Modifier –PD One of the Biggest Changes of CPT 2012

2012’s biggest change did not come in the form of the addition or deletion of a CPT code, but rather initiation of a modifier. 

The CPT 2012 manual brought several CPT procedure codes and modifier changes. But on top of all the changes, the big news was inception of modifier PD. It was introduced to designate services furnished to a Medicare beneficiary in the three days prior to an inpatient admission in a facility wholly owned or wholly operated by the hospital. This is inclusive of the physician practices that self-designate ownership interest, as well as enable payment at the facility rate and identify that the service is subject to the three day payment window. 

The existing as well as new patient definitions in the Evaluation and  Management (E/M) guidelines was revised to add further clarifications to the words “ specialties” and “subspecialties”. According to this revision, even if the physician is of the same specialty, differences between the subspecialty would require a significant new patient work-up and would be considered a new visit, say for instance cardiologist vs. electrophysiologist.

CPT codes 2012 lookup for some specialties: 

CPT codes for Integumentary services related to surgery

There have been extensive changes for Integumentary services including the deletion of 24 codes, revision of six codes and the addition of eight new codes. The Skin Replacement codes (15271-15278) subheading was revised drastically. New skin replacement guidelines were added to state that skin replacement surgery now consists of the surgical preparation and topical placement of an autograft, which includes cultured tissue autograft, or skin substitute homograft, allograft and xenograft. 

CPT procedure codes  for Musculoskeletal services related to surgery

Two new codes for the treatment of Dupuytren's Contracture were added to the Musculoskeletal section of CPT 2012 which are code 20527 for the injection of an enzyme, such as collagenase, into the contracture and code 26341 is the follow up code for the manipulation of the Dupuytren Cord POST ENZYME injection. This code is to be used for subsequent visit(s) post the initial injection.

The phrase "bone biopsy included when performed" has been added to all vertebroplasty codes to be consistent with the kyphoplasty codes. You cannot report a separate bone biopsy in addition to a vertebroplasty. It’s not acceptable anymore.

CPT codes cardiology (for Cardiovascular services related to surgery)

CPT code 71090, insertion pacemaker, fluoroscopy, radiological supervision and interpretation was assessed and found to be used in combination with Pacemaker/ICD procedures more than 75% of the time and as such as has been deleted. If fluoroscopic guidance is used for diagnostic lead evaluation minus lead insertion, coders need to use 76000, fluoroscopy up to 1 hour physician time.

CPT codes for Digestive system services related to surgery

CPT codes 49080 and 49081 (abdominal paracentesis) have made way for codes 49082-abdominal paracentesis without imaging guidance, 49083-WITH imaging guidance, and 49084-Peritoneal lavage with imaging guidance.

This is just a glimpse of few of the CPT code and verbiage changes that was incorporated this year and that had a say in your practice’s coding.

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