If you haven't done so yet, it's time to look at the 1999 edition of CPT and review the changes to the codes you use most. Here are some of the areas where you probably should pay extra attention.

Evaluation and management

There's not much new in the E/M section of CPT. However, you will find a new code, 99298, for subsequent neonatal intensive care of very-low-birth- weight infants. If you work with this especially fragile patient population, you now have an additional code to help report your services.

Joint x-rays

If you provide radiology services, you should note that the CPT editorial panel has revised the codes for radiologic exams of the knee (73560– 73564). Specifically, it has deleted all references to specific views of the knee and added numbers of views to some of the codes. Additionally, CPT now includes a new code, 76006, to be used when a physician applies stress during a radiologic exam of a joint. You should use this code in addition to the appropriate code for the radiologic exam of the joint itself.

Lab and pathology services

In the laboratory and pathology section, the CPT editorial panel has revised two of the organ- or diseaserelated panels. First, codes for carbon dioxide (bicarbonate) and total bilirubin have been added to the comprehensive metabolic panel (80054). Also, in the hepatic function panel (80058), the code for total or direct bilirubin (82250) has been replaced with separate codes for total bilirubin (82247) and direct bilirubin (82248).

Additionally, the anatomic pathology subsection has been reorganized to include 11 new generic codes, revised explanatory language and four revised codes addressing distinct Pap smear technologies. Each family of codes in this subsection now includes choices for the combination of methods of Pap smear preparation, screening and rescreening. See the codes beginning at 88141 for more details.

Immunizations

CPT 1999 also includes extensive revisions to the immunization codes. For example, the editorial panel has added a section for immune globulins that includes 17 new codes beginning with 90281. Also, it has added two codes, 90471 and 90472, to report the administration of an immunization, so the immunization (i.e., vaccine and toxoid) codes themselves, beginning with 90476, now identify the vaccine product only.

Further, the editorial panel has substantially revised and expanded the vaccine and toxoid codes so that they more precisely report the products and their administration. CPT now includes multiple codes for a particular vaccine to cover its use according to different schedules. If your practice provides any immunizations, you should review this section carefully.

Osteopathic manipulation

Finally, if you provide osteopathic manipulative treatment (OMT), be aware that CPT's guidelines for codes 98925-98929 have been revised to clarify the appropriate use of E/M codes in addition to those for OMT. The changes include instruction in the use of modifier -25, which relates to services provided on the same day.

Of course, these are only highlights of this year's changes to CPT. To avoid problems with getting paid in 1999, check the new edition closely for the codes you bill most often.