CPT® 2012 Update: Revisions Expand Your Prolonged Services Reporting Scope

2012 CPT® revision opens opportunity of using code by every specialty.

When your gastroenterologist examines a patient for a condition for instance protracted vomiting, ICD-9 code 787.03, necessitating in-office medication and observation or obstipation/ impaction (564.09, 560.3) needing in-office enema or disimpaction, you might be able reporting prolonged services codes +99354 and +99355 in order to capture the time and work. The good news is that a CPT® 2012 revision permits you even more bandwidth in using these codes. Read on for advice on correct reporting with this change.

Broaden Office or Outpatient Prolonged Services

In 2012, you’ll have more tractability as far as applying office or outpatient prolonged services code +99354 is concerned, credit goes to this provider-related CPT® 2012 revision:

Old way: +99354 – (Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service; first hour [List separately besides code for office or further outpatient Evaluation and Management service].

New way: +99354 (Prolonged service in the office or other outpatient setting requiring direct patient contact further than the usual service; first hour [List separately besides code for office or further outpatient Evaluation and Management service]).

Big change in 2012: As per CPT® 2012 revision, the latest descriptor removes the words "physician" and "face-to-face", which extends the scope for reporting prolonged services. The descriptor is now apt for use by a wider range of providers and is not restrained for face-to-face physician services offered in an outpatient or office setting.

Likewise, the additional 30-minute CPT codes follow the same revision removing face-to-face physician time.

New way: For every added 30 minutes of prolonged services, you’ll report +99355 (Prolonged service in the office or further outpatient setting requiring direct patient contact further than the usual service; each added 30 minutes [List separately besides code for prolonged service])

Old way: + 99355 in 2011 was Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service; each additional 30 minutes [List separately besides code for prolonged physician service].

Append to Appropriate E/M Codes

You must keep in mind that prolonged services are additional codes that you have to report with suitable evaluation and management codes. You can report prolonged services after your gastroenterologist spends a total of 30 minutes beyond the typical times (as mentioned in the CPT® guidelines) for a specific E/M code.

As per CPT® 2012 revision, while the level of service of a particular code is met, still, the time involved with the patient goes beyond the highest level of that code grouping, you would use the prolonged service codes. You will report prolonged services in the outpatient setting or office with +99354. You can report every added 30 minutes of direct patient contact with +99355.

CPT Codes: Stay current and get the reimbursements you deserve

Current Procedural Terminology (CPT) Codes have become the “currency” of healthcare, mandating all manner of payments to physicians be it the most complex surgical procedures or routine office visits.

CPT codes are five-digit numbers assigned to every service a medical practitioner provides to a patient after which they are used by insurers to determine the amount of reimbursement that a practitioner will receive. These codes ensure uniformity since everyone uses the same codes to convey the same thing. However, there are circumstances when the reimbursements don’t come in.

To ensure that you do not miss out on the reimbursements, you need to have a sound understanding of CPT codes, apart from having a thorough knowledge of the latest medical terminologies, procedures and diagnosis. What’s more, you need to develop careful observation because that is exactly what can help you avoid common coding goof-ups and compliance issues.

A very important part of getting the right CPT codes is staying current. Keep yourself up-to-date with the from CPT code list. The updates come every year in January, and it’s not a difficult proposition getting hold of it; but the key is to know their correct application. Keep track of what changed and what didn’t, which code deletion is likely to affect you, how you need to handle payers that do not accept the 2009 CPT codes, etc.

That apart, modifiers can also make your coding a lot easier, and bring you the reimbursement without much of a hassle. Be on the watch for them because they ease out the complexities when you have similar conditions to code in a given instance.

So stay abreast of the latest CPT codes and keep the cash flowing in, each time, every time!

CPT Codes Online: Reducing slip-ups and the time it takes to get paid

With so many Current Procedural Terminology (CPT) codes doing the rounds today, coding right have become a difficult proposition. The astounding number of available procedure codes often results in incorrect coding thus resulting in expensive billing and reimbursement follies.

