2012 cpt update.pptx [read-only] - wolterskluwerlb.comophthalmology 2012 cpt update 37. 42 5 1 0011...

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coding Compliances o l u t i o n s

2012 CPT Update

Georgeann Edford, RN, MBA, CCS-P

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Agenda

• CPT

– Reorganization

– Bundling

– Deletion

• RBRVS

– Valuation

• Hot Topics

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Which Came First

EGG?

CHICKEN?

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Annual CycleCPT

EditorialPanel

Level ofInterest

Survey

SpecialtyRVS

Committee

RUCReview

CMS

MedicarePaymentSchedule

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Process to Improve Valuation

RUC

• Objective Screens– New Technology

– Site of Service Anomalies

– High Growth

– High Intra-service work

– Services originally surveyedby one specialty and nowperformed by another

– Harvard Valued Utilization

– Bundled CPT Services

CMS

• Fastest Growing

• Low Value but billed inmultiple units

• Low Value but high volumecodes

• Multi-Specialty Points ofComparison List

• CMS High Expenditurecodes

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Code Valuation

• Total Number of Codes Identified 1199

• Codes Completed 896

• Codes Under Review 303

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Key Issues

• Bundling of 2 or more procedures done atthe same time into one CPT code

• Clarification of code usage via guidelines,and parentheticals

• Movement away from specificmanufacturers and type of graft

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Major Code Groups Changed

• Audiology

• Cardiology

• Cardiothoracic Surgery

• E&M

• General Surgery

• Neurology

• Ophthalmology

• Orthopedics

• Pain Management

• Pathology

• Prevention

• Pulmonary

• Radiology

• Vascular Surgery

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General Surgery Changes

• Debridement Guidelines

• Repair Closure Guidelines

• Chronic Wound Dermal Substitute

• Digestive System

• Female Genital System

– Colpopexy

= New or Revised Text

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Wound Care

• Debridement (11042 – 11047)

– Reported for injuries, infections, wounds andchronic ulcers

– Single wound: depth using the deepest level

– Multiple wounds: sum the surface area of thesame depth but do not combine if differentdepths.

• Document wound measurements!

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Repair (Closure) Guidelines

• When more than one classification ofwound is repaired, list the more complicatedas the primary procedure.

• Rationale for change was to moreappropriately describe the scenarios listed;

• Modifier 59 has now replaced modifier 51in the instructions of number 2 and 4 of therepair guidelines.

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Skin Replacement SurgeryGuidelines

• Skin replacement surgery consists ofsurgical preparation and topical placementof an autograft (including tissue culturedautograft) or skin substitute graft (i.e.homograft, allograft, xenograft).

• Measurement guidelines should be appliedto codes that reference “100 sq cm or 1% ofbody area of infants and children.”

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Other Changes - Surgery Section

• Laparoscopy Stomach (43647) parentheticalchanges removing reference to Category IIIcodes 0155T, 0156T)

• Anoscopy (46615) added a parenthetic notereferencing Category III code 0288T fordelivery of thermal energy.

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Other Changes - Surgery

• 47000 Biopsy Liver

• Colpopexy - Parenthetical note addedfollowing intraperitoneal colpopexy 57283instructing user NOT to report code 57283with codes 57556, 58263, 58270, 58280,68292 and 58294.

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ORTHOPAEDICS

2012 CPT Update

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Musculoskeletal System

• Two new codes added for Dupuytren’scontracture

– Newly added cross-references

– Instruction note added following code 26341

• 20527 – Injection, enzyme (e.g.collagenase), palmar fascia cord

• 20550 – Injection(s), single tendon sheathor ligament, aponeurosis (e.g. plantarfascia)

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Spine (Vertebral Column)

• Revised parenthetical note directing users tothe injection procedure for facet joint codes.

