Your CPT Questions

May 2006

Q: Last December I received a letter from a Centers for Medicare and Medicaid Services CERT contractor about a CPT code. As I understand it, CERT (comprehensive error rate testing) is a CMS program to monitor the accuracy of payments from Medicare. I provided the required documentation for the case in question. It turns out that my billing service had undercoded the services provided. I have not heard back from CMS or the CERT contractor since submitting the documentation. When will I hear from them?

A. If your experience with the CERT program, an audit program run by a CMS contractor, is similar to that of many others, it may take months for CMS to respond. One pathology group was asked in November 2005 to provide documentation supporting its billing (coding) within 30 days. It did so. The group did not hear back from CMS until they received a certified letter in March 2006, some five months later.

Q: I routinely perform squash (cytologic) preparations in conjunction with my frozen sections for brain tumor intraoperative consultations. I understand that there are new CPT codes for intraoperative cytologic evaluations. Do I bill for the frozen sections and the squash preparations now that these new codes are available?

A. No. The new intraoperative cytology codes, CPT codes 88333 and 88334, are intended to replace the prior combination of 88329, Pathology consultation during surgery, and 88161, Cytology, smears, any other source; preparation, screening and interpretation. The same rules apply for both sets of codes. The frozen section and intraoperative cytologic consultation should not be billed together if they are performed simultaneously, aiding in a single diagnosis. In this case, only the frozen section should be billed.

Frequently asked questions about CPT are published bimonthly in “Capitol Scan.” This section of CAP TODAY is a product of the CAP Economic Affairs Committee.

The codes and descriptions listed here are from Current Procedural Terminology, 4th ed., CPT 2006. CPT 2006 is copyrighted by the American Medical Association. To purchase CPT books, call the AMA at 800-621-8335.

For more information about CPT coding, visit the CPT Coding Resource Center on the CAP Web site.