CPT Changes Aren’t Always Obvious to Readers
By Sheri Poe Bernard, CPC
When the latest edition of the American Medical Associa-tion’s (AMA) CPT arrives, we tear off the plastic wrap, flip to the section we use the most and pore over our book, searching for the trademark triangles and dots that tell us what’s new and what’s changed in the procedural coding system upon which we base our medical reporting and reimbursement.
This year, we’ll see that dozens of laparoscopic procedures have been reassigned to their anatomic sections, and the separate Laparoscopy/Hysteroscopy section in CPT has been dissolved. We’ll note that practices focusing on neurology or pain management have experienced sweeping change, and many anesthesia codes have been realigned. In the Professional Edition, we will find scores of new illustrations and hundreds of new CPT Assistant references.
Thousands of notations are marked as having changed, too, and these changes are often as important as the code changes themselves. For example, new notes relating to the spine and spinal cord (62263-62319) identify procedures in which the injection of contrast material should not be reported separately and codes for which fluoroscopic guidance should be reported separately.
Another improvement in CPT 2000 is an expanded index, which has grown by 35 pages. This will simplify code searches, especially for laboratory procedures and tests. More synonyms, abbreviations and “see” notes are also included.
In total, this year’s CPT contains 7,755 active codes. Of these codes, 136 are flagged as new, 93 are flagged as changed and 91 codes have been deleted. It’s a lot to absorb, but more important, is it the entire story?
While CPT identifies significant changes in its 2000 edition, not all changes are flagged. Clinical personnel at your facility should already be creating a report, identifying all the changes that will affect your practice. Make sure this report includes a careful comparison of CPT 1999 to CPT 2000 to ensure that all relevant changes are captured and understood–even if they aren’t flagged with triangles and circles.
Small punctuation or word changes are often not flagged as revisions in CPT. For 2000, the AMA changed many punctuation standards. Apostrophes identifying possessives were deleted–physician’s became physicians and Meckel’s became Meckels. More care was taken to accurately identify injectables: the tetanus immune globulin was changed from TIG to TIg and Hepatitis B immune globulin was changed from HBIG to HBIg. Thousands of notations were changed from “see” to “use” (For preparation of custom breast implant, see/use 19396). These changes have little impact on coding, and therefore were not flagged as revisions.
Other seemingly insignificant changes weren’t flagged as revisions but could have an impact on accuracy in coding. Here’s an example:
1999: 31505 Laryngoscopy, indirect (separate procedure); diagnostic
2000: 31505 Laryngoscopy, indirect; diagnostic (separate procedure)
Because the content of 31505 did not change significantly, this code was not flagged as a revised code for 2000. However, in rewriting this code, the placement of the semicolon was changed. According to CPT convention, this affects the indented procedures that follow 31505:
31510 with biopsy
31511 with removal of foreign body
31512 with removal of lesion
31513 with vocal cord injection
The AMA uses indented procedures to conserve space. By CPT convention, anything appearing before the semicolon of the preceding “parent” code is considered part of the indented procedure’s description. Thus, the changes in 31505 are reflected in the full description for code 31510 from 1999 to 2000 as follows:
1999 31510 Laryngoscopy, indirect (separate procedure); with biopsy
2000 31510 Laryngoscopy, indirect; with biopsy
In this year’s CPT, more than 100 indented procedures are linked to “parent” codes with revised wording occurring before the semicolon. Thus, the meanings of these 100 indented codes have been changed, but not flagged. Reported as revised for 2000 is 62280:
1999 62280 Injection of neurolytic substance (e.g., alcohol, phenol, iced saline
2000 62280 Injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced
saline solutions), with or without other therapeutic substance;
Indented code 62281 is not identified as revised, but because of the placement of the semicolon, its meaning has changed significantly:
1999 62281 Injection of neurolytic substance (e.g., alcohol, phenol, iced saline
solutions); epidural, cervical or thoracic
2000 62281 Injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), with or without other therapeutic substance;
epidural, cervical or thoracic
Today, 62281 includes infusion, with or without other therapeutic substance.
A clinical review of CPT can identify for your office all changes that will affect coding and reimbursement at your facility. This review should include a complete comparison of all codes from 1999 to 2000. Your clinician should also keep a list of potential errors or conflicts within the coding system, and contact the AMA with any questions. The AMA keeps track of errata found in its publication.
At the annual symposium in Chicago this year, the AMA distributed a brief errata of CPT 2000 to attendees. The errata identified several errors in the published 2000 CPT, and you may want to note these changes directly into your CPT coding book.
In error, CPT does not present code 28309 as an indented procedure. As an indented procedure, the complete description for 28309 would include a portion of code 28306. The correct description for 28309 is:
28309 Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; multiple (e.g., Swanson type cavus foot procedure).
Conversely, CPT 2000 presents 29848 as an indented procedure, which it is not. Code 29848 reports the endoscopic surgical release of transverse carpal ligament and stands alone. It has no relationship with 29843, the wrist arthroscopy procedure that is erroneously presented as its “parent” code.
A cross-reference for 64450 directs readers to 62310-62319, which is a typographical error. The correct cross-reference for 64550 is 64622-64627. A cross-reference for 97124 directs readers to 97250, a deleted code. The correct reference is 97140.
In 80050, a general health panel code, the reader is instructed that this panel must include a “comprehensive metabolic panel (80054).” However, 80054 was deleted for 2000. The correct code is 80053.
A previously deleted code, 80053 was reinstated in 2000 to accommodate sequential listing of panel codes. Unfortunately, the AMA failed to delete an old notation, “80053 has been deleted,” which precedes the resurrected and completely valid 80053. Disregard this notation.
Should you have any questions regarding CPT errata, contact the CPT Editorial Research and Development staff at (312) 464-4723.
Sheri Poe Bernard is a project manager at Ingenix. She is a member of the National Advisory Board of the American Academy of Professional Coders (AAPC).