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2011 CPT CHANGES Powered By Docstoc
					New Haven Local Chapter
      January 26, 2012

        Presented by
   Kelly M. Anastasio
 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
 The symbol “ Ο” indicates a reinstated or
  recycled code
 The  :Instructions for Use of the CPT Codebook”
  has been updated to include defining language
  for “physician and other qualified healthcare
 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.
 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
 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
   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
   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
86 revised codes
60 new codes
48 deleted codes
 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
 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)
 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
 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
 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.
 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,
 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) ”
 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,
       32097 Thoracotomy w/ dx bx(s) of lung nodule(s)
       32098 Thoracotomy w/ bx(s) of pleura
   Revised: 32100-32160 thoracotomy codes removes
    “biopsy” and “major”
 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
 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….
 New or replacement perm PM w/ leads reported w/
 Insertion PM pulse generator ONLY reported w/ 33212-
  33213, 33221
 Removal and replacement of perm PM pulse generator
  reported w/ 33227-33229
 Insertion of PM leads reported w/ 33216, 33217 or
  33217 and 33224
 Insertion or replacement of a PCD pulse generator and
  leads reported w/ 33249; for a multiple lead system,
  report 33249 w/33235
 Insertion of PCD pulse generator reported w/
 Removal w/ replacement of cardioverter-defribrillator
  pulse generator reported w/ 33262-33264
 Revised:   33960 and 33961 no longer 24 hours to
  initial day and subsequent day
 Deleted: bypass grafts 35548, 35549, 35551,
 Added: mod sedation to 36200, 36245-36248
 New: 36251 selective cath placement(1st order)
  main renal artery & any accessory renal artery(s)
  for renal angiography, including arterial puncture,
  cath placement, fluoro, contract inj’s, image
  postprocessing, permanent recording images,
  radiological S&I, pressure gradient measurements
  when performed, flush aortogram when
  performed; unilateral
  36252   bilateral
 Guidelines for Vascular Inj Procedures revised to
  remove reference to “Catheters, drugs and contrast
  media are not included in the listed service for the
  inj procedure” because many of the procedures
  include catheters
 New: 36253 Superselective cath placement (one or
  more 2nd or higher renal artery branch(s) renal
  artery and any accessory remal artery(s) for renal
  angiography, includes arterial puncture, cath, fluoro,
  contract inj(s), image post-processing, permanent
  recording of images, radiological S&I, pressure
  gradient measurements when performed and flush
  aortogram when performed, unilateral
       36254 bilateral
 New: 37191 Insertion intravasular vena cava filter,
  endoscopic approach including vascular access,
  vessel selection, radiological S&I, ontraprocedural
  roadmapping, imaging guidance (u/s and fluoro)when
 New: 37192 Repositioning intravasular vena cava
  filter, endoscopic approach including vascular access,
  vessel selection, radiological S&I, intraprocedural
  road-mapping, imaging guidance (u/s and
  fluoro)when performed
 New: 37193 Retrieval (removal) intravasular vena
  cava filter, endoscopic approach including vascular
  access, vessel selection, radiological S&I,
  intraprocedural road-mapping, imaging guidance (u/s
  and fluoro)when performed
 New:  37619 Ligation of inferior vena cava
 Deleted: 37620 and 75940 and rplaced with
  three New codes (previous slide) for reporting
  intravascular vena cava filter procedures via
  endovascular approach

 New: 38232 Bone marrow harvesting for
 transplantation, autologous
 Revised: 47000 includes mod sedation
 Deleted: 49080, 49081 and replaced with 3
  New codes:
  49082 Abdominal paracentesis (diagnostic or
   therapeutic); w/o imaging guidance
  49083 Abdominal paracentesis (diagnostic or
   therapeutic); w/imaging guidance
  49084 Peritoneal lavage, including imaging
   guidance, when performed
 Guidelines revised for Injection, Drainage or
  Aspiration: Fluoro can be reported separately
  when used for placement of injections w/
  62310-62319; Proper use of 62310-62311 and
  62318-62319; and Indirect visualization
 Revised: 62367 to specify that it does not
  include refilling of a programmable, implanted
  pump that is used for intrathecal or epidural
  drug infusion
 New: 62369 reported when a physician’s skill is
  not required to perform the service and 62370
  is reported when the service does require a
  physician’s skill
   Revision: 63202-63035 codes used for open laminotomies done
    w/ direct visualization
   Reference: if laminotomy is percutaneuos approach, report w/
   Revision: 64553, 64555, 64561, 64565, 64575, 64580, 64581,
    64585 to include, “array”
   Deleted: 64560, 64577
   Revision: Guidelines for Neurolytic Agent
   Deleted: 64622-64627 replaced by 4 New codes:
     #64633 Destruction by neurolytic agent, paravertebral facet joint
      nerve(s) w/ imaging guidance (fluoro or CT); cervical or thoracic,
      single facet joint
     #+64634 each addt’l facet joint
     #64635 Destruction by neurolytic agent, paravertebral facet joint
      nerve(s) w/ imaging guidance (fluoro or CT); lumbar or sacral, single
      facet joint
     #+64636 each addt’l facet joint
 Deleted:   69802