If you want to get the coding right the very first time, research and careful considerations are the key. There are various sources of access for the Current Procedural Terminology codes, both online and offline.

Electronic CPT codes help; Electronic Medical Record (EMR) and practice management solutions now integrate CPT codes directly into their software to perk up the process. Offices have the option to choose frequently used CPT codes, incorporate them into their software and make use of this code set to make simple the correct-coding procedures. This does away with the goof-ups and saves time in the billing and reimbursement process.

Doctors and nurses can use CPT codes online to estimate patient payment portion correctly before finishing the patient visit. In addition, integrated CPT codes allow an office to use real-time electronic charge capture.

Online CPT codes enable point-of-service charge capture which accelerates the reimbursement process, reduces coding slip-ups and eliminates lost charge slips. Industry averages indicate that medical offices misplace 2-4 charge slips per week, resulting in loss. Electronic charge slips used with online CPT codes can get rid of lost charge slips and the overlooked revenue, all this while minimizing mistakes and the time it takes to get paid.

Therefore it goes without saying that the whole process of medical coding and billing becomes easy with the online access.

CPT Codes: Know the three categories

Maintained by American Medical Association (AMA), Current Procedural Terminology (CPT) codes can be found in various paperwork and documentation as we make the transition through any healthcare experience.

When you do a CPT code search, you’ll find that there are three types of CPT codes:

Category I CPT Code

Category II CPT Code - Performance Measurement

Category III CPT Code – Emerging Technology

Category I CPT codes

These types of codes describe a procedure or service identifiable with a five-digit CPT code and descriptor nomenclature. Category I CPT codes are restricted to clinically-recognized and generally accepted services. These codes are the permanent CPT codes

AMA offers free online CPT code searches as well

Current Procedural Terminology (CPT) codes are used in various paperwork as we transition through any healthcare experience. The American Medical Association (AMA) strives to provide you the latest CPT codes to assist you with correct reporting of procedures and services. Each year an annual publication is prepared that makes changes to the tune of significant updates in medical terminology and practice.

The association, through its department of CPT Editorial Research and Development, gives staff support to the process of addition, modification and deletion of CPT codes. The editorial panel comprises 17 members and conducts meetings thrice a year to consider proposals for changes to CPT. It has eleven physicians who are nominated by the National Medical Specialty Societies and approved by the AMA Board of Trustees.

The CPT Advisory Committee supports the panel in its efforts. The advisory committee is made up of representatives of over 100 medical specialty societies and other health care organizations. In order to establish new CPT codes, one can submit a coding request form; the CPT Advisory Committee then reviews the proposed code.

Apart from all these, the AMA comes up with a monthly newsletter, an annual publication, an educational primer, an annual CPT coding symposium, and an online service.

Despite controversy, AMA offers free CPT code searches online. Since February 2002, the association has been offering free searches of its online CPT coding manual. The AMA believes that patients should have as much information as possible when taking health care decisions. No one should put off reporting a condition or symptom to the physician just because of the cost.

CPT III codes: Temporary codes for emerging technologies

Developed by the American Medical Association (AMA), CPT coding is a standard code that is applied to procedures and services for the purpose of patient records. There are three types of CPT codes: Category I, II and III.

Category III codes are temporary codes for new and emerging technologies. The idea behind this category of codes is to aid researchers track emerging technology and services to substantiate extensive usage and clinical efficiency. So if you are someone who embraces new technology, there’s quite a possibility that you are familiar with Category III CPT codes.

This category of CPT codes has been created to allow for data collection and utilization tracking for new procedures that do not meet the criteria for Category I CPT codes. Category III codes comprise five digits, with four digits followed by the letter ‘T’ in the last field. These codes are temporary in nature and will make an exit if the procedure or service does not get accepted as Category I code within five years.

