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LIST OF MODIFIERS

Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbur...

2011 CPT CODE CHANGES


Also see the list of new and Deleted CPT codes effective for the year 2012

Evaluation and Management – 3 New Codes

99224 - Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient’s hospital floor or unit.

99225 - Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient’s hospital floor or unit

99226 - Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient’s hospital floor or unit.

Integumentary System – 3 New & 2 Deleted codes

New CPT codes (Add-on Codes)

11045 - Debridement Subcutaneous Tissue, each additional 20 sq cm
11046 - Debridement Muscle/Fascia, each additional 20 sq cm
11047 - Debridement Bone, each additional 20 sq cm

Deleted codes

11040 & 11041 Debridement; skin; partial & full thickness

Musculoskeletal System – 5 New Codes

22551 - ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
22552 - ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC
29914 - ARTHROSCOPY HIP W/FEMOROPLASTY
29915 - ARTHROSCOPY HIP W/ACETABULOPLASTY
29916 - ARTHROSCOPY HIP W/LABRAL REPAIR

Respiratory System – 4 New Codes

31295 - NSL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS
31296 - NSL/SINUS NDSC SURG W/DILAT FRONTAL SINUS
31297 - NSL/SINUS NDSC SURG W/DILAT SPHENOID SINUS
31634 - BRONCHOSCOPY BALLOON OCCLUSION

Cardiovascular System – 20 New & 23 Deleted

New CPT codes

33620 - APPLICATION RIGHT & LEFT PULMONARY ARTERY BANDS
33621 - TTHRC CATHETER INSERT FOR STENT PLACEMENT
33622 - RECONSTRUCTION COMPLEX CARDIAC ANOMALY
37220 - REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL
37221 - REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOP UNI
37222 - REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL
37223 - REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSI VSL
37224 - REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI
37225 - REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL
37226 - REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL
37227 - REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL
37228 - REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI
37229 - REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL
37230 - REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL
37231 - REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL
37232 - REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL
37233 - REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL
37234 - REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL
37235 - REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA VSL
38900 - INTRAOP SENTINEL LYMPH ID W/DYE NJX

Deleted Codes

35454 – 35474 Transluminal balloon angioplasty
35480 - 35495 Transluminal peripheral atherectomy
39520 - 39531 Repair, diaphragmatic hernia

Digestive System – 18 New & 4 Deleted

New CPT codes

43283 - LAPS ESOPHAGEAL LENGTHENING ADDL
43327 - ESOPG/GSTR FUNDOPLASTY W/LAPT
43328 - ESOPG/GSTR FUNDOPLASTY W/THORCOM
43332 - RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH
43333 - LAPT RPR PARAESOPH HIATAL HERNIA W/ MESH
43334 - RPR PARAESOPH HIATAL HERNIA W/THORCOM W/O MESH
43335 - RPR PARAESOPH HIATAL HERNIA W/THORCOM W/MESH
43336 - RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH
43337 - RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/MESH
43338 - ESOPHAGUS LENGTHENING
43753 - GASTRIC TUBE PLMT W/ASPIR & LAVAGE
43754 - GASTRIC TUBE DX PLMT W/ASPIR 1 SPECIMEN
43755 - GASTRIC TUBE DX PLMT W/ASPIR MULT SPECIMENS
43756 - DUODENAL TUBE DX PLMT W/IMG GID 1 SPECIMEN
43757 - DUODENAL TUBE DX PLMT W/IMG GID MULT SPECIMEN
49327 - LAPS W/INSERTION NTRSTL DEV W/IMG GID 1+
49412 - PLMT INTRSTL DEV OPN W/IMG GID 1+
49418 - INSJ INTRAPERITONEAL CATHETER W/IMG GID

Deleted Codes

43324 - Esophagogastric fundoplasty (eg, Nissen, Belsey IV, Hill procedures)
43325 - Esophagogastric fundoplasty; with fundic patch (Thal-Nissen procedure)
43600 - Biopsy of stomach; by capsule, tube, peroral (1 or more specimens)
49420 - Insertion of intraperitoneal cannula or catheter for drainage or dialysis; temporary

