Journal of AHIMA - February 2012

Coding Notes
CPT Code Updates for 2012

By Karen O’Hara, BS, CCS-P

THE 2012 UPDATES to the CPT code set include 278 new codes, 139 code revisions, and 98 code deletions. This brings the total number of CPT codes to 9,641. All major sections of the CPT code set, as well as the introduc- tion and appendix A, have undergone changes. Beginning with the introduction to the code set, the “Instructions for Use of the CPT Codebook” were revised to include the CPT definition of qualified healthcare professionals, distinguishing them from clinical staff members. All changes are effective January 1 of this year. This article offers a summary of the updates, highlighting no- table changes for 2012. The complete list of changes is found in appendix B of the code set.

Evaluation and Management

The evaluation and management (E/M) section includes revisions to the definitions of new and established patients. The definitions now include reference to physicians of the same specialty and subspecialty when determining a new or established patient within a group practice.

The revised definitions state that the physician or another physician from the same group practice must be from the exact same specialty and subspecialty. To illustrate this definition, a revised “Decision Tree for New and Established Patients” was reinstated in 2012.

Other E/M changes include revisions to the prolonged services subsection, including:

x Removing the reference to “physician” and “face-to-face” from the title

x Adding “other qualified healthcare professional” to the
guidelines
x Defining direct patient care
x Adding observation as a setting for the inpatient pro-
longed services codes
In correlation with these changes, typical times were added to
the initial observation codes 99218–99220. Finally, the inpatient
neonatal and pediatric and neonatal critical care services sub-
section guidelines were revised to differentiate professional and
facility reporting, as well as add language to assist in the transfer
of care of the patient to another physician.

Surgery

In the integumentary subsection, 24 codes were deleted, six codes were revised, nine codes were added, and certain subsection guidelines were revised.

The section title for wound care management and skin substitutes was revised to “Skin Replacement Surgery.” The guidelines clarify the intent and use of these services, including definitions describing surgical preparation, autografts/tissue-cultured autografts, and skin substitute grafts.

Based on current clinical practice, a new subsection titled “Skin Substitute Grafts” was added, featuring eight new codes and guidelines that direct coding professionals to separately report the supply of the skin substitute graft(s). Specific instruction is provided related to the use of new code 15777 for biologic implant for soft tissue reinforcement.