There are over 500 CPT® code changes for 2012. Some changes are minor revisions to clarify code use and consistency with terminology for code descriptions. There are new combination codes to report the surgical service and radiology supervision and interpretation. The sections of CPT® with the most code changes are integumentary, respiratory, cardiovascular and laboratory and pathology.
Evaluation and Management
The new and established patient descriptions were revised to include "exact same specialty and subspecialty who belong to the same group practice." This clarification can be helpful for providers in multi-specialty offices. Although a patient may be "established" with a physician in the practice, if referred to a physician of a different specialty or subspecialty, the service can be billed as a new patient. For example, a patient is seen by a family medicine physician for years. The patient develops diabetes mellitus and the family medicine physician refers the patient to an endocrinologist in the same group practice. When the patient is seen by the endocrinologist, the service can be billed as a new patient because she is being seen by a physician of a different specialty.
Skin Replacement Surgery
Significant changes were made to codes in the skin replacement surgery subsection. Prior to 2012, codes for skin replacement surgeries were selected based on the type of skin substitute that was used as well as the location and size of the defect. Codes in ranges 15300-15431 have been deleted and replaced with eight new codes which simplify coding. In order to select the new skin substitute graft codes, you need to know the location and total wound surface area. For wounds of the trunk, arms and legs that measure up to 100 sq cm, report codes 15271-15272. If the total wound surface area is greater than or equal to 100 sq cm for adults and children 10 years of age or older or 1% in infants and children, report 15273-15274. For all other anatomic sites, report 15275-15276 for wounds that measure up to 100 sq cm. Wounds with a total wound surface area greater than or equal to 100 sq cm for adults and children 10 years of age or older or 1% in infants and children, report 15273-15274. For example, a patient requires a skin graft using a skin substitute to repair a 127 sq cm wound on the patient's back. The correct codes are 15273 for the first 100 sq cm and 15274 for the remaining 27 sq cm.
Repair (Closure)
There were not any code changes in the repair subsection but there was a revision to the coding guidelines. According to CPT® coding guidelines, "when more than one classification of wounds is repaired, list the more complicated as the primary procedure and the less complicated as the secondary procedure, using modifier 59." This is a change in the guidelines but does not mean that all payers will require the use of modifier 59 when reporting multiple repairs from different classifications. It is important to review the changes to the guidelines and parenthetical notes as well as the code changes. The changes to guidelines and parenthetical notes are printed in green and have the bow tie symbol at the beginning and end of the code revision. There is another example of a revision to a parenthetical note following revised codes 22520-22522 to alert the coder that a bone biopsy (20225) is included when performed on the same level as the vertebroplasty.
Lungs and Pleura
There were many revisions to code descriptions in this category for consistency in code description. New codes were added to report biopsy(sies). The new codes are selected based on the approach and the type of tissue biopsied. Also notice that biopsy is pleural so if more than one biopsy is taken on the same lung the codes are only reported once. Biopsies performed by thoracotomy are reported with 32096-32098. Biopsies performed using Video-assisted thoracic surgery (VATS) are reported with 32607-32609.
Pacemaker or Pacing Cardioverter-Defibrillator
The coding guidelines were revised for reporting pacemakers and cardioverter-defibrillators. Also, a helpful table was added to aid in the selection of the correct codes. New combination codes were added to report the removal and replacement of the pulse generator during the same session for pacemakers (33227-33229) and cardioverter-defibrillators (33262-33264). Prior to 2012, if a pulse generator was removed and replaced, two codes were required. If during the same session a pulse generator is removed and replaced and the leads are also replaced, it may require up to three codes if it is a multiple lead system (three or more chambers of the heart). For example, if a patient requires a removal and replacement of a pulse generator and leads for a dual lead system, report 33233 Removal of permanent pacemaker pulse generator only and 33208 Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular.
Vascular Injection Procedures
Three new codes were created to report the selective catheter placement of renal arteries. The codes include access, imaging guidance, contrast injections, images processing, permanent image recording and radiological supervision and interpretation. All the services for this procedure can now be reported with one code. The codes are selected based on the order and if the procedure is performed unilaterally or bilaterally.
Destruction by Neurolytic Agent
Codes 64622-64627 were deleted and replaced with new codes (64633-64636) to report the 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). Imaging guidance is included and should not be reported separately. If the procedures are performed bilaterally, append modifier 50.
Laboratory and Pathology
An entire new section was created for molecular pathology. There are 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.
It is important to review all the new, revised and deleted codes each year. Make sure to update superbills/encounter forms and coding tools. Review all coding guidelines and parenthetical notes. This is extremely important because often information regarding bundling of services is covered in the guidelines and parenthetical notes.
Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC has over 15 years experience in the medical field. She manages the clinical development of the AAPC exams program. She oversees the development of exam content for all certification exams and exam preparation material such as study guides and practice tests. She assisted with the development of the Medical Coding Training CPC curriculum that is used by PMCC licensed instructors and the AAPC distance learning course. She has also served as national externship director for the AAPC's Xtern program and as advertising coordinator.
Prior to joining the AAPC, she spent many years at ConCorde Career Institute, Fla., where she served in several roles, including as an instructor and program director for the coding and medical assistant programs. Ms Jimenez has also worked as a billing and coding manager and medical assistant. Ms Jimenez received her Bachelor of Arts degree in psychology from Florida Atlantic University.
