dures, the guidelines were revised, eight codes were deleted,
18 codes were added, and 22 codes were revised to reflect current practice. The new guidelines differentiate the procedure
approaches: percutaneous, thorascopic (video-assisted thorascopic surgery [VATS]), and thoracotomy.
The guidelines further differentiate the types, location, and
amount of tissue removed and the intent of the procedure as
diagnostic or therapeutic. This important delineation will assist
users when the diagnostic procedure results in a more extensive
procedure performed at the same session.
In addition the new guidelines address the use of intraoperative pathology to determine whether these more extensive procedures are required.
In correlation with these changes, several instructional parenthetical notes and cross-references were added throughout the
section. The parenthetical notes and cross-references provide
further clarification in reporting these procedures. The extensive changes to the lungs and pleura subsection should help users clearly report the procedures performed.
Changes to the cardiovascular subsection are found largely
within the pacemaker codes, where a new table was added for
2012. The table lists codes for both pacemaker systems and implantable cardioverter-defibrillators based on the procedure
performed.
Along with revisions to 14 codes and the addition of nine
codes, the moderate sedation symbol has been added to many
of the pacemaker codes. Instructional guidelines and definitions were added to clarify the intent and use of these codes.
Another significant change in the cardiovascular subsection
involves the reporting of arteriovenous (AV) shunts for dialysis.
New guidelines for diagnostic studies of AV shunts for dialysis
clarify codes 36147 for introduction of a needle or catheter and
36215 for selective catheter placement. New guidelines for interventions for AV shunts created for dialysis were also added to
help report these procedures.
The moderate sedation symbol was also added to several selective catheterization procedures, and three new codes were
added for insertion, replacement, and retrieval of intravascular
vena cava filter.
Changes in the surgery section also occurred in the musculo-skeletal and nervous system subsections, including revisions to
the spinal instrumentation codes and new guidelines and codes
for image-guided neurolysis of facet joint nerve(s).
Radiology
The radiology section includes a revision to code 70355 for or-thopantogram to include the example “panoramic x-ray” to better reflect the intent of the code. Code 74174 was also added for
computed tomographic angiography (CTA). This single code
combines a CTA of the abdomen and pelvis with contrast and
includes noncontrast images when performed and image post-processing.
To coincide with the addition of 74174, several instructional
parenthetical notes were added throughout the radiology sec-
Coding Notes
tion instructing users to report the new combined CTA code
when performed on the abdomen and pelvis, rather than the
single codes for CTA of the abdomen (e.g., 74175) and CTA of
the pelvis (e.g., 72191).
In the radiation oncology subsection, the radiation treatment
management guidelines were revised to reference new code
77469 for intraoperative radiation treatment management. The
guidelines clarify that this code represents only the intraoperative session management and does not include medical evaluation and management outside of that session.
Pathology
The largest change to the pathology section is the introduction
of the new molecular pathology subsection, which includes
new guidelines and 101 new codes.
As the new guidelines state, “Molecular Pathology proce-
dures are medical laboratory procedures involving the analyses
of nucleic acid to detect variants in genes that may be indica-
tive of germline (e.g., constitutional disorders) or somatic (e.g.,
neoplasia) conditions, or to test for histocompatibility antigens
(e.g., HLA).”
The codes are split between 92 tier I codes and nine tier II
codes. The difference between the two tiers is the volume in
which the procedures are performed, with the tier II codes per-
formed in lower volumes than the tier I procedures.
For the purposes of CPT reporting, the molecular pathology
guidelines include definitions that apply to the tier I and tier II
codes.
Medicine
Several changes were made throughout the medicine section,
including significant revisions within the pulmonary subsection. Ten codes were deleted and new codes were added for
pulmonary function testing to reflect commonly performed
procedures.
As part of these revisions, the new heading “Pulmonary Diagnostic Testing and Therapies” was added along with guideline
revisions providing new instructions for existing codes, as well
as four new codes.
Also included for 2012 is a new table in the cardiac catheterization subsection that provides guidance based on the catheter
placement type and additional services performed for reporting
cardiac catheterization procedures.
The neurology and neuromuscular subsection experienced
changes in both the sleep medicine and electromyography areas. The sleep medicine guidelines were revised to include definitions to help report these procedures. In electromyography,
three new add-on codes were created to describe needle electromyography procedures when performed in conjunction with
nerve conduction studies.
Additional changes can be found throughout the medicine
section in several subsections, including immunization administration, special otorhinolaryngologic services, and ophthalmology.
