CPT coding changes for 2013

by Steve Adams, CPC, CPC-H, CPC-I

There are more than 700 changes this year to CPT.  In this article I’ll address the changes that I think will have the biggest impact on your practice.  However, don’t forget to check Appendix B in the back of your CPT code book for a full listing of all the coding changes since I’m not addressing all 700 in this article.

Evaluation and Management Coding

Without a doubt, the biggest change will be the addition of two new codes for Transitional Care Management.

These new codes are based on the complexity of medical decision-making and the amount of time between discharge and the patient’s first face-to-face visit with the physician or other qualified health care provider. Code 99495 requires moderately complex medical decision-making and a face-to-face visit within 14 days. Code 99496 requires highly complex medical decision-making and a face-toface visit within seven days.

Both codes require communication with the patient or caregiver within two business days of discharge by telephone, direct contact, or electronic means, and that, by the first face-to-face visit following discharge, the patient’s medications are reconciled with the medications listed on the patient’s chart. 

When CMS puts more information out on these new codes I’ll be sure to send out a message thru my listserv – (which you can join by sending me an email at steve.adams@ingaugehsi.com).

Three additional codes (99487-99489) are for Complex chronic care coordination services – at this time, CMS is not allowing for reimbursement of these services, but it might be worth your time to review your payer contracts to see if these are services that might be paid for by commercial carriers. The intent of these codes is to allow reimbursement to physicians for the time it takes to coordinate services of those patients enrolled in Accountable Care Organizations.

Skin

The only change in the skin section this year is with CPT code 15740 (island pedicle flap).  The code now has expanded language that indicates it now requires identification and dissection of an anatomically named axial vessel.

Orthopedic

One new code was added for pre-sacral interbody technique Arthrodesis – that code is located in the Anterior Arthrodesis section and identified as CPT code 22586.  This is a new code for 2013.

Two new codes have been developed that describe the revision of a total shoulder arthroplasty – those two codes are 23473 and 23474 and are based on whether or not you did a humeral OR glenoid component or a humeral AND glenoid component revision.

For the elbow, two new codes 24370 and 24371 describe a revision of an elbow arthroplasty that includes either revision of the humeral OR ulnar component or a humeral AND ulnar component.

Respiratory

Four new codes in the Endoscopy section of the Trachea and Bronchi now allow for additional procedures to be performed on the bronchial valve(s).  The codes are 31647-31651. CPT 31649 and 31651 are both add on codes and directions for their use are located under the code for reference.

In addition, 31660 and 31661 allow physicians to now code for bronchial thermoplasty – 1 lobe or 2 or more lobes.

If your provider does thoracentesis, please review the new CPT codes 32554 and 32555 as they now replace the previous codes for these services.  The former codes that have been deleted and replaced were the very common – 32421 and 32422.

Cardiology

Several changes are in place for cardiology practices this year.  There are 14 deleted and 47 new codes in the cardiology section.

CPT codes 92980, 92981, 92982, 92984, 92995, and 92996 will no longer be used.  They will be replaced with 13 new codes which will help classify your services as follows.

 Angioplasty, atherectomy, and/or stent placement

 Single major coronary artery or branch vs. each additional branch 

 Native artery vs. coronary artery bypass graft (CABG)

 Chronic total occlusion (CTO)

 Service performed during acute myocardial infarction (AMI)

The new codes for above are found within CPT code range: 92920-92973.

Again, these codes will drastically change the way you bill for PTC services – you will now be able to bill for additional coronary artery studies or their branch(es).  Make sure you review these codes carefully with your physician to make sure the documentation within the note outlines the specific information in the above bulleted items.

In addition to the coronary revascularization changes, cardiologists will see changes in how they code for:

 Ventricular Assist Devices

 Cervical, Cerebral, and Carotid Angiography

 Transcatheter Foreign Body Removal

 Transcatheter Therapy Infusion

 Mechanical Thrombectomy

 EP Studies

Here’s some information on those changes:

A procedure becoming more common is Transcatheter Aortic Valve Replacement – this procedure was given eight new codes this year.  The code range for TAVR/TAVI is 33361-33369.

Three new codes were added to CPT for the additional services billed with a Ventricular Assist Device. So, if your providers do VADs – please review the codes 33990-33992. You will no longer have to use category III code 0048T to describe this procedure.

For non-selective and selective catheter placement, CPT has expanded its selection of all inclusive services in the new code range 36221-36228.  These codes identify both selective and non-selective catheter procedures that would also include ipsilateral extracranial, intracranial and vertebral circulation studies done during the same procedure.  These are considered “complete” codes and the intervention codes are included and not separately billable any longer.

CPT code 37197 is a new code for 2013 and describes transcatheter retrieval of an intravascular foreign body and 37201 has been deleted and replaced with four new codes (37211-37214) that describe different methods used for Transcatheter therapy.

For EP procedures, make sure to review the new codes 93653-93657. These codes have been added to better describe the comprehensive nature of the services provided for EP and catheter ablation services.

Gastroenterology

CPT code 43234 was deleted – that code was used in the past for an upper gastrointestinal endoscopy, simple primary examination.

Genitourinary

A new code was added for chemodenervation of the bladder via cystouretheroscopy.  That new code is 52287.

Nervous System

Within this section I suggest you review the changes to the chemodenervation codes 64612-64615. There have been two revisions and one new code (64615) that describes the chemodenervation of muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (for chronic migraine).

Radiology

For radiologic examinations of the cervical spine, please review the codes 72040-72052 as the number of views taken, per code, has been revised.

With the addition of new “complete” cardiology codes for selective and non-selective interventional services, the old imaging codes for angiography have been deleted.  So, effective 2013 you will no longer use 75650-75685.

Again, the new cardiology codes include the services that were formerly described in 75650-75685.

Pathology

The new CPT codes that have changed won’t affect most physicians.  The changes within this section include 116 molecular pathology codes that will enhance the reporting of diagnostic tools to advance the medical industry’s goal of reducing disease burdens, improving health outcomes and reducing long-term care costs.

Nerve Conduction Studies

Nerve conduction study codes 95900, 95903, 95904, and H–reflex codes 95934 and 95936 have been deleted. Seven new nerve conduction codes (95907–95913) have been created to better describe these services.

With the new codes, the unit of service in codes 95907–95913 is the number of nerve conduction studies performed. According to CPT a single conduction study is defined as a sensory conduction test, a motor conduction test with an F–wave or without an F wave test, or an H–reflex test. Each type of nerve conduction study is counted only once when multiple sites on the same nerve are stimulated or recorded. The numbers of these separate tests should be added to determine which code to use.

Don’t forget, when in doubt always check with Appendix J in your CPT manual.  Appendix J outlines the number of nerves that are typically coded for various medical conditions.

Sleep Study (Polysomnography)

Please make sure that you review codes 95782 and 95783 for polysomnography codes since these new codes represent services for patients younger than 6 years of age.  The other codes in the section have been revised to indicate a patient over the age of six.

Coding Changes for Psychiatry

The psychiatric codes have been completely revised for 2013. The AMA conducted a comprehensive review of the psychiatry CPT codes and created new codes as well as a new coding methodology to more accurately reflect current psychiatric practice. 

There are twelve new codes in this section for common services – they start with 90785-90863.  The best way to cross code the old codes to the new codes are thru the APA at this link:

http://www.psych.org/practice/managing-a-practice/cpt-changes-2013/current-proceduralterminology-cpt-code-changes-for-2013

If you’d like copies of the cross coding of these services you can send me an email at steve.adams@ingaugehsi.com or go to the link above.



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