Health Information Management

CPT code changes spread throughout surgery sections

JustCoding News: Outpatient, January 11, 2012

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The AMA added a total of 60 new codes throughout the surgery section of the 2012 CPT® Manual, 18 of which appear in the cardiovascular and respiratory system subsections. The AMA also revised 86 codes and deleted 48 codes in the surgery section.

In addition, the AMA included significant guideline changes in certain subsections of the manual. Coders should note these changes as well as the code changes.

Integumentary system changes

The integumentary system subsection includes nine new codes, 26 deleted codes, and six revised codes.

Four new codes (15271–15274) include a primary code and an add-on code for skin substitute grafts applied to the patient’s trunk, arms, and legs. Coders should report codes 15271 and 15272 for wounds with a total surface area of less than 100 square centimeters, says Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, who is also an AHIMA-approved ICD-10 trainer. For wounds with a total surface area equal to or greater than 100 square centimeters, coders should report codes 15273 and 15274.

New codes 15275–15278 also represent skin substitute grafts; however, coders should report these codes for areas other than the trunk, arms, and legs. Codes 15275 and 15276 denote wounds with a total surface area of less than 100 square centimeters. Codes 15277 and 15278 denote wounds with a total surface area equal to or greater than 100 square centimeters. The only difference between these sets of codes is the anatomical sites involved, says Safian.

In the past, coders would have reported a code for each type of skin substitute. As of January 1, different types of grafts are included in a smaller code range. The eight new codes replace codes 15170–15176, 15300–15301, 15230–15321, 15330–15331, 15335–15336, 15340–15341, 15360–15361, 15365–15366, 15400–15401, 15420–15421, and 15430–15431.

“They are actually becoming more efficient,” says Safian. “The new codes change the description of the procedure to skin substitute graft.”

The old add-on codes represented each additional 100 square centimeter, while the replacement codes denote 25 square centimeters. “We not only changed the general definition to skin substitute graft, we also changed the measurement of what each code is reporting,” Safian says.

The AMA also approved a new add-on code (+15777) to report the implantation of biologic implant for soft tissue reinforcement.

Musculoskeletal system changes

The AMA included seven new codes and 10 revised codes in the musculoskeletal system subsection of the CPT Manual.

“There are various new instructional notes and listings of codes that should also be assigned throughout this chapter and it’s important that you take a few minutes to browse it and make sure you are familiar with the changes,” says Christi Sarasin, CCS, CCDS, CPC-H, FCS, principal of the Sarasin Consulting Group in Friendship, MD, and an AHIMA-approved ICD-10 trainer.

In particular, the AMA added two new codes for the treatment of Dupuytren’s contracture (codes 20527 and 26341). When coders report 20527, which denotes the injection of an enzyme, they should also report code J0775 for the Xiaflex™ itself, says Sarasin. Coders should report code 26341 (manipulation of the palmer fascial cord) for subsequent days of manipulation, similar to how they would report subsequent days of a wound check, Sarasin says.

In addition, the AMA added two new codes for reporting arthodesis using a posterior or posterolateral technique (22633 and +22634). The new codes combine the posterior and posterolateral approaches with posterior interbody technique. They also include the laminectomy and the discectomy sufficient to prepare the interspace.

“Be very careful about the documentation and whether it’s simply sufficient to prepare that space or if there is another clinical reason for doing something more,” Sarasin says.

The AMA developed these codes to combine procedures that providers frequently perform together. The AMA created a similar combination for 2011 by combing the codes for CT of the abdomen and CT of the pelvis into one code.

Coders should also pay attention to the exclusions note under codes 22520, 22521, and +22522. The note instructs coders not to report these codes in conjunction with 20225, 22310–22315, 22325, and 22327 when providers perform these procedures at the same level of the spine as the ones described in codes 22520–22522.

For example, it is inappropriate to code for a bone biopsy or fracture treatment at the same level as a vertebroplasty, says Sarasin. Likewise, coders should report 22523 and 22525 for kyphoplasty.

The AMA determined that providers have billed code +29286 (correction, cocked-up fifth tow with plastic skin closure [e.g., Riuz-Mora type procedure]) shoulder procedure more than 95% of the time, Sarasin says. As a result, the AMA returned the code to add-on status.

Similarly, physicians typically perform codes 29880 and 29881 for surgical knee arthroscopy with meniscetomy in conjunction with 29877 (arthoscopy with condroplasty). For this reason, the AMA bundled code 29877 into codes 29880 and 29881, says Sarasin.

The AMA also added three new codes to the extremity category of codes to denote the application of a multilayer compression system. The new codes are:

  • 29582: Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed
  • 29583: Application of multi-layer compression system; upper arm and forearm
  • 29584: Application of multi-layer compression system; upper arm, forearm, hand, and fingers

“We now have codes for the upper arm, forearm, hand, and fingers that are appearing in the lower extremity subsection of the application of casting and strapping subsection,” Sarasin says. “There are numerous codes that are out of sequence in the CPT code book. That is something that is becoming more prevalent.”

