The biggest change 2012 will see did not come with the addition or deletion of a CPT code, but rather the inception of a modifier. Modifier -PD has been established to designate services furnished to a Medicare beneficiary in the three days prior to an inpatient admission in a facility wholly owned or wholly operated by the hospital. This includes physician practices that self-designate ownership interest. Modifier -PD will allow payment at the facility rate and identify that the service is subject to the three day payment window. According to CMS' definition of "wholly owned and operated entity," a freestanding clinic would meet the definition if the hospital has "exclusive responsibility for conducting and overseeing the entities routine operations." If the freestanding clinic meets this definition, the technical components of any service provided are subject to the three day payment window and bundling to the inpatient claim. Confusion has risen over whether Evaluation and Management (E/M) codes are considered "services" and subject to the three day payment. To see the final rule, please reference the Nov. 28, 2011, Federal Register.
Evaluation and Management (E/M)
Clarification of New and Established Patient definitions is the largest revision in the E/M section of CPT 2012. The terms "exact" and "subspecialty" have been added to indicate the professional services would be from a physician or another physician of the "exact" and same specialty and "subspecialty" who belongs to the same group practice within the past three years. This clarifies the issue of physicians who may be of the same specialty, but not subspecialty, requiring significant work up when seeing a patient for the first time (i.e., cardiologist vs. electrophysiologist). A new decision tree has been added to the E/M Guidelines section.
"Typical times" also have been added to codes 99218-99220 (Initial Observation Care).
Surgery/Integumentary
The Integumentary System subsection saw several comprehensive changes for 2012, including the deletion of 24 codes, revision of six codes and the addition of eight new codes.
The Skin Replacement codes (15271-15278) subheading was revised drastically. New skin replacement guidelines were added to state that skin replacement surgery now consists of the surgical preparation and topical placement of an autograft, which includes cultured tissue autograft, or skin substitute homograft, allograft and xenograft. If the graft is anchored and performed in the office setting, routine dressing supplies are not separately reportable.
Clarification of "100 sq cm or 1% body area of infant/children" was also mentioned in the new guidelines. When determining the involvement of body size, the measurement 100 sq cm is applicable to adults and children 10 years of age and older and percentages apply to children younger than 10 years of age. These measurements are the size of the recipient area and not the donor area.
Surgery/Musculoskeletal
Two new codes for the treatment of Dupuytren's Contracture have been added to the Musculoskeletal section of CPT 2012. CPT code 20527 is for the injection of an enzyme, such as collagenase, into the contracture and code 26341 is the follow up code for the manipulation of the Dupuytren Cord POST ENZYME injection. This code is to be used for subsequent visit(s) following the initial injection.
The phrase "bone biopsy included when performed" has been added to all vertebroplasty codes to be consistent with the kyphoplasty codes. The main difference between a verbebroplasty and a kyphoplasty is a balloon is utilized during kyphoplasty and not during vertebroplasty. Reporting a separate bone biopsy in addition to a vertebroplasty is no longer acceptable.
Two new arthrodesis codes have been added to report lumbar arthrodesis using a combined posterior or posterolateral technique with a posterior interbody technique including laminectomy and/or discectomy to prepare interspace (other than for decompression) for each interspace and segment. Code 22633 is for the single lumbar vertebrae and code 22634 is an add-on code for each additional interspace. CPT codes 22612 and 22630 should not be assigned with these new CPT codes (22633/22634).
New instructions under the Spinal Instrumentation subsection have been revised and broken down into three categories:
- Removal (22850, 22852, 22855): use when taking out hardware and not when insertion or reinsertion is performed
- Reinsertion (22849): use when hardware is going back in at the same levels/location (i.e., failed hardware) and includes removal (22850, 22852, 22855)
- Insertion (22840-22848): use when new hardware is put in which "exceeds" the previously placed hardware and includes removal (22850, 22852, 22855)
Surgery/Cardiovascular
CPT code 71090, insertion pacemaker, fluoroscopy, radiological supervision and interpretation was reviewed and found to be used in combination with Pacemaker/ICD procedures more than 75% of the time and therefore it has been deleted for CPT 2012. If fluoroscopic guidance is used for diagnostic lead evaluation without lead insertion, (i.e., a malfunctioning lead) coders are to assign CPT code 76000, fluoroscopy up to one hour physician time.
Several parenthetical notes have been added to this subsection to provide more accurate instructions on pacemaker/ICD coding. Also a table has been added to page 171 of the AMA CPT 2012 book, to assist in proper code selection.
Surgery/Endovascular
Language has been added to state that closure devices and pressure application are inclusive in Lower Extremity Arterial Endovascular Revascularization (37220-37235).
CPT codes 37620/75940 and 37620/36010 (IVC filter placement) were flagged as being billed in combination of more than 75% of the time, and therefore new CPT codes were created for endovascular IVC placement. Code 37191 is for the insertion of the IVC filter and includes vascular access, vessel selection, radiological supervision and interpretation an imaging guidance. This includes IVUS (intravascular ultrasound) and a completion angiography. Code 37192 is for the repositioning and code 37193 is for the retrieval or removal of the IVC filter.
Surgery/Digestive System
CPT codes 49080 and 49081 (abdominal paracentesis) have been deleted and replaced with codes 49082-abdominal paracentesis without imaging guidance, 49083-WITH imaging guidance, and 49084-Peritoneal lavage with imaging guidance.
Conclusion
This article represents a very brief overview of the 2012 CPT code and verbiage changes. Please refer to your 2012 CPT book for an entire listing of additions, deletions and revisions. Please contact Susan Rohde at srohde@eidebailly.com with any questions or concerns regarding the new 2012 CPT changes.
