Current Procedural Terminology (Excerpted from Current Procedural Terminology 2013 published by the AmericanMedical Association)

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1 Current Procedural Terminology (Excerpted from Current Procedural Terminology 2013 published by the AmericanMedical Association) NOTE: If you have questions about coding, please contact your insurance company for their interpretation of the new codes. For additional help with your coding questions, CAMFT recommends: Health care professionals, including LMFTs, are required to use Current Procedural Terminology (CPT) to identify treatment procedures on insurance claim forms and elsewhere. Current Procedural Terminology is a listing of descriptive terms and identifying codes for reporting medical services and procedures. The purpose of such terminology is to provide a uniform language for health care practitioners, patients, and third parties. CPT 2013 is the most recent revision of this work. It is the most widely accepted nomenclature for the reporting of procedures and services under government and private health insurance programs. It is also used for administrative management purposes such as claims processing and for the development of guidelines for medical care review. Each procedure or service is identified with a five digit code. The health care practitioner selects the name of the procedure or service that most accurately identifies the service performed. The practitioner may also list other additional procedures performed, pertinent special services, and/or any modifying or extenuating circumstances. Of course, any service or procedure should be adequately documented in the records of the practitioner. You will note that the descriptors of the procedures often refer to terms such as medical, physician, or psychiatric, but these codes can also be used by mental health professionals as well. Keep in mind that procedural codes change from time to time. Old procedures sometimes become obsolete, new procedures are developed, and existing procedures are modified to reflect changes in practice. Thus, these codes as published will not remain the same in perpetuity. We are publishing those codes that we believe our membership uses or should have a workingknowledge of as they practice. This listing is not complete, and we would refer you to the American Medical Association for additional information, should you need it. You may note that not all of the procedures listed herein are within the scope of practice of an LMFT, but we believe it is important for LMFTs to be familiar with such procedures because they are related to the treatment of mental disorders. If you would like to get a complete book of Current Procedural Terminology 2013, which includes all identified medical procedures, contact the American Medical Association, 515 North State

2 GENERAL PSYCHIATRIC DIAGNOSTIC PROCEDURES 90791: Psychiatric Diagnostic Evaluation. The psychiatric diagnostic evaluation is an integrated biopsychosocial assessment, including history, mental status, and recommendations. This evaluation may include communication with family or other sources and review and ordering of diagnostic studies : Psychiatric Diagnostic Evaluation with Medical Services. The psychiatric diagnostic evaluation with medical services is an integrated biopsychosocial and medical assessment, including history, mental status, other physical examination elements as indicated, and recommendations. The evaluation may include communication with family or other sources, prescription of medications, and review and ordering of laboratory or other diagnostic studies. In certain circumstances, family members, guardians, or significant others may be seen in lieu of the patient. Codes and may be reported more than once for the patient when separate diagnostic evaluations are conducted with the patient and other informants. Report services as being provided to the patient, and not to the informant or other party, in such circumstances. Codes and may be reported once per day, and not on the same day as an evaluation and management service performed by the same individual for the same patient. The psychiatric diagnostic evaluation may include interactive complexity services when factors exist that complicate the delivery of the psychiatric procedure. These services should be reported with add-on code 90785, which is used in conjunction with and 90792, the psychiatric diagnostic evaluation codes. Codes and are used for the diagnostic assessment or reassessment of the patient, if required, and do not include the rendering of psychotherapeutic services. Psychotherapy services, including for crisis, may not be reported on the same day. When using and 90792, follow these guidelines: 1. Do not report or in conjunction with , , , or Use and in conjunction with when the diagnostic evaluation includes interactive complexity services and have been deleted so do not use them. Use or instead , 90805, 90806, 90807, 90808, and have been deleted so do not use them. To report, see psychotherapy codes 90832, 90834, 90837, or psychotherapy add-on codes when performed with an evaluation and management service (90833, 90836, 90838, , , and ) , 90811, 90812, 90813, 90814, and have been deleted so do not use them. To report interactive psychotherapy, report in conjunction with psychotherapy codes 90832, 90834, or psychotherapy add-on codes when performed with an evaluation and management service (90833, 90836, 90838, , , and ) , 90817, 90818, 90819, 90821, and have been deleted so do not use them. To report, see psychotherapy codes 90832, 90834, 90837, or 2013 Current Procedural Terminology Codes 2

