Health Information Management

New CPT codes coming in July

APCs Insider, April 2, 2003

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April 25, 2003
Vol. 4, No. 16


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We've got terrific resources for your APC coding team. Check out our two APC newsletters.

"Briefings on APCs" is a monthly newsletter devoted entirely to managing under APCs, including tips, charts, and advice from the experts.

"APC Answer Letter" is a question and answer publication - readers supply the questions, our experts supply the answers. Click on the links to find out more.


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Keith Siddel,
MBA, PhD (c),
president, CEO
HRM, Hospital Resource Management

Cheryl D'Amato,
director health information management
HSS, Inc.

Julie Downey,
ambulatory coding coordinator, HIM
University Colorado Hospital

Carole Gammarino,

Julia R. Palmer
Health Information Management Division of HRM

Valerie Rinkle, MPA,
revenue cycle director
Asante Health System





New CPT codes coming in July

The American Medical Association (AMA) will release nine Category III codes effective July 1, 2003. This set of temporary codes will be used for emerging technology, services, and procedures. They help track data to be used to support or discourage further use of the new techniques and services or FDA approval of them.

(CMS issued more coding changes this month - do you want to let them know how difficult this makes your job? See below)

The new codes will not have to meet the usual CPT code requirements that services/procedures be performed by many health care professionals across the country; that FDA approval be documented or imminent within a given CPT cycle; and that the service/procedure has proven clinical efficacy. Instead, the service or procedure has to have relevance for research, either ongoing or planned.

These codes will be assigned an alphanumeric identifier and a letter in the last field (for example, 1234T). These codes will be located in a separate section of CPT, following the "Medicine" section. The new codes and their purposes will be explained in this section.

For more information, check out the AMA Web site.

Still confused on how to correctly code injections and infusions?

Check out the audio tape of HCPro's recent audio conference "Coding and billing for injections and infusions" featuring Julie Downey, CPC,CPC-H, Melinda Stegman, CPC, CPC-H and Yvonne Hoiland, MBA, CCS.

Your APCs Weekly Monitor, is a free weekly e-zine from HCPro, publisher of Briefings on APCs, the monthly newsletter devoted entirely to managing under APCs, and the newsletter, APC Answer Letter, with answers to readers' questions about coding for APCs.

The Monitor is a complimentary companion publication, with a specific mission: to provide answers to your tough questions about the APC regulations.

If you have a question about APC coding that you would like addressed in the Monitor, post it on our Web site at Each week, our team of experts answers questions that will appeal to the majority of readers. The elected questions and their corresponding answers are delivered to your inbox every Friday.

TODAY'S TOPICS: Separate infusions, use two codes

Question: Can we code both Q0084 and Q0081 for a patient in an outpatient infusion center with physician orders for a chemotherapy infusion and a leucovorin infusion?

Answer: Yes. The leucovorin infusion is separate and distinct from the chemotherapy infusion. You can add modifer -59 to the infusion therapy code to indicate you know the services are separate, even though it is not required by the CMS grouper. You would not bill the leucovorain drug infusion if it was the only drug infused with the chemotherapy.

ASK THE EXPERT: In the December 2002 "APC Answer Letter" you advised coding a psychiatric evaluation of an ED patient with E/M code 99282 and psychiatric evaluation code 90801 with modifier -25.

Our billing system is still kicking these codes out, stating, "CCI conflict with CPT/HCPCS codes 90801 and 99282. OCE 19/OCE 20 warning." The 19/20 warning will not allow modifiers to be added to either CPT code. What is your advice?

Click here for the expert's answer!

Coding and Compliance Feature Article of the Month:
Observation miscoding can cost you

Wouldn't you like to be one of 15 people who can make a difference in the healthcare world by letting CMS know what you think about APC and their OPPS implementation rules?

It's easier than you think.

Join the Provider Roundtable sponsored by HCPro Inc., Nimitt Consulting Inc., and 3M Health Information and take part in discussing APC/OPPS issues that you want to see addressed.

Jugna Shah, MPH, of Nimitt Consulting Inc., the group's facilitator, will work with the group to submit its questions and comments to CMS with a united voice, starting with the 2004 proposed rule.

The roundtable panel will consist of 15 health professionals representing different hospital departments that deal with OPPS and APC changes every day.

To apply, e-mail Jugna Shah and request an application. Deadline for submitting applications is May 15, 2003.

Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.


Why are breast procedure and mammography coding and documentation so important?

Are you aware of recent coding and modifier changes for breast procedure coding? It's critical that it is done accurately, in a timely manner, and in compliance with government standards to avoid false claims. It's important to the fiscal well-being of your facility and to ensure that patients receive appropriate results of their procedures.

Learn what you need to know during a 90-minute live audioconference, "Strategies for Accurate Breast Procedure and Mammography Coding" on Tuesday, April 29, beginning at 1 p.m. Eastern. You need a solid understanding to be in compliance.

For more information or to register, CLICK HERE or call our customer service department at 800-650-6787. Be sure to mention source code EZ9087A.

Does your injection coding need a booster shot?

Who is responsible for coding injections and infusions at your facility?

Have you given those staff members enough training and the tools they need to do their jobs? Are you getting reimbursed the appropriate amount for the work you do?

We've got answers! Listen to the tape of our March 27 audioconference, "Coding and Billing for Injections and Infusions: Tough Issues, Easy Answers." Hundreds of HIM professionals heard expert advice and have already implemented a stronger internal program to improve facility coding and billing in this critical area of health care. Think of it as a $229 investment in your injection and infusion reimbursement.

For more information or to buy the tape, CLICK HERE, or call our customer service department at 800-650-6787. Be sure to mention source code EZ0926A.

APCs Weekly Monitor (c) 2003 HCPro, Inc. You have permission to forward APCs Weekly Monitor, in its entirety only, to your colleagues, provided this copyright notice remains part of your transmission. Better yet, send them to where they can subscribe to the newsletter directly. All other rights reserved. None of this material may be reprinted without the expressed written permission of HCPro, Inc.

DISCLAIMER Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. Users of this service should consult attorneys who are familiar with federal and state health laws.

SPONSORSHIPS For information about sponsoring APCs Weekly Monitor, contact Margo Padios at or call 781/639-1872, ext. 3145. If you would like further information about any of HCPro's products, including books, seminars, videos, consulting services, or newsletters please visit

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Copyright 2003 HCPro, Inc.

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