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2011 CPT CHANGES New Haven Local Chapter January , 201

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2011 CPT CHANGES New Haven Local Chapter January , 2011 Presented by Kelly M. Anastasio 38 new codes, 20 revised and some deletions as well as resequenced codes ... – PowerPoint PPT presentation

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Title: 2011 CPT CHANGES New Haven Local Chapter January , 201


1
2011CPT CHANGES
  • New Haven Local Chapter
  • January , 2011
  • Presented by
  • Kelly M. Anastasio

2
A Continuation Of 2010 Resequencing CPT Codes
  • AMA developed a resequencing system in 2010 to
    assist with integrating new codes into existing
    code families regardless of the availability of
    sequential numbers
  • In other words, 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 code

3
Introduction of the CPT Codebook
  • The new subheading, TIME has been added to
    follow the subheading, SPECIAL REPORT
  • This new subsection informs the physician and
    coder of the standards that must be followed when
    time is the basis for code selection
  • Time is the face-to-face time with the patient a
    unit of time is attained when the mid-point has
    been passed

4
Evaluation and Management
  • A great tool, EVALUATION and MANAGEMENT
    TABLES, has been added for assistance in
    appropriate EM code selection
  • The tables are housed just after the Illustrated
    Anatomical and Procedural Reviews and just before
    the EM Service Guidelines begin
  • Hospital Observation Services section has
    significant revisions.
  • The last sentence of the Hospital Observation
    Services Guidelines, Typical times have not yet
    been established for this category of services
    was deleted.
  • We have the addition of three new resequenced
    codes in the Subsequent Hospital Observation
    Subsection
  • 99224, 99225 and 99226

5
Evaluation and Management
  • The Critical Care Service guidelines (paragraph
    6) were revised to clarify that the technical or
    facility component of ancillary services is not
    packaged into the critical care codes. The
    following statement has been added, Facilities
    may report the above services separately.
  • For reporting by professionals, was also added
    to the beginning of paragraph 6
  • Pediatric Critical Care Patient Transport
    guidelines were revised to describe services that
    are inherent and not separately reportable.

6
Surgery
  • 55 revised codes and 62 new codes extensive
    revisions have been made in the Integumentary
    System MS System has 12 revised codes numerous
    Cardiovascular System changes 15 new codes in
    Digestive System and many changes, revisions,
    additions or deletions to Urinary, Male, Female,
    Nervous, Eye/Ocular and Auditory Systems

7
Integumentary System
  • Complex Repair section guidelines revised to
    clarify the necessary preparation includes
    creation of a limited defect for repairs or
    debridement of complicated lacerations or
    avulsions. They also further inform the
    physician and coder that the complex repair codes
    do not include excision of benign or malignant
    lesions, excisional prep of a wound bed or
    debridement of an open fx or dislocation.
  • Skin Replacement/Skin Substitute Guidelines now
    have two subheadings to clarify the reporting of
    Surgical Preparation and Application of Skin
    Replacements and Skin Substitutes

8
Integumentary System
  • New guidelines to define wound debridement and
    surface area related debridement of subcutaneous
    tissue, biofilm, epidermis, dermis, muscle and/or
    fascia.
  • Excision and Debridement subheading revised,
    removing reference to excision because there is
    no distinction between excision and debridement
  • Codes 11010,11011 and 11012 were editorially
    revised for standardization of the nomenclature
    to describe debridement including removal of
    foreign material at the site of an open fx and/or
    dislocation (eg excisional debridement) skin and
    subcutaneous tissues, muscle fascia, muscle and
    bone

9
Integumentary System
  • Skin debridement codes, 11040-11041 have been
    deleted and you are instructed to report 97597
    and 97598 for debridement of skin, ie, epidermis
    and/or dermis only
  • 11042-11044 were revised by surface area and
    depth and the depth was further split into four
    levels of wound surface ( epidermis/dermis,
    subcutaneous tissue, muscle, bone)
  • Three new add-on codes, 11045, 11046 and 11047
    were added to report each addtl 20 sq cms

