By Alexander Miller, MD, January 01, 2013
Starting with this issue I have the privilege of writing Cracking the Code, following the lead of Dirk Elston, MD, who has expertly informed us on coding issues since the column’s inception. I will strive to maintain the quality and practicality that Dr. Elston has brought to Cracking the Code, answering tough coding questions for you. But first, let me answer an easier one.
Why do I need to get a new CPT manual, anyway? It’s really no different than the one I have from two years ago. Besides, my biller takes care of all of this stuff.
I hear this question from some of my colleagues.
Well, for one thing, you, the physician, are the “captain of the ship,” and you are ultimately responsible for billing precision. For another, you would like to be fairly reimbursed for the work that you do. A coding manual, in its yearly updated form, provides proper billing codes for use when billing for medical services. What happens when you end up billing with a deleted code? You do not get paid — your claim will be rejected for using an invalid code. What if you use a redefined code improperly, assuming that it had not changed? Not only may you not be paid, but you could be accused of fraudulent billing. The cost of the CPT manual is minute compared to the aggravation and monetary loss from either non-payment or having the expense of having to rebill resulting from the use of improper codes. In the update for 2013, there are a number of important changes, including:
- language adding “qualified health professional” wherever the word “physician” is used;
- a redefinition of 15740, island pedicle flap, that radically restricts the use of this code in dermatologic procedures; and
- a more succinct wording of 67810, incisional biopsy of eyelid skin, which now specifies that use of this code is only appropriate when eyelid margin along with skin is included in the biopsy. [pagebreak]
The purpose of the CPT — Current Procedural Terminology — is to provide a uniform coding system for physicians and other health care providers to allow for billing third-party payers for services. Simply saying, “I did this, here is my charge, pay me,” worked decades ago, and still may work in cash-paying transactions, but not when third-party payers are involved. Due to the ever-expanding multitude of available medical services and permutations in their delivery, a standard, consistent, mutually understandable and reproducible system for communicating what was done was established in 1996 as the CPT code set that is published by the American Medical Association. It serves to standardize the reporting of medical services and facilitates the assignment of price values for these services. Consider the vast staff demands, confusion in communication, and delays in payment that would result without such a system.
Clearly, proper use of CPT codes is essential to any medical office’s business. A good coding manual will offer dermatologists guidance regarding a variety of coding questions, including the parameters for using Evaluation and Management (E/M) codes for office visits, the right codes to describe most dermatologic procedures and surgeries, the proper codes for various histopathology services, and the appropriate use of modifiers. Proper use of modifiers is essential to optimal billing and payment results. We dermatologists are major users of modifiers, as we commonly do multiple procedures during one patient visit or do procedures along with a separate E/M service. Payment rejections by insurers based upon lack of or improper use of modifiers are common — and unpleasant! Avoid unpleasantness: get an updated coding manual and make sure you use it. [pagebreak]
There are many manuals that offer the latest CPT information; the AMA publishes its own, as do various companies. Are you curious about what codes have been added or redefined in CPT 2013? All of the changes are listed in Appendix B of the AMA manual. The AAD offers a dermatology-specific coding manual that includes all of the dermatology-relevant CPT updates; as a bonus, it also includes guides for dermatologists to use in participating in Medicare’s various incentive and reporting programs and tips for handling audits.
Lastly, one may wonder, “When is the updated CPT released every year?” The CPT updates are typically available in October of each year but its new/revised codes go into use on Jan. 1. So if you haven’t purchased a new coding manual, the time is now. You can order the Academy’s coding manual online at www.aad.org/store or call (866) 503-SKIN to order it.
Interestingly, the new year’s ICD diagnostic codes are also released in October. However, the ICD codes become effective on Oct. 1. That is why when ICD-10 rolls in it will be activated on Oct. 1, 2014 rather than Jan. 1, 2015. Peculiar, but true. (Learn more about implementing ICD-10 at www.aad.org/ICD10.) In subsequent issues of Cracking the Code, I will endeavor to explain specific peculiarities and challenges of CPT coding.