In September, FPM reminded you to update your charge sheets and superbills to reflect the ICD-9 changes that went into effect on Oct. 1 (see “ICD-9 Changes: Update Now or Pay Later,” September 2004, page 17). Now it’s time to make CPT-related changes. Here is a highlight of some of the relevant changes that will go into effect on Jan. 1, 2005.

Vaccines and their administration

CPT 2005 includes new codes (90465-90468) for immunization administration for patients under 8 years of age when the physician counsels the patient or the patient’s family. You should report these codes only when the patient is under 8 years of age and the physician provides face-to-face counseling during the administration of a vaccine. Otherwise, you should report vaccine administration using the current administration codes, 90471-90474.

There are new and revised vaccine codes, too. Specifically, CPT 2005 has added 90656, “Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use.” It has revised 90700 (DTaP) by adding the phrase, “for use in individuals younger than 7 years,” to reflect the age group for which this vaccine is intended.

Laboratory services

New and revised codes for Helicobacter pylori (H. pylori) testing are included in CPT 2005. A new code, 83009, has been introduced for “ Helicobacter pylori, blood test analysis for urease activity, non-radioactive isotope (e.g., C-13).” CPT has also revised the previous codes, 83013 and 83014, to specify that they relate to a breath test for H. pylori. Thus, in 2005, 83013 is for “ Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (e.g., C-13),” and 83014 is for “ Helicobacter pylori; drug administration.”

Procedural services

With respect to procedural services, CPT now has a list of codes (see Appendix G in CPT) that include conscious sedation as an inherent part of providing the service. These codes are also noted throughout CPT by a symbol (⊙) next to the code number. For codes so designated, it is not appropriate to report both the service and one of the conscious sedation codes (99141 and 99142). Otherwise, separate reporting of conscious sedation is appropriate. Code 45378 (diagnostic colonoscopy) is among the codes on the new list that family physicians use.

Pulmonary function testing

For 2005, CPT has revised two of the pulmonary function testing codes used by family physicians. Specifically, 94060 and 94070 have been revised to read as follows:

• 94060: “Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration.”

• 94070: “Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (e.g., antigen(s), cold air, methacholine).”

The revisions attempt to clarify that the administration of the bronchodilator is not included in spirometry. They also eliminate the word “evaluation” from 94060 to indicate that E/M services may be separately reported, where appropriate. Additionally, CPT 2005 has added a parenthetical after both codes to indicate that 99070, or the appropriate supply code, should be used to report the bronchodilator supply (in the case of 94060) or other agents (in the case of 94070).

Evaluation and management (E/M) services

Fortunately, there is very little change in the E/M section of CPT this year. Of note is an editorial change to codes 99293-99296 (inpatient pediatric and neonatal critical care) to eliminate inconsistencies between CPT and ICD-9 coding related to the neonatal period. ICD-9 defines the neonatal period as beginning at birth and extending through the 28th postnatal day. Prior to 2005, CPT defined the neonatal period as extending through the 30th postnatal day. For 2005, CPT has revised its codes to be consistent with the ICD-9 definition of the neonatal period.

Be prepared

These are only some of the CPT changes that are effective Jan. 1. The 2005 codes will be immediately enforceable because the Centers for Medicare & Medicaid Services (CMS) has eliminated the 90-day grace period previously given to physicians and other health care professionals to help them transition to the new CPT and HCPCS codes. In announcing the change, CMS cites the fact that the Health Insurance Portability and Accountability Act (HIPAA) “requires usage of the medical code set that is valid at the time that the service is provided.” Therefore, for dates of service on or after Jan. 1, 2005, you must use the updated CPT codes. Claims with invalid CPT codes will likely be denied or returned by your Medicare carrier and possibly by other payers. For more information on CMS’ decision to eliminate the grace period, see http://www.cms.hhs.gov/manuals/pm_trans/R89CP.pdf.

Remember to make your changes as soon as possible. The earlier you make the transition to CPT 2005, the fewer claims hassles you’ll experience.