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January 25, 2018

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Medical Coding News Archives

2012 CPT Instruction Added as New Language for 2013 E/M Code Descriptors

September 21, 2012:

Karen Adkins, Clinical/Technical Editor

Many users of CPT may have overlooked new coding guidance in the introduction to the 2012 CPT Professional Edition because it was not flagged as new or revised text.

Paragraphs 2 and 3 under “Instructions for Use of the CPT Codebook” on page x advise coders to note that, while a particular service or procedure may be assigned to a specific section, providers outside that specialty group can still use that code. Additionally, the procedures and services listed throughout the book are for use by any qualified physician or other qualified health care professional or entity (for example, hospitals, laboratories, or home health agencies).

“Physician or other qualified health care professional” is described in CPT as an individual “qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable).” A qualified health care professional must practice within state licensure guidelines, which determine the scope of practice and are even more restrictive than the CPT guidelines. The professionals within this definition are separate from “clinical staff" and are able to practice independently; they may report services independently or under incident-to guidelines. CPT defines clinical staff as “a person who works under the supervision of a physician or other qualified health care professional and who is allowed, by law, regulation, and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service.” Keep in mind that there may be other policies or guidance that can also affect who may report a specific service.

Note that the 2013 CPT Professional Edition adds the phrase “physician or other qualified health care professional” to codes in the E/M section.


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