3 psychotherapy add-on codes when performed with an evaluation and management service (90833, 90836, 90838, , , and ) , 90824, 90826, 90827, 90828, and have been deleted so do not use them. To report interactive psychotherapy, report in conjunction with psychotherapy codes 90832, 90834, or psychotherapy add-on codes when performed with an evaluation and management service (90833, 90836, 90838, , , and ). PSYCHOTHERAPY PROCEDURE CODES Psychotherapy is the treatment of mental illness and behavioral disturbances in which the clinician, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. The codes for reporting psychotherapy are divided into three categories: Psychotherapy; Psychotherapy for Crisis, and Other Psychiatric Services. PSYCHOTHERAPY 90832: Psychotherapy, 30 minutes (approximately minutes) with patient and/or family member : Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the primary procedure, and use in conjunction with , , and : Psychotherapy, 45 minutes (approximately minutes) with patient and/or family member : Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the primary procedure). Use in conjunction with , , and : Psychotherapy, 60 minutes with patient and/or family member : Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the primary procedure). Use in conjunction with , , and Use the appropriate prolonged service code ( ) for psychotherapy services 68 minutes or longer. Use in conjunction with 90832, 90833, 90834, 90836, 90837, and when psychotherapy includes interactive complexity services. PSYCHOTHERAPY FOR CRISIS 90839: Psychotherapy for crisis, first 60 minutes : Psychotherapy for crisis, each additional 30 minutes after the first 60 minutes (List separately in addition to code for primary service). Use in conjunction with Current Procedural Terminology Codes 3

4 Do not report or in conjunction with 90791, 90792, psychotherapy codes or other psychiatric services, or under : Psychoanalysis 90846: Family psychotherapy (without the patient present) 90847: Family psychotherapy (conjoint psychotherapy) (with patient present) 90849: Multiple-family group psychotherapy 90853: Group psychotherapy (other than of a multiple-family group) Use in conjunction with for the specified patient when group psychotherapy includes interactive complexity has been deleted so do not use it. To report, use in conjunction with OTHER PSYCHIATRIC SERVICES OR PROCEDURES 90863: Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (List separately in addition to the code for primary procedure) : Narcosynthesis for psychiatric diagnostic and therapeutic purposes (eg, sodium amobarbital (Amytal) interview) : Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management. Use this code only once during course of treatment. Do not report in conjunction with 90868, 90869, 95860, 95870, 95928, 95929, or : Subsequent delivery and management of services provided pursuant to 90867, per session : Subsequent motor threshold re-determination with delivery and management of services provided pursuant to : Electroconvulsive therapy (includes necessary monitoring) : Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying, or supportive psychotherapy): 30 minutes : Same as 90875, but for 45 minutes : Hypnotherapy : Environmental intervention for medical management purposes on a psychiatric patient s behalf with agencies, employers, or institutions : Psychiatric evaluation of hospital records, other psychiatric reports, psychometric and/or projective tests, and other accumulated data for medical diagnostic purposes : Interpretation or explanation of results of psychiatric, other medical examinations and 2013 Current Procedural Terminology Codes 4

5 procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patients : Preparation of report of patient s psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other individuals, agencies, or insurance carriers : Unlisted psychiatric service or procedure BIOFEEDBACK For psychophysiological therapy incorporating biofeedback training, see or : Biofeedback training by any modality : Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry Current Procedural Terminology Codes 5

