New CPT Codes Hold Interest for RTs Performing Patient Education
October 26, 2005
AARC representatives recently attended an American Medical Association (AMA) CPT meeting where the 2006 CPT codebook was released and includes some codes of special interest to respiratory therapists.
AARC Director of Government Affairs Cheryl West, and Board member Susan Rinaldo- Gallo attended the CPT conference in Seattle earlier this week. New codes in the patient education area may be useful for respiratory therapists providing patient education. Specifically the new codes are:
Education and Training for Patient Self-Management
* 98960 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes, individual patient.
* 98961 2–4 patients
* 98962 5–8 patients
“The purpose of these codes is to teach self-management of a patient’s illness or disease, or delay disease comorbidity” said Rinaldo-Gallo after looking through the AMA’s CPT 2006 manual and the CPT Changes, 2006, An Insider’s View. “Asthma was an example given where patient education could be provided.”
The curriculum used in patient education must be recognized by a physician society or by a nonphysician healthcare professional society/association, such as the AARC. “The AARC, as a professional society, would certainly qualify as an organization which, in the future, could approve such curriculums”, said West.
Although the AARC's CRCE program accredits continuing education programs to assist repiratory therapists in meeting the continuing education requirements of their state boards, the AARC does not currently have a mechanism to review and approve curriculums of programs to provide asthma education to patients.
“These new codes have interesting potential, especially in the private sector for allowing reimbursement of patient education on self-management geared at improving quality of life through preventative care and lowering total healthcare costs as a result,” said Rinaldo-Gallo, noting that these are areas where respiratory therapists excel.
There is one critical point to keep in mind with the creation of these new codes. The CPT codes are “the property” of the AMA, and the Medicare program uses the codes in processing its’ claims. However, the Medicare program does not use all the CPT codes the AMA creates. Because this new code is specifically for non-physician services, and Medicare will not directly use codes that are not physician directed, Medicare has stated the program will not reimburse for these codes.
While it is not surprising that Medicare will not cover these non physician codes, it does not mean other private insurers or public health programs such as Medicaid will not recognize the codes for reimbursement purposes. This is an excellent first step in recognizing the importance of education and training for patient self management provided by non physicians.
CPT® is Current Procedural Terminology, and was developed by the American Medical Association in 1966. Each year, an annual publication is prepared, that makes changes corresponding with significant updates in medical technology and practice and is used almost universally to code procedures for reimbursement by third party payers.
Rinaldo-Gallo is the AARC’s representative to the CPT/HCP Advisory Committee and ensures that the interests of respiratory therapists are communicated as new codes are developed.