CPT© 2012
re-establishes the
“Decision Tree for news vs
Established Patiens”
That was included in CPT© 2010,
out left out in 2011
Category I
Changes
The majority of changes to CPT 2012"’ involve Category
I codes, to include over 200 new codes, more than 180 deleted codes, and more than
130 revisions. Only the Anesthesia (00100-01999) and Surgery: Urinary System
(50010-53899) portions of CPT° were untouched this year.
Evaluation
and Management
El M changes include the addition of “reference times” to
Initial Observation Care codes 99218, 99219, and 99220. For example, the descriptor
for 99220 now specifies, “Physicians typically spend 70 minutes at the bedside
and on the patient’s hospital floor or unit.” The new language allows
physicians to report the initial observation care codes using time as the key
component, when counseling or coordination of care dominates the encounter.
Prolonged Services codes 99354-99355 (office or outpatient)
and 99356-99357 (inpatient or observation) gain instructions stating these
codes may be used by physicians or other qualified health care professionals.
These add-on services specifically include total faceto-face time with the
patient, as well as non face-to-face services on the patient’s floor or
hospital/nursing facility unit during the same session. The time does riot have
to be continuous, but only a single prolonged service code may be reported per
day.
Prolonged services without direct patient contact
(99353-99359) also gain guidelines, clarifying that these add-on services may
be provided on a different date than the related, primary service (which must
have been face-to-face, but need not have a reference time). Added guidelines now precede the Inpatient
Neonatal and Pediatric Critical Care (99468—99476) and Initial and Continuing
Intensive Care Services (99477-99480) codes to define more precisely the services
included and how the codes are applied.
lntegumentary
The big news in the Integumentary section is a near complete
overhaul of the skin replacement/skin substitute codes. Many codes in the
15300-15431 range have been deleted, replaced by fewer (and much simplified)
codes, such as 15271 Application of skin
substitute graft to trunk, arms, legs, total wound surface area up to I00sq cm;
first 25 sq cm or less wound surface area and +15272 each additional 25 sq cm wound
surface area, or part thereof (List separately in addition to code for primary
procedure). The replacement codes (15271-+15278) do not include supply of
the graft, which may be reported separately.
Add-on code 15777 Implantation
of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement
(eg, breast, trunk) (List separately in addition ta code for primary procedure)
has been established to describe biologic implant for soft tissue reinforcement.
Many other integumentary code descriptors include minor revisions.
Musculoskeletal
Changes to musculoskeletal codes involve mainly descriptor
revisions, either to clarify the intent of the service or to describe bundled
services. For example, descriptors for percutaneous vertebroplasty
(22520-22522) specifically identify bone biopsy as an included service when
performed. A number of injection procedures (e.g.,
27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image
guidance (fluoroscopy or CT) including arthrography when performed)) now
clearly include image guidance.
Two new codes (22633 and 22634) describe arthrodesis via combined
posterior and posterolateral technique with posterior interbody technique.
Respiratory
System
Codes describing thoracotomy and other procedures of the
lung and pleura undergo significant changes, to include nearly a full page of new
instructions and added parenthetical notes. Every “removal of lung” code
(32440-32491) has been revised. There are six new codes for thoracotomy
(32096-32098, with biopsy; and 32505-+32507, with wedge resection), and an entirely
new category (32601-32674) has been established for video-assisted thoracic
surgery (VATS), which includes a dozen new codes.
Cardiovascular
Pacemaker or Pacing Cardioverter-Defibrillator codes (33202-33249)
have undergone frequent revisions in the past few years, and 2012 is no
exception. There’s an additional page of instructions for code application, as
well as a quick reference chart to help with code selection for the insertion,
removal, etc. of a pulse generator and its various components. Over a dozen codes
in this section have been revised, with nine codes added.
Combination codes were added to report renal catheterization
and angiography (36251-36254). The new codes include the radiological supervision
and interpretation. Added instructions
clarify that replacement of ventricular assist device pump (33981-33983)
includes removal of the new pump, as well as connection, de-airing, and
initiation of the new pump.
