CHICAGO — Make yourself aware of the new endocrinology diagnosis and procedure codes for this year, Dr. S. Sethu K. Reddy advised at the annual meeting of the American Association of Clinical Endocrinologists.
An important change is that the CPT code for “therapeutic, prophylactic, or diagnostic injection” is now 90772; it used to be 90872, said Dr. Reddy, chairman of coding and reimbursement for AACE. The G-code for a therapeutic or diagnostic injection, either subcutaneous or intramuscular, has been changed from G0351 to a C-code, C-8952, he said.
In addition, there are some important changes to the ICD-9 codes, said Dr. Reddy, chairman of the endocrinology, diabetes, and metabolism department at the Cleveland Clinic. For example, there is a new code, 259.5, for androgen insensitivity syndrome, and another new code, 276.50, for volume depletion of an unspecified nature; that code was expanded from 276.5 to add a fifth digit. There is also a third new code, 278.02, for overweight, he said.
New V codes include V15.88 for history of fall, V17.81 for family history of osteoporosis, and V26.31 for genetic disease carrier status testing. There is also a series of V codes related to weight: V85.0 for a body mass index (BMI) of less than 19 kg/m
Coding for diabetes education is also changing, according to Dr. Reddy. For instance, the Centers for Medicare and Medicaid Services will no longer pay for G108 (diabetes outpatient self-management training services, individual, per 30 minutes) or G109 (diabetes self-management training services, group session [two or more], per 30 minutes) codes if a registered nurse is doing the training; instead, the trainer must be a certified diabetes educator.
“If the [trainer] is not a certified diabetes educator, you may end up having to use a level 1 nurse visit,” he warned.
There is one exception to that rule: If the education program is being done by a hospital in a dedicated education room and is certified by the American Diabetes Association, registered nurses may be used as trainers, he said. The failure to include office-based practices in this exemption “is taking many office-based endocrinologists out of the loop of patient education.”
AACE also has been working on getting a code for insulin pump training, Dr. Reddy said. “We applied for a code for insulin pump training about 3 years ago. It was changed to an intensive insulin therapy code, and it finally evolved into an educational training or patient self-management code.” The advantage of this code, which is new this year, is that it can be used for other disorders such as asthma and osteoporosis.
The code for “education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family), each 30 minutes, individual patient” is 98960. There are also codes 98961 for groups of 2–4 patients and 98962 for groups of 5–8 patients. “The challenge is for AACE to develop standardized curriculum with a pretest and a posttest, and foster political support for coverage,” he said.