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.