Digestive
There are relatively few changes to this section ofCPT@
Several parenthetical notes have been added to clarify code selection. For instance,
a note added to the Stomach: Laparoscopy codes (43644-43659) instructs, “For
laparoscopic implantation, revision or removal of gastric neurostimulator
electrodes, lesser curvature [morbid obesity], use 43659.” Three new codes
(49082-49084) describing abdominal paracentesis replace deleted codes 49080 and
49081. Liver biopsy (47000) now includes moderate sedation, when provided.
Genital
Systems
There are no changes in the Surgeryl Male Genital System
portion of CPT° The Surgeryl Female Genital ‘System codes also are unchanged,
but several parenthetical notes have been added throughout the section. Among
these is instruction to report 11981 for insertion of a non-biodegradable contraception
implant, and 11976-11981 for removal with subsequent insertion.
Nervous
System
Codes 64622-64627 have been deleted, replaced by 64633-64636
for destruction ofparavertebral facet joint by neurolytic agent. The new codes
specify location (cervical or thoracic and lumbar or sacral) and the number of
joints injected (single and each additional). Many additional code descriptors
have undergone revision to better specify the intent or application of the code.
For example, the term “array” was added to implantation of neurostimulator code
(64553-64565 and 64575-64585) descriptors to clarify that the codes are applied
per array, not per individual electrode (an array may contain several
electrodes). New parenthetical notes and instructions appear throughout the
section.
Eye/Ocular
Aclnexa and Kuditory System
These sections include only minor chalnges, including new
parenthetical instructions (e.g., “For fitting of contact lens for treatment of
disease, see 92071, 92072”) and the deletion of 69802 Labyrinthotomy, with perfusion of vestibuloactive drug(s); with
mastoidectomy.
Radiology
Of the many changes to the Radiology section, the most
significant include the creation of new codes to report intra-operative
radiation treatment delivery (77424, 77425) and intra-operative radiation treatment
management (77469). New instructions specify that radiation treatment
management is reported in units offive fractions or treatment sessions,
regardless of the actual time period in which the services are furnished.
Atherectomy codes 75992‘-75996 have been deleted and
replaced with other codes. For instance, in 2012, in place of 75995, use Category
III code 0235T Transluminal peripheral
atherectomy, open or percutaneaus, including radiological supervision and
interpretation; visceral artery (except renal), each vessel.
Path and
Lab
CPT° 2012 establishes an entirely new section for molecular
pathology, including two full pages of instruction and dozens of new codes for
Tier 1 (81200-81383) and Tier 2 (81400-81408) molecular pathology procedures.
Molecular pathology procedures involve analyses of nucleic acid to detect
variants in genes that may be indicative of germline or somatic conditions, or
to test for histocompatibility antigens. Code selection is based on the specific
gene analyzed.
Parenthetical notes now accompany HIV-1 and HIV-2 testing
code 86703 (single result) to clarify proper coding for alternative testing,
such as HIV-1 antigens(s) with HIV-1 and HIV-2 antibodies (87389), and when to
apply modifier 92 with 86701-86703 and 87389.
Medicine
Descriptor revisions clarify immunization coding (90460,
+90461) by vaccine component, rather than per injection. Esophageal motility
studies will no longer be reported with 91011 or 91012; instead, you will use
revised codes 91010 (for motility study) and +910l3 (an add-on code for
stimulation or perfusion). Code 92070 is deleted and replaced by two new codes
(92071 and 92072) for contact lens fitting to treat ocular surface disease or to
manage keratoconus, respectively.
A full page of instructions has been added for sleep
medicine testing, and new codes have been added to report needle electromyography,
per extremity (95885, limited; and 95886, complete) or non extremity (95887).
Hydration codes (96360 and +93631) also come with significant additional
instructions in 2012, to better explain the meaning of “initial infusion,” “sequential
infusion,” and “concurrent infusion.”
Category III
Codes
Over 30 new Category III codes have been added to CPT° 2012,
including those for intramuscular autologous bone marrow cell therapy
(0263T-0265T), percutaneous laminotomy/laminectomy (0274T, 0275T), corneal
incision (0289T, 0290T), and more. Category III codes describe emerging technologies
and, unlike Category I “unlisted procedure” codes, allow for tracking and
collection of specific data. If a Category III code is available, it must be
reported instead of a Category I unlisted procedure code.
Look for more: We’ll be covering specific information on
individual CPT° code changes in upcoming issues of Coding Edge.
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