Updates for CPT for 2011 Part I Presented by Alice Marie Reybitz, RN, BA, CPC, CPC-H, CPC-I H 1 Objectives What codes were added, revised, or deleted Why were these codes added, revised, or deleted How will it effect your office Tips for staying compliant Which codes will affect the reimbursement 2 1
Overview and Introduction Each November we are given the new CPT codes They become effective January 1 st. Codes are utilized based on the date of service The information presented here was current as of the air date 3 New Additions to the CPT Book E/M Tables Color Coded Table of Contents in EACH Section Numbers Out of Sequence Coding Tip boxes 4 2
E/M Guidelines E/M revisions for 2011 include many time component clarifications: Intra-service time in inpatient settings Intra-service time in outpatient settings A restatement that Time shall be considered the key factor in leveling when counseling/coordination of care dominate the encounter Of course this MUST be documented thoroughly 5 E/M Codes Subsequent Observation Care got the biggest make over 99224 99225 99226 6 3
Anesthesia Guidelines Anesthesia Guidelines got no makeover this year 7 Anesthesia Codes No new codes this year 8 4
Surgery Section Overview General Revision in fine needle biopsy 9 Debridement Integumentary System 11000-11047 10 5
Musculoskeletal System Incision 20000 deleted 20005 revised Introduction 20664 revised Grafts +20930 +20931 11 Musculoskeletal System Fracture/Dislocation 22315 Arthrodesis 22551 +22552 Spinal Instrumentation +22851 12 6
Excision 27065 27066 27067 27070 27071 Musculoskeletal System 13 Arthroscopy 29914 29915 29916 Musculoskeletal System 14 7
Code 29916 Clinical Example 20 year old male, football injury Anti-Inflammatory Drugs and steroid injection brought little or no relief MRI revealed acetabular tear of labrum Surgery to repair the labrum 15 Endoscopy 31295 31296 31297 Respiratory System 31634 16 8
Code 31296 Clinical Example 40 year old male patient Four months of medical management Nasal Endoscope to assist with guidewire and balloon catheter placement Dilation accomplished with the balloon to widen the ostium space 17 Cardiovascular System Cardiac Valves 33411 Other Complex Cardiac Anomolies 33620 33621 33622 18 9
Cardiovascular System Thoracic Aortic Aneurysm 33860 33861 33863 33864 Endovascular Repair of Iliac Aneurysm 34900 19 Cardiovascular System Transluminal Angioplasty 35454-35456 35459, 35470 35473-35474 35480-35485 35490-35495 Deleted 37220-37227 37228-37235 0234T-0238T New 20 10
Cardiovascular System Transluminal Angioplasty 35471 35472 Transluminal Atherectomy These codes were deleted all together 21 Cardiovascular System Transcatheter Procedures 37205 37206 37207 37208 22 11
Cardiovascular System Endovascular Revascularization (Open, Percutaneous, Transcatheter) 37220-37223 37224-37227 37228-37231 +37232-37235 23 Code 37232 Clinical Example 72 year old diabetic female Presenting symptom, gangrenous toes on the left foot Ultrasound and other studies reveal the tibial peroneal occlusions and stenoses Balloon dilation performed to open vessels 24 12
Cardiovascular System Lymph Nodes and Lymphatic Channels +38900 25 Cardiovascular System Diaphragm 39502 39520 39530 39531 Deleted because of the nature of the hernia repairs, whether esophageal, transabdominal. or gastric 26 13
Digestive System Special Mention of Coding Tip Those pesky colonoscopies 27 Digestive System Esophagus +43283 Repair 43324, 43326 deleted 43327-43328 43332-43337 +43328 +43338 28 14
Clinical Example Code 43327 65 year old female, hiatal hernia Unresponsive to medical treatment Referred for repair of hernia 29 Excision 43600-deleted 43605-revised Introduction 43753-43757 Digestive System 30 15
Code 43757 Clinical Example Special note for the drugs Drugs are used to stimulate the gastric flow These may be charged The fluid used to administer these drugs may not be charged 31 Incision 47480 Introduction 47490 Laparoscopy 49324 +49327 +49412 Digestive System 32 16
Digestive System Introduction, Revision, Removal 49418 49419 49420- deleted 49421 49422 33 Urinary System Excision 50250 Laparoscopy 50542 Urethra/Other Procedures 53860 Laparoscopy 55866 34 17
Urinary System Prostate/Other Procedures 55876 Introduction-Female System 57155 57156 35 Nervous System Skull, Meninges, and Brain +61781 +61782 +61783 61795-deleted 36 18
Nervous System Introduction/Injection of Anesthetic Agent 64479 +64480 64483 +64484 37 Neurostimulators 64566 64568 64569 64570 64573-deleted 64575-revised Nervous System 38 19
Chemodenervation 64611 Neuroplasty 64708 64712 64713 64714 Nervous System 39 Eye 65778-new 65779-new 65780-revised 66174-new 66175-new 66761-revised Special Senses 40 20
Code 65778 Clinical Example 25 year old female, status post chemical burn of the right eye Topical and systemic medications have failed Decision to apply amniotic membrane to advance lack of corneal healing 41 Special Senses Ear 69801-Labyrinthotomy, transcanal 69802-Labyrinthotomy, mastoidectomy 42 21
Operating Microscope Rewording in the guidelines for code 69990, the add on code for the operating microscope 43 Conclusion Covered the changes to E/M Covered the changes to Anesthesia Covered changes to Surgery Covered changes to the Specialties 44 22
CPT Changes 2011, Part I alice.reybitz@aapc.com 1-800-626-2633, ext. 168 45 23