by April 1."