2014 Coding Changes
AAPC RICHMOND VA. CHAPTER
JANUARY 2014
2
Overview & Objectives

Identify coding changes for the upcoming year
(HIGHLIGHTS)
 CPT®
 HCPCS
 What's
new for 2014- over 330 coding changes
AAPC Richmond Va. Chapter - January 2014
3
CPT®
175 NEW CODES
47 DELETED CODES
107 REVISED CODES
AAPC Richmond Va. Chapter - January 2014
4
Evaluation & Management

Interprofessional Telephone/Internet Consultations
(99446 - 99449) four new codes


Time-based!!

must document a minimum of 5 minutes to report 99446

Time includes review of medical record, diagnostic test, verbal & written communication
Request from treating physician to consultant for opinion and/or treatment advice to assist
in the diagnosis and/or management of the patient

no face to face w/ patient

Complex and/or urgent situations where a timely face-to-face service with the consultant
may not be feasible

New patient to consultant or Established patient with new problem or exacerbation of an
existing patient

No face-to-face with consultant last 14 days or next 14 days

Report only once in a seven day period
AAPC Richmond Va. Chapter - January 2014
5
Evaluation & Management (cont.)

Complex Chronic Care
Coordination Services
(99487 - 99489)

Codes did not change

Guidelines revised to detail:

Typical adult patients

Typical pediatric patients

Requirements for care coordination
offices/practices
AAPC Richmond Va. Chapter - January 2014

Requirements:

Provide 24/7 access to clinical staff

Use standardized methodology to
identify CCCC patients

Internal process whereby identified
patients being receiving treatment in
a timely manner

Standardized medical record form
and format

Engage and educate patients and
caregivers and coordinate care
among all service professionals
6
Evaluation & Management (cont.)

Transitional Care Management Services
(99495 - 99496)

Codes did not change/ just revised

Can report for new or established patients

Separately reported E&M cannot be reported on the same day

Discharge service may not be used as required face-to-face
visit
AAPC Richmond Va. Chapter - January 2014
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Integumentary - Lund-Browder
(No more “Rule of Nines” in CPT)
Area
Birth-1yr
1-4 Yrs
5-9 Yrs
10-14 Yrs
15 Yrs
Adult
Head
19
17
13
11
9
7
Neck
2
2
2
2
2
2
Trunk*
13
13
13
13
13
13
Buttock*
2.5
2.5
2.5
2.5
2.5
2.5
Genitalia
1
1
1
1
1
1
U Arm*
4
4
4
4
4
4
L Arm*
3
3
3
3
3
3
Hand*
2.5
2.5
2.5
2.5
2.5
2.5
Thigh*
2.5
6.5
8
8.5
9
9.5
Leg*
5
5
5.5
6
6.5
7
Foot*
3.5
3.5
3.5
3.5
3.5
3.5
AAPC Richmond Va. Chapter - January 2014
8
Integumentary - Breast Procedures

New biopsy with localization codes:

Include localization devices, when performed

Include imaging of the biopsy specimen, when performed

Differ based on type of guidance

Stereotactic
(19081, +19082)

Ultrasound
(19083, +19084)

MRI
(19085, +19086)
AAPC Richmond Va. Chapter - January 2014
Integumentary - Breast Procedures
(cont.)

New introduction codes for localization devices

Differ based on type of guidance

Mammographic
(19281, +19282)

Stereotactic
(19283, +19284)

Ultrasound
(19285, +19286)

MRI
(19287, +19288)
AAPC Richmond Va. Chapter - January 2014
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10
Musculoskeletal

Tumor resections


Changed terminology from: Malignant neoplasm to sarcoma
New and revised codes for removal of foreign body
and removal of prosthesis

Specifically describes what is removed foreign body or
prosthesis
AAPC Richmond Va. Chapter - January 2014
11
Respiratory

Pleural catheter & thoracentesis

Parenthetical notes revised to state not to report in conjunction
when performed on the same side of the chest
AAPC Richmond Va. Chapter - January 2014
12
Cardiovascular

Pacemaker or Pacing Cardioverter Defibrillator


Guidelines revised

Relocation of skin pocket: requires creation of a new skin pocket

Revision of skin pocket, not reported separately

Subcutaneous implantable defibrillator system
TAVI/TARI new code for transapical exposure
AAPC Richmond Va. Chapter - January 2014
13
Cardiovascular (cont.)

New codes

Fenestrated Endovascular Repair of the Visceral and Infrarenal
Aorta (34841 - 34848)

Transcather placement of an intravascular stent(s) (37217, 37236
- 37239)

Vascular Embolization and Occlusion (37241 - 37244)
AAPC Richmond Va. Chapter - January 2014
14
Digestive - BIG CHANGES

Endoscopy codes: specifically rigid and flexible
esophagoscopy= significant changes

13 new codes

Description revision for nearly all remaining
codes

New parenthetical instructions
AAPC Richmond Va. Chapter - January 2014
15
Digestive - BIG CHANGES

Esophagoscopy (43191 - 43232)

Esophagogastroduodenoscopy (43233 - 43259)

Endoscopic Retrograde
Cholangiopancreatography - ERCP (43260 43278)

Abdomen, Peritoneum, and Omentum Introduction, Revision, and Removal
AAPC Richmond Va. Chapter - January 2014
16
Digestive (cont.)

