WASHINGTON — There are some new billing codes available this year to think about incorporating into your practice, Dr. Joel F. Bradley Jr. said at a meeting sponsored by the American Academy of Pediatrics.
Dr. Bradley of Vanderbilt University in Nashville, Tenn., and a member of the American Medical Association's CPT Editorial Panel, offered a few thoughts on these cutting-edge codes:
▸ Pay-for-performance. Pay-for-performance may be closer than you think. Although it is presently voluntary for physicians participating in Medicare, “most physicians now will be using CPT codes initially to participate in pay-for-performance programs,” said Dr. Bradley.
To this end, CPT has created a category of codes (category II codes) that are a set of supplemental tracking codes, which can be used for performance measurement. “The American Academy of Pediatrics is participating in the process by which these codes come to fruition in CPT,” said Dr. Bradley.
“What's the Medicare plan—which private payers are likely to follow?” he asked. “In 2006, physicians now enroll in a voluntary pay-for-reporting program … in 2007 or 2008, they'll be paid for reporting quality measures, and then beyond 2008, they should be paid for performance.”
▸ Moderate sedation. “Most of you who work in children's hospitals know that physicians there have not been paid often for doing procedural sedation unless you're an anesthesiologist,” said Dr. Bradley. Physicians who are hospitalists or who specialize in emergency or critical care are doing a lot of sedation as part of sedation teams. “To support that service, new codes were created this year for moderate sedation that allow physicians who are either providing sedation for their own procedure or supporting another physician to get paid,” said Dr. Bradley. These codes are 99143–99145 and 99148–99150.
▸ Special services. “These are a little bit different in that they're not Evaluation and Management] codes but codes that are added on with existing E/M codes when you provide those E/M services under special circumstances,” said Dr. Bradley.
The most commonly used of these codes are 99050, 99051, and 99058.
Code 99050 is used for services provided in the office at times other than regularly scheduled office hours.
Code 99051 “allows you to bill separately on top of an E/M code for services provided during regularly scheduled evening, holiday, and weekend office hours,” said Dr. Bradley.
Code 99058 is an add-on charge for services provided on an emergency basis in the office that disrupt other scheduled office services.
▸ Obesity interventions. Also this year, there are new ICD-9 codes for obesity interventions. “These are V codes that are pediatric codes for [body mass index] percentiles by age,” said Dr. Bradley. “So that at least now, you'll be able to stratify a population in your practice by BMI.” These V codes provide a way of tracking patients through a medical record system. If payers begin to cover obesity interventions based on levels of BMI, “you've got a way to prove to your payers the medical necessity of providing an intervention.”