This commentary is a summary prepared by McKesson’s Revenue Management Solutions division and highlights certain changes, not all changes, in 2012 CPT codes relating to the specialty of Anesthesiology. This commentary does not supplant the American Medical Association’s current listing of CPT codes, its documentation in the annual CPT Changes publications, and other related publications from American Medical Association, which are the authoritative source for information about CPT codes. Please refer to your 2012 CPT Code Book, annual CPT Changes publication, HCPCS Book and Payer Bulletins for additional information, including additions, deletions, changes and interpretations that may not be reflected in this document.
CPT is a registered trademark of the American Medical Association (“AMA”). The AMA is the owner of all copyright, trademark and other rights to CPT and its updates. CPT codes, descriptions and other data are copyright 1966, 1970, 1973, 1977, 1981, 1983-2012 American Medical Association. All rights reserved.
CPT® Code Changes for 2012 - ANESTHESIOLOGY and PAIN MANAGEMENT
The American Medical Association’s Current Procedural Terminology (CPT) 2012 contains new and revised codes. Revenue Management Solutions (RMS), a division of McKesson, prepared this summary to provide you with details on CPT and American Society of Anesthesiologists (ASA) code changes as well as new Healthcare Common Procedure Coding System (HCPCS) procedure codes issued by the Centers for Medicare and Medicaid Services (CMS).
Other than the typical ASA Crosswalk changes, there are no other major changes in the field of anesthesia coding. However, there are a significant number of changes applicable to interventional pain management that should be reviewed by these providers.
EVALUATION AND MANAGEMENT CHANGES
New vs. Established Patient
CPT has again revised the definition of terms regarding New vs. Established Patients in the guidelines section of this chapter. Last year, CPT removed the New vs. Established Decision Tree, but this feature has been added back in for 2012.
The 2012 manual further defines a new patient as one “who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the last 3 years.”
An established patient is one who has received face-to-face services from the physician or another physician of the exact specialty and subspecialty who belongs to the same group, within the past 3 years.
Initial Observation Care
As with other evaluation and management CPT codes, typical times have been added to this series of codes:
- 99218 = 30 minutes at bedside and on patient’s floor/unit
- 99219 = 50 minutes at bedside and on patient’s floor/unit
- 99220 = 70 minutes at bedside and on patient’s floor/unit
Guidelines for use of these codes appearing just before the code listing have been revised for 2012. CPT has defined “direct patient contact” as face-to-face services and non face-to-face services on the patient’s floor or unit in the facility during the same session. This section also has been revised to add “other qualified healthcare professionals” to those providers allowed to report these codes, along with physicians.
Inpatient Neonatal and Pediatric Critical Care
Introductory guidelines for these services now mirror Critical Care services to include procedures not separately reportable in addition to these daily-use codes. This listing also includes Car Seat evaluation (94780-94781).
These guidelines also establish reporting criteria for transfers of improving neonates and pediatric patients. These services are to be reported using subsequent hospital visit codes (99231-99233) on the date of transfer to a lower level of care.
PAIN MANAGEMENT PROCEDURAL CHANGES
Pelvis and Hip Joint
CPT instruction in conjunction with CPT code 27096 (Sacroiliac Joint Injection) has been revised to indicate that CT or fluoroscopic guidance to confirm needle placement is inherent in the procedure. If guidance is not used, providers are required to report code 20552 (Trigger Point injection). Additionally, the code has been revised to indicate that arthrography is included in procedure code 27096 and may not be reported separately.
SPINE AND SPINAL CORD
Injection, Drainage or Aspiration
The introductory section of the Injection, Drainage or Aspiration section has been revised to include guidance on reporting epidural injections for diagnostic or therapeutic reasons. CPT now includes clear direction that when administering a single injection on a given calendar day, whether by needle or via catheter, the single injection codes 62310 or 62311 must be reported. Threading and removing the epidural catheter during the same daily session should be treated the same as a single injection.
Only when the catheter is left in place to deliver substance(s) over prolonged periods of time should codes 62318 or 62319 be utilized. CPT provides an example of a prolonged period as more than one single calendar day.
Due to the addition of codes specific to neurolytic destruction, epidural/subarachnoid injection and catheter codes have been revised. For 2012, these codes specifically exclude injection of neurolytic substances.
Code 62287 (percutaneous decompression of intervertebral disc) now includes language specifically directing use of this code for “needle based technique” removal of disc material with use of an endoscope. CPT is further distinguishing percutaneous from open procedures.
Code 62367 is revised to indicate that this code should not be used to report reprogramming or refill of an implanted intrathecal pump. Codes 62369 and 62370 have been added to report these services. Code 62369 should be reported when clinical staff performs the pump reprogramming and refill, while code 62370 is reported when a physician’s skill (or qualified health professional) is required for these services.
Neurostimulators (Peripheral Nerve)
CPT has revised several codes in this section for neurostimulator procedures to more clearly delineate usage of these codes. The section introduction now defines an electrode array as “a catheter or other device with more than one contact.” Each contact may be adjusted during programming services. Codes 64553 – 64565 (percutaneous implantation) and codes 64575 – 64581 (incision for implantation) have been changed to indicate placement of electrode arrays.
For codes relating to subcutaneous placement, the reader is directed to temporary codes 0282T – 0284T.
Destruction by Neurolytic Agent (e.g., Chemical, Thermal, Electrical or Radiofrequency)
CPT has deleted paravertebral facet joint destruction codes (64622 – 64627) but has added 4 new codes to more accurately reflect the work performed. Previously, one unit of service was used to report denervation of a single nerve at a single vertebral level, though two nerves innervate one unilateral facet joint at each spinal level.
New codes 64633 – 64636 have been added identifying the facet joint as the unit of service rather than the spinal level. Bilateral modifier -50 will apply if a provider treats both facet joints at a single level, however the number of nerves destroyed at a joint will not affect the units of service.
These codes are out of sequence in the 2012 CPT-4 manual.
Additionally, image guidance is included in these procedure codes, and code 77003 (fluoroscopy) or 77012 (CT guidance) may not be reported separately. If the procedure(s) is performed without guidance, code 64999 must be reported.
The introductory guidelines to this code section have been revised for 2012 to clarify the intended use for (95971-95979). CPT language now defines “simple” versus “complex” programming. A complete list of parameters appears in this section.
- Simple programming – 3 or fewer parameters identified as changed
- Complex programming – 4 or more parameters identified as changed
Historically, complex programming codes have also included a time element within the code (first hour, each additional 30 minutes). In 2012, CPT clarifies that if a procedure is less than 31 minutes in duration, codes 95972, 95974 and 95978 should be reported with modifier -52, indicating a reduced service.
Refilling and Maintenance of Implantable Pump
In addition to the changes to the reservoir/pump implantation codes previously mentioned, CPT changes the description of the Refilling and Maintenance codes (95990-95991).The description of these codes now includes electronic analysis of the pump when performed in conjunction with the refilling. Providers will no longer report 62367 or 62368 when reporting the code for refilling and maintenance. These codes still distinguish these services performed by a physician (or qualified non-physician practitioner) and clinical staff.
Due to the changes to CPT code 27096 (Sacroiliac Injection), code 73542 (SI joint arthrography) has been deleted.
Due to changes in code descriptions for sacroiliac joint injections and paravertebral facet joint nerve destruction codes, code 77003 has been revised again in 2012. Fluoroscopic guidance is still separately billable when performed in addition to epidural or subarachnoid injections.
Computed Tomography Guidance
As with the inclusion of fluoroscopic guidance in the sacroiliac injection CPT code, the parenthetical guidance appearing after the entry for CPT code 77012 (CT guidance for needle placement) has added code 27096 to the list of procedures in which CT guidance is included.
TEMPORARY CODES (CATEGORY III)
Peripheral Subcutaneous Field Stimulation
Peripheral field stimulation has four Category III codes assigned for 2012. Providers will be able to report implantation, revision and removal of electrodes and permanent pulse generators for this emerging treatment of chronic pain where electrodes are placed subcutaneously in the field, or area, of pain.
ANESTHESIA CODING CHANGES NEW ASA CODES:
No new ASA codes are added for 2012.
NEW Relative Value Guide (RVG) COMMENTS:
The ASA has revised the comment for code 01844 (Anesthesia for vascular shunt, or shunt revision, any type). The comment indicates “for anesthesia for excision or removal of infected grafts, report an anesthesia code from the appropriate arterial anatomical location.”
Below is a table of codes with primary crosswalk changes for 2012 which incorporates the new CPT codes for the year. Please see the CPT and ASA manuals for complete descriptions as well as other codes with only alternate crosswalk changes.
Where alternates exist, selection of the appropriate anesthesia code may depend on the site of the procedure.
Courtney Hanna, CHC, CPC
Compliance Program Director, Anesthesia
McKesson Revenue Management Solutions
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