Now that you've hung your new calendar on the wall, it's time to open your CPT 2000 book to see what's new. The following areas, in particular, deserve family physicians' attention.

Evaluation and management

The CPT editorial panel revised the descriptor for the highest level emergency department code, 99285, to acknowledge that a patient's clinical condition and/or mental status may preclude you from obtaining, for example, pertinent medical history.

The 99291 and 99292 critical care codes have also been revised. The CPT editorial panel deleted the word “unstable” and the phrase “requiring the constant attendance of the physician” from the descriptors. It also revised the time frame in the descriptor for 99291 to the first 30-74 minutes. This change makes the descriptor more consistent with the table of reporting examples that accompanies these codes and the instruction to report the appropriate level E/M code when less then 30 minutes of critical care has been provided.

Additionally, the notes preceding the critical care codes have been revised substantially, and I strongly encourage you to read them if you provide critical care. The revisions include an expanded definition of critical care that does not reference the terms “stable” or “unstable.” They also clarify when it is appropriate to use these codes rather than neonatal intensive care codes. Also, the descriptors for neonatal intensive care codes 99295-99297 were revised to refer to ventilator or nasal continuous positive airway pressure “when indicated,” and the notes preceding these codes and 99298 were revised to describe the procedures included in the codes.

Laboratory services

The codes for organ or disease-oriented lab panels have changed again, and I recommend you review this section if you do lab work in your office. For example, the thyroid panel codes, 80091 and 80092, have been deleted. You must now report appropriate codes for specific individual tests.

The basic metabolic panel, 80049, comprehensive metabolic panel, 80054, and hepatic function panel, 80058, have been deleted and replaced with new codes, 80048, 80053 and 80076, respectively. (See a summary of these changes below.) While CPT code changes took effect Jan. 1, these three new lab panel codes will not be accepted by HCFA until after the first quarter of 2000 because of Y2K complications. Claims for tests performed on or after Jan. 1, to and including March 31, may be submitted before April 1 using 1999 CPT codes or held until April 1 and submitted with the new 2000 CPT codes. The 1999 CPT codes will not be accepted for claims submitted after March 31 for tests performed during the first quarter of 2000.

Procedural services

The CPT editorial panel also revised the notes preceding the repair codes to indicate wound closure methods. In particular, CPT now clarifies that the repair codes include wound closure using skin adhesive. HCFA recently established a separate code, G0168, for wound closure utilizing tissue adhesives only. If you close a wound using only tissue adhesive on a Medicare patient, use G0168. Otherwise, use the appropriate CPT code.

The CPT editorial panel also revised the notes to clarify how to report wound repairs occurring in different anatomic sites. You should read these notes before coding your next wound repair.

Elsewhere, there have been some changes in the codes for diagnostic or therapeutic nerve blocks performed by family physicians. Specifically, 64440, 64441, 64442 and 64443 have been deleted and replaced with new para-vertebral facet injection codes 64470-64476, which have been introduced to clarify the spinal anatomy, substances injected and the spinal level or levels involved. The CPT manual includes cross-references to direct you to the appropriate new code.

Other changes

The immunization administration codes, 90471 and 90472, have been revised to clarify that 90471 is for one vaccine, either single or combination, and 90472 is for each additional vaccine. If you administer two separate vaccines to a patient, use codes 90471 and 90472 for administering them. In 1999, you would have coded 90472 once only, since it covered two or more vaccines/toxoids.

Regarding the vaccine/toxoid codes, 90745 has been deleted. It is now captured in the revised 90744, “Hepatitis B vaccine, pediatric/adolescent dosage, for intramuscular use.”

A new modifier for repeat clinical diagnostic laboratory tests, -91, allows you to indicate that you repeated a patient's lab test on the same day to obtain multiple test results. This modifier may not be used in four instances:

• When you repeat tests to confirm initial results;

• When problems with specimens or testing equipment occur;

• When a normal, one-time reportable result is all that is required;

• When other codes are available to describe the series of results (e.g., glucose tolerance tests).

These are only some of the many CPT changes for 2000. If you want to avoid problems with filing claims and getting paid this year, a thorough examination of the codes you bill most often is definitely in order.