By Linda Barney, MD,, note Savarise, MD, MBA, and Jenny Jackson, MPH published January 1, 2012 • Print-Friendly

The Current Procedural ax (CPT)* 2012 hand-operated comprises several brand-new codes and also code changes pertaining to general surgery and also its very closely related specialties. This short article summarizes these modifications.

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New modifier

The Affordable treatment Act (ACA) requires all health care plans to begin covering immunizations and preventive solutions without any cost sharing. Modifier 33 has actually been included to CPT 2012 to identify preventive services. This modifier allows providers to identify that the business was preventative under applicable laws and also that patient cost sharing does no apply.

Evaluation and management

The brand-new and established patient meanings in the evaluation and management (E/M) guidelines have actually been revised to include additional granularity to the terms “specialties” and also “subspecialties.” The term “exact subspecialty” was included to specify the the expert services would certainly be provided by a doctor of the exact same specialty and subspecialty, who belongs to the same team practice, within the previous three years. This revision clarifies that although the physician may be of the exact same specialty, differences in between the subspecialty may require a far-ranging new patient work-up and should thus be taken into consideration a new patient visit fairly than an established patient visit.


As a suggest of clarification, in 2011 the debridement guidelines proclaimed that add-on code 11045, Debridement, subcutaneous organization (includes epidermis and also dermis, if performed; each added 20 sq cm, or part thereof, should be reported through modifier 59, if many wounds room debrided on the exact same day. However, add-on codes do not need the use of a modifier. The 2012 revised guidelines now suggest that coders must use full 59 v either 11042, Debridement, subcutaneous organization (includes epidermis and dermis, if performed); first 20 sq cm or less) or 11044, Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); an initial 20 sq cm or less, as appropriate.

Skin instead of surgery

Comprehensive changes have to be made come the skin replacement surgery subsection. The transforms include deletion the 24 codes, revision of 6 codes, and also the creation of eight brand-new codes (15271–15278). This post gives just a short overview the the changes; a more detailed skin replacement surgery short article will be released in February.

Reference to the expression “skin substitutes” has been eliminated as a subheading in the skin replacement surgery section; the codes in this ar are currently in a new section in the manual, described as “skin instead of grafts.” However, part codes continue to be in the skin replacement surgical procedure section, including surgical preparation; topical location of one autograft; tissue-cultured autograft; and skin instead of homograft, allograft, and xenograft. The accuse instruct the the graft is anchored using the provider’s choice of fixation, and when services are carry out in the office, regimen dressing offers are no reported separately.

HIGHLIGHTCMS recently listed a clear up on monitoring codes. An ext specifically, Medicare now has explicit rules related to the billing that subsequent observation codes (99224–99226). These rules are particular to Medicare and do not follow existing CPT guidance. Note that personal payors may or may not follow these guidelines.Under Medicare’s guidelines, just the medical professional who admits a patient because that observation may bill the subsequent monitoring codes. Thus, subsequent observation treatment is only rendered through the admitting doctor on the day(s) various other than the early or discharge date. Medical professionals who carry out consultations when a patient is admitted to hospital outpatient monitoring services need to bill the ideal outpatient evaluation and management organization (99201–99215).Additionally, subsequent observation codes will certainly be contained in the global surgical fee. Thus, just services that meet the criteria to append full 24, unrelated evaluation and also management, post-operative, exact same physician; 25, separate, significant evaluation and also management, very same physician and same day; or 57, decision because that surgery, come the evaluation and also management service may be billed come Medicare in a an international period.

Other flaps and grafts

A brand-new add-on password 15777, Implantation of biological implant (eg, acellular dermal matrix) because that soft organization reinforcement (eg, breast, trunk), has been established. Because that bilateral chest procedures, report 15777 v modifier 50. Because that implantation of fabricated mesh or various other prosthesis for open incisional or ventral hernia fix or closure that a necrotizing soft organization infection wound, report 49568 in conjunction with 49560–49566 or 11004–11006, as appropriate. Password 15777 is no to be offered for the topical applications of skin instead of graft come a wound surface, which have to be report with new codes 15271–15278.