6 CENTRAL NERVOUS SYSTEM ASSESSMENTS/TESTS (e.g., Neuro-Cognitive, Mental Status, Speech Testing) The following codes are used to report the services provided during testing of the cognitive function of the central nervous system. The testing of cognitive processes, visual motor responses, and abstractive abilities is accomplished by the combination of several types of testing procedures. It is expected that the administration of these tests will generate material that will be formulated into a report. A minimum of 31 minutes must be provided to report any per hour code. Services 96101, 96116, 96118, and report time as face-to-face time with patient and the time spent interpreting and preparing the report. (For development of cognitive skills, see 97532, 97533) (For a mini-mental status examination performed by a physician, see Evaluation and Management services codes) 96101: Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI, Rorschach, WAIS), per hour of the psychologist s or physician s time, both face-to-face time with the patient and time interpreting test results and preparing the report. Do not report for the interpretation and report of or is also used in those circumstances when additional time is necessary to integrate other sources of clinical data, including previously completed and reported technical and computer administered tests : Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI and WAIS), with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face : Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI), administered by a computer, with qualified health care professional interpretation and report : Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour : Developmental screening, with interpretation and report, per standardized instrument form : Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments) with interpretation and report : Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist s or physician s time, both face-to-face time with the patient and time interpreting test results and preparing the report Current Procedural Terminology Codes 6

7 96118: Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales, and Wisconsin Card Sorting Test), per hour of the psychologist s or physician s time, both face-to-face time with the patient and time interpreting test results and preparing the report. Do not report for the interpretation and report of or is also used in those circumstances when additional time is necessary to integrate other sources of clinical data, including previously completed and reported technician- and computer- administered tests : Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales, and Wisconsin Card Sorting Test), with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face : Neuropsychological testing (eg, Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report : Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional s time, both face-toface time administering tests to the patient and time interpreting these test results and preparing the report. (For Psychological and neuropsychological testing by a physician or psychologist, see , ) Health and Behavior Assessment/Intervention Health and behavior assessment procedures are used to identify the psychological, behavioral, emotional, cognitive, and social factors important to the prevention, treatment, or management of physical health problems. The focus of the assessment is not on mental health but on the biopsychosocial factors important to physical health problems and treatments. The focus of the intervention is to improve the patient s health and well-being utilizing cognitive, behavioral, social, and/or psychophysiological procedures designed to ameliorate specific disease-related problems. Codes describe services offered to patients who present with primary physical illnesses, diagnoses, or symptoms and may benefit from assessments and interventions that focus on the biopsychosocial factors related to the patient s health status. These services do not represent preventive medicine counseling and risk factor reduction interventions. For patients that require psychiatric services ( ) as well as health and behavior assessment/intervention ( ), report the predominant service performed. Do not report in conjunction with on the same date. Evaluation and Management services codes (including Counseling Risk Factor Reduction and Behavior Change Intervention [ ]), should not be reported on the same day. (For health and behavior assessment and/or intervention performed by a physician, see Evaluation and Management or Preventive Medicine service codes) 2013 Current Procedural Terminology Codes 7

8 96150: Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psycho-physiological monitoring, health-oriented questionnaires), each 15 minutes face- to-face with the patient; initial assessment : Re-assessment : Health and behavior intervention, each 15 minutes, face-to-face; individual : Group (2 or more patients) 96154: Family (with the patient present) 96155: Family (without the patient present) 97532: Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 minutes : Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes. Non-Face-to-Face Nonphysician Services Telephone Services Telephone services are non-face-to-face assessment and management services provided by a qualified health care professional to a patient using the telephone. These codes are used to report episodes of care by the qualified health care professional initiated by an established patient or guardian of an established patient. If the telephone service ends with a decision to see the patient within 24 hours or the next available urgent visit appointment, the code is not reported; rather, the encounter is considered part of the pre-service work of the subsequent assessment and management service, procedure, and visit. Likewise, if the telephone call refers to a service performed and reported by the qualified health care professional within the previous seven days (either qualified health care professional requested or unsolicited patient follow-up) or within the postoperative period of the previously completed procedure, then the service(s) are considered part of that previous service or procedure. Do not report if reporting performed in the previous seven days : Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion : Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; minutes of medical discussion Current Procedural Terminology Codes 8

