More on CPT Codes for your Practice

Doctor with PatientIn an earlier post, we described CPT Category II codes and how they are used as tracking codes to facilitate data collection for the purposes of performance measurement. So how do you report these codes and what are the codes for these screenings? Here are some of the basics for common clinical situations.

Blood Pressure for Hypertensive Members

A BP reading code should be reported for each office visit. To capture the BP reading, you should include a line for the BP Systolic and one for BP Diastolic procedure codes. Each need to be included and should be billed with a zero charge. (This code is not going to meet the intent for the CBP measure, but will for the CDC BP measure). BP Systolic

  • Less than 130 - 3074F
  • 130-139 - 3075F
  • 140+ - 3077F

BP Diastolic

  • Less than 80 - 3078F
  • 80-89 - 3079F
  • 90+ - 3080F

BMI at Office Visits

Some payors are beginning to request that a BMI diagnosis code be included on all office visit claims. The following diagnosis codes can be used to report a patient’s BMI. It is not necessary to link the BMI diagnosis code to a line item of a claim but it should be included in the diagnosis list transmitted on the claim. BMI Diagnosis Codes

  • BMI less than 19 - v85.0
  • 19-24 - v85.1
  • 25-25.9 - v85.21
  • 26-26.9 - v85.22
  • 27-27.9 - v85.23
  • 28-28.9 - v85.24
  • 29-29.9 - v85.25
  • 30-30.9 - v85.30
  • 31-31.9 - v85.31
  • 32-32.0 - v85.32
  • 33-33.9 - v85.33
  • 34-34.9 - v85.34
  • 35-35.9 - v85.35
  • 36-36.9 - v85.36
  • 37-37.9 - v85.37
  • 38-38.9 - v85.38
  • 39-39.9 - v85.39
  • 40-44.9 - v85.41
  • 45-49.9 - v85.42
  • 50-59.9 - v85.43
  • 60-69.9 - v85.44
  • 70+ - v85.45

Diabetes Hemoglobin A1c Testing

Claims including procedure code 83036 or 83037 should include a line item with the results and be billed with a zero charge. HbA1c

  • Below 7 - 3044F
  • 7 - 9 - 3045F
  • Above 9 - 3046F

Care for Older Adults

The following codes assist in the assessment of older adult’s coordination of care. If your practice is performing standard functional assessments or pain screening using a standardized tool, you can include these quality HCPCS or CPT II codes with the office visit code to help meet the HEDIS Care for Older Adult Measures. Assessment or Screening Type

  • Advance Care Planning - 1157F
  • Advance Care Planning - 1158F
  • Advance Care Planning - S0257
  • Functional Status Assessment - 1170F
  • Medication List - 1159F
  • Medication List - G8427
  • Medication Review - 1160F
  • Medication Review - 90863
  • Medication Review - 99605
  • Medication Review - 99606
  • Pain Assessment - 1125F
  • Pain Assessment - 1126F
  • TCM 7 Day - 99496

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