Medical billing - Use of CPT Codes With Long Descriptors

The CPT long descriptions mean CPT 5-digit identifying code numbers and complete procedural descriptions. The CPT codes are considered the Level I codes in HCPCS. The CPT codes are numeric and NOT alpha-numeric. The CPT codes and long descriptions can be used on Web sites as long as each document does not contain over 30 percent of a section (e.g., first level section heading in the CPT book “Table of Contents,” e.g., “Surgery") or subsection (e.g., a second level heading in the “Table of Contents,” e.g., “Surgery: Integumentary System") of the CPT-4 book. For example, in the CPT section “Surgery,” subsection “Hemic and Lympathic Systems,” the total codes in this subsection are 47. If contractors need to display the codes and long descriptions, they would be able to list only 14 codes and long descriptions (30 percent). For any subsection that contains less than 30 CPT codes, this requirement does NOT apply.

Some CPT sections have subsections with only a few codes. For these CPT sections, e.g., “Anesthesia, Evaluation and Management, and Pathology and Laboratory,” the subsection limitation does not apply. The limit on the use of long descriptions is 30 percent of a total section.

Section 20.7.6.1 contains a list of sections and subsections of CPT and the number of codes in each subsection. This attachment will be updated by the AMA and supplied to contractors by CMS on an annual basis. (Note that Attachment I is an Excel File and is included as a separate document.)
 
If necessary, over 30 percent of a section of codes with their long descriptions may be used if the long descriptions are integrated into narrative text. The codes and long descriptions cannot be presented in consecutive listings even if used to convey fee schedule or payment policy information. Section 20.7.6.2 provides an example of long descriptions and codes integrated into text.
 
Remember that the 30 percent rule applies only to CPT codes with long descriptions. Contractors may use as many CPT codes, or CPT codes and short descriptions as necessary.

Contractors are not permitted to use over 30 percent of a subsection of CPT-4 codes with long descriptions. AMA states that in doing so CMS is violating the AMA’s copyright in CPT. As stated above, if over 30 percent of CPT-4 codes and long descriptions are used in a particular document, the long descriptions must be part of a narrative text (that are necessary for the presentation of information in that text and are not presented in consecutive listings) as in §20.7.6.2. There may be circumstances where the contractor believes the 30 percent rule should be waived. The CMS and the AMA will deal with these situations on a case-by-case basis. If such a case occurs, contractors contact the regional office that will communicate the case to CMS CO for evaluation.
 
Fee schedules cannot include long descriptions. Only CPT short descriptions (28 characters or less) can be used in fee schedules.

No comments:

Medical Billing Popular Articles