The American Medical Association’s annual update of the Current Procedural Terminology codes and descriptions was recently released. Each year after the publication of the new CPT book, ACEP’s Coding and Nomenclature Advisory Committee provides a summary of the most relevant CPT changes for emergency medicine.

Of note for 2010, the musculoskeletal subsection has been greatly expanded to include new guidelines defining procedures related to excision of subcutaneous and other soft-tissue tumors.

A total of 41 new codes have been added. In addition, there is a new code (29581) to report the application of a multilayer venous wound compression system.

Effective Oct. 1, 2010, several ICD-9 diagnosis code additions and revisions appear that are relevant to emergency medicine:

• The diagnosis code set describing gouty arthropathy has been expanded and refined with several new codes, including gouty arthropathy, unspecified (274.00), gouty arthropathy, acute (274.01), chronic gouty arthropathy, without mention of tophus (274.02), and chronic gouty arthropathy, with tophus (274.03).
• There is a new code for acute chemical conjunctivitis (372.06).
• There is a significant expansion and refinement of the venous embolism and thrombosis code set.
• There is greater granularity in the reporting of viral illnesses including influenza due to identified avian influenza virus (488.0) and influenza due to identified novel H1N1 influenza virus (488.1).
• Several new codes describe vomiting with greater granularity, including vomiting of fecal matter (569.87), bilious vomiting in newborn (779.32), and other vomiting in newborn (779.33).
• A series of codes better describes alterations in a patient’s emotional state: nervousness (799.21), irritability (799.22), impulsiveness (799.23), and emotional lability (799.24).
• Several important pediatric codes include apparent life-threatening event in infant (799.82), torus fracture of ulna alone (813.46), torus fracture of radius and ulna (813.47), and nursemaid’s elbow (832.2).
• There are multiple new poisoning codes: by antidepressant, unspecified (969.00); by monoamine oxidase inhibitors (969.01); by selective serotonin and norepinephrine reuptake inhibitors (969.02); by selective serotonin reuptake inhibitors (969.03); by tetracyclic antidepressants (969.04); by tricyclic antidepressants (969.05); by other antidepressants (969.09); by psychostimulant, unspecified (969.70); by caffeine (969.71); and by amphetamines (969.72).

The 2010 ICD-9 book has a complete list of new and deleted codes.

Medicare Physician Fee Schedule 2010 Final Rule

On Oct. 30, 2009, Medicare released the Medicare Physician Fee Schedule Final Rule, with final publication in the Federal Register Nov. 25, 2009. The Final Rule sets payment rates for Medicare providers with rates going into effect beginning with dates of service Jan. 1, 2010.