Only a handful of the many coding updatesfor 2013 have an impact on pain management or anesthesia services. CPT2013 defines time as "face-to-face time" with patients for all time-basedcodes, except that specific instructions or instructions are given in the code. Thesecodes do not include anesthesia codes. The reference refers to codes whoseselection was based on how long it takes to complete the service. Thepassing of the midpoint is a unit of time. If another service isperformed simultaneously with a time-based services, the time for reportingthat service must not include the time related to the concurrent service.
CPT also introduced the term QualifiedHealthcare Professional and gave instructions on its use in the CPT Codebook. AQHP can be defined as an individual who has been trained, licensed/regulated,educated, and privileged (when applicable) and who provides a professionalservice within the scope of his/her practice. He/she also independently reportson that service. Itis important to distinguish between clinical staff and qualified healthcareprofessionals. Clinicalstaff are those who work under the direction of a doctor or another qualifiedhealthcare professional. Theycan perform or assist with the performance of a professional service aspermitted by law, regulation, and facility policy, but they cannot report itindividually.
No revisions, deletions or additions ofanesthesia codes have been made for 2013.
These coding changes, revisions, anddeletions are important for pain management professionals.
Codes Updated for Complex Chronic CareCoordination Services
99487 Complex care coordination services; 1 hour per month of clinical staff time directed and directed by a doctor or other qualified health professional.
- 99
- 4
88 Complex care coordination services; 1 hour of clinical staff time directed per physician or other qualified healthcare professional, with one face to face visit per calendar month
- 994
- 8
9 Complex chronic coordination services; each additional 30-minutes of clinical staff time directed and managed by a physician, or other qualified health professional, per calendar year (List separately to code for primary procedure).
- Th
e new codes allow physicians, otherqualified healthcare professionals, and clinical staff to bill their time incoordinating medical specialties and services necessary to manage complexpatient conditions, daily activities, and psychosocial needs. Theyinclude all non face-to-face care coordination services, and may include oneface-to-face office/outpatient/home/domiciliary evaluation and management visitassociated with the care plan for the patient's chronic conditions.
Important to remember is that these codescannot be reported more than once per calendar month. Thesecodes cannot be reported together with the E/M and Medicine sections excludedcodes in the same calendar month. They must be able tounderstand the guidelines for the use of the new codes.
These codes are considered bundled servicesby Medicare for 2013, and they will not be reimbursed. TheCMS states that the codes represent services that are well bundled with theservices they relate and can't be paid separately. Temporarily,the status indicator B has been given to the codes 99487-99488 and 99489. Thisindicates that payments for covered services are always included in otherservices. CMSplans to look at codes for complex care coordination services in its overallstrategy to support primary and secondary care. CMS will also examineways to promote primary care in a fee for service payment system.
Notes on the Nervous System Section
Neurostimulators, Peripheral Nerve Section
- : CPT code 64561 has been revised to indicate that the code also includes image guidance and should not be reported separately. The code description reads "percutaneous implant of neurostimulator electrode array; Sacral nerve, including image guidance, if applicable."
Destruction by Neurolytic agent (e.g. Destruction by Neurolytic Agent (e.g. The addition of parentheticals indicates the coding for specific chemodenervation processes. The chemodenervation agent must also be reported separately.
Revised codes:
64612 Chemodenervation (of muscle(s); muscle(s), innervated facial nerve unilateral(eg for blepharospasm; hemifacial spasm);
- 64614 Che
modenervation (muscle(s), extremity, and/or trunk) Dystonia, cerebral palsy, multiple Sclerosis (report only one time per session).
This section contains new code:
64615 Chemodenervation (injection of muscle(s)); innervated by facial and trigeminal, cervical spine, accessory nerves, bilateral (e.g. Chronic migraine (report only one time per session, not with 64612-64614)
Other Codes
95907-95913: These codes are for nerve conduction testing in 2013. They indicate the number of studies, not each nerve, and the unit of service.
- 95907 can b
- e
used for one or two studies; 95908 for three to four studies; 95909 for five to six studies; 95909 for five to six studies; 95910 for seven to eight studies; 95911 for nine-ten studies; 95909 for five to six studies; 95910 for seven studies; 95910 for 7-8 studies. 95911 can be used for nine studies, 95912 for eleven-12 studies, 95912 for nine studies and 95912. 95912 for thirteen studies
Codes to m
- o
nitor neurophysiology eitherinside or outside the operating room
+95940: Continuous intraoperative neurophysiology monitoring in the OR, one-on-one. Personal attendance required for each 15-minutes
- +95941 C
ontinuous IONM from outside the OR (remote, nearby) or to monitor > 1 case per hour while in the OR. This code is not reimbursable through CMS. For the unidirectional attention that the monitoring physician gives to one patient, a G code (G0453), has been created. It is important to accurately record the start/stop times.
The number +95940 should be used to reportthe time that the monitoring professional was present in the OR. Other casescannot be monitored simultaneously. +95941 can be used toreport any cases in which the monitoring professional is not physically presentin an OR; or when the monitoring person is physically present in more than oneOR case.
Deleted codes
The codes for nerve conduction tests 95900, 95903 or 95904 were deleted.
- The intraoperat
ive neurophysiology +95920 has now been deleted.
