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Reader Questions: Have Your Pick With Category II Codes - But Don't Substitute

Track E/M Components With New Category II Codes

Question: What is the new Category II section in CPT, and how should we use it?
   
Florida Subscriber

Answer: CPT 2004 introduces the Category II code section, but these codes probably won't add anything to your reimbursement. The Category II codes track performance measurements. The AMA intends to use these codes to collect data about quality of care.
 
Using Category II codes is optional, and you may not substitute them for the regular Category I CPT codes. Suppose you're trying to track the use of smoking-cessation counseling on your pulmonary rehab patients and you don't have an electronic health record. Reporting one of the new smoking-cessation Category II codes, such as 0004F (Tobacco use cessation intervention, counseling) or 0005F (Tobacco use cessation intervention, pharmacologic therapy), will allow you to do this through your claims-data or practice-management software rather than through chart reviews.
 
Make sure you still report the counseling Category I code, such as 99401 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes), linked to ICD-9 code 989.84 (Toxic effect of other substances, chiefly nonmedicinal as to source; tobacco).




Only Report Observation if Doctor Specifies

Question: How should I handle maternity patients who come into the obstetric unit to rule out labor, and only stay an hour or so? Should I code these as observation or outpatient?
        
Georgia Subscriber

Answer: If the physician specifically states that he ordered "observation," and he gives you supporting documentation to this effect, that's the only time observation codes are appropriate. On the other hand, if he merely ordered a nonstress test or other such screening, you should code the services as outpatient.

- Reader Questions reviewed by Sarah L. Goodman, MBA, CPC, CPC-H, CCP, president of SLG Inc. Consulting in Raleigh, N.C.