Urinary System – 1 New Code

53860 - Transurethral Radiofrequency Treatment for Stress Incontinence

Female Genitourinary System – 1 New Code

57156 - Insertion of Vaginal Brachytherapy Device

Nervous System – 8 New & 2 Deleted codes

New CPT Codes

61781 - Stereotactic Computer Assisted PX IDRL CRNL
61782 - Stereotactic Computer Assisted PX XDRL CRNL
61783 - Stereotactic Computer Assisted PX SPINAL
64566 - POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
64568 - INC IMPLTJ CRNL NRV NSTIM ELTRDS & PULSE GENER
64569 - REVISION/REPLMT NSTIM CRNL ELTRDS
64570 - REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATOR
64611 - CHEMODENERV PAROTID & SUBMANDIBL SALIVARY GLANDS BI

Deleted CPT codes

61795 - Stereotactic computer-assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure)
64573 - Incision for implantation of neurostimulator electrodes; cranial nerve

Eye and Ocular Adnexa – 4 New Codes

65778 - PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN
65779 - PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED
66174 - TRLUML DILAT AQUEOUS CANAL W/O DEV/STNT
66175 - TRLUML DILAT AQUEOUS CANAL W/DEV/STNT

Radiology – 5 New Codes

74176 - CT ABD & PELVIS W/O CONTRAST
74177 - CT ABD & PELVIS W/CONTRAST
74178 - CT ABD & PELVIS W/O CONTRST 1+ BODY REGNS
76881 - US EXTREMITY NON-VASC REAL-TIME IMG COMPL
76882 - US EXTREMITY NON-VASC REAL-TIME IMG LMTD

Pathology & Laboratory–15 New & 13 Deleted codes

New CPT codes

80104 - DRUG SCRN QUAL 1+ CLASS NONCHROMOTOGRAPHIC EA
82930 - GASTRIC ACID ANALYIS W/PH EA SPECIMEN
83861 - MICROFLUID ANALYSIS TEAR OSMOLARITY
84112 - PLACENTAL ALPHA MICROGLOBULIN C/V QUAL
85598 - PHOSPHOLIPID NEUTRALIZATION HEXAGONAL
86481 - TB ANTIGEN RESPONSE GAMMA INTERFERON T-CELL SUSP
86902 - BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA
87501 - INFECTIOUS AGENT DNA/RNA INFLUENZA EA TYPE
87502 - INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
87503 - NFCT AGENT DNA/RNA INFLUENZA 1+ TYPES EA ADDL
87906 - NFCT GEXYP DNA/RNA HIV 1 OTHER REGION
88120 - CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL
88121 - CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA
88177 - CYTP C/V AUTO THIN LYR PREPJ ADEQUACY EA EVAL
88363 - EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSIS
88749 - UNLISTED IN VIVO LAB SERVICE

Deleted codes

82926 - Gastric acid, free and total, each specimen
82928 - Gastric acid, free or total, each specimen
86903 - Blood typing; antigen screening for compatible blood unit using reagent serum, per unit screened
89100 - Duodenal intubation and aspiration; single specimen (eg, simple bile study or afferent loop culture) plus appropriate test procedure
89105 - Duodenal intubation and aspiration; collection of multiple fractional specimens with pancreatic or gallbladder stimulation, single or double lumen tube
89130 - Gastric intubation and aspiration, diagnostic, each specimen, for chemical analyses or cytopathology;
89132 - Gastric intubation and aspiration, diagnostic, each specimen, for chemical analyses or cytopathology; after stimulation
89135 - Gastric intubation, aspiration, and fractional collections (eg, gastric secretory study); 1 hour
89136 - Gastric intubation, aspiration, and fractional collections (eg, gastric secretory study); 2 hours
89140 - Gastric intubation, aspiration, and fractional collections (eg, gastric secretory study); 2 hours including gastric stimulation (eg, histalog, pentagastrin)
89141 - Gastric intubation, aspiration, and fractional collections (eg, gastric secretory study); 3 hours, including gastric stimulation
89225 - Starch granules, feces
89235 - Water load test