10
Musculoskeletal System
  • 20000 has been deleted
  • 20005 was revised to define the depth of the
    incision and drainage
  • Requiring general anesthesia has been removed
    from 20664
  • 20930 now includes osteopromotive material and
    20931 is no longer a child code and is used to
    identify structural allograft in spine surgery
    only
  • 22315 was revised to remove with or without
    anesthesia

11
Musculoskeletal System
  • 22551 Arthrodesis, anterior interbody, including
    disc space prep, discectomy, osteophytectomy and
    decompression of spinal cord and/or nerve roots
    cervical below C2 has been added as well as the
    add-on code 22552 for each addtl interspace
  • 22851 was revised to remove threaded bone
    dowel(s) as it is rarely used
  • Three new codes for hip arthroscopy have been
    added
  • 29914 Arthroscopy, hip, surgical with
    femoroplasty
  • 29915 with acetabuloplasty
  • 29916 with labral repair

12
Respiratory System
  • Three new codes to represent endoscopic dilation
    of the sinus ostia 31295 Nasal/Sinus endoscopy,
    surgical with dilation of maxillary sinus
    ostium, transnasal or via canine fossa 31296
    with dilation of frontal sinus ostium 31297 with
    dilation of sphenoid sinus ostium
  • Revised guidelines state 31295-31297 describe
    dilation, any method and fluoroscopy is included
    when performed and these codes are used to report
    unilateral procedures unless otherwise stated
  • 31634 has been established to report bronchoscopy
    with balloon occlusion, with assessment of air
    leak, with administration of occlusive substance,
    if performed

13
Cardiovascular System
  • 33411 has been revised by replacing cusp with
    sinus as the noncoronary sinus
  • Three new codes have been established in the
    Single Ventricle and Other Complex Cardiac
    Anomalies section 33620 Application of rt and lt
    pulmonary artery bands 33621 Transthoracic
    insertion of catheter for stent placement with
    catheter removal and closure 33622
    Reconstruction of complex cardiac anomaly with
    palliation of single ventricle with aortic
    outflow obstruction and aortic arch hypoplasia,
    creation of cavopulmonary anastomosis and removal
    of rt and lt pulmonary bands

14
Cardiovascular System
  • 33861 has been deleted and 33860, 33863 and 33864
    have been revised to more accurately describe
    ascending aorta graft procedures for thoracic
    aortic aneursym
  • 33863 has been revised to describe aortic root
    replacement using a valved conduit rather than a
    composite prosthesis
  • 33864 has been revised to specify remodeling of
    aortic root rather than the aortic annulus
  • 34900 has inserted, using ilio-iliac tube
    endoprosthesis and striking the phrase, graft
    placement for

15
Cardiovascular System
  • 35454, 35456, 34459, 35470, 35473, 35474,
    35480-35485 and 35490-35495 have been deleted to
    accommodate the edition of the new lower
    extremity endovascular revascularization
    procedures (37220-37235).
  • 35536 and 35626 have been revised to include the
    aortoinnominate vein and to specify the
    aortocarotid vein.
  • Throughout the Vascular Injection Procedures,
    cross references and parenthetical notes have
    been added to direct the coder to the new cardiac
    catheterization and injection procedure codes in
    the Medicine Section

16
Cardiovascular System
  • AMA has addressed the entire spectrum of
    endovascular lower extremity revascularization
    procedures and as a result the following changes
    were instituted in CPT 2011
  • Two new subsections were added Endovascular
    Revascularization (Open, Percutaneous,
    Transcatheter) and Atherectomy (Open,
    Percutaneous) for Supra-Inguinal Arteries
  • New guidelines were written to specifically
    provide information on the procedures as well as
    defined instruction for appropriate reporting
  • Modifier 59 should be used when reporting
    different legs being treated, even if the mode of
    therapy is different

