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Paul Cadorette, director of education for mdStrategies, discusses five changes to CPT codes in 2011.
1. New -PT modifier for screening procedures. A new HCPCS modifier took effect Jan. 1 for use in cases where a screening colonoscopy or screening flexible sigmoidoscopy was planned, but clinical findings lead to a diagnostic colonoscopy. According to Mr. Cadorette, under the Affordable Care Act, patients were not responsible for out-of-pocket payment for screening services. However, prior to Jan. 1, if the screening service turned into a diagnostic procedure in which the physician found a polyp and had to perform a polypectomy, the patient would be responsible for their deductible and co-insurance.
This financial responsibility came as a surprise to many patients who had scheduled a screening and expected not to have to pay. "By adding the -PT modifier, the Medicare claims processing system is being told to waive the deductible," Mr. Cadorette says. "CMS is saying that a surgical procedure performed in conjunction with the screening will still be considered part of the screening service."
2. Revision to guidelines for discontinued colonoscopies. In 2010, CPT guidelines told coders they should report an incomplete colonoscopy with modifier -52, which is a reduced services modifier, according to Mr. Cadorette. In 2011, those guidelines have been revised. Now, the CPT handbook states that if the service is incomplete, coders should use modifier -53 to indicate a discontinued procedure. Modifier -53 serves as a physician modifier, while the ASC should report the procedure with a -74 modifier (discontinued outpatient hospital/ASC procedure after administration of anesthesia). Mr. Cadorette says a discontinued procedure might be recorded because of incomplete preparation, an anatomical variation or a tumor located in the colon that the physician couldn't advance the scope beyond.
3. Coding threaded bone dowels. CPT 22851 was used for biomechanical devices that included threaded bone dowels. "Previously, they considered a threaded bone dowel a biomechanical device because this type of bone graft was threaded and it would be screwed it into the spinal interspace, giving it mechanical properties," Mr. Cadorette says. "This was the only bone graft you would code as a biomechanical device." Due to a revision in the parenthetical notes, starting in 2011, coders should report a threaded bone dowel as a structural bone allograft with a code from the bone graft section instead.
4. Anterior interbody technique for cervical fusion. In the past, when a physician performed a discectomy to reduce pressure on the nerve root from a herniated disc, the physician would decompress the nerve root and the coder would report a decompression procedure in addition to the spinal arthrodesis. "The AMA acknowledges that, more often than not, these two services are performed together," Mr. Cadorette says. Starting in 2011 the AMA has added two new CPT codes: 22551 and 22552.
Coders would still use CPT 22554 if the physician performs a minimal discectomy without the decompression procedure. But while last year, coders could report a cervical arthrodesis and discectomy procedure separately, now coders are required to just report one code (CPT 22551) because AMA considers both services to be components of the primary procedure.
5. Pain management injection codes. The AMA has also started adding fluoroscopy into the primary portion of the pain management injection CPT codes, so just like the facet injections, coders can no longer report fluoroscopy in addition to the transforaminal injection codes 64479-64484. "When a transforaminal injection is performed, you no longer report the fluoroscopy component (CPT 77003), since it is already included in the CPT code definition," Mr. Cadorette says. He also says that epidural, transforaminal and facet injections performed at the T12-L1 level should be reported with a code from the cervical/thoracic series of codes rather than the lumbar/sacral code set.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
Read more on coding guidelines:
-CMS Issues Corrections for HCPCS Level II Code Set
-10 Most-Read Surgery Center Coding, Billing and Collections Articles
-SCODI Code Removed From CPT 2011 Codebook
Paul Cadorette, director of education for mdStrategies, discusses five changes to CPT codes in 2011.
1. New -PT modifier for screening procedures. A new HCPCS modifier took effect Jan. 1 for use in cases where a screening colonoscopy or screening flexible sigmoidoscopy was planned, but clinical findings lead to a diagnostic colonoscopy. According to Mr. Cadorette, under the Affordable Care Act, patients were not responsible for out-of-pocket payment for screening services. However, prior to Jan. 1, if the screening service turned into a diagnostic procedure in which the physician found a polyp and had to perform a polypectomy, the patient would be responsible for their deductible and co-insurance.
This financial responsibility came as a surprise to many patients who had scheduled a screening and expected not to have to pay. "By adding the -PT modifier, the Medicare claims processing system is being told to waive the deductible," Mr. Cadorette says. "CMS is saying that a surgical procedure performed in conjunction with the screening will still be considered part of the screening service."
2. Revision to guidelines for discontinued colonoscopies. In 2010, CPT guidelines told coders they should report an incomplete colonoscopy with modifier -52, which is a reduced services modifier, according to Mr. Cadorette. In 2011, those guidelines have been revised. Now, the CPT handbook states that if the service is incomplete, coders should use modifier -53 to indicate a discontinued procedure. Modifier -53 serves as a physician modifier, while the ASC should report the procedure with a -74 modifier (discontinued outpatient hospital/ASC procedure after administration of anesthesia). Mr. Cadorette says a discontinued procedure might be recorded because of incomplete preparation, an anatomical variation or a tumor located in the colon that the physician couldn't advance the scope beyond.
3. Coding threaded bone dowels. CPT 22851 was used for biomechanical devices that included threaded bone dowels. "Previously, they considered a threaded bone dowel a biomechanical device because this type of bone graft was threaded and it would be screwed it into the spinal interspace, giving it mechanical properties," Mr. Cadorette says. "This was the only bone graft you would code as a biomechanical device." Due to a revision in the parenthetical notes, starting in 2011, coders should report a threaded bone dowel as a structural bone allograft with a code from the bone graft section instead.
4. Anterior interbody technique for cervical fusion. In the past, when a physician performed a discectomy to reduce pressure on the nerve root from a herniated disc, the physician would decompress the nerve root and the coder would report a decompression procedure in addition to the spinal arthrodesis. "The AMA acknowledges that, more often than not, these two services are performed together," Mr. Cadorette says. Starting in 2011 the AMA has added two new CPT codes: 22551 and 22552.
Coders would still use CPT 22554 if the physician performs a minimal discectomy without the decompression procedure. But while last year, coders could report a cervical arthrodesis and discectomy procedure separately, now coders are required to just report one code (CPT 22551) because AMA considers both services to be components of the primary procedure.
5. Pain management injection codes. The AMA has also started adding fluoroscopy into the primary portion of the pain management injection CPT codes, so just like the facet injections, coders can no longer report fluoroscopy in addition to the transforaminal injection codes 64479-64484. "When a transforaminal injection is performed, you no longer report the fluoroscopy component (CPT 77003), since it is already included in the CPT code definition," Mr. Cadorette says. He also says that epidural, transforaminal and facet injections performed at the T12-L1 level should be reported with a code from the cervical/thoracic series of codes rather than the lumbar/sacral code set.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
Read more on coding guidelines:
-CMS Issues Corrections for HCPCS Level II Code Set
-10 Most-Read Surgery Center Coding, Billing and Collections Articles
-SCODI Code Removed From CPT 2011 Codebook