Coding & Billing

Financial Management

By: Cristina Bentin

Published: 3/11/2011

Share:

CPT Changes You Need to Know for 2011


By now, you've probably noticed the many CPT code changes to the ASC list for 2011. Here are a few highlights.

Hip arthroscopy
CPT adds 3 new codes for reporting arthroscopic femoroplasty, acetabuloplasty and labral repair. A parenthetical note advises users not to report these codes in conjunction with CPT 29862 or 29863.

  • 29914 — Arthroscopy, hip surgical; with femoroplasty (e.g., treatment of cam lesion) ($1,876.83)
  • 29915 — with acetabuloplasty (e.g., treatment of pincer lesion) ($1,876.83)
  • 29916 — with labral repair ($1,876.83)

Endoscopy
Balloon sinus dilation not only makes its way into CPT but also onto CMS's ASC list of approved surgical procedures. Balloon sinuplasty is an endoscopic, catheter-based procedure performed to alleviate sinusitis. During the procedure, a small, flexible, sinus balloon catheter is utilized to open up blocked sinus passageways by displacement of tissue, restoring normal sinus drainage. Three codes have been established to describe balloon sinuplasty. Instructional notes following these codes preclude the reporting of CPT code(s) 31295-31297 in conjunction with other sinus surgeries performed on the same sinus as the endoscopic dilation.

  • 31295 — Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (e.g., balloon dilation), transnasal or via canine fossa ($1,198.96)
  • 31296 — with dilation of frontal sinus ostium (e.g., balloon dilation) ($1,198.96)
  • 31297 — with dilation of sphenoid sinus ostium (e.g., balloon dilation) ($1,198.96)

Bronchoscopy
Pneumothorax is a commonly encountered disease that may develop into a persistent bronchial-pleural fistula in some patients. Persistent air leaks after spontaneous pneumothorax are common. CPT code 31634 describes a bronchoscopic technique performed to resolve persistent bronchial-pleural fistulas. It includes fluoroscopic guidance when performed.

  • 31634 — Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; w/balloon occlusion, with assessment of air leak, with administration of occlusive substance (fibrin glue), if performed ($406.83)

CPT users should be diligent in reporting the insertion of bronchial valves when applicable in addition to CPT code 31634. Some CPT manuals do not provide a cross reference following CPT 31634 to see new add-on Category III code +0250T.

A cross reference does follow CPT code series 31634-31635 directing users of CPT to see Category III codes 0251T-0252T for removal of implanted bronchial valves.

  • 0250T — Airway sizing and insertion of bronchial valve(s), each lobe (List separately in addition to code for primary procedure) (Use in conjunction with 31622, 31634) ($1109.14)
  • 0251T — Bronchoscopy, rigid or flexible, including fluoro, when performed; with removal of bronchial valve(s), initial lobe ($406.83)
  • 0252T — with removal bronchial valve(s), each add'l lobe ($406.83)

Debridement
CPT revised the language of CPT codes 11010-11012 to specify debridement at the site of an open fracture and/or an open dislocation (excisional debridement) skin and subcutaneous tissues, muscle fascia, muscle and bone. Due to the deletion of skin debridement codes 11040-11041, CPT cross-references direct you to CPT 16020-16030 for debridement of burn wounds or CPT 97597-97598, which aren't on Medicare's ASC-approved list of procedures, for debridement of skin (epidermis and/or dermis only). Clinical documentation must specify the depth of the debridement describing each layer.

  • 11010 — Debridement including removal of foreign material associated with at the site of an open fracture (s) and/or an open dislocation(s) (e.g., excisional debridement); skin and subcutaneous tissues
  • 11011 — skin, subcutaneous tissue, muscle fascia, and muscle
  • 11012 — skin, subcutaneous tissue, muscle fascia, muscle and bone

Report CPT wound debridement codes (11042-11047) by depth using the deepest level of tissue removed. If multiple wounds are debrided, add/sum the surface area of those wounds that are at the same depth, but don't combine sums from different depths. Physicians will be required to detail the depth of the debridement for appropriate reporting.

  • 11042 — Debridement, skin and subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less
  • 11045 — Each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Use add-on code +11045 in conjunction with 11042 ($105.84)
  • 11043 — Debridement, skin, subcutaneous tissue and muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less
  • 11046 — each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Use add-on code +11046 in conjunction with 11043 ($105.84)
  • 11044 — Debridement, skin, subcutaneous tissue, muscle, and bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less
  • 11047 — each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure (Use add-on code +11047 in conjunction with 11044) ($329.04).

CPT cross-reference directs you not to report 11042-11047 in conjunction with CPT codes 97597-97602 for the same wound.

Resequenced codes are flagged with the (#) symbol. CPT includes references at the locations where the out-of-sequenced codes would normally be found, numerically directing you to the appropriate code series.

Eye and ocular adnexa
Category III codes 0016T-0017T, reflecting destruction of localized lesion by transpupillary thermotherapy or destruction of macular drusen, photocoagulation, have been deleted in 2011 with the reporting of either procedure taking a step backwards. Report the unlisted CPT code 67299 for these 2 procedures. CMS doesn't include unlisted procedures on its ASC list of approved procedures.