Few things to keep in mind about Category III codes:

• As per AMA, it’s not right to use a CPT I code or an unlisted procedure if Category III code exists
• Identify a base code that’s quite like the Category III code
• Determine the fee schedule for the Category III code using the same methodology as for unlisted procedures
• Watch the reimbursements closely

The AMA updates these codes twice a year, in January and July. So if you need to get hold of the most current listing of CPT III codes, you can check out the AMA website.

Right CPT Modifier Will Bring in the Right Cash Flow

Current Procedural Terminology (CPT) codes consist of five-digit numbers that represent individual services and procedures. The CPT is currently identified by the CMS as level I of Healthcare Common Procedure Coding System (HCPCS).
CPT codes may be further defined by starred designations for certain minor surgical procedures and by modifiers to explain an unusual circumstance associated with a service or procedure.
What is a CPT modifier?
CPT modifier is an added feature of the CPT to indicate that certain circumstances have changed the performance service.
To cite an example - 51: When several surgeries are performed during the same operative session. Normally, most payers pay 100 percent for the first procedure, but decrease the reimbursement on the second, third, and fourth procedures.
There are three ways to ensure that you are using modifiers correctly:

Firstly, there are software technologies available that will prompt physicians to select the right modifiers at the time of service.

Secondly if the modifier is likely to reduce the amount of payment, leave the amount as it is and let the payer reduce it when he receives the claim. And if there’s likelihood of the modifier increasing the payment, increase the payment on the claim before you file it; don’t expect the payer to do it for you.

Thirdly, you’ll do well to know the payers’ policies regarding the use of modifiers. Remember that rules may differ among the payers.

Keeping pace with the CPT code list and modifiers can be a daunting challenge. This year saw around 700 CPT code changes and with just a few months to go before the year comes to an end, you’ll do well to gear yourself up for additional changes in the coming year.

2010 CPT Code Changes at one Place

January 2010 is just round the corner. As we step into the New Year, CPT will witness a plethora of changes, so much so that you’ll have a tough time keeping pace with what’s been added, what’s been revised, what’s been deleted. You’ll also need to know all the text and guideline changes if you are to make a mark in your coding career.

As far as cardiology is concerned, the American Medical Association (AMA) has released four new Category I CPT codes to report cardiac CT (CCT) and Cardiac CT angiography (CCTA) exams.

The new codes, to get going from January 1, 2010, are the result of several years of hard work put in by the American College of Cardiology (ACC), the Society of Cardiovascular CT (SCCT), the American Society of Nuclear Cardiology (ASNC) among others.

For more of such cardiology and other CPT updates, you can get hold of the CPT book, which is a treasure trove of coding know how. But you’ll do well to remember that there are many a 2010 CPT code changes which will not make it to the printed form until the year 2011.

But worry not! There are online sources of information which provides you with all the 2010 CPT code changes. If you want to know about all the 2010 CPT coding changes to cardiology, you can go for all-encompassing medical coding websites which will give you the key to your practice. Such websites also provide you with free trails which you can go for. Once you’re satisfied with the whole thing, you can register yourself for it.

When you sign up for such a coding website, you’ll save yourself from having to flip through the big CPT book. So get going!

Differentiates HCPCS Codes & CPT codes

While CPT stands for Current Procedural Terminology, HCPCS stands for Healthcare Common Procedure Coding System. These are two different code sets for medical billing, and both can be used to submit claims.

The CPT codes are Level I HCPCS codes maintained by the American Medical Association (AMA) while HCPCS is maintained by Centers for Medicare and Medicaid Services (CMS). The Level I codes are numeric such as 99213 for a mid-level office visit.

The Level II HCPCS is a standardized coding system which is used to identify products, supplies, and services not covered in the CPT codes. Referred to as alpha-numeric codes, these codes consist of a single alphabetical letter followed by four numeric digits.

Which code set you use should be based on choosing the code which accurately describes the service that is performed. Whether that should be a CPT or a HCPCS code must be determined by the provider.