17
Cardiovascular System
  • 37220-37223 were added to describe procedures
    performed in the iliac vascular territory (i.e.
    common iliac, internal iliac, external iliac)
  • 37224-37227 describe procedures performed in the
    femoral/popliteal territory
  • 37228-27235 describe procedures performed in the
    tibial/peroneal territory (i.e. anterior tibial,
    posterior tibial, peroneal arteries)
  • All above codes include moderate sedation and
    should not be reported separately

18
Hemic and Lymphatic System
  • 38900 is a new add-on code for Intraopertive
    identification of sentinal lymph node(s) includes
    injection of non-radioactive dye, when performed

Mediastinum and Diaphram
  • A number of parenthetical notes have been added
    for instructional guidance within 39501 and 39503
    to synchronize with the changes made in the 4300
    series for esophageal procedures

19
Digestive System
  • Add-on code 43283 has been established to report
    a laparoscopic esophageal lengthening procedure
  • 43324, 43326 have been deleted 43327 and 43328
    have been established to identify open
    esophagogastric fundoplasty procedures via
    laparotomy or thoracotomy
  • 43332-43338 have been established to identify
    hiatal hernia repair procedures using various
    approaches
  • 43600 has been deleted as this was considered
    obsolete and 43605 has been changed to a parent
    code and revised to include, biopsy of the
    stomach

20
Digestive System
  • Five new codes for reporting diagnostic and
    therapeutic gastric and duodenal intubation and
    aspiration procedures have been established,
    43753-43757
  • Guidelines have been revised in the Rectum,
    Endoscopy subsection to assist in accurate
    reporting in the instance when the physician is
    unable to advance the colonoscope beyond the
    splenic flexure due to unforeseen circumstances
    when the procedure was scheduled for a total
    colonoscopy
  • Cholecystotomy codes have been editorially
    revised to instruct code 47480 is intended to
    describe an open procedure and 47490 is intended
    to include bundled service of a percutaneous
    approach with radiological SI

21
Digestive System
  • 49324 has been revised to describe tunneled
    intraperitoneal cath, rather than cannula or
    permanent cath
  • Add-on code 49237 has been established to
    describe laparoscopic intra-abdominal intrapelvic
    and/or intraperitoneal placement of interstitial
    device(s) for radiation therapy guidance
  • Many additions, revisions and deletions from the
    Abdomen, Peritoneum and Omentum/Introduction
    Revision/Removal section to represent current
    practice add-on code 49412 describes open
    intra-abdominal, intra-pelvic and/or
    retroperitoneum placement of interstitial
    device(s) for radiation therapy guidance

22
Digestive System
  • 49418 has been added to identify the complete
    procedure for percutaneous insertion of tunneled
    intraperitoneal cath
  • 49420 has been deleted

23
Urinary System
  • 50542 has been editorially revised to clarify
    ultrasonic guidance is inherent in the service
  • 53860 is the new code that replaces the previous
    Cat III code, 0193T, which describes
    transurethral radiofrequency micro-remodeling for
    stress urinary incontinence
  • MALE GENITAL SYSTEM
  • 55866 has been revised to include, includes
    robotic assistance
  • FEMALE GENITAL SYSTEM
  • 57155 has been revised to change tandems from
    plural to singular
  • 57156 has been added to represent the insertion
    of vaginal radiation afterloading apparatus for
    clinical brachytherapy

24
Nervous system
  • 61795 has been deleted for stereotactic
    computer-assisted volumetric procedure and three
    add-on codes have been added to distinguish
    between the different anatomical regions61781
    stereotactic computer-assisted procedure
    cranial, intradural 61782 cranial, extradural
    and 61783 spinal
  • Parenthetical notes added following 63075 and
    63076 to advise not to report these codes in
    addition to the interbody fusion services even if
    provided by separate providers
  • New subheading, Paravertebral Spinal Nerves and
    Branches has been added to synchronize with the
    changes made for 64479-64484

25
Nervous System
  • 64566 has been added to report posterior tibial
    neurostimulation (PTNS), percutaneous needle
    electrode, single treatment, includes programming
  • 64568 has been added to describe incision for
    implantation of cranial nerve neurostimulator
    electrode array and pulse generator
  • 64569 has been added for revision or replacement
    of cranial nerve neurostimulator electrode array,
    including connection to existing pulse generator
  • 64570 has been added to describe removal of
    cranial nerve neurostimulator electrode array and
    pulse generator

