With greater integration, and with emergency department groups, urgent care centers, and multispecialty groups participating in myriad practice models, the updated language in CPT will help to clarify the patient’s status for payers and prevent visits from inappropriately being classified as “established.”

Changes to Observation Codes

The initial observation codes (99218-99220) have been updated with a new listing of typical times spent at the bedside and on the patient’s floor or unit. Those times now appear as 30 minutes for 99218, 50 minutes for 99219, and 70 minutes for 99220.

Typical times do not appear in the descriptors for observation services codes 99234-6 for CPT 2012.

These typical time additions to the subsequent observation codes come into play with new language in the prolonged services codes.

Code 99356 (Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour (list separately in addition to code for inpatient Evaluation and Management service) has a new parenthetical list of applicable code ranges that now include the initial admit to observation codes. (Use 99356 in conjunction with 99218-99220, 99221-2-99223, 99251-99255, 99304-99310, 90822, and 90829.) Of note, CPT Errata added the subsequent observation codes (99224-99226) to this code range parenthetical for use with prolonged service codes.

Effective Oct. 1, 2011, several icd-9 diagnosis codes became available that are relevant to emergency medicine.

Time Not a Factor in ED Code Selection

New “Coding Tips” appear in the CPT E/M section about the significance of time as a factor in the selection of certain E/M codes. This is not a new concept but provides a reminder that the inclusion of time is there to assist physicians in selecting the appropriate E/M level. However, it has been a long-standing tenet within CPT that time is not a factor in selecting the appropriate emergency department level of service. The inclusion of the separately delineated emergency department “coding tip” reiterates that time is not a factor in selecting emergency department E/M codes “since services are provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time.”

There is a small but meaningful change in the laceration repair code preamble replacing the instruction to report wound repairs of different classification, as well as those involving nerves, blood vessels, and tendons in a complex repair using modifier -59 (Distinct procedural service) rather than -51 (Multiple procedures) as in years past. This should help to identify to the payers truly separate repairs that should be fully reimbursed rather than be subject to a significant decrease in payment.