Coders can report codes for the multilayer compression system or the Unna boot, but not both, Sarasin says. Providers generally apply Unna boots for venous stasis ulcers and chronic edematous ulcers of the leg. Providers generally do not apply these dressings in the same types of settings, she adds.

According to parenthetical notes included below codes 29582–29584, coders should not report them with endovenous ablation therapy (36476 and 36479).

Respiratory system changes

The AMA added three new codes for thoracotomy with diagnostic biopsies of lung infiltrates (code 32096), lung nodules or masses (code 32097), and pleura (code 320980).

Coders will also find new codes for the use of video-assisted thoracic surgery, specifically thoracoscopy. These new diagnostic codes include:

  • 32607–32608 for diagnostic biopsies
  • 32609 for biopsy of the pleura

The new surgery codes also include the following surgical thoracoscopy codes:

  • 32666–32667 for therapeutic wedge resection
  • +32668 for diagnostic wedge resection followed by lung resection

The codes for these surgical procedures differentiate between the tissue location, the type, and nature of the wedge resection (diagnostic or therapeutic), says Sarasin.

Also note that code 32667, which is an add-on code, denotes a metastatic tumor of a different type, Sarasin says. Ideally, the surgeon would remove all nodules with a 1–2 cm margin.

Additionally, new surgical thoracoscopy codes include thoracoscopy for:

  • Removal of lung or lung segments (codes 32669–32671).
  • Resection-plication of emphysematous (code 32672).
  • Resection of thymus (code 32673). Coders should report this code for patients with myasthenia gravis—not for a tumor taken by way of video-assisted thoracopscopic surgery treatment or an excision performed through an external slit, says Sarasin.
  • Mediastinal and regional lymphadenectomy (+32674). Lymph nodes that are listed with single digits are mediastinal, while though listed with double digits are regional, says Sarasin.

The AMA revised code 32601 (diagnostic thoracoscopy) to include “pericardial sac” and “mediastinal” because this service includes these areas as part of the diagnostic procedure, says Sarasin.

Cardiovascular system changes

Nine of the new codes in this section involve cardiovascular pacemakers or cardioverter-defibrillators, including:

  • 33221: Insertion of pacemaker pulse generator only; with existing multiple leads
  • 33227–33229: Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator
  • 33230–33231: Insertion of pacing cardioverter-defibrillator pulse generator only
  • 33262–33264: Removal of cardioverter-defibrillator pulse generator

Note that all of these codes are out of numerical order, and the symbol indicating new or revised text is missing, says Sarasin.

Coders now have four new catheter placement codes from which to choose, depending on the type of catheter placement and whether the physician performs the procedure unilaterally or bilaterally. The new codes are:

  • 36251: Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography unilateral
  • 36252: Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography bilateral
  • 36253: Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography unilateral
  • 36254: Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography bilateral

These codes include the catheterization and renal angiography of the main renal artery as well as all of the accessory renal arteries on the same side, road mapping, pressure gradient measurements, radiological supervision and interpretation, moderate sedation, and use of a closure device, says Sarasin. They do not include endovascular intervention by way of an embolization, insertion of a stent, angiography, or ultrasonic guidance. Coders should report these procedures separately, says Sarasin.

The AMA also added three new codes for intravascular vena cava filters, depending on whether the physician performed insertion (code 37191), repositioning (code 37192), or retrieval (code 37193). Physicians place intravascular vena cava filters for patient who have deep vein thrombosis and cannot be placed on anticoagulants, says Sarasin.

Digestive system changes

The AMA added three new codes in the digestive system subsection, including two for abdominal paracentesis (diagnostic or therapeutic):

  • 49082: Without imaging guidance
  • 49083: With imaging guidance

Coders should report the third new code, 49084, to denote peritoneal lavage, including imaging guidance, when performed. This is an open procedure that physicians typically perform on acute unstable patients. Physicians use it to assess a patient’s blood for enteric contents and for additional laboratory analysis, Sarasin says.

Nervous system changes

Changes to the codes for the nervous system include four new codes for destruction by neurolytic agent, paravertebral facet joint nerve(s) with imaging guidance (fluoroscopy or CT). The codes are divided into two sections:

  • Cervical or thoracic (codes 64633, +64634)
  • Lumbar or sacral (codes 64635, +64636)

Each pair of codes features one code for the first level and an add-on code for the additional levels.

Coders will find new codes for electronic analysis of programmable, implanted pump; with programming and refill (code 62369) and with programming and refill (i.e., requiring a physician’s skill) (code 62370). Coders should not report 62369 and 62370 in conjunction with codes 95990 and 95991 as the latter two codes are for refilling of an implantable pump without reprogramming.

E-mail your questions to Senior Managing Editor Michelle A. Leppert, CPC-A, at To learn more about the CPT changes for 2012, order an on-demand copy of HCPro’s December 6 audio conference, CPT 2012: Overview of Major Code Changes.

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