Medicine – 39 New & 41 Deleted codes


New CPT codes

90460 - IMADM THROUGH 18YR ANY ROUTE 1ST VAC/TOXOID
90461 - IMADM THROUGH 18YR ANY ROUTE EA ADDL VAC/TOXOID
90644 - MENINGOCOCCAL & HIB CONJ VACCINE 4 DOSE IM
90664 - INFLUENZA VAC PANDEMIC FORMULA LIVE INTRANASAL
90666 - INFLUENZA VACCINE PANDEMIC SPLT PRSRV FREE IM
90667 - INFLUENZA VACCINE PANDEMIC SPLT ADJUVANT IM
90668 - INFLUENZA VACCINE PANDEMIC SPLT IM
90867 - TRANSCRANIAL MAG STIMJ TX PLANNING
90868 - TRANSCRANIAL MAG STIMJ TX DLVR & MGMT
91013 - ESOPHGL MOTILITY STD W/I&R STIM/PERFUSION
91117 - COLON MOTILITY STDY MIN 6 HR CONT RECORD W/I&R
92132 - CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI
92133 - COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE
92134 - COMPUTERIZED OPHTHALMIC IMAGING RETINA
92227 - REMOTE IMG DX RETINL DIS W/ALYS & REPORT UNI/BI
92228 - REMOTE IMG MGT RETINL DIS W/I&R UNI/BI
93451 - RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
93452 - L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
93453 - R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
93454 - CATH PLMT & NJX CORONARY ART ANGIO IMG S&I
93455 - CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
93456 - CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
93457 - CATH PLMT R HRT/ARTS/GRFTS W/NJX&ANGIO IMG S&I
93458 - CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
93459 - CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
93460 - R & L HRT CATH WINJX HRT ART& L VENTR IMG S&I
93461 - R&L HRT CATH W/INJEC HRT ART/GRFT&L VENT IMG S&I
93462 - LEFT HEART CATH BY TRANSEPTAL PUNCTURE
93463 - MEDICATION ADMIN & HEMODYNAMIC MEASURMENT
93464 - PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASURE
93563 - NJX SEL HRT ART CONGENITAL HRT CATH W/S&I
93564 - NJX SEL HRT ART/GRFT CONGENITAL HRT CATH W/S&I
93565 - NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I
93566 - NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I
93567 - NJX SUPRAVALV AORTOG HRT CATH W/S&I
93568 - NJX PULMONARY ANGIO HRT CATH W/S&I
95800 - SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
95801 - SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL
96446 - CHEMOTX ADMN PRTL CAVITY PORT/CATH

Deleted Codes

Immunization Administration

90465 - Immune admin 1 inj,

90466 - Immune admin addl inj,
90467 - Immune admin o or n, 1 inj,
90468 - Immune admin o/n, addl inj,

91000 Esophageal intubation

Manometry

91011 - Esophagus motility study w mechoyl
91012 - Esophagus motility study w acid perfusion studies 91052 - Gastric analysis test

91055 - Gastric intubation for smear
91105 - Gastric intubation treatment
91123 - Irrigate fecal impaction
92135 - Ophth dx imaging post seg

Electrocardiographic services

93012 - Transmission of ecg
93014 - Report on transmitted ecg

Ambulatory ECG Monitoring

CPT codes 93230 - 93237

Heart Catheterization and Injection procedure Codes

93501 - Right heart catheterization
93508 - Cath placement, angiography
93510 - Left heart catheterization; percutaneous
93511 - Left heart catheterization; by cutdown
93514 - Left heart catheterization by ventricular puncture

Combined Heart Catheterization

CPT codes 93524 - 93529

Injection procedures

CPT codes 93539 - 93545

Imaging Supervision

CPT codes 93555 - 93556

Chemotherapy Administration

96445 - Chemotherapy administration into peritoneal cavity, requiring and including peritoneocentesis

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