Whether it’s new modifiers, E/M, radiology, or Category II codes, we have the outlook for what’s on the horizon.
By Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC
CPT® 2012 arrives with over 500 code changes, plus minor additions to the Evaluation and Management Services Guidelines.
The revised evaluation and management (E/M) guidelines clarify the “three-year rule” for new versus established patients, stressing “A new patient … has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years” [emphasis added]. In this context, CPT® 2012 defines “professional services” to mean any face-to-face service “rendered by a physician and reported by a specific CPT® code(s).”
To help determine a patient’s status easily, CPT 2012® re-establishes the “Decision Tree for New vs. Established Patient” that was included in CPT® 2010, but left out in 2011.
The “Instructions for Use of the CPT Codebook” are unchanged, as are the Anesthesia, Surgery, and Medicine sections guidelines. Appendix A adds two modifiers not found on the inside front cover of the book, however.
Modifier 33 Preventive services has been effective since Jan. 1, 2011, but appears in CPT® for the first time. Append this modifier when reporting preventive services delivered “in accordance with a US Preventive Services Task Force A or B rating in effect” and “other preventive services identified in [legislative or regulatory] preventive services mandates.” Examples include the Medicare initial preventive physical exam (G0402) and annual wellness visits (G0438 and G0439).
Do not apply modifier 33 for separately reported services specifically identified as preventive (such as screening mammography, 77057; screening colonoscopy, G0105 or G0121; or prostate screening with PSA, G0103). If the physician converts a screening colonoscopy to a diagnostic colonoscopy (e.g., 45385), you should instead append modifier PT Colorectal screening test converted to diagnostic test or other procedure to the diagnostic colonoscopy code to indicate the procedure began as a preventive service.
Append modifier 92 Alternative laboratory platform testing when:
- A laboratory test is performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable, analytical chamber;
- the test does not require permanent dedicated space; and,
- the test is designed to be carried or transported to the vicinity of the patient for immediate testing at that site.
For Medicare payers, modifier 92 indicates point-of-service HIV testing (86701-86703 and 87389) only. Per Centers for Medicare & Medicaid Services (CMS) transmittal 2277, modifier 92 is effective Oct. 1, 2011 for this purpose. Modifier 92 was introduced in CPT® 2008, and Medicare will allow you to apply the modifier retroactively to claims filed on or since Jan. 1, 2008.
CPT® 2012 re-establishes the “Decision Tree for New vs. Established Patient” that was included in CPT® 2010, but 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
E/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 face-to-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 not have to be continuous, but only a single prolonged service code may be reported per day.
Prolonged services without direct patient contact (99358-99359) 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.
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 100 sq 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 to code for primary procedure) has been established to describe biologic implant for soft tissue reinforcement. Many other integumentary code descriptors include minor revisions.
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.
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.
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.
There are relatively few changes to this section of CPT®. 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.
There are no changes in the Surgery/Male Genital System portion of CPT®. The Surgery/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.
Codes 64622-64627 have been deleted, replaced by 64633-64636 for destruction of paravertebral 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 Adnexa and Auditory System
These sections include only minor changes, 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.
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 of five 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 percutaneous, 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.
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 +91013 (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.”
Good weather, a good friend, and a good codebook—what more does a girl need?
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.
Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC, is AAPC director of education, and a member of the CPT® Health Care Professionals Advisory Committee (HCPAC).
December 1st, 2011