CPT codes

One positive advancement for pharmacy is that Current Procedural Terminology (CPT) codes have been developed specifically for MTM services provided by pharmacists. These codes are a standard used within health care to bill for goods and services. Separate codes have been developed for an initial encounter of 15 minutes of MTM service for a new patient (99605), initial encounter of 15 minutes of MTM service for an established patient (99606), and additional 15-minute increments (99607). While there has yet to be widespread use of these CPT codes by pharmacists, it is anticipated that their use will increase as plans implement MTM services involving pharmacists (American Society of Health-System Pharmacists, 2007). 

American Society of Health-System Pharmacists. 2007. Pharmacists CPT codes become permanent. Available at www.ashp.org/sJashp/article news.asp CID= 167 DID=2024 id=23065 accessed on November 21, 2007. 

Once the value-added service has been designed, fees established, and the method(s) for compensation selected, the pharmacist must learn how to submit claims. When providers submit claims to Medicare, Medicaid, or any other third-party payers, the claim typically is submitted on the CMS Form 1500. One exception to this is the hospital outpatient clinic, which uses CMS Form 1450. On CMS Form 1500, information regarding the submitting entity, referring physician, type of services offered, and related health condition is included. To convey this type of information, CPT codes and ICD-9-CM codes are used. These coding systems provide detailed information regarding the types of services provided and the specific health condition in a numerical format. Example CMS 1500 and 1450 forms are available on the CMS Web site (www.CMS.hhs.gov). 

CPT codes are numerical codes that are used to describe specific types of patient visits, procedures, and laboratory tests that are performed. By using a numerical scheme, these codes can convey a great deal of information with a single five-number code. Following an outpatient visit, this CPT code can indicate whether a patient is new or has been seen previously (established), whether the physician saw the patient, and the complexity of the office visit. For example, CPT codes 99211 to 99215 describe office visits provided to established patients, indicate the complexity of the visit (e.g., the higher the code in the series, the more complex), and may indicate if the patient was seen by a nonphysician (i.e., a physician is not required to see the patient personally with the 99211 code) (AMA, 2006). 

Recently, CPT codes for MTM services were approved by the American Medical Association CPT Editorial Panel. These codes can be used by pharmacists to submit MTM claims pursuant to Medicare Part D... 

In general, the provider determines which CPT code best describes the service that was provided. The specific insurance carriers may have restrictions on which CPT codes can be used. For example, Medicare does not allow pharmacists to use CPT codes 99211 through 99215 but will allow a physician to bill for the nonphysician services (e.g., the pharmacist) using the 99211 code. This can be done if billing using the Incident to Physician Services Regulations described earlier in this chapter (Snella, 1999). 

CPT codes also indicate which laboratory procedures were offered. On the billing claim form, each laboratory test or laboratory panel performed is coded separately. An example of a CPT laboratory code is 83036, which corresponds to a hemoglobin A c determination (AMA, 2006). The CPT code 83036QW indicates a hemoglobin A c determination was performed using a CLIA-waived device. A complete list of CLIA-waived tests and their CPT codes is located on the CMS Web site (CMS, 2007b, 2007c). 

Immunizations also are coded according to CPT codes. When providing immunizations, the CPT codes... 

American Pharmacists Association (APhA). 2007. CPT codes for MTM made permanent. Available at www. pharmacist.com/AM/Template.cfm Section=News room TEMPLATE=/CM/HTMLDisplay.cfm CONTENTID=l4l26 accessed on November 2007. 

Claims for reimbursements must be submitted to the CMS using CPT codes for PET procedures along with Dx (ICD-9-CM) codes for all approved clinical indications. For billing purposes, several CPT codes have been assigned for all PET procedures with a few exceptions, which require HCPCS codes for billing. CPT codes can be used for denial of reimbursement for noncov-ered procedures. Private payers may be billed using CPT codes, while some private payers may require the use of the CMS HCPCS codes. 

AMA (2009). CPT codes, professional edition. The American Medical Association, Chicaco, IL... 

The next step in the description of the DNA sequence is the analysis of the pair-wise nearest-neighbor correlations Cy, for example, the normalized probabilities to And successive pairs of the nucleotides i and j. Eor all 16 possible successive dinucleotides in the coding strand of DNA, only the functions Cag and CcT correlate with OGT. The excess probabilities to find ApG and CpT pairs in the coding DNA are increasing significantly with OGT, correlation coefficient R = 0.68 and 0.601 (Fig. 2, upper row). Remarkably, the codon bias explains the observed sequence correlations in the coding parts of DNA. Eirst,... 

Figure 22 Observed annual average concentrations of non-seasalt sulfate (cf. text) at stations in the North and South Atlantic (triangles) and predictions from several chemical transport models (line codes and acronyms are shown at upper right). Data were provided by D. Savoie and J. Prospero (University of Miami). Stations along the bottom axis refer to Heimaey, Iceland (HEI) Mace Head, Ireland (MAH) Bermuda (BER) Izania (IZO) Miami, Florida (RMA) Ragged Point, Barbados (BAR) Cape Point, South Africa (CPT) King George Island (KGI) and Palmer Station, Antarctica (PAL). From Penner et al. (2001) (reproduced by permission of Intergovernmental Panel...

CPT-4 Current Procedural Terminology plus HCPCS Health Care Financing Administration Common Procedure Coding System... 

A variety of controlled vocabiilary codes can be used in some sources for more precise search results. Examples include the North American Industrial Classification System (NAICS), healthcare common procediire coding system (HCPCS), current procediiral terminology (CPT), Universal Medical Device Nomenclature System (UMDNS), and the International Classification of Disease (ICD). However, it is not always easy to determine which information soimce uses which code, if any, and which procedure or disease state the codes cover. 

Table 10.1. CPT and HCPCS codes related to PET and PET/CT procedures CPT/HCPCS Description...

However, in the United States, the CMS uses these codes for classification of surgical, diagnostic, and therapeutic procedures. Along with CPT/HCPCS codes, Dx (ICD-9-CM) codes must be provided on the claim form for reimbursement. These codes are annually reviewed and updated. A few current representative Dx (ICD-9-CM) codes for the diagnosis of diseases by PET studies are given in Table 10.2. 

However, while these classification systems per se are wonderful, the alphanumeric and numerical codes representing them are tedious, diverse, and, to the uninitiated, enigmatic. Level I CPT is numeric. Level II codes are alphanumeric and primarily include nonphysician services such as ambulance services and prosthetic devices. Level III consists of local codes for state Medicaid agencies. The current version of CPT is the CPT-4 is divided into three sections with further codes, two for performance measurement and one for emerging technology. 

Physician s Current Procedural Terminology (CPT) list of medical services and procedures performed by physicians and other providers. Each service and/or procedure is identified by its own unique 5-digit code. CPT has become the health care industry s standard for reporting of physician procedures and services, thereby providing an effective method of nationwide communication. 

Interestingly, CPT does not bind to topoisomerase I and only weakly to B-DNA under physiological conditions [5], so both biomolecules and CPT are needed to form stable ternary complex 50. Additional evidence supporting such mechanism comes from the observation of resistance of cell lines toward CPT which have specific mutations of enzyme [180-182] (for medical consequences of CPT resistance, see [4, 183]). Similarly, deletion of gene coding topoisomerase I from yeast (Saccharomyces cerevisiae) resulted in fuU resistance of viable cells to CPT, with restoration of sensitivity to CPT after expression of human or yeast topoisomerase I [184, 185]. The schematic mechanism of CPT action is given in Fig. 22.6. 

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