Hands and fingers

Two brand-new codes are available to report the treatment of Dupuytren’s contracture. Report code 20527 for the injection of one enzyme (for example, collagenase) right into the palmar fascial cord (ie, Dupuytren’s cord). Password 26341 is reported because that the manipulation of the palmar fascial cord carry out on the following day and also follow-up treatment within 10 work (for example, wound check). Fabrication and application that a practice orthotic is separately reportable.

Lungs and pleura

Comprehensive alters were made come the lungs and also pleura section of CPT, including a new section added to determine video-assisted thoracoscopic surgery (VATS).

The accuse provide particular instructions as soon as the services of intraoperative pathology room used. In these circumstances, if a more extensive procedure is required due to the outcomes of the consultation, then only the most extensive procedure code is reported. The new guidelines prohibit use of smaller procedure codes, such as biopsies, in addition to an ext extensive lung procedure codes such together lobectomies, uneven the measures were performed on different lobes, or the contralateral lung. In these cases it would be suitable to append the 59 modifier (distinct procedural service).

Code 32095—previously supplied to report biopsy actions of the lung or pleura via thoracotomy— has been deleted. Three new codes are accessible to report incisional (thoracotomy) biopsy procedures: 32096, Thoracotomy, v diagnostic biopsy(ies) the lung infiltrate(s) (eg, wedge, incisional), unilateral; 32097, Thoracotomy, with diagnostic biopsy(ies) that lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral; and 32098, Thoracotomy, with biopsy(ies) of pleura.

Therapeutic wedge resection steps are currently reported through 32505, Thoracotomy; v therapeutic wedge resection (eg, mass, nodule), initial.

Two new add-on codes for open wedge resection have been created: 32506, Therapeutic wedge resection (eg, fixed or nodule), each additional resection, ipsilateral (List independently in enhancement to password for main procedure), and also 32507, Diagnostic wedge resection complied with by anatomic lung resection (List individually in enhancement to code for primary procedure).

In CPT 2012, the ax “video-assisted thoracoscopic surgery” (VATS) replace instead instead “thoracoscopy.” CPT code 32602, Thoracoscopy, diagnostic (separate procedure); lungs and also pleural space, with biopsy, has been deleted. Three brand-new codes have actually been produced to report lung or pleural room biopsy procedures: 32607, Thoracoscopy; through diagnostic biopsy(ies) that lung infiltrate(s) (eg, wedge, incisional, unilateral); 32608, Thoracoscopy; v diagnostic biopsy(ies) the lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral; and 32609, Thoracoscopy; through biopsy(ies) that pleura. Password 32607 and also 32608 should not be reported much more than once per lung.

Code 32666 identifies an early therapeutic wedge resection utilizing VATS. If carry out bilaterally, comprehensive 50 might be appended come the code.

Add-on code 32667 is provided to report extr thoracoscopic therapeutic wedge resections. Add-on code 32668 is provided to report diagnostic wedge resection the is adhered to by anatomic lung resection. Password 32668 have the right to only be reported in conjunction with CPT password 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32503, 32504, 32663, 32669, 32670, and 32671.

New password 32669–32674 space for VATS removal measures that vary according come the amount of tissue removed or in the an obstacle of removal. CPT code 32674, Thoracoscopy, surgical; v mediastinal and local lymphadenectomy, is an add-on code, which have the right to only be report in conjunction with 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32503, 32504, 32505, 32663, 32666, 32667, 32669, 32670, and also 32671. For procedures on the ideal lung, mediastinal lymph nodes encompass the paratracheal, subcarinal, paraesophageal, and those in the inferior pulmonary ligament. For measures on the left lung, mediastinal lymph nodes include the subcarinal, paraesophageal, and those in the aortopulmonary window, and inferior pulmonary ligament.

