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Billing Code Changes for 2011 Most Relevant to Internists

CPT Code Changes; New Codes for a Subsequent Observation Care Service

There are three new codes in the evaluation and management (E/M) section of the Current Procedural Terminology (CPT) 2011 code book that describe a physician's "subsequent observation care" service to a patient. The new procedure codes can be billed for the increasingly common service of evaluating and managing a patient after the date of their admission to "observation status" in a hospital but prior to the date of observation status discharge.

ACP disputes the relative value CMS assigned to these codes, believing that the assignments do not fully account for the physician work involved in providing the services. ACP has undertaken significant effort to realize a CMS relative value assignment that adequately captures the physician work and other resource inputs for these services relative to others. The College will continue to urge CMS to use the RUC-recommended relative values.

CPT Code Short Code Descriptor 2011 Total Relative Value Units
99224 Subsequent observation care, per day, for the evaluation and management of a patient, straightforward 0.82
99225 Subsequent observation care, per day, for the evaluation and management of a patient, moderate 1.45
99226 Subsequent observation care, per day, for the evaluation and management of a patient, complex 2.17

We direct readers to the CMS Physician Fee Schedule Search, to find the specific payment amount for these services that result from the 2011 conversion factor.

International Classification of Diseases (ICD-9) Diagnosis Changes

Read the ACP description of the ICD-9 code changes most relevant to internists which actually took effect October 1, 2010. This resource also indicates how to access the complete set of diagnosis code changes to determine if any beyond those ACP identified as most pertinent apply to your practice.