• Exclusionary parenthetical added followingcodes for vertebroplasty (22520 – 22522)

• Exclusionary parenthetical revisedfollowing the codes for kyphoplasty(22523-22525)

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Arthrodesis Changes

• Parenthetical notes added through out thissection

• Two new codes were added for lumbararthrodesis– 22633 – Arthorodesis, combined posterior or posterolateral

technique with posterior interbody technique includinglaminectomy and or discectomy sufficient to prepare interspace(other than for decompression) for each interspace and segment

– 22634 – each additional space and segment

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Casting and Strapping Changes

• Newly added series of codes to reportapplication of multilayer compressionsystem

29581 - Application of multilayer compressionsystem; leg (below knee), including ankle and foot– 29582 - thigh and leg, including ankle and foot, when

performed

– 29583 - upper arm and forearm

– 29584 - upper arm, forearm, hand, and fingers

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CARDIOTHORACIC SURGERY

2012 CPT Update

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Lung and Pleura Changes

• New codes were added to the Lung andPleura section for biopsy(ies) performed viaThoracotomy– 32096 – Thoracotomy, with diagnostic biopsy(ies) of

lung infiltrate(s) (eg, wedge, incisional), unilateral

– 32097 – Thoracotomy, with diagnostic biopsy(ies) oflung nodules(s) or mass(es) (eg, wedge, incisional),unilateral

– 32098 – Thoracotomy, with biopsy(ies) of pleura

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• New codes were added to the Lung andPleura section for biopsy(ies) performed viaThoracoscopy

• 32607 – Thoracoscopy; with diagnosticbiopsy(ies) of lung infiltrate(s) (eg, wedge,incisional), unilateral

• 32608 - with diagnostic biopsy(ies) of lungnodule(s) or mass(es) (eg, wedge, incisional),unilateral

• 32609 - with biopsy(ies) of pleura

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Lungs and Pleura Revisions

• New codes were added to the surgicalthoracoscopy section

• 32666 – Thoracoscopy surgical; with therapeutic wedgeresection (eg, mass, nodule), initial unilateral

+ 32677 - with therapeutic wedge resection (eg, mass,nodule each additional resection, ipsilateral

+ 32668 with diagnosis wedge resection followed byanatomic lung resection

• 32669 - with removal of single lung segment

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• 32670 – with removal of two lobes (bilobectomy)

• 32671 – with removal of lung (pneumonectomy)

• 32672 – with resection-plication for emphysematous lung(bullous or non-bollous) for lung volume reduction (LVRS)unilateral includes any pleural procedure when performed

• 32673 – with resection of thymus, unilateral or bilateral

+ 32674 – with mediastinal and regional lymphadenectomy

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CARDIOLOGY

2012 CPT Update

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Cardiology Update

• Pacemaker or Pacing Cardioverter-Defibrillator

– Revised guidelines including new definitions• Radiological supervision and imaging is included

in these codes (CPT 71090 was deleted)

• Numerous revised codes

• Many new codes

• New table in Book to help with coding

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Cardiology Update

• New codes were added to the Pacemaker or PacingCadioverter-Defibrillator section

• 33221 – Insertion of pacemaker pulse generator only; with existingmultiple leads

• 33227 – Removal of permanent pacemaker pulse generator withreplacement of pacemaker pulse generator; single lead system

– 33228 - dual lead system

– 33229 - multiple lead system

33240-Insertion of single or dual chamber pacing cardioverterdefibrillator pulse generator only; with existing single lead

– 33230 – with existing dual leads

– 33231 – with existing multiple leads

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Cardiology Update

• 33262 – Removal of pacing cardioverter-defibrillator pulse generator withreplacement of pacing cardioverterdefibrillator pulse generator; single leadsystem

– 33263 - dual lead system

– 33264 - multiple lead system

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Other changes – Cardiology

33249 –

Insertion or repositioning replacement ofelectrode permanent pacing cardioverter-defibrillator system with transvenous lead(s)for, single or dual chamber pacingcardioverter-defibrillator and insertion ofpulse generator

