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Letter
to Payers on 2009 CPT Code Renumbering
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On
January 1, 2009, certain neonatal and pediatric
inpatient evaluation and management (E&M)
CPT codes were renumbered. This renumbering was
done to allow for sufficient room in CPT
nomenclature for potential expansion in this
area of codes, and to allow for consecutive code
placement in this family of neonatal and
pediatric codes. This change was sought by the
AAP and implemented in the 2009 CPT
nomenclature. This was an editorial change that
did not represent any change in the procedures
related to these codes.
We
have learned that some state Medicaid programs
and private sector payers have used this
renumbering as an opportunity to classify these
renumbered codes as "new" codes,
effectively lowering payment associated with
them. To combat these changes in payment, the
Academy is making available a Dear
Medical Director letter, for AAP chapters
and pediatric councils to use, clarifying that
these renumbered CPT codes are not
"new" codes but simply codes that have
been renumbered. This letter is available on the
State Government Affairs site of the AAP Member
Center (login required), with 2 attachments. The
first
attachment lists the renumbered codes, the second
attachment is a March 2009 CPT
Assistant article,
outlining the changes further.
AAP
chapters and pediatric councils experiencing
reductions in payment for these codes in
Medicaid and with other payers are encouraged to
use this letter and attachments to seek
reinstatement of payment. A cover letter from
your chapter or pediatric council outlining the
specifics of the payment reduction could
accompany the Academy's letter and may be
helpful in reversing such a cut.
For
assistance with Medicaid and other public payer
advocacy, please contact Dan Walter in the
Division of State Government Affairs at
800/433-9016 ext 4086, or dwalter@aap.org.
For assistance with private payer advocacy,
please contact Lou Terranova in the Division of
Health Care Finance and Quality Improvement at
800/433-9016 ext 7633 or lterranova@aap.org.
The
Division of State Government Affairs sends this
update to the Academy's Executive Committee,
Board of Directors, District Vice
Chairs,
Chapter Presidents, Chapter Vice Presidents,
Chapter Legislative Contacts, Committee on State
Government Affairs, Committee on Federal
Government Affairs, Chapter Executive Directors,
and other interested AAP members and staff.
For additional state legislative information,
strategy suggestions, in-depth resources on
issues of pediatric interest, and past editions
of this update, log onto the AAP Member Center
and see the State Government Affairs area at http://www.aap.org/moc/stgovaffairs.
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