CPT Changes for 2012: An Overview

Isn’t getting a new CPT book a little like a birthday present?  The excitement of unwrapping it, the suspense about what’s inside.  A new CPT book may not be as much fun as a new video game or as intriguing as a jewelry box, but coders eagerly anticipate it.

A listing of code changes for the year can be found in Appendix B of the CPT book, “Summary of Additions, Deletions and Revisions.”  This is the first place coders look for an overview of changes. The Professional Edition of the CPT book shows editorial changes in green within the body of the book, which can be very helpful.  It focuses a practice on the changes that matter for their specialty.

The 2012 CPT Book has the return of the new and established patient visit Decision Tree.  The tree defines a new patient in a practice as a patient who has not been seen by a physician in that group in the past three years of the “exact same subspecialty.”  This will lead some subspecialists within a group to bill for new patient visits in place of established, but heed this caution:  CPT sets coding rules and payers set reimbursement rules.  Currently, Medicare and most payers only consider specialties that are designated by the two-digit specialties developed by Medicare.  If the subspecialist in question doesn’t have this two digit specialty designation, the payer will continue to process the claim as an established patient.

Increase to work RVUs

The initial observation codes 99218-99220 were assigned typical times for 2012, which is a change from previous years.  (99218: 30 minutes; 99219: 50 minutes; 99220: 70 minutes.)  CMS has increased the work RVUs for the initial observation services to match the work RVUs for initial inpatient services, a major improvement for physicians who maintain that the work of the admission is the same, whether the status is observation or inpatient.  Adding typical time for the observation services means that a physician may use prolonged services codes with them. CPT also changed the wording for prolonged services codes, taking out the words, “face-to-face.”  Keep in mind that CMS requires that prolonged services are face-to-face services, not unit services, and requires start and stop time, not total time.

CPT continues its practice of listing codes out of numerical sequence, in the position in the CPT book where they fit within the logical structure of CPT.  These out of sequence codes are identified with a pound (#) sign in front of them. 

Here are some other changes that will be of interest to some specialties:

• There are significant changes in the skin replacement codes, (15271-15278).  Eight new codes were created, six revised and twenty four deleted.
• There are changes to the lungs and pleura section, starting with code 32035.  Codes are deleted, revised and added.  The editorial comments at the start of the section are all new.
• The term “Video-Assisted Thoracic Surgery” is introduced in CPT.  Thoracic surgeons will want to review codes starting with code 32601.
• Cardiologists have seen enough coding and reimbursement policy changes in the past few years.  They could be forgiven for wanting to be skipped this year!  The codes have not changed, but the editorial comments at the start of the pacemaker section (before code 33202) are new.  There are some revisions to the descriptions of the codes that follow.  There is a terrific chart which will help to code pacemakers and implantable cardioverter-defibrillators services in this section.  The chart lists the codes for insertions and removals.
• Read the revised editorial comments at the start of the section on Diagnostic Studies of Arteriovenous Shunts for Dialysis if this is a service provided in the practice.  These are before code 36147.
• Definitions for codes in the spine section changed, with editorial comments, in the book before code 62263.
• CPT added many molecular pathology procedures, starting with code 81200.  Unfortunately, CMS has not valued these codes as of now.

When the new book arrives, look first at the summary of additions, deletions and revisions in Appendix B.  Then, look at the editorial comments at the start of each section that describes services done in the practice.  Pay attention to the symbols at the bottom of each page indicate a code is new, revised or contains new or revised text.  Avoid coding denials by keeping up to date with CPT.

Betsy Nicoletti, M.S., CPC, is the founder of Codapedia.com, a wiki for physician reimbursement. She is a nationally known speaker and consultant, and can be reached at www.mpconsulting.org. You can watch an informational video by Betsy Nicoletti on Better Collections Through Improved Medical Coding now. Or, view her archived webinar on What You Can Do to Prepare for Medicare Payment Reductions. She has also written recently on What You Need to Know About Annual Wellness Visits for Medicare Patients and Why Can’t We Get Paid? A Look at Denials.