26
Nervous System
  • 64611 has been established for chemodenervation
    of the salivary glands
  • In the Eye and Ocular Adnexa section, 65778
    Placement of amniotic membrane on the ocular
    surface for wound healing self-retaining and
    65779 single layer, sutured have been added for
    procedures on damaged ocular surface tissue
  • Under the Anterior Sclera section, 66174
    Transluminal dilation of aqueous outflow canal
    w/o retention of device or stent and 66175 with
    retention of device or stent have been converted
    from the previous Cat III codes 0176T and 0711T

27
Nervous System
  • 66761 has been revised to state, per session
    instead of 1 or more sessions
  • Revision to the Operating Microscope Guidelines
    to advise the coder not to report with
    22551-22552 as well as 0226T-0227T

28
Radiology
  • Three new Cat I codes for reporting combination
    CT of the ab/pelvis have been established 74176
    CT, ab/pelvis w/o contrast material, 74177 w/
    contrast material, 74178 w/o contrast material in
    one or both body regions followed by contrast
    material(s) and further sections in one or both
    body regions
  • The Aorta and Arteries introductory guidelines
    and cross-reference notes have been updated to
    support the establishment of lower extremity
    endovascular revascularization codes performed
    for occlusive disease (37220-37235)

29
Radiology
  • 76150 and 76350 are obsolete procedures and have
    been deleted from the 2011 CPT code set
  • New codes 76881 US, extremity, nonvascular,
    real-time w/ image documentation complete and
    76882 limited, anatomic specific have been
    established and 76880 has been deleted.
  • In the Radiation Oncology section, the guidelines
    have been revised to clarify the requirements for
    reporting each radiation treatment management
    service and they clarify that the required
    services are included in the Radiation treatment
    Management codes.

30
Pathology and Laboratory
  • Many deletions, 16 new codes as well as
    resequencing of codes in this section
  • 80104 has been added to report specific drug
    screen, qualitative analysis by multiplexed
    method for 2-15 drugs or drug classes
  • Gastric acid analysis codes 82926 and 82928 have
    been deleted and 82930 has been established as a
    more simplified code
  • 83861 has been established for tear analysis by
    direct microfluidic specimen collection and tear
    film osmolarity
  • 84112 has been established to report PAMG-1
    through cervicovaginal secretion

31
Pathology and Laboratory
  • 85598 Phospholipid neutralization hexagonal
    phospholipid has been added
  • 86480 has been revised to report TB testing by
    cell mediated immunity antigen response
    measurement and by gamma interferon and 86467 has
    been added to report TB testing by enumeration of
    gamma interferon-producing T-cells in sell
    suspension
  • 86902 was established to report blood typing,
    antigen screening each antigen test
  • 87501, 87502 and add-on 87503 have been added to
    report influenza virus assay reverse
    transcription and amplified technique by type and
    subtype

32
Pathology and Laboratory
  • Now that raltegravir has been approved for use in
    HIV-naïve patients, it will be important for
    clinicians to determine if there is any
    underlying resistance (per DHHS guidelines) and
    87901 limits reporting the polymerase region of
    the HIV virus and not the integrase region.
    87906 has been established to report HIV-1, other
    regions (eg intergrase, fusion)
  • 88120 and 88121 were established to allow
    specific reporting for multiple probe kits for
    cytopathology
  • 88177 was added to report each separate
    additional evaluation of fine needle aspiration
    to determine adequacy of diagnosis at the same
    site

33
Pathology and Laboratory
  • 88363 was added to accurately report the
    pathologists identification and selection of
    appropriate tumor tissue from previous surgical
    specimen
  • 88749 was established to report unlisted in-vitro
    tests
  • 89225 and 89235 have been deleted because of
    low-volume utilization and obsolete services

