CPT Updates 2015

CPT U

PDATES

2015

M

ARYLAND

AAHAM

D ARLENE H ELMER , CMA, CPC, ACS-AN, CMPE, MBA

A PPROVED AHIMA ICD-10 T RAINER

J ANUARY 16, 2015

Anesthesia Business Consultants, LLC Confidential Presentation Materials

Disclaimer

Anesthesia Business Consultants, LLC (“ABC”) has provided this In-Service presentation, handouts and supplemental documentation and information (collectively, the “Presentation”) as a service to its clients. The Presentation is for general informational purposes only and should not be taken as legal advice or understood to create a legal contract or other covenant or agreement of any kind between ABC.

Although the information found in this Presentation is believed to be reliable, no warranty, expressed or implied, is made regarding the accuracy, adequacy, completeness, legality, reliability, or usefulness of any information, either isolated or in the aggregate. The information in the Presentation is supplemental to, and not a substitute for, the AMA CPT-4 Codebook, any federal or state regulations, or payer/carrier contract or policies. There is no guarantee that the use of this material will prevent differences of opinion with payers/carriers/or regulators in payment and/or reimbursement disputes. It is further noted that any and all liability arising from the use of materials or information and/or presented at the seminar is the sole responsibility of the participant, and his/her respective employer(s) who, by their attendance at this Presentation, evidences agreement to hold harmless the aforementioned parties, their employees and affiliates. The Presentation is intended to be used as a teaching “tool”. CPT® Codes are copyright by the American Medical

Association.

2


CPT Updates 2015

Key new and deleted CPT code coming in 2015

 Impact of changes on provider coding and billing



•

Inside the numbers:

261 new codes, 128 revised codes and 146 deleted codes

• Significant changes in

• E/M section

•

• Spinal Procedures

Cardiovascular

•

• Pathology/Lab

Digestive

3


Common Themes













•

Clarification of devices

Pacemaker section – were pacing cardioverter defibrillators now implantable defibrillators

•

New methods/approaches

Electrophysiologic evaluation for single or dual chamber transvenous pacing cardioverter-defibrillators

•

Deletion of low utilization codes

Application of turnbuckle jacket

•

Codes created for recognition of work

New code 34819 created for “physician planning”

Clarification when codes should not be billed together

Electromyography codes in Urology section

4


Social History

Age appropriate review of past and current activities that includes significant information about:

 Marital status and/or living arrangements

 Current employment

 Occupational history

 Military history (NEW for 2015)

 Use of drugs, alcohol, and tobacco

 Level of education

 Sexual history

 Other relevant social factors

5


E/M Changes

New Codes:



•

99490 Chronic care management, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional per calendar month

Code reported once per month

• Provided by clinical staff under direction of physician

• At home, assisted living or rest home

•

• Include face to face and non face to face

Activities are located in the guidelines

6


E/M Changes

 99497 Advance care planning; first 30 minutes

 99498 each additional 30 minutes (add on code)

 Face to face services between physician/healthcare practitioner and family to discuss advanced directives

 Patient does not need to be present

 No active management of medical issues need to be present

 Some E//M services may be reported but no critical care

7


E/M Changes

Revised Codes:

 99487 Complex chronic care management with moderate or high medical decision-making; 60 minutes per month

 99489 each additional 30 minutes (add on code)

8


Anesthesia

Deleted:

 00452 Anesthesia for procedures on clavicle or scapula; radical surgery

 00622 Anesthesia for procedure on thoracic spine and cord; thoracolumbar sympathectomy

 00634 Anesthesia for procedures in lumbar region; chemonucleolysis

9


Surgery

 Surgery

• New guidelines for vertebroplasty/vertebral augmentation

•

• New codes for open treatment of rib fractures

New codes added/revised for arthrocentesis and ablation therapy procedures

 Cardiovascular System

•

•

• Changes to guidelines for pacemaker and implantable defibrillator

Subsection for extracorporeal membrane oxygenation

Revised guidelines/codes for endovascular revascularization services

10


Surgery

 Digestive

• Extensive changes for lower endoscopy procedures with new guidelines and codes for Stomal Endoscopy