You need to be well-versed with HCPCS CPT code changes and rules to accurately describe the service that is performed. But doing so is not an easy task; it takes up a lot of your time as well.

However, there are various one-stop medical coding websites which will certainly help you get on top of the latest HCPCS CPT code changes so that you know how to code right. Normally, such coding websites come stored with all CPT and HCPCS coding know how and other information that will help you find and use CPT and HCPCS codes more easily.

In other words, such websites will guide you through current modifiers, code additions and deletions, among a host of other information pertaining to HCPCS/CPT codes. So go for one today!

CPT Codes 77002, not 77003 with 64640

If your payer denies 77003 when you bill it with 64640, stating that the codes are mutually exclusive, can you use 77002 instead for the guidance (C-arm imaging) of the needle?

Yes you can use 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]). This often is the complaint CPT code to report in conjunction with 64640 (desctruction by neurolytic agent; other peripheral nerve or branch).

The reason is: Code 77002 describes fluoroscopic guidance during pain management injection procedures when your physician needs guidance for needle placement in areas other than the spine. If you submit 64640, it signals the payer that you’re not reporting a spinal injection.

Code 77003 is for fluoroscopic guidance of the procedures included in the descriptor. The injection represented by 64640 falls outside those parameters.

If your provider performed the destruction procedure in an ambulatory surgery center or hospital outpatient department, append modifier 26 (professional component) to report your provider’s professional component of the fluoro-scopic needle guidance. You also need to check with your local payer about specific guidelines for these procedures. The most recent CCI edits do not bundle 77002 and 64640 as a comprehensive/component pair or as mutually exclusive. But you need to keep a check on whether your local payer has different bundling policies.

If you want to know more on this and get the complete list of CPT codes, there are various one-stop medical coding websites to get you there. Some websites also offer free trial, which you can choose to go for before registering yourself for one. So get going!

CPT/HCPCS Coding Changes

CPT is the acronym for Current Procedural Terminology while HCPCS stands for Healthcare Common Procedure Coding System. While the former is a uniform coding system comprising descriptive terms and identifying codes that are used to identify medical services and procedures provided by physicians and other healthcare professionals, the latter is a standardized coding system that is mainly used to identify products, supplies and services not found in the CPT. HCPCS lookup is normally referred to Level II HCPCS codes.

At the start of every calendar year, CPT and HCPCS code sets and manuals are updated; the changes are inclusive of coding additions, deletions and replacements.

The HIPAA transaction and code set rule calls for usage of the code set that is valid at the time that the service is provided. There’s no grace period as such during which discontinued codes may be used.

In order to boost timely payment of claims, all CPT and HCPCS codes submitted for reimbursement must be current and active as on the date on which the service is provided.

For the most current CPT HCPCS codes, there are one-stop medical coding websites where you can head to. Such one-stop shop websites teach coders to make use of CPT HCPCS codes using real world medical examples.

Such comprehensive resources also help just-in coders succeed by providing basic instruction on the structure, rules, and guidelines relating to CPT/ HCPCS coding. Here, you can even find the most common coding issues you are likely to encounter as a beginner in this profession.

So if you are looking for a complete explanation of symbols and formatting used in CPT/HCPCS coding, these one stop shops are just right for you.

Oncology CPT codes For Simulation Claims

Since you have only one chance to report simulation per treatment course, you should nab the right code the very first time by focusing on the number of ports, treatment volumes and treatment devices.

You can choose four simulation codes from the CPT basket:

77280 - therapeutic radiology simulation-aided field setting; simple

77285 - Intermediate

77290 - Complex

77295 - 3-dimensional


Each code has both professional and technical components, so be sure to append modifier 26 (professional component) when reporting only the physician’ services.
If your coding software doesn’t alert you when modifier 26 is an option, see if you can enter notes manually for a pop-up reminder.

77280 is right for a single treatment area with either a single port or parallel opposed ports and simple or no blocking, as per CPT guidelines preceding the simulation codes.

