Coding Nuggets were provided by Jeannie C. Cagle, R.N., CPC, a senior consultant of The Coker Group with more than 20 years experience in clinical health. The Coker Group is an SMA approved partner.

Question

I know that every year, the ICD-9 codes change but it seems like we used to be able to take more time getting up to speed and start with new CPT codes and ICD-9 codes on January 1. What are the rules now?

• Answer

  You aren't crazy, ICD-9 codes used to be started on October 1 of each year but you had a 'grace period' before they absolutely had to be used, up until a couple of years ago.  Now ICD-9 codes go into affect on October 1 of each year and there is no grace period. So to head off denials for deleted or revised codes, you must be on top of the changes before October 1. This year, there are 144 new codes in addition to several revisions and deletions. The most notable additional codes are the 54 new lymphoma category codes.  The code changes are published each May in the Federal Register. This year's codes were in the May 3 edition, starting on page 24977.

Question

I have been reading through the CPT manual here in my spare time and have noticed the prolonged services codes. Can the doctor use these codes when she visits an inpatient in the hospital for a consult in addition to the time she spends with family? Sometimes she has invested 2+ hours of her time. My question is about code 99354.

• Answer

  First of all, you've probably been surprised at how much great information is in the CPT book - it is a great resource but we often don't have time to look things up. Great job for taking the time to read in the CPT book! But in answer to your question, unfortunately, the prolonged services codes are described as "Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service" and the example given is for treatment of an acute asthmatic patient in an outpatient setting. But when it is appropriate to use, the it should be billed in addition to the initial E&M code assigned and never billed alone. Remember that each E&M has typical time assumed and this code is in addition to that time. One more thing, less than 30 minutes should not be reported separately. For more information, see the Evaluation and Management section of the CPT book under the heading of "Prolonged Services".

Question

We are having a debate over the "Chief Complaint". Does the chief complaint have to match the final diagnosis code billed?

• Answer

  The CPT manual describes the Chief Complaint as "a concise statement describing the symptom, problem, condition, diagnosis or other factor that is the reason for the encounter, usually stated in the patient's words". So if the patient says they have come in for one reason, but as the encounter progresses, another problem is discovered or the diagnosis becomes known, there is no need to change the entry, because what was recorded is the reason for the encounter according to the patient. Sometimes patients don't clearly state the real reason for the encounter because of embarrassment or they just know they feel 'sick'. Be sure that in your practice you record more than just "here for follow up" or "no problems" as it might not be clear why the patient needed to be seen from a vague entry. If they are feeling great but following up for something like diabetes, then state the Chief Complaint as "Here for follow up of diabetes".