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VASCULAR SURGERY

2012 CPT Update

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Vascular Injection Updates

• AV Shunts for Dialysis (Diagnostic Studies)– New guidelines for Diagnostic Studies of Arteriovenous (AV)

shunts for dialysis explain appropriate reporting for 36147 &36215

– Code 36147 includes the work of directly accessing and imagingthe entire AV shunt

– 76937 is reported for Ultrasound guidance

– Arterial inflow is reported separately (eg, 36215 – 1st order, but not36200) if the catheter is advanced to the location proximal to anddistinct from the arterial anastomosis

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• The moderate sedation symbol has beenadded to the selective catheterization codes36200, 36245, 36246, 36247 and 36248 toindicate that moderate sedation is includedas part of the procedure

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• Four new codes were added for SelectiveCatheterization – Renal Angiography

• 36251 – Selective catheter placement (1st order), mainrenal artery an any accessory renal artery(s) for renalangiography; unilateral– 36252 - bilateral

– 36253 – Superselective catheter placement (one or more secondorder or higher renal artery branches; unilateral

– 36254 - bilateral

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IVC Filter Transcatheter Procedures

• Includes:

– Venous non-selective and selective cathetermanipulation required to image the IVC andrenal veins

– Filter deployment/manipulation/removal

– Post-procedure completion angiography

– Ultrasound guidance for venous access

– Intravascular ultrasound

– Moderate Sedation

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PAIN MEDICINE

2012 CPT Update

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Pain Management –New Guidelines

• Use of Fluoroscopy

• Placement and use of a catheter

• Threading a catheter

• Intermittent bolus

• Reporting codes 62310 – 62319

• Percutaneous spinal procedures

• Endoscopic assistance during an openprocedure 36

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OPHTHALMOLOGY

2012 CPT Update

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Ophthalmology(Special Services)

• 92070 has been deleted. To report, seecodes 92071, 92072

• 92071 – Fitting of contact lens for treatment ofocular surface disease

• 92072 - Fitting of contact lens for managementof keratoconus, initial fitting

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Ophthalmology –Glaucoma Testing

• Tonometry is bundled into eye exam

• Ocular blood flow measurement are reported withCategory III code 0198T – Measurement of ocular bloodflow by repetitive intraocular pressure sampling, withinterpretation and report

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coding Compliances o l u t i o n s

BREAK

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RADIOLOGY

2012 CPT Update

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Radiology – Surgery

• CPT codes 49080, 49081 have been deleted.

• 49082 – Abdominal paracentesis (diagnostic ortherapeutic); without imaging guidance– 49083 - with imaging guidance

• 49084 – Peritoneal lavage, including imaging

guidance, when performed.

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Abdominal and Pelvic CTA

CTA – computed tomographic angiography

• 74174 – Computed tomographicangiography, abdomen and pelvis, withcontrast material(s), including noncontrastimages, if performed, and imagepostprocessing

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Nuclear Medicine

• 78226 – Hepatobiliary system imaging,including gallbladder when present;

• 78227 - with pharmacologic intervention,including quantitative measurement(s) whenperformed

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Radiation Oncology

• 77424 – Intraoperative radiation treatmentdelivery, x-ray, single treatment session

• 77425 - Intraoperative radiation treatmentdelivery, electrons, single treatment session

• 77469 – Intraoperative radiation treatmentmanagement

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Radiation Oncology

• New Guidelines for Treatment Management– Units of five; fractions or sessions

– Includes minimum of one exam by a physician formedical E&M

– 77469 represents only the intraoperative sessionmanagement and not E&M outside of that session

– Professional services include review of port films,dosimetry, does delivery and treatment parameters andreview of patient treatment set-up

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PATHOLOGY

2012 CPT Update

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Molecular Pathology

• Entire New Section

– Guidelines and Introductory Notes

– Definitions

– Tier 1• 92 new codes

• Human Leukocyte Antigen (HLA) typing

– Tier 2

• 9 new code/Levels

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HIV Testing

• A combined single result assay to identify patients infectedwith HIV utilizes testing for:

– HIV - 1 antigen (p24)

– HIV – 1 antibodies (HIV group M and group O)

– HIV – 2 antibodies

• 87389 – Infectious agent antigen detection by enzymeimmunoassay technique, qualitative or semiqualitative,multiple step method; HIV-1 antigen(s), with HIV-1 andHIV 2 antibodies, single result

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Pathology/Lab Modifier 92

• Alternative Laboratory Platform Testing

– When a lab test is being performed using a kitor transportable instrument that wholly or in patconsists of a single use, disposable analyticchamber, the service may be identified byadding the 92 modifier to the usually laboratoryprocedure.

