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.”