Health Information Management

2012 CPT code changes for ASCs: Shoulder and knee scopes and pain management

JustCoding News: Outpatient, November 30, 2011

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by Stephanie Ellis, RN, CPC

Providers at ambulatory surgery centers (ASC) often perform shoulder and knee arthroscopic procedures, as well as pain management procedures. Let’s take a look at some of the significant changes the AMA made to the CPT® coding for these procedures for 2012.

CPT changes to shoulder and knee arthroscopy codes

For dates of service beginning January 1, 2012, if a provider performs an arthroscopic subacromial decompression of the shoulder and the arthroscopy is the only scope procedure the provider performed, coders must now report CPT code 29999 (unlisted scope). The AMA changed CPT code 29826 (arthroscopic subacromial decompression) into an add-on code for 2012. This means coders can only report when another scope procedure is the primary procedure.

The AMA also revised arthroscopic knee meniscectomy codes 29880 and 29881 to include a debridement/chondroplasty procedure (code 29877) in the same or other compartments. This means that when a provider performs a chondroplasty on the same knee as a meniscectomy, even if it is the only procedure he or she performs in a knee compartment, coders cannot report it separately with codes 29877 or G0289.

CPT changes to pain management procedure codes

In 2011, the AMA revised the transforaminal epidural steroid injection codes to include the use of imaging (fluoroscopy or CT) in the procedure. Therefore, ASCs could no longer bill the imaging separately with code 77003-TC.

For 2012, the AMA is doing the same with the epidural steroid injection (ESI) CPT codes:

  • 62310 (cervical or thoracic ESI)
  • 62311 (lumbar or sacral ESI)
  • 62318 (cervical or thoracic by continuous infusion)
  • 62319 (lumbar or sacral by continuous infusion)

These four codes now include the contrast for localization when the provider uses it with ESI procedures, so ASCs cannot separately bill the use of contrast with radiology code 77003.

The AMA also made the following minor revisions to the spinal cord neurostimulator codes:

  • Code 64561 is for the percutaneous implantation of neurostimulator electrode array of the sacral nerve (transforaminal placement) for an InterStim® used for an overactive bladder (usually used for stage I trial procedures). In other words, the AMA added the word “array” following the word “electrode”. The CPT Manual instructs coders to use new Category III codes 0282T–-0284T when a provider implants trial or permanent electrode arrays or pulse generators for use in peripheral subcutaneous field stimulation procedures.
  • The AMA made the same change (i.e., adding the term “array” to the code descriptor) to code 64581 for incision for implantation of neurostimulator electrode array of the sacral nerve (transforaminal placement) for the stage II permanent InterStim procedure.
  • Similarly, the AMA also added the word “array” to code 64585 for the revision or removal of a peripheral neurostimulator electrode array. It made no no change to the code for the implantation of the generator used in the permanent procedure.

Codes for radiofrequency procedures on facet joints have changed for 2012. The AMA deleted the following codes for 2012:

  • Code 64622 for destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level
  • Add-on code 64623 for destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level addition (listed with the code for the primary procedure)
  • Code 64626 for destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level
  • Add-on code 64627 for destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level (list separately with the code for the primary procedure)

However, the AMA added the following new CPT codes to replace those listed above. Coders should use code 64633 for the destruction of paravertebral facet joint nerve(s) by neurolytic agent with fluoroscopic or CT image guidance; cervical or thoracic, single facet joint for the first first level performed. (For additional levels, coders will need to report add-on code 64634.)

Beginning in 2012, coders can use code 64635 for the destruction of paravertebral facet joint nerve(s) by neurolytic agent with fluoroscopic or CT image guidance; lumbar or sacral, single facet joint for the first level performed. Report add-on code 64636 for additional levels.

Finally, AMA revised CPT code 77003 for fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid). The code now reads: Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint). The AMA removed the words "paravertebral facet joint nerve. or sacroiliac joint), including neurolytic agent destruction".

The AMA also made many significant changes to the CPT codes for spinal fusion, laminectomy, laminotomy, and discectomy, percutaneous vertebroplasty, and percutaneous lumbar discectomy procedures. Consult the 2012 CPT Manual for details on these changes.

Editor’s note: Stephanie Ellis, RN, CPC, is the president of Ellis Medical Consulting, Inc., in Brentwood, TN. You may contact her at sellis@ellismedical.com.
 



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