34
Medicine Section
  • 38 new codes, 20 revised and some deletions as
    well as resequenced codes
  • Immunization Administration(IA) codes 90465,
    90466, 90467, 90468 have been replaced with two
    codes, 90460 and 90461 to more accurately report
    the time and effort when providing combination
    vaccines
  • 90470 was established in concert with H1N1 code
    90663
  • Several vaccine products have been established
  • 90644 combination vaccine with Hib and
    Meningoccal serogroups CY
  • 90664, 90666, 90667, 90668 became effective July
    1, 2010 and are now enter in Cat I as of January
    1, 2011

35
Medicine Section
  • The Psychiatry section guidelines referring to
    f/u visits have been revised for accurate
    consultation reporting
  • The guidelines for reporting psychotherapy with
    medical eval have been revised to clarify that
    when reporting, face-to-face time includes time
    spent providing both psychotherapy and the e/m
    service
  • 90867 therapeutic repetitive transcranial
    magnetic stimulation tx planning and 90868
    delivery management, per session have been
    added to replace the deleted Cat III codes 0160T,
    0161T
  • 91000 has been deleted as this procedure was
    considered obsolete

36
Medicine Section
  • 91010, 91013 have been established to report
    esophageal motility studies
  • 91011, 91012, 91052, 91055, 91105 and 91123 have
    been deleted
  • 91117 has been added to report colon motility
    studies
  • 92132 has been converted from Cat III code 0187T
    due to the national usage of this code
  • 92133 has been added to report scanning
    computerized ophthalmic diagnostic imaging,
    posterior segment, with interpretation and
    report, uni or bil optic nerve and 92134 for
    retina

37
Medicine Section
  • 92227 and 92228 have been established to report
    remote imaging for screening retinal disease and
    management of active retinal disease
  • Cardiovascular monitoring services guidelines
    have been moved to a new section titled
    Cardiovascular Monitoring Services
  • Telephonic transmission codes 93012, 93014 have
    been deleted to report such services, use
    93268-93672
  • Holter and event monitoring services sections
    have been improved to allow more precise, clear
    reporting

38
Medicine Section
  • 93224-93227 have been revised to describe
    external electrocardiographic recording up to 48
    hrs term wearable was replaced with
    external For less than 12 hours continuous
    reporting, report with mod 52
  • 93268-93272 have been revised to describe
    external patient and when performed autoactivated
    electrocardiographic rhythm derived event
    recording w/ symptom-related memory loop w/
    remote download capability up to 30 days and 24
    hours of attended monitoring

39
Medicine Section
  • Cardiac Catheterization section has been
    restructured to include imaging supervision,
    interpretation and report.
  • Codes 93501, 93508-93529 have been deleted.
  • Codes 93451-93464 have been established to report
    diagnostic cardiac cath.
  • Codes 93452-93461 include contrast injection(s0,
    imaging supervision interpretation and report
  • Cardiac cath for congenital abnormalities are
    still reported with 93530-93533
  • 93462 describes left heart cath by transseptal
    puncture through intact septum or transapical
    puncture

40
Medicine Section
  • 93464 describes physiologic exercise study
    performed in conjunction w/ cardiac cath report
    once per cath procedure
  • Injection procedure codes 93539-93556 have been
    deleted and new codes 93563-93568 have been
    established the new codes include imaging
    supervision, interpretation and report
  • Noninvasive Vascular Diagnostic Studies
    introductory guidelines have been revised
  • Codes 93922-93924 for noninvasive arterial
    physiologic studies have been revised to clarify
    reporting limited bilateral vs one extremity
    which would require appending modifier 52

41
Medicine Section
  • The Medicine/Neurology and Neuromuscular
    Procedures guidelines have been revised to
    clarify that codes 95812-95822, 95920,
    95950-95953 an d95956 use recording time as basis
    for code use
  • In support of the deletion of Cat III codes
    0203T, 0204T, sleep study codes 95800, 95801 have
    been established for unattended sleep study
    testing services
  • 95857 has been revised by deleting Tensilon and
    replacing it with Cholinesterase inhibitor
    challenge
  • New note to advise not to report 95920 for
    Intraoperative neurophysiology test, per hour if
    recoding lasts 30 mins or less
  • New guidelines added in the Special EEG test
    section to clarify 95950-95953 and 95956 are used
    per 24 hrs of recording if recording 12 hours or
    less, modifier 52 is to be appended