9 98968: Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; minutes of medical discussion. Do not report during the same month with Do not report when performed during the service time of codes or OFFICE OR OTHER OUTPATIENT CONSULTATIONS New or Established Patient The following codes are used to report consultations provided in the office or in an outpatient or other ambulatory facility, including hospital observation services, home services, domiciliary, rest home, or emergency department. Follow-up visits in the consultant s office or other outpatient facility that are initiated by the consultant or patient are reported using office visit codes for established patients ( ). If an additional request for an opinion or advice regarding the same or a new problem is received from the attending physician and documented in the medical record, the office consultation codes may be used again Office consultation for a new or established patient, which requires these three key A problem focused history; A problem focused examination; and Straightforward medical decision making. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 15 minutes face-to-face with the patient and/or family Office consultation for a new or established patient, which requires these three key An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Usually, the presenting problem(s) are of low severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family Current Procedural Terminology Codes 9

10 99243 Office consultation for a new or established patient, which requires these three key A detailed history; A detailed examination; and Medical decision making of low complexity. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family Office consultation for a new or established patient, which requires these three key A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family Office consultation for a new or established patient, which requires these three key A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes face-to-face with the patient and/or family. INITIAL INPATIENT CONSULTATIONS New or Established Patient The following codes are used to report physician consultations provided to hospital inpatients, residents of nursing facilities, or patients in a partial hospital setting. Only one initial consultation should be reported by a consultant per admission Initial inpatient consultation for a new or established patient, which requires these three key A problem focused history; A problem focused examination; and Straightforward medical decision making Current Procedural Terminology Codes 10

11 Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 20 minutes at the bedside and on the patient s hospital floor or unit Initial inpatient consultation for a new or established patient, which requires these three key An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Usually, the presenting problem(s) are of low severity. Physicians typically spend 40 minutes at the bedside and on the patient s hospital floor or unit Initial inpatient consultation for a new or established patient, which requires these three key A detailed history; A detailed examination; and Medical decision making of low complexity. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 55 minutes at the bedside and on the patient s hospital floor or unit Initial inpatient consultation for a new or established patient, which requires these three key A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes at the bedside and on the patient s hospital floor or unit Initial inpatient consultation for a new or established patient, which requires these three key A comprehensive history; 2013 Current Procedural Terminology Codes 11

12 A comprehensive examination; and Medical decision making of high complexity. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 110 minutes at the bedside and on the patient s hospital floor or unit. COMPREHENSIVE NURSING FACILITY ASSESSMENTS DOMICILIARY, REST HOME (E.G., BOARDING HOME), OR CUSTODIAL CARE SERVICES The following codes are used to report evaluation and management services in a facility which provides room, board, and other personal assistance services, generally on a long-term basis. They also are used to report evaluation and management services in an assisted living facility. The facility s services does not include a medical component. For definitions of key components and commonly used terms, please see Evaluation of Management Services Guidelines. For care plan oversight services provided to a patient in a domiciliary facility under the care of a home health agency, see New Patient Domiciliary or rest home visit for evaluation and management of a new patient, which requires these three key A problem focused history; A problem focused examination; and Straightforward medical decision making. Usually, the presenting problem(s) are of low severity. Physicians typically spend 20 minutes with the patient and/or family or caregiver Domiciliary or rest home visit for evaluation and management of a new patient, which requires these three key An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend Current Procedural Terminology Codes 12

13 minutes with the patient and/or family or caregiver Domiciliary or rest home visit for evaluation and management of a new patient, which requires these three key A detailed history; A detailed examination; and Medical decision making of moderate complexity. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes with the patient and/or family or caregiver Domiciliary or rest home visit for evaluation and management of a new patient, which requires these three key A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Usually, the presenting problem(s) are of high severity. Physicians typically spend 60 minutes with the patient and/or family or caregiver Domiciliary or rest home visit for evaluation and management of a new patient, which requires these three key A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Physicians typically spend 75 minutes with the patient and/or family or caregiver. Established Patient Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components. A problem focused interval history; A problem focused examination; Straightforward medical decision making Current Procedural Terminology Codes 13