CPT revised its language for its irodotomy/iridectomy by laser surgery to reflect "per session." For greater specificity, CPT modified Category III code 0191T, insertion of anterior segment aqueous drainage device, to specify "into the trabecular meshwork" and adds yet another Category III code to specify "into the suprachoroidal space."

Due to their conversion to a Category I status, Category III codes 0176T-0177T have been deleted. CPT has established new codes to capture transluminal dilation of aqueous outflow canal w/ or w/o stents. CPT has also established new codes for the placement of amniotic membrane on the ocular surface for wound healing, self-retaining or sutured.

  • 66761 — Iridotomy/iridectomy by laser surgery (e.g., for glaucoma) (1 or more sessions) (per session)
  • 66174 — Transluminal dilation of aqueous outflow canal; without retention of device or stent ($1,675.21)
  • 66175 — with retention of device or stent ($1,675.21)
  • 65778 — Placement of amniotic membrane on the ocular surface for wound healing; self-retaining ($314.70)
  • 65779 — single layer, sutured ($291.90)
  • 0191T — Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach into the trabecular meshwork
  • 0253T — Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the suprachoroidal space ($945.91)

Get Paid Using the PT Modifier When Screening Colonoscopies Become Diagnostic Procedures

After weeks of confusion and rejected claims, carriers should be properly reimbursing GI facilities that use the new PT modifier to bill for Medicare-covered colonoscopies that start out as screening procedures but end up as diagnostic procedures due to the finding of a polyp or some other clinical indication, says the Ambulatory Surgery Center Association.

The problem stemmed from a healthcare reform initiative that lets Medicare beneficiaries receive such preventive care as a screening colonoscopy for colorectal cancer with no money out of pocket, says Marie Edler, ASCA's former director of state and reimbursement policy. When a Medicare beneficiary presents for a covered screening colonoscopy, Medicare will pay the full provider and facility fee. The patient, meanwhile, isn't responsible for a deductible or a co-pay. As is sometimes the case, however, a clinical finding can change a screening to an actual diagnostic procedure. Medicare introduced the PT modifier, effective Jan. 1, 2011, and applicable to the physician and the facility, to address such scenarios, says Ms. Edler.

"If a patient was scheduled for a Medicare-covered screening colonoscopy but during the screening itself the procedure changed to a diagnostic colonoscopy, then Medicare would still honor the waiver of the patient's deductible — though not the co-pay — in response to the screening benefit the beneficiary had believed they would be entitled to," says Ms. Edler.

Things didn't go as planned, however. ASCs across the country reported that regional carriers were rejecting claims billed with the PT modifier with a variety of denial explanations. Medicare told ASCA last month that it was issuing private clarifications and instructions directly to the carriers to correct the claims processing errors, says Ms. Edler.

— Dan O'Connor

Stereotaxis
The deletion of add-on code +61795 for stereotactic computer-assisted volumetric (navigational) procedure clears the way for 3 new anatomically correct add-on codes (intracranial, extracranial, spinal). While not included as part of the CPT language, report add-on code +61782 when used in applicable ENT procedures. Exclusionary notes follow each new add-on code precluding its reporting with certain CPT procedures when performed at the same session.

  • 61781 — Stereotactic computer-assisted (navigational) procedure; cranial, intradural (List separately in addition to code for primary procedure)
  • 61782 — cranial, extradural (List separately in addition to code for primary procedure)
  • 61783 — spinal (List separately in addition to code for primary procedure)

Introduction/injection of anesthetic agent
CPT has revised the language of the transforaminal epidural injection series to include fluoroscopic and CT guidance. A cross-reference directs you to see Category III series 0228T-0231T for transforaminal epidural injection under ultrasound guidance.

  • 64479 — Injection(s), anesthetic agent and/or steroid, transforaminal epidural; with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level
  • 64480 — Cervical or thoracic, each additional level (List separately in addition to code for primary procedure)
  • 64483 — Lumbar or sacral, single level
  • 64484 — Lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

Category III codes 0228T-0231T were effective July 1, 2010, but they weren't added to the CPT manual until 2011.

  • 0228T — Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic, single level ($294.00)
  • 0229T — each additional level (List separately in addition to code for primary procedure) ($150.41)
  • 0230T — Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral, single level ($294.00)
  • 0231T — each additional level (List separately in addition to code for primary procedure) ($150.41)

See Category III code series 0213T-0218T when you use ultrasound guidance to perform a paravertebral facet joint injection.

Neurostimulators
CPT established 4 new neurostimulator codes in 2011. Each code within CPT series 64568-64570 describes the 2 services the physician typically performs rather than reporting 2 separate services/codes.

  • 64566 — Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming ($103.38)
  • 64568 — Incision for implantation of cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator ($21,333.84)
  • 64569 — Revision or replacement of cranial nerve (e.g., vagus nerve) neurostimulator electrode array including connection to existing pulse generator ($841.60)

An instructional note follows CPT 64569 directing you to report CPT 61885 when only the replacement of a pulse generator is performed.

  • 64570 — Removal of cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator ($1,444.14)

Related Articles