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Surgical Path

• Special Stains Revised to:

– Better define these special stains

– Eliminate confusion where two code definitionsmay overlap

– Deleted code 88318

– Revised code 88314 and 88319

– Defined units of service

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AUDIOLOGY

2012 CPT Update

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Audiology/SLP/Otolaryngology

• Audiologic Function Tests– New code 92558 for differentiating limited evoked

otoacoustic testing.

– Codes 92587 and 92588 revised

• Evaluation and Therapeutic Services– 92605 revised to include time

– 92518 New add-on code to report additional 30 minutes

– 92621 Language revised to reflect standard add-on code

• 69802 has been deleted53

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PULMONARY MEDICINE

2012 CPT Update

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Overview of Code Changes

• Pulmonary Function Testing (PFTs)

– Deleted codes

– New codes

– New Instructions on Existing Codes

• Car seat/Bed testing

• Category III Tracking codes

– Bronchial Thermoplasty

– Wheezometry55

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PFTs

• 10 codes deleted

DeletedCode

Description New Code Description

93720 Plethysmography, complete

94726Plethysmographyfor determinationof lung volumes

93721 Plethysmography, tracing

93722 Plethysmography,interpretation & report

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NEUROLOGY

2012 CPT Update

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Neurology & NeuromuscularProcedures

• 5 New Codes

• 6 Revised Codes

• 17 New/Revised Guidelines

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Evoked Potentials & Reflex Tests

• New Code

– #95939 – Central motor evoked potential study(Transcranial motor stimulation); in upper andlower limbs

– Not to be reported with Central motor evokedpotentials in upper or lower limbs. (95928,95929)

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EVALUATION ANDMANAGEMENT

2012 CPT Update

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E&M Changes

• Definition of New & Established patient revised

• Decision tree

• Observation (typical times)

• Prolonged Services (editorial revisions)

• Inpatient Neonatal Intensive Care and Pediatric andNeonatal Critical Care Guideline Revisions

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New and Established Patient

• A new patient is one who has not receivedany professional services from the physicianor another physician of the exact samespecialty and subspecialty who belongs tothe same group practice, within the past 3years.

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Observation Care &Prolonged Services

• Addition of “typical time” to the descriptor.

• “Prolonger Physician Service With Direct(Face To Face) Patient Contact

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Neonatal and PediatricCritical and Intensive Care

• Guideline changes to this subsection todifferentiate provider and facility reportingand new language for transfer of care.

• Guideline and changes to the Initial andContinuing Intensive Care Servicessubsection on transfer of care.

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INFUSIONS

2012 CPT Update

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Hydration, Injections & Infusions

• Guideline revisions – times accessing the secondlumen

• Definitions for Initial, Sequential and ConcurrentInfusions

• E&M codes that can be reported are specified

• Hydration is further defined

• New examples of infusions are added

• 96367 revised to clarify additional newdrug/substances

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PROVISIONS OFAFFORDABLE HEALTH CAREACT – PREVENTIVE SERVICES

2012 CPT Update

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Annual Wellness Visit G0438

• Very limited

• Focused on identifying risk factors

• Not to be confused with “Preventive Visits”

• Consists of:– History (Medical and Family)

– Limited Exam

– Counsel• Written screening schedule

• Establish risk factors - prevention

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QUESTIONS

2012 CPT Update

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2012 cpt update.pptx [read-only] - wolterskluwerlb.comophthalmology 2012 cpt update 37. 42 5 1 0011...

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