A operated doctor plans to execute a VATS wedge biopsy of two suspicious lesions in the best lung: one in the top lobe and also one in the reduced lobe. His plan is to proceed with a therapeutic procedure if the frozen section biopsy of one of two people lesion proves to it is in malignant. The upper lobe lesion is a non-small cabinet carcinoma top top frozen section of the wedge biopsy. The reduced lobe lesion is a bright granuloma. The operated doctor proceeds to carry out a VATS top lobectomy and mediastinal lymphadenectomy. Reportable codes include the following:

32663, VATS lobectomy+32668, VATS diagnostic wedge resection+32667, VATS extr wedge resection+32674, VATS mediastinal and local lymphadenectomy

Note: code 32663 is the major code. The various other codes space add-on codes and also do not need modifiers.

IVC filter and ligation the the vena cava

Codes 37620, Interruption, partial or complete, of inferior vena cava through suture, ligation, plication, clip, extravascular, intravascular (umbrella device), and 75940, Percutaneous location of IVC filter, radiological supervision and interpretation, have actually been deleted for 2012. Three new bundled codes were developed to report insertion, repositioning, and removal the an inferior vena cava (IVC) filter: 37191, Insertion of intravascular vena cava filter, endovascular strategy including vascular access, ship selection, and radiological supervision and also interpretation, intraprocedural roadmapping, and imaging indict (ultrasound and also fluoroscopy), when performed; 37192, Repositioning of intravascular vena cava filter, endovascular technique including vascular access, ship selection, and radiological supervision and also interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and also fluoroscopy), as soon as performed; and 37193, Retrieval (removal) that intravascular vena cava filter, endovascular technique including vascular access, vessel selection, and also radiological supervision and interpretation, intraprocedural roadmapping, and imaging accuse (ultrasound and also fluoroscopy), as soon as performed.

New code 37619, Ligation of inferior vena cava, has been created to report the open surgical procedure performed in trauma patient or other acute open ligation indications.

Paracentesis and also peritoneal lavage

In 2012, codes 49080, Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial, and also 49081, Peritoneocentesis, ab paracentesis, or peritoneal lavage (diagnostic or therapeutic); subsequent, have actually been deleted and replaced with new codes that indicate whether it was done through or there is no imaging guidance: 49082, Abdominal paracentesis (diagnostic or therapeutic; without imaging guidance), and also 49083, Abdominal paracentesis (diagnostic or therapeutic); v imaging guidance.

Additionally, a new code was developed to report peritoneal lavage, 49084, Peritoneal lavage, consisting of imaging guidance, once performed.

Medicare doctor fee schedule

In enhancement to coding changes for 2012, the final dominion for the Medicare physician fee schedule renders many changes to the physician work-related relative value devices (wRVUs). The transforms in wRVUs native 2011 worths come after testimonial of procedures and also services that the Centers because that Medicare & Medicaid solutions (CMS) figured out as “potentially misvalued,” and for procedures and services established by specialties as undervalued and reviewed v the five-year review process. The American university of surgeons was affiliated in the American clinical Association/Specialty society Relative Value scale Update Committee (RUC) survey and also review the 95 codes. Although few of these codes reduced in value by as lot as 13 percent, other codes boosted by as much as 124 percent.

The table gift 42 general surgery codes and also nine observation service codes through wRVUs the CMS is transforming in 2012. As more hospitals entrust patients to outpatient status for basic fee reimbursement rather of inpatient status, that is vital to note that CMS agreed to value observation (outpatient) E/M codes equal to the equivalent inpatient E/M codes.

If friend have extr coding questions, contact the ACS Coding Hotline in ~ 800-227-7911 in between 7:00 am and also 4:00 pm mountain time, excluding holidays.

See more: Cách Phân Biệt Ngọc Trai Thật Giả Phân Biệt Cực Nhanh, Cách Nhận Biết Ngọc Trai Thật, Giả Cực Nhanh

Editor’s noteAccurate coding is the obligation of the provider. This review is only a resource to help in the billing process.