2013 CPT Code Changes May Impact Your Practice

The Current Procedural Terminology (CPT) 2013 code book is now available for physicians, and any changes to reimbursement as a result of code changes, additions or deletions are expected from the Centers for Medicare and Medicaid Services (CMS) by the end of 2012.

Although the 2013 CPT code set includes 186 new codes, 119 deleted codes and 263 code revisions, there are only a few that will directly impact otolaryngology, said Richard Waguespack, MD, president-elect of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and CPT advisor for the Triological Society. Dr. Waguespack said major changes are expected in 2014, including potential code changes related to esophagoscopy and chemodenervation of the larynx.

Many of the changes that will impact otolaryngology in 2013 were made to clarify introductory language in separate sections, and additions in 2013 include codes for reporting pediatric sleep studies and intraoperative neurophysiology monitoring.

“It is clearly important for physicians, and certainly the key people in their office who submit claims, to maintain an awareness of these changes. Physicians are ultimately responsible for the billing that is done in their name. They need to make sure that their office from top to bottom is educated on a continual basis about any changes, especially this time of year,” said Dr. Waguespack.

Changes in Language

Among the changes to introductory language are clarifications related to skin replacement surgery, with specific definitions given for surgical preparation, autografts and skin substitute grafts. This guidance specifies that the graft is anchored using the individual’s choice of fixation and that routine dressing supplies are not reported separately when the services are performed in the office.

Another change was made to the introductory language for the Other Flaps and Grafts section. Specifically, it clarifies the difference between code 15740, Flap: Island Pedicle Requiring Identification and Dissection of an Anatomically Named Axial Vessel and services that should be reported with adjacent tissue transfer codes 14000-14302.

“Many otolaryngologists will often use the term ‘flap,’ and they have be very careful when they report their services to assure correct use in the context of CPT definitions. They need to be well informed about the specific language used in the CPT codes and should use that language whenever possible in their dictation or documentation related to flaps and grafts,” said Dr. Waguespack. “Otherwise, it could result in decreased payment or overpayment and, of course, no one wants an audit.”

Under the section on Vestibular Function Tests, Without Electrical Recording, the language clarifies that the spontaneous nystagmus test (92531) and positional nystagmus test (92532) are considered part of the physical exam and should not be reported with evaluation and management services.

The coding for chemodenervation has been changed with the addition of code 64615, which relates to muscles innervated by facial, trigeminal, cervical spinal and accessory nerve, bilateral (as in chronic migraine). This code can only be reported once per session and cannot be reported in conjunction with other codes that are listed. This is the code to be reported generally by otolaryngologists who treat migraine headaches with botulinum toxin injections.

Slight changes have been made to the Allergy and Clinical Immunology Procedures section, specifying that interpretation and reports associated with testing are not reported separately from the tests themselves. It also clarifies that counseling for use of devices (such as air filters) is reported with evaluation and management codes. A new subsection and two new codes for Ingestion Challenge Testing, 95076 and +95079, are available for 2013. The code 95075 has been deleted. Codes 95076 and +95079 are time-based, and if time spent is less than 61 minutes, an E&M service is reported, if appropriate.

New Codes

Two new codes have been added for reporting pediatric sleep studies when an otolaryngologist is supervising the sleep lab and is interpreting the attended sleep study in a child. One new code is 95782, related to polysymnography in a child younger than age 6, with four or more parameters of sleep, when attended by a technologist. Code 95783 is also related to a child younger than age 6, with four or more additional parameters of sleep and initiation of continuous positive airway pressure therapy or bilevel positive airway pressure ventilation, when attended by a technologist.

The 2013 changes also include two new add-on codes related to intraoperative neurophysiological monitoring, replacing code 95920. In this section, the language is clarified to specify that the monitoring of nerve function should be reported by the person actually monitoring rather than by the surgeon. The language related to codes 95940 and 95941 makes clear that if the monitoring is performed by the surgeon or anesthesiologist, those professional services are included in the surgeon’s or anesthesiologist’s primary service code(s) for the procedure. Additionally, these codes are not to be used for automated monitoring devices that do not require continuous attendance by a professional qualified to interpret the testing and monitoring.

Dr. Waguespack emphasized the importance of replicating CPT language whenever possible when documenting procedures and testing, and noted that physicians should be involved with the correct reporting of services rendered.

“You want to make sure that your reporting is consistent with these definitions” in the CPT 2013 code book, he said.