42
Medicine Section
  • Revisions have been made for 95953 to include
    unattended and for 95956 to include attended
    by a technologist or nurse
  • 96040 is reported for each 30 min increment of
    face-to-face time not to be reported for 15 mins
    or lt and report 96040 once for each 16-30 mins
  • Central Nervous System guidelines have been
    revised to clarify that a minimum of 31 mins must
    be provided to report any per hour code
  • New code 96446 is used to report chemotherapy
    admin into the peritoneal cavity via indwelling
    port or cath
  • In accordance with the revisions to 11040-11044,
    a note has been listed to instruct users to
    preclude the reporting of 97597-97602 with
    11042-11044

43
Category II and III Codes
  • 31 new codes and 4 new clinical conditions as
    well as 6 revised clinical conditions to the Cat
    II section
  • There are 52 new Cat III codes and 12 deleted
    which the majority of have been converted to Cat
    I codes
  • 0016T unlisted 67299
  • 0017T unlisted 67299
  • 0058T and 0059T have been reinstated
  • 0104T unlisted 93799
  • 0150T unlisted 93799
  • 0130T unlisted 99199
  • 0160T 90867
  • 0161T 90868
  • 0176T 66174
  • 0177T 66175
  • 0187T 92132
  • 0253T insertion anterior segment device,
    internal approach, subrachoroidal space
  • 0203T 95800
  • 0204T 95801

44
Category II and III Codes
  • Five new codes to report automated testing
    performed for audiometry 0208T, 0209T, 0210T,
    0211T, 0212T
  • New codes 0213T-0218T are used to report u/s
    guidance for cervical-thoracic and lumbar-sacral
    facet joint nad median nerve branch diagnostic
    blocks
  • Four new codes to report use of minimally
    invasive technique for fusion of the spinal facet
    joints 0219T-0222T
  • Three new codes to describe acoustic cardiography
    procedures 0223T-0225T
  • 0226T, 0227T are new codes for reporting high
    resolution anoscopy
  • Four new codes, 0228T-0231T, have been added to
    distinguish between use of fluoro and CT guidance
    codes and u/s codes
  • 0232T platelet rich plasma injection any site
  • 0233T multi-wavelength fluorescent spectroscopy
    to measure skin AGEs
  • Five codes, 0234T-0238T, have been added to
    support atherectomy performed by any method in
    arteries and inguinal ligaments

45
Category II and III Codes
  • 0232T platelet rich plasma injection any site
  • 0239T bioimpedance spectroscopy
  • 0240T and 0241T used to report esophageal
    motility studies 3D
  • 0242T GI tract transit and pressure
    measurements via wireless capsule
  • 0243T and 0244T used to report acoustic
    respiratory measurements for diagnostic wheeze or
    cough-related diseases
  • Four new codes have been established to report
    ORIF of rib fxs 0245T-0248T
  • 0249T doppler-guided hemorrhoid ligation
  • Three new codes, 0250T, 0251T, 0252T, have been
    added for bronchoscopic procedures for insertion
    and removal of bronchial valves
  • 0254T, 0255T endovascular repair of iliac
    artery bifurcation procedures
  • 0256T,0257T implantation of a cath-delivered
    prosthetic aortic heart valve
  • 0258T, 0259T transthoracic cardiac exposure

46
Lastly
  • Appendix A has updated modifiers 50, 76, 77 and
    78
  • Appendix I has been revised to include revisions
    and additions of modifiers to the genetic testing
    code modifiers Histocomparibility/Blood
    Typing/Identity/Microsatellite list
  • HAPPY NEW YEAR AND HAPPY CODING!
  • Kelly.anastasio_at_yale.edu
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