Health Information Management

AMA releases CPT Category III codes

APCs Insider, July 23, 2003

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University Colorado Hospital

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Julia R. Palmer
Health Information Management Division of HRM

Valerie Rinkle, MPA,
revenue cycle director
Asante Health System




AMA releases CPT Category III codes effective January 2004

Here is the new list of temporary CPT codes representing emerging technology, services, and procedures released July 1 by AMA. You must use always a Category III code when it is available, instead of a Category I unlisted code that might also apply.

The AMA says that using the Category III codes is critical in the evaluation of health care delivery and the formation of public and private policy. Although these codes may not show up in an outpatient setting very often, it is important to be aware of them.

AMA releases Category III codes semi-annually via its Web site and the full set of temporary codes for emerging technology, services, and procedures are published annually in the CPT book.

CPT Category III codes

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TODAY'S TOPIC: Don't use CPT 93225 for outpatient telemetry

Question: Is it appropriate to bill telemetry monitoring during an outpatient hospital visit such as observation under CPT 93225?

Answer: CPT 93225 should not be used to bill telemetry during an outpatient visit. Code 93225 is reported for holter monitoring using superimposed scanning. The reimbursement for telemetry monitoring is included in the applicable OPPS payment for observation or the facility's E/M reimbursement.

Facilities should check their chargemaster and make sure this CPT code is not connected to any telemetry revenue code.

Ask the Expert: In an outpatient department of a hospital, can a hospital use the low-level evaluation and management (E/M) code for an encounter with nursing services concerning false labor?

Click here for the answer!

TIP OF THE WEEK Properly code and bill drug-eluting intracoronary stents

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.


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