2012 CPT CHANGES

1. 2012 CPT CHANGES New Haven Local Chapter January 26, 2012 Presented by Kelly M. Anastasio kelly.anastasio@yale.edu

2. CPT SYMBOL REMINDERS� AMA developed a resequencing system in 2010 to assist with integrating new codes into existing code families regardless of the availability of sequential numbers. The number assigned to some new CPT codes will not necessarily fit into the numerical order of some code families The symbol � #� indicates a resequenced code The symbol � ?� indicates a reinstated or recycled code

3. Introduction of the CPT Codebook The :Instructions for Use of the CPT Codebook� has been updated to include defining language for �physician and other qualified healthcare professionals.� This update is to reduce the number of questions that often arise regarding professionals who are qualified and licensed to perform a service, but not independently report that service and those non-physician healthcare professionals who are able to perform a professional service w/I their scope of practice and independently report a professional service.

4. Evaluation and Management New and Established Patient definitions have been revised providing further clarifications of professional services rendered by physicians regardless of their specialties and subspecialties. This revision clarifies that, although the physician may be of the same specialty, differences among subspecialties might require a significant New Patient workup and should therefore be considered a New Patient service rather than an Established Patient service The Decision Tree for New vs. Est Patients has been added back into your E&M Guidelines

5. Evaluation and Management Hospital Observation Services: typical times have been added to the initial observation codes based on a crosswalk from the Hospital In-patient Services codes Prolonged Services: Editorial revisions to the Prolonged Services codes, 99354-99359 and introductory guidelines to clarify the definition of direct patient contact and removal of physician-specific references in the title and code descriptors, as well as the addition of the language, �other qualified healthcare professionals� to the introductory guidelines

6. Evaluation and Management In-Patient Neonatal Intensive Care Services: revised guidelines for consistency with the current Critical Care guidelines for codes 99291-99292 to differentiate the inclusive provider services from the appropriate facility reporting of services frequently performed at the time of critical care Pediatric and Neonatal Critical Care Services guidelines: codes 99468-99472, 99475, 99476 and 99477-99480 have been updated to include the new car seat evaluation codes 94780-94781 Initial and Continuing Intensive Care Services: new introductory language has been added preceding 99477 pertaining to the circumstance when the transfer of care of a sick neonate receiving intensive care services occurs from one physician to another physician in a different group, and both will be providing services on the same date of service

7. Surgery 86 revised codes 60 new codes 48 deleted codes

8. Integumentary System Implantable contraceptive capsule codes 11975 and 11977 have been deleted. Coder is redirected to see 11976 and11981 Repair Code Guidelines have replaced modifier 51 to modifier 59 New guidelines to clarify reporting of would care management and skin substitutes. Skin Replacement (15271-15278) Surgery subsection has comprehensive changes; 24 deleted codes, 6 revised codes and 8 new codes have been added New Sub-Section, �Skin Substitute Grafts� has been added

9. Integumentary System New Add-On: 15777 reports implantation of biologic implant for soft tissue reinforcement Revised Guidelines for Burns, Local Treatment to expand the range of codes for reporting of skin replacement graft(s)

10. Musculoskeletal System New Codes for Dupuytren�s contracture: 20527 injection of enzyme into palmer fascial cord and 26341 manipulation of palmer fascial cord performed on subsequent day with some f/u care included (i.e. wound check) To support the changes in the Nervous System spine injection section, there is a parenthetical note in the MS System/Spine that directs the coder to the appropriate nervous system injection codes Exclusionary note following 22520-22522 and 22523-22525 to preclude the reporting of fx reduction and bone bx procedures in conjunction with the vertebroplasty and kyphoplasty codes. In addition, �bone bx included when performed� has been added

11. Musculoskeletal System Arthrodesis family of codes has been revised to include 2 new l-spine arthrodesis codes, 22633, 22634 to report combined posterior or posteriorlateral technique including lami and/or discectomy Revised: 22610 and 22612 by replacing �or without� to �when performed� Revised: 22612 and 22630 should not be reported at the same level and 22634 should not be reported with 22633 Spinal Instrumentation introductory guidelines revised for reinsertion of instrumentation.

12. Musculoskeletal System Revised:27096 to include CT or fluoro imaging guidance and arthrography when performed. Revised: 29581 eliminated reference to diagnostic terms and include reference to anatomic regions New: series of codes for reporting application of multilayer compression systems to the thigh, leg, ankle, foot, upper arm, forearm, hand and fingers, 29852-29854 Revised: 29826 is reported >95% of the time with other scope procedures to AMA did away with the multiple procedure reduction rule & made 29826 an add-on code Revised: 29880, 29881 now include �chondroplasty when performed on the same or separate compartment(s) �

13. Respiratory System 22 codes revised, 8 deleted and 18 new Revised: Lungs/Pleura guidelines have been revised to reflect current medical practice by differentiating procedures that were originally identified by single codes. Such revises include different approaches, definitions and instructions Deleted: 32096 and replaced with 3 new codes 32096 Thoracotomy w/ dx bx(s) of lung infiltrates, unilateral 32097 Thoracotomy w/ dx bx(s) of lung nodule(s) unilateral 32098 Thoracotomy w/ bx(s) of pleura Revised: 32100-32160 thoracotomy codes removes �biopsy� and �major�

14. Respiratory System Deleted: 32600, no longer performed Deleted: VATS codes 32602, 32603, 32605; report with revised code 32601 New: 32607, 32608, 32609 to identify thoracoscopic biopsy procedures Deleted: 32657 and 3 new codes created 32666 Thoracoscopy, surgical; w/ therapeutic wedge resection, initial unilateral +32677 Thoracoscopy, surgical; w/ therapeutic wedge resection, each addt�l resection, ipsilateral +32688 Thoracoscopy, surgical; w/ diagnostic wedge resection followed by anatomic lung resection New: 32669-32674 used to report VATS removal procedures based on amountand/or type of tissue removed,or in the difficuloty of removal

15. Cardiovascular System The AMA/Specialty Society RVS Committee indentified the following codes as being reported together in various combinations >75% of the time: 33207, 33208, 22313, 33213, 33233, 33240, 33241, 33249, 71090 & 93541. To accommodate such combinations of PM and PCD services reported together many Guideline changes/revisions have been made Deleted: 71090 and 76000 can be reported for diagnostic lead eval w/o a lead procedure New: #33221 insertion of pacemaker pulse generator w/multiple leads To Sum It Up�.