If the simulation involves three or more converging ports, two separate treatment areas, or multiple blocks, according to CPT guidelines, 77285 is the right code.
If you are to report 77290, the simulation should involve three or more treatment areas, tangential ports, rotation or arc therapy, complex blocking, custom shielding blocks, brachytherapy source verification, contrast use or hyperthermia, according to CPT guidelines.

77295 calls for documentation of computer-generated 3-D reconstruction of tumor volume and surrounding critical normal tissue from CT or MRI data to prepare for therapy, as laid down in CPT guidelines.

To get more insight on CPT codes for oncology, you can register yourself for one-stop medical coding websites, where you’ll get the entire CPT code list, the latest changes, among a host of other coding know how.

CPT Latest Changes

Come January 2010, and Current procedural Terminology (CPT) will bring with it lots of changes and challenges. If you are a coder and want to avoid denials, you need to keep pace with what’s new, what’s been added and what’s been deleted as far as the CPT codes are concerned.

But getting on top of all the CPT code changes is not too big a task as there are various sources you can fall back on to keep you updated on the latest CPT code changes. For one, you can go for CPT changes 2010 workshop which American Medical Association (AMA) hosts. There is also a “CPT network”, an internet-based system that provides members with tools to quickly research a database of frequently-asked questions. If you are a registered user and find the answer to a specific question missing, you will have the capacity to submit an electronic inquiry using a standardized form directly to the CPT coding experts.

What’s more, you can even go for CPT/RVU Search, which gives users of CPT the opportunity to perform CPT code searches and get hold of vital CPT coding information.

To keep yourself up-to-date and current, you can even sign up to receive e-mail notification when changes are posted to the AMA website. There are also medical coding conferences that take place at regular intervals which you can attend to get on top of the CPT changes.

Moreover, there are also various one-stop medical coding websites where you can have access to free CPT codes online. Normally, such websites offer free trails and if you see that it suits your purpose, you can go ahead and register for it.

CPT Changes To Keep The Cash Flowing

To use CPT codes, you need to have substantial knowledge in the general medical parlance. The year 2010 will witness a lot of CPT code additions, deletions and revisions. So much so that it’s easy to be overwhelmed.

How do you keep your coding up to date and current whilst ensuring the reimbursements that you deserve?

If you are to avoid claim denials and coding errors this January, you certainly need to keep pace with the latest CPT changes. Since the changes are all too many, focus on the relevant and critical updates to CPT.

After every CPT code change, coders find themselves asking:

What you should stop using?

What you should start using?

What you need to use differently?

Why are there so many changes for the coming year?

If such questions are clouding your mind, there are various sources to help you out – both online and offline. There are books published by a number of publishers including the American medical Association (AMA) that holds the right to it. Apart from the CPT book, there are other one-stop coding websites, where you can get all the CPT code changes. Normally these websites offer study guides, tutorials and assessments that can help you get acquainted with specific CPT codes. Some websites offer free trails which you can try out and register for it later on if it fits your requirements. Normally, a CPT coding website would offer you simple instant connections to official code descriptors and guidelines.

When you register yourself for one, you’ll find that keeping pace with the approximately 500 CPT changes for the coming year is no big deal at all.

Craniotomy and Laminectomy Codes

Read this expert medical billing and coding article and see what CPT codes apply in the following mentioned scenarios.

Question: For the patient with a diagnosis of a clinoidal meningioma, your surgeon carried out a stereotactic pterional osteoplastic craniotomy along with resection of clinoidal/sphenoid wing mass. For the microdissection in surgery, he used an intraoperative microscope. Prior to decompressing the superior orbital fissure, the tumor was extirpated through the opticocarotid, carotid "oculomotor, as well asprechiasmatic spaces. Furthermore, your surgeon carried out an intraoperative electrophysiological monitoring by means of SSEPs and motor evoked potentials. How do you report this procedure?