• Renamed colon and rectal section

 Nervous system

•

• New injection codes for myelography

New codes for transversus abdominus plane block

11


Surgery

 Global package definition

• Definition was revised to clarify who can perform these services and identify what services are included in addition to the operation

•

•

•

• Furnished by physician or other qualified health care professional

• E/M services subsequent to the decision for surgery (use to say

“one E/M service”)

Further changes – CMS has approved final rule-

CMS will transition post op days to ZERO

• Current 10 day procedures = CY 2017

• Current 30 day procedures = CY2018

Surgical RVU’s will be reevaluated to account for surgery only

12


Musculoskeletal

New Codes:

 20604 Arthrocentesis, aspiration and/or injection, small joint or bursa; without ultrasound guidance**

 20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa with ultrasound guidance, with permanent recording and reporting**

 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa; with ultrasound guidance, with permanent recording and reporting**

**when codes are changed to include ultrasound guidance you can no longer bill for the guidance separately

13


Musculoskeletal

New Codes:





20983 Ablation therapy for reduction or eradication of 1 or more bone tumors including adjacent soft tissue when involved by tumor extension, percutaneous, including imagining guidance when performed; cryoablation

21811 Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 1-3 ribs





21812 4-6 ribs

21813 7 or more ribs

** codes include moderate sedation so anesthesia cannot be billed separately as well as image guidance

14


Musculoskeletal

New Codes:

 22510 Percutaneous vertebroplasty, 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic

 22511 lumbosacral

 22512 each additional cervicothoracic or lumbosacral vertebral body (add on code)

15


Musculoskeletal

New Codes:

 22513 Percutaneous vertebral augmentation, including cavity creation using mechanical device, 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic

 22514

 22515 lumbar each additional thoracic or lumbar vertebral body (add on code)

16


Musculoskeletal

New Codes:

 22858 Total disc arthroplasty, anterior approach, including discectomy with end plate preparation; second level cervical (add on code)**

 27279 Arthrodesis, sacroiliac joint, percutaneous or minimally invasive, with image guidance, incudes obtaining bone graft when performed, and placement of transfixing device **

**

Category III code deleted to create Category I code

17


Musculoskeletal

Revised Codes:

 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa; without ultrasound guidance

 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa; without ultrasound guidance

 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa; without ultrasound guidance

18


Musculoskeletal

Revised Codes:

 20982 Ablation, therapy for reduction or eradication of 1 or more bone tumors including adjacent soft tissue when involved by tumor extension, percutaneous, including image guidance when performed; radiofrequency

 27280 Arthrodesis, open, sacroiliac joint, including instrumentation when performed

 27370 Injection of contrast for knee arthrography

19


Cardiovascular

New Codes:

 33270 Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters when performed**

 33271 Insertion of subcutaneous implantable defibrillator electrode**

**Category III code deleted to make Category I code. Check guidelines

20


Cardiovascular

New Codes:

 33272 Removal of subcutaneous implantable defibrillator electrode

 33273 Repositioning of previously implanted subcutaneous implantable defibrillator electrode

 33418 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis**

 33419 additional prosthesis(es) during same session

(add on code)**

**Category III code deleted to make Category I code . Codes include angiography and radiological supervision/interpretation to guide the repair

21


Cardiovascular

New Codes:

 33946 Extracorporeal membrane oxygenation

(ECMO)/extracorporeal life support (ECLS) provided by a physician; initiation, veno-venous

 33947 initiation, veno-arterial





33948

33949 daily management, each day, veno-venous daily management, each day, veno-arterial

 33951 insertion of peripheral cannula(e), percutaneous, birth through 5 years of age

22


Cardiovascular

New Codes:





33952

33953 insertion of peripheral cannula(e), percutaneous, 6 years and older insertion of peripheral cannula(e), open, birth through 5 years of age

 33954 insertion of