Esophagoscopy

Cricopharyngeus muscle (upper esophageal sphincter)
to and including the gastoesophageal junction

Includes examination of the proximal region of the
stomach via retroflexion when performed

Selecting code need to know if a rigid or flexible
scope is used

Reason for separating the code is the different
types of anesthesia used
AAPC Richmond Va. Chapter - January 2014
17
Digestive (cont.)

Esophagogastroduodenoscopy
(AKA: Upper GI)

Cricopharyngeus muscle (upper esophageal
sphincter) to and including the duodenum

Consistent terminology

Explanation of proper modifier use

Duodenum deliberately not examined

Modifier 52 - Repeat examination not planned

Modifier 53 - Repeat examination planned
AAPC Richmond Va. Chapter - January 2014
18
Digestive (cont.)

ERCP


Requires visualization of one or more of the ductal
systems

Pancreatic

Biliary
Altered postoperative anatomy

Unlisted codes (47999 or 48999) for ERCP via
gastrostomy or via Roux-en-Y
AAPC Richmond Va. Chapter - January 2014
19
Digestive (cont.)

New codes for image-guided fluid collection draining
by catheter (abdomen, peritoneum, and omentum)

49405
Visceral Percutaneous

49406
Peritoneal or Retroperitoneal, Percutaneous

49407
Peritoneal or Retroperitoneal, Transvaginal or
Transrectal
AAPC Richmond Va. Chapter - January 2014
20
Urinary

One new code

Combination code

52356 Cystourethroscopy with ureteroscopy
with lithotripsy including insertion of indwelling ureteral
stent(eg, Gibbons or double-J type)
AAPC Richmond Va. Chapter - January 2014
21
Nervous

New Codes in the Chemodenervation Section - Somatic Nerves

64616
Neck muscle(s) excluding larynx (unilateral)

64617
Larynx, unilateral, percutaneous
includes needle EMG guidance

64642
One extremity; 1 -4 muscles

+64643
Each additional extremity, 1 - 4 muscles

64644
One extremity; 5+ muscles

+64645
Each additional extremity, 5+ muscles

64646
Trunk muscles; 1 - 5 muscles

64647
Trunk muscles; 6+ muscles
AAPC Richmond Va. Chapter - January 2014
22
Eye & Ocular Adnexa

One new code - Anterior Sclera - Aqueous Shunt

66183
Insertion of anterior segment aqueous drainage
device, without extraocular reservoir, external
approach

Replaces the category III code 0192T
AAPC Richmond Va. Chapter - January 2014
23
Auditory System

Guideline for cerumen removal 69210

Clarifies that an instrument is required

Revised to report unilateral procedure (continue to use modifier
50 for bilateral procedures)

Added guidance from CPT® Assistant
AAPC Richmond Va. Chapter - January 2014
24
Radiology

Radiologic exam of spine 72040 now specifies “2 or 3 views instead
of “3 or less”

Revisions to guidance codes and parenthetical references based
on codes for which guidance is now included:


Transcatheter Procedures- supervision included in new codes 37236-37239

Fluoroscopic Guidance

Magnetic Resonance Guidance
Revisions to radiation oncology simulation guidelines:
inappropriately described as “simulation”, more appropriately
labeled as “planning”
AAPC Richmond Va. Chapter - January 2014
25
Pathology & Laboratory

New Molecular Pathology Table


Expansion of molecular pathology parenthetical lists of included
items
10 New Therapeutic Drug Assay Codes
AAPC Richmond Va. Chapter - January 2014
26
Medicine


Vaccines - New Flu Codes

Includes four strains (two type A and two type B)

Patients age determines the code
Special Otorhinolaryngologic Services


Repair of Structural Heart Defects


New speech related codes
Two new percutaneous transcatheter repair codes
Intracardiac Electrophysiological Procedures/Studies

3 revised codes - all for comprehensive electrophysiologic evaluations
AAPC Richmond Va. Chapter - January 2014
27
Medicine (cont.)

Intraoperative Neurophysiology


Guidelines revised to define specifically what the time monitoring
and time in the OR includes

Monitoring - Time to set up, record, and interpret the baseline studies,
and to remove electrodes at the end of the procedure

OR - Time is cumulative and only includes time physically present in the
room; may begin prior to incision
Active Wound Care Management

One new code - low frequency non-contact non-thermal US for
wound assessment (per day)
AAPC Richmond Va. Chapter - January 2014
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Next Steps

Review all new codes, guidelines, and parenthetical







Highlight the changes for your specialty
New guidelines/parenthetical printed in green.
Look in the index for any changes.
Update coding cheat sheets with the new codes
Make sure super bills, charge masters are updated with the
new codes
Load new codes into software
Educate staff on changes
AAPC Richmond Va. Chapter - January 2014
29
Questions? & Reminders…

Current 2014 CPT

2014 CPT® Errata

2014 CPT® Changes: An Insider’s View

CPT Assistant

AHA Coding Clinic
AAPC Richmond Va. Chapter - January 2014
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Contact Information

Presentation Prepared by- Chandra Stephenson, CPC,
CPC-H, CPCO, CPMA, CPC-I, CANPC, CEMC, CFPC,
CIMC, COSC

Presentation Presented by- Colleen Mescall, MHA/E,
CPC, CPMA, CPC-I, 2014 RAC President, 2013-2015
National Advisory Board Member
AAPC Richmond Va. Chapter - January 2014