Analysis of the 2010 CPT Code Changes

Fall is here, and along with the change in the weather comes the annual change to CPT codes.

Evaluation and Management: The E/M Guidelines at the beginning of the Evaluation and Management chapter were updated to expand the definition of Concurrent Care to include "Transfer of Care." The new definition reminds users to not use consultation codes when a transfer of care occurs, unless such transfer happens after the initial consultation evaluation.

Language within the nursing facility codes changed to remove the language “with the patient and/or family or caregiver” and replace it with “at the bedside and on the patient’s facility floor or unit.” The new text matches text within other facility E/M codes.

Surgery: The Special Report description in the Surgery Guidelines was shortened and the additional report items list has been removed. Additionally, th adjacent tissue transfer’s code number has been changed and there is now an add on code for each additional 30 sq cm’s transferred over 60 sq cm.

Soft tissue excision codes now include sizes and additional codes for radical resection of a tumor (eg malignant neoplasm) were expanded to include all existing soft tissue excision locations. Note that many of these codes are resquenced, which means they are not in the typical order of small to large, minor to major or proximal to distal. For example, code 28039 -Excision, tumor, soft tissue of foot or toe, subcutaneous, 1.5 cm or greater, appears before 28043 - Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm. The AMA is no longer renumbering codes to make room for new codes within each section. Instead, the symbol # will be used to denote a code has been resequenced. More information on this and a list of resequenced codes can be found in CPT Appendix N.

There are new codes for laparoscopic paraesophageal hernia repair, including fundoplasty with and without implantation of mesh (43281-43282); laparoscopic longitudinal gastrectomy (i.e. sleeve gastrectomy) performed as a gastric restrictive (weight loss) procedure (43775); and transanal approach to excision of a rectal tumor, partial or full thickness (45171-45172). Complex cystogram codes were expanded to include urethral pressure profile studies and voiding pressure studies (51727-51729).

Bronchoscopy: The bronchoscopy codes were modified to include the text “including fluoroscopic guidance, when performed;” which had been in the section header (31622-31656). Hemorrhoidectomy codes were changed from simple, complex or extensive to single column/group or 2 or more column/groups (46250-46262 and 46945-46946). Similarly, the language was changed in the surgical treatment of anal fistula codes, replacing “complex or multiple” and replacing it with locations (46275-46280).

H1N1: New codes for H1N1 include: 90470 for the administration of the vaccine, and 90663 for the vaccine. See the AMA page at: http://www.ama-assn.org/ama/pub/h1n1/resources/cpt-codes.shtml for more information.

To view the updates to the CPT code set, go to the Search Code Sets tab in CCH Coding Comply, select the CPT code set, select added, modified, and/or deleted in the Filter Actions and in the Start Date field enter 01/01/2010.

Written by Kathy Lindstrom, RHIT