Medicare Compliance & Reimbursement - 2012 Issue 11
CPT® 2013: Make the Most of 'Other Qualified Healthcare Professionals' Billing
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Article Overview
This article explains CPT® 2013 updates tied to evaluation and management reporting, along with the AMA guidance that clarified the meaning of “other qualified health care professional.” It is aimed at coders, billers, and practice managers who need to understand which types of nonphysician personnel are addressed by the revised terminology and why the changes matter for claim reporting and documentation review.
Why This Topic Matters
The article helps readers identify whether their practice’s nonphysician professionals fall within the updated CPT® terminology used in E/M reporting. That can affect how services are interpreted, documented, and billed under the revised code language.
Article Sections
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Introduction to the CPT® 2013 changes
Introduces the reporting issue addressed by the article and frames the broader changes affecting E/M services in CPT® 2013.
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Get Familiar With Code Modifications
Summarizes the nature of the wording revisions made across multiple E/M code definitions and the purpose of the updated terminology.
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Know the 'Qualified Healthcare Professional' Definition
Reviews the AMA’s definition of the term and the related guidance that clarified how it differs from clinical staff.
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Result
Describes the practical implications discussed in the article for categories of nonphysician personnel in the context of the updated terminology.
What You Will Learn
- How CPT® 2013 revised E/M terminology related to nonphysician reporting
- How the AMA defined “other qualified health care professional”
- How the article distinguishes qualified professionals from clinical staff
- Which categories of personnel are discussed in connection with the revised language
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physician office administrators
- Surgical practice staff
Codes Discussed
Code Ranges Discussed
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