Answer: You report CPT code 61512 (Craniectomy, trephination, bone flap craniotomy for excision of meningioma, supratentorial). Generally, skull base codes are not reported if a craniotomy code specific to the procedure takes place.

In case there is documentation for a skull base approach, after that you would pair the suitable approach code for the location of the neoplasm (anterior v. middle fossa, intradural v. extradural) with the definitive resection code of the similar anatomical site.

As both microdissection and stereotactic navigation are defined, you may also go ahead and report the add-on CPT codes +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) for the microsurgical dissection and +61781 (Stereotactic computer-assisted [navigational] procedure; cranial, intradural [List separately in addition to code for primary procedure]) for the navigational procedure. Remember that the neurophysiological monitoring can never be reported by a member of the operating team.

You Must Now Report Laminectomy Code With 63655

Question: Can you bill together for a laminectomy meant for decompression of nerve roots carried out at the same side of spinal cord stimulation (SCS) implant? The patient had a spinal stenosis in the thoracic region and the SCS was placed at the similar level.

The patient’s OP report mentions "laminectomy from T9-T10, AMA drill was brought in use to further expand the laminectomy for decompression. A set of instruments was used to accomplish neurolysis at this level……"

Answer: The CPT code 63655 (Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural) contains the laminectomy done to implant the electrodes. You cannot report the laminectomy CPT codes like 63003 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy [eg, spinal stenosis], 1 or 2 vertebral segments; thoracic) with 63655 at the similar level.

CPT Codes +33225 Pacing Systems: Confusion? Here is the Solution

Mark this LV-lead modification in your manual.

Some biventricular upgrade cases have been frustrating for medical coders, but there’s good news.

Looking for the accurate code combination is much easier now that the AMA has published an official rectification to the main CPT codes you might report with +33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator [including upgrade to dual chamber system and pocket revision] [List separately in addition to code for primary procedure]).

Add Gen Change Codes to Primary Options

The corrections document for AMA’s CPT® 2012 manual reviews the parenthetical instruction following +33225. The revision adds four CPT codes to the list of possible primary codes for +33225:

• 33228 (Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system
• 33229, … multiple lead system)
• 33263 (Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; dual lead system)
• 33264 (… multiple lead system)

Keep in mind that because +33225 is an add-on code, you should report it in addition to a primary code. You may never report +33225 without an accurate primary code.

Review These Upgrade Cases for Denials

The addition of CPT codes 33228, 33229, 33262, and 33264 to the list of primary codes resolves an issue many coders have faced as the codes became effective in January.

Affected cases are upgrades from a single- or dual-lead pacemaker or implantable cardioverter-defibrillator system to a biventricular (BiV) system. Specifically, the cases involve the physician placing the left ventricle lead (+33225), altering the pulse generator, and connecting earlier placed lead(s) to the new battery.

For instance, assume the physician does away with an existing single pacer generator, inserts a BiV pacer generator, connects the present right ventricle (RV) lead, and implants and connects a new left ventricle (LV) lead. The 2012 coding guidelines originally published didn’t propose clear guidance on how to code this scenario.

The problem: The logical assumption is that you must report +33225 with the applicable generator change code when a case includes LV lead placement (+33225) and generator change (such as 33228, 33229, 33263, or 33264). However, CPT® did not list the novel generator change codes as acceptable primary codes for +33225.

Result: When practices attempted to report the generator change CPT codes along with +33225, they received denials.

Practices were left trying to find a different coding option. Some coders wondered if at all they could code the LV lead placement (+33225), a new system insertion (such as 33206-33208, Insertion of new or replacement of permanent pacemaker with transvenous electrode[s] …), and possibly battery removal (such as 33233, Removal of permanent pacemaker pulse generator only). This is technically inappropriate from a coding perspective as there was an LV lead added, however no RA or RV lead changed. The new system codes need lead insertion or replacement, so CPT codes 33206-33208 would not be appropriate here.