The Current Procedural Terminology (CPT) code set for 2011 includes several changes of interest to ob-gyns. Additionally, CPT has added several features to the CPT-4 manual to help clarify coding in a variety of situations, including new guidelines, Coding Tips, and Evaluation and Management tables. These new features are in addition to new, revised and deleted CPT codes. These changes take effect January 1. Because of HIPAA requirements, insurers must accept new codes beginning January 1. The American Medical Association CPT Editorial Panel approved these changes for 2011.

Influenza Pandemic Vaccine Codes
CPT released four new CPT-4 codes this year to report the pandemic formulation of the combination flu vaccine (CPT-4 codes 90664, 90666, 90667 and 90668). These codes are only for pandemic use.

  • 90664 Influenza virus vaccine, pandemic formulation, live, preservative free, for intranasal use
  • 90666 Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use
  • 90667 Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use
  • 90668 Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use

Recommended coding for flu vaccine for the 2010-2011 flu season is to report non-pandemic codes from CPT-4 code series 90655 – 90660.

Integumentary Codes
The guidelines and many of the codes in the wound debridement section, such as codes 11042 – 11047, have been revised and new add-on codes have been established to further delineate the work performed, by depth of tissue and surface area of the wound.

Intraperitoneal Catheters
Codes in the intraperitoneal catheters section have been revised and new codes have been added to provide more specific identification of placement procedures.

  • 49418 Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous
  • 49419 Insertion of a tunneled intraperitoneal catheter with subcutaneous port
  • 49422 Removal of a tunneled intraperitoneal catheter

CPT code 49420 (Insertion of intraperitoneal cannula or catheter for drainage or dialysis; temporary) has been deleted.

Intraperitoneal Chemotherapy Administration
96446 Chemotherapy administration into the peritoneal cavity via indwelling port or catheter
Code 96445 (Chemotherapy administration into peritoneal cavity, requiring and including peritoneocentesis) has been deleted.

Introduction: Brachytherapy
57155 Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy
57156 Insertion of vaginal radiation afterloading apparatus for clinical brachytherapy

Maternity Care and Delivery Guidelines
The guidelines for maternity care have been updated to clarify the proper reporting of E/M services when appropriate with delivery only codes and delivery with postpartum care codes. The new guidelines are as follows:

  • Postpartum care only services (59430) include office or other outpatient visits following vaginal or cesarean delivery.
  • When reporting delivery only services (59409, 59514, 59612, 59620), report inpatient post delivery management and discharge services using E/M codes. Delivery and postpartum services (59410, 59515, 59614, 59622) include delivery services and all inpatient and outpatient postpartum services.
  • Medical problems complicating labor and delivery management may require additional resources. These services should be identified by reporting codes from the Medicine and E/M sections of CPT in addition to the appropriate codes for maternity care.”

Pathology and Laboratory/Chemistry
Code 84112 has been established for reporting placental alpha microglobulin-1 (PAMG-1), through cervicovaginal secretion.

  • 84112 Placental alpha microglobulin-1 (PAMG-1), cervicovaginal secretion, qualitative)

Subsequent Observation Care Codes (99224-99226)
Subsequent observation care codes have been established for reporting observation services that extend beyond the initial day of service. These codes include reviewing the medical record, the results of diagnostic studies and any changes in the patient’s status since the last assessment by the physician.

  • 99224 Subsequent observation care, per day for the evaluation and management of a patient which requires 2 of these 3 requirements: problem focused interval history, problem focused exam, and straightforward or low medical decision-making. Typical time is 15 minutes.
  • 99225 Subsequent observation care, per day for the evaluation and management of a patient which requires 2 of these 3 requirements: expanded problem focused interval history, expanded problem focused exam, and moderate medical decision-making. Typical time is 25 minutes.
  • 99226 Subsequent observation care, per day for the evaluation and management of a patient which requires 2 of these 3 requirements: detailed interval history, detailed exam, and medical decision-making of high complexity. Typical time is 35 minutes.

The introduction section of CPT now includes new guidelines for time measurement for those codes with a time basis for code selection. Per the new guidelines:

  • Time is the face-to-face time with the patient
  • The “interpretation and report” in the code description is not intended to indicate that report writing is part of the reported time.
  • A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes). A second hour is attained when a total of 91 minutes have elapsed.
  • For codes ranked in sequential typical times, when the actual time for the service falls between two typical times, the code with a typical time closest to the actual time is reported.
  • When another service (such as a procedure) is performed concurrently with a time based service, the time associated with the concurrent service should not be included in the time used for reporting the time based service.
  • Times for services measured in units other than days are considered continuous times even if the service extends into another calendar date.

The descriptions of several modifiers have been revised for 2011 in order to clarify their usage.
Modifier 50 (Bilateral procedure) has been revised to delete the term (operative) when describing procedures.

Modifiers 76 -78 (repeat procedures and unplanned return to the operating/procedure room) have been revised to clarify that these modifiers may be reported by a physician “or other qualified healthcare professional.” Additionally, CPT clarified that modifiers 76 and 77 should not be appended to an evaluation and management service.