14 Usually, the presenting problem(s) are self-limited or minor. Physicians typically spend 15 minutes with the patient and/or family or caregiver Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Usually, the presenting problem(s) are low to moderate severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key A detailed interval history; A detailed examination; and Medical decision making of moderate complexity. Usually, the presenting problem(s) are moderate to high severity. Physicians typically spend 40 minutes with the patient and/or family or caregiver Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key A comprehensive interval history; A comprehensive examination; and Medical decision making of moderate to high complexity. Usually, the presenting problem(s) are moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 60 minutes with the patient and/or family or caregiver. HOME SERVICES The following codes are used to report evaluation and management services provided in a private 2013 Current Procedural Terminology Codes 14

15 residence. For definitions of key components and commonly used terms, please see Evaluation and Management Services Guidelines. For care plan oversight services provided to a patient in the home under the care of a home health agency, see 99374, (For care plans oversight services provided to a patient in the home under the individual supervision of a physician, see 99339, 99340) New Patient Home visit for the evaluation and management of a new patient, which requires these three key A problem focused history; A problem focused examination; and Straightforward medical decision making. Usually, the presenting problem(s) are of low severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family Home visit for the evaluation and management of a new patient, which requires these three key An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family Home visit for the evaluation and management of a new patient, which requires these three key A detailed history; A detailed examination; and Medical decision making of moderate complexity. with the nature of the problem(s) and the patient s and/or family s needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend Current Procedural Terminology Codes 15

16 minutes face-to-face with the patient and/or family Home visit for the evaluation and management of a new patient, which requires these three A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Usually, the presenting problem(s) are of high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family Home visit for the evaluation and management of a new patient, which requires these three key A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Physicians typically spend 75 minutes face-to-face with the patient and/or family. Established Patient Home visit for the evaluation and management of an established patient, which requires at least two of these three key A problem focused interval history; A problem focused examination; Straight forward medical decision making. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 15 minutes face-to-face with the patient and family Home visit for the evaluation and management of an established patient, which requires at least two of these three key An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity Current Procedural Terminology Codes 16

17 Counseling and/or coordination of care with other providers or agencies are provided consistent Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family Home visit for the evaluation and management of an established patient, which requires at least two of these three key A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Usually, the presenting problem(s) are moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family Home visit for the evaluation and management of an established patient, which requires at least two of these three components. A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. with the nature of the problem(s) and the patient and/or family needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 60 minutes face-to-face with the patient and/or family. CASE MANAGEMENT SERVICES Physician case management is a process in which a physician is responsible for direct care of a patient, and for coordinating, managing access to, initiating, and/or supervising other health care services needed by the patient. MEDICAL TEAM CONFERENCES Medical team conference with interdisciplinary team of healthcare professionals, face-toface with patient and/or family, 30 minutes or more, participation by a nonphysician qualified health care professional Medical team conference with interdisciplinary team of healthcare professionals, patient and/or family not present, 30 minutes or more; participation by physician Medical team conference with interdisciplinary team of healthcare professionals, patient and/or family not present, 30 minutes or more; participation by a non-physician qualified health 2013 Current Procedural Terminology Codes 17

18 care professional. Work Related or Medical Disability Evaluation Services Work related or medical disability examination by the treating physician that includes; Completion of a medical history commensurate with the patient s condition; Performance of an examination commensurate with the patient s condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report Work related or medical disability examination by other than the treating physician that includes; Completion of a medical history commensurate with the patient s condition; Performance of an examination commensurate with the patient s condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report. OTHER EVALUATION AND MANAGEMENT SERVICES Unlisted evaluation and management service Modifiers A modifier provides the means to report or indicate that a service or procedure that has been performed or has been altered by some specific circumstance but has not changed its definition or code. Modifiers also enable health care professionals to effectively respond to payment policy requirements established by other entities. 22 Increased Procedural Services: When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work. 52 Reduced Services: Under certain circumstances a service or procedure is partially reduced or eliminated at the physician s election. Under these circumstances the service provided can be identified by its usual procedure number and the addition of the modifier 52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service. ON-LINE MEDICAL EVALUATION Online assessment and management service provided by a qualified non-physician health care professional to an established patient or guardian, not originating from a related assessment and management service provided within the previous seven days, using the Internet or similar electronic network Current Procedural Terminology Codes 18