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2013 CPT Coding Changes Pain Management and Anesthesia

Posted by on in Legislative and Compliance
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The 2013 CPT® Changes and Codebook are now available to health care providers.  Overall, the 2013 changes include 186 new codes, 119 deleted codes, and 263 revised codes. In addition CPT revised 18 modifiers and updated 150 guidelines.  The very good news for anesthesia and pain management providers is only a small handful of these changes directly impact the services they routinely provide.  Following are general comments regarding the 2013 changes:

  • No Anesthesia codes were deleted, revised, or added for 2013.
  • Pain management providers should take note of the four revised codes and one new code in the nervous system section of CPT 2013. The majority of changes occur in the denervation subsection, where CPT revised codes 64612 and 64614 and added 64615 for bilateral chemodenervation of muscles innervated by the facial, trigeminal, cervical spinal and accessory nerves.
  • CPT also changed the parenthetical note for code 76942, ultrasound guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation that now includes paravertebral facet joint injections using ultrasound.
  • The Instructions for Use of the CPT Codebook introduced the term “Qualified Healthcare Professional” (QHP) and how it will be used throughout the CPT Codebook.  The use of QHP is based on AMA CPT policy of neutrality with respect to identifying who may perform a procedure or service that is described in the CPT Codebook. It states:

Qualified Healthcare Professional (QHP)

A “physician or other qualified healthcare professional” is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service.

These professionals are distinct from “clinical staff."  A clinical staff member is a person who works under the supervision of a physician or other qualified healthcare professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service.

Other policies may also affect who may report specific services.

The following changes are also noteworthy:

  • CPT 2013 defines time for all time based codes (i.e., codes whose selection depends on the amount of time it takes to perform the service—not the anesthesia codes) and states that unless specific instructions to the contrary are contained in the code or code range instructions, “time is the face-to-face time with the patient.”  Further, a unit of time is attained when the mid-point is passed. Finally, when another service is performed concurrently with a time-based service, the time associated with the concurrent service should not be included in the time used for reporting the time-based service.
  • New codes for Complex Chronic Care Coordination Services (99487-99489) and for Transitional Care Management Services (99495 and 99496) were added. These codes have very specific documentation and reporting requirements.  While CPT is neutral as to which providers may perform these services, it is unlikely they would be part of anesthesia or pain management ; however, any QHP may perform the services.
  • We are aware of some pain management practices now offering behavioral health and psychotherapy services and want to bring to their attention that CPT 2013 includes a complete rewrite of the Medicine-Psychiatric Services section resulting in 11 new codes, 4 revised codes and 27 deletions. 
  • The Cardiovascular Surgery section includes new codes and guidelines for Aortic Valve, transcatheter aortic valve replacement, and diagnostic carotid angiography procedures.  Medicine-Cardiovascular services section of CPT also underwent extensive revision in 2013.

The below table provides specific CPT code changes of interest to anesthesia and pain management.

CHANGESDESCRIPTIONCOMMENTS
Revised text is in italics; Additions and Deletions for the same code range/set are listed together to see the difference in the old to the new codes.
Revised76942Ultrasonic guidance for needle placement, (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretationDo not report 76942 in conjunction with 27096, 32554, 32555, 32556, 32557, 37760, 37761,43232, 43237, 43242, 45341, 45342, 64479-64484, 64490-64495, 76975, )213T-0218T, 0228T-0231T, 0232T, 0249T, 0301T
Revised64561Percutaneous implantation of neurostimulator electrode array: sacral nerve (transforaminal placement), including image guidance, if performed 
Revised64612Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasmTo report a bilateral procedure, use modifier 50.
Revised64614Chemodenervation of muscle(s); extremity and/or trunk muscle(s) (eg, for dystonia, cerebral palsy, multiple sclerosis Report 64614 only once per session.
New64615Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)Report 64615 only once per session.
Deleted95900, 95903 and 95904These nerve conduction tests codes have been deleted. 
New95907-95913Nerve conduction tests studies new codes in 2013 are used to reflect number of studies performed, rather than each nerve, as the unit of service.95907 is for 1-2 studies; 95908 is for 3-4 studies; 95909 is for 5-6 studies; 95910 is for 7-8 studies; 95911 is for 9-10 studies, 95912 is for 11-12 studies; 95913 is for 13 or more studies.
Deleted+95920Intraoperative neurophysiology has been deleted. 
New+95940Continuous IONM in the OR one on one monitoring requiring personal attendance, each 15 minutes 
New+95941Continuous IONM, from outside the OR (remote or nearby) or for monitoring of > 1 case while in the OR, per hourCMS will not pay for CPT code +95941, but created a G code (G0453) to divide into 15 minutes increments for the undivided attention by the monitoring physician to one patient; NOTE: start/stop time must be documented to report properly.

We hope that this summary will be useful.  You might wish to keep it on hand until you and your coding staff become familiar with the 2013 changes.

Tony Mira founded MiraMed Global Services, Inc. in 2005 and serves as its President and Chief Executive Officer. Mr. Mira also Co-Founded MiraMed's subsidiary Anesthesia Business Consultants, LLC in March 2001 and serves as its President and Chief Executive Officer. By bringing these companies together under the MiraMed moniker, he has formed one of the largest healthcare Business Process Outsourcing (BPO) companies in the United States.


Also, Tony has been named (along with his wife Sue) the Honorary Co-Chair of  the JDRF Metro Detroit and Southeast Michigan Chapter 29th Annual Promise Ball.  JDRF:  Improving Lives.  Curing Type 1 Diabetes.  To learn more or to place a donation, click the following link: http://www.jdrfdetroitpromiseball.org

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Guest Thursday, 27 November 2014