 Revised: 70355 now includes (eg panoramic views)
 Deleted: 71900, report with 33206-33249
 Revision: 72114 now states, “views, minimum of
  6views”; 72120 now includes, “bending views only, 2
  or 3 views”
 Deleted: 73542 . Reference: Radiology service
  included w/ 27096
 New: 74174 CT angiography,ab & pelvis w/ contrast,
  including noncontrast images, if performed and
  image postprocessing
 Deleted: 75722, 75724. Report w/ 36251, 36253,
  36252, 36254
 Deleted: 75940, report w/37191
 Revision: 75962, 75964 w/ the addition of 37193,
  cross-reference added here for removal of vena
  cava filter
 Revision: 77003 removed reference for sacroiliac
  and neurolytic agent destruction
 Deleted: 77079, 77083
 New: #77424 Intraop radiation tx delivery, x/r,
  single tx session; #77425 Intraop radiation tx
  delivery, electrons, single tx session; #77469
  Intraop radiation management
 Deleted: 78220, 78223
 New: 78226 Hepatobilliary system imaging, including
  gallbladder when present; 72887 w/ pharmacologic
  intervention, including quantitative measurement(s)
  when performed
 In the Nuclear Medicine-Respiratory System, 9 codes
  deleted, 78584-78596, and 4 New added:
       78579 Pulmonary ventilation imaging
       78582 Pulmonary ventilation imaging and perfusion
       78597 Quantitative differential pulmonary perfusion,
        including imaging when performed
       78598 Quantitative differential pulmonary perfusion and
        ventilation, including imaging when performed
   New Section: Molecular Pathology which includes 101
    new codes!!Review all guidelines and definitions as
    well as recognize the new section is further divided
    into 2 subsections, Tier 1 and Tier 2 procedures

 Revised: 90460, 90461
 Deleted: 90470, 90663
 New: 90869 reports subsequent motor threshold
 Deleted: 92070; replaced with 2 New codes:
       92071 Fitting of contact lens for tx of occular surface disease
       92092 Fitting of contact lens for management of keratoconus,
        initial fitting
   Deleted: 92129, 92130
   New: #92558 Evoked otoacoustic emissions, screening,
    automated analysis
   Revised: 92605; use new code 92618 report the time of service
    and that the service must be face-to-face w/ the patient
   New Sub-Section added to Medicine/Noninvasive Vascular
    Diagnostic Studies, entitled Other Noninvasive Vascular
    Diagnostic Studies with new code 93998 for unlisted noninvasive
    vascular diagnostic studies
   The Pulmonary subsection has many revisions to combine a
    number of procedures that are commonly performed together for
    pulmonary testing procedures; some deletions of codes that
    were previously separately
   Revisions: 95975-+95975 have minor descriptor changes; 95990-
    95991 revised to included electronic analysis of the pump when
   Revised: 96367 states it is a al infusion of a new drug/substance
 59New codes, 5 Revised codes and 1 deleted
 code. Cat II codes are used for supplemental
 tracking for performance measurement under
 Medicare’s PQRI or private payor-for-
 performance program(s). Codes remain optional
 and are not tied to a fee schedule
 31 New codes, 3 Revised codes, 9 Deleted
 codes. Cat III Guidelines have been revised and
 expanded to better explain the rules and the
 archiving process. The 5 year rule remains but
 if it is determined that a temporary code is still
 needed, it may remain a Cat III and be shelved.
  Happy 2012 Coding!

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