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The Only Constant is Change ...

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01/04/2012

(From the November/December issue of 'Billing' by Melody W. Mulaik, MSHS, CPC, CPC-H, RCC, PCS, FCS)

Another year has quickly flown by and it is already time to prepare for 2012. In today's environment, it is impossible to predict exactly what is going to happen in the world of physician reimbursement. One thing we know for sure, change is constant

Every year we receive new codes and say goodbye to existing (and sometimes longstanding) procedure codes. Some coding changes have little to no impact on the organization's reimbursement, but others can be devastating. As of the writing of this article, the physician conversion factor has not been set for 2012 and the RVUs for the new and revised codes have not been published, so it is not possible to determine the specific financial impact of the coding changes.

Although it is very rare for a medical specialty to escape with no coding changes during the update process, some specialties are always impacted more than others. Following are key coding changes that may impact your office-based cardiology and radiology clients. Note that this list should not be used in place of the 2012 CPT® Manual.

New and Established Patient


The definitions of new and established patient have been revised. In order to be considered an established patient, the patient must now have received professional services within the past three years from the physician or another physician of the "exact same specialty and subspecialty" who belongs to the same group practice. The guidelines previously stated "same specialty." The decision tree for determining whether a patient is new or established has been restored. The tree appeared in the 2010 CPT® Manual but did not appear in 2011.

Prolonged Services


In all of the prolonged service codes (99354-99359), the words "Prolonged physician service" have been changed to "Prolonged service," indicating that these codes also apply to nonphysician practitioner services.

In the codes for prolonged office / outpatient service with direct (face-to-face) patient contact (99354-99355), the words "face-to-face" have been deleted. The code descriptions now read "direct patient contact." There is no information in the chapter introduction about the reason for this change. Presumably it will be explained in the section guidelines when they become available. The same change was made to codes 99358-99359.

The codes for prolonged inpatient services (99356-99357) have been revised so that they can also be used for observation services. The code descriptions now read, "Prolonged service in the inpatient or observation setting."

Cardiology


In 2011, Cardiology had many coding changes. This trend is continued in 2012 with many revisions to existing codes as well as new codes. Specifically:
  • The pacemaker insertion codes (33206-33208) have been revised to clarify that they can be used for insertion of a new or replacement pacemaker.
  • The pacemaker generator insertion codes (33212-33213) have been revised to specify that they are for inserting a pacemaker generator and attaching it to an existing single or dual lead system. Previously, these codes referred to insertion of a single or dual chamber generator.
  • A new code has been added for inserting a pacemaker generator and attaching it to multiple existing leads (e.g., insertion of a replacement generator in a patient with a biventricular pacemaker system). This scenario is not covered by codes 33212-33213.
  • The codes for repair of pacemaker and defibrillator electrodes (33218-33220) have been revised to clarify that code 33218 should be used for repair of one electrode, and 33220 should be used for repair of two electrodes, regardless of how many electrodes the patient's device has. Previously these codes referred to single and dual chamber devices.
  • The code for insertion of a left ventricular lead without generator insertion (33224) has been revised to clarify that it includes removing and replacing the existing generator, not inserting a new generator.
  • The code for insertion of a left ventricular lead at the time of generator insertion (33225) has been revised to specify that it includes pocket revision.
  • The code for left ventricular lead repositioning (33226) has been revised to reflect that it includes removing and replacing the existing generator, not inserting a new generator.
  • The code for removal of pacemaker pulse generator (33233) has been revised to reflect that it should be assigned only for generator removal without replacement.
  • Three new combination codes have been added for replacement of pacemaker pulse generators, including the removal of the old generator and insertion of a new generator (33227-33229). Code selection is based on the number of leads.
  • The code for insertion of ICD pulse generator (33240) has been revised to indicate that it should be used for insertion of a pulse generator in a patient with an existing single lead. Two new codes (33230-33231) have been added for insertion of a pulse generator in a patient with existing dual or multiple leads.
  • The code for removal of ICD pulse generator (33241) has been revised to reflect that it is to be used only for generator removal without replacement.
  • Three new codes have been added for replacement of ICD pulse generators, including the removal of the old generator and insertion of the new generator (33262-33264).
  • The code for insertion of an ICD system (33249) has been revised to reflect that it can be used for inserting new or replacement generator and leads. The new code description no longer includes repositioning.
  • The codes for prolonged extracorporeal circulation (33960-33961) have been revised to refer to days instead of 24-hour periods.

Radiology


Radiology always has coding changes each year and this year is no exception. Specifically:
  • The codes for catheterization of the aorta (36200) and for selective lower body catheterization (36245-36248) have been newly designated as including moderate sedation.
  • Four new codes (36251-36254) have been established for selective renal artery angiograms. These new codes include both the catheter placement and the imaging. Concurrently with the establishment of the new renal angiogram codes, the old S & I codes (75722-75724) have been deleted.
  • Three new codes have been established for vena cava filter procedures, including insertion (37191), repositioning (37192), and removal (37193). Note that these codes include catheter placement, imaging supervision and interpretation, and use of ultrasound. Concurrently with the establishment of these new codes, the code that was previously used for vena cava filter placement or ligation (37620) has been deleted.
  • The code for injection for identification of sentinel node (38792) has been revised to reflect that it is to be used only for injection of radiopharmaceuticals, not for injection of nonradioactive dye.
  • The existing codes for paracentesis (49080-49081) have been deleted. Three new codes have been established for paracentesis and peritoneal lavage (49082-49084).
  • The code for therapeutic disk aspiration (62287) has been revised to include associated imaging services. The new code description no longer includes percutaneous laser discectomy.
  • Two of the codes for lumbosacral spine x-rays (72114, 72120) have been revised. A complete study with bending views (72114) now requires at least 6 views, while a study that is limited to bending views (72120) requires 2-3 views (decreased from 4 views).
  • A new combination code has been established for CTA of the abdomen and pelvis [74174, Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including non-contrast images, if performed, and image post-processing].
  • The code for CT bone density study of the appendicular skeleton (77079) has been deleted. The code for axial CT bone density study (77078) remains in effect. The code for bone density study by radiographic absorptiometry (77083) has been deleted.
  • The codes for nuclear liver function study (78220) and hepatobiliary imaging (78223) have been deleted. Two new codes have been established for hepatobiliary imaging (78226-78227).
  • All but one of the existing lung scan codes (78580-78596) have been deleted, and four new codes have been established. For coding purposes, there is no longer a distinction between aerosol and gaseous ventilation imaging. The 2012 codes for lung scans are:

    78579 Pulmonary ventilation imaging (e.g., aerosol or gas)
    78580 Pulmonary perfusion imaging (e.g., particulate)
    78582 Pulmonary ventilation (e.g., aerosol or gas) and perfusion imaging
    78597 Quantitative differential pulmonary perfusion, including imaging when performed
    78598 Quantitative differential pulmonary perfusion and ventilation (e.g., aerosol or gas), including imaging when performed

Regardless of who performs the critical function of coding, is imperative that both the client and the billing company correctly implement the new codes to ensure mutual success. n


Melody W. Mulaik, MSHS, CPC, CPC-H, RCC, is the President and Co-Founder of Coding Strategies, Inc. located in Atlanta, GA. She is a frequent speaker and author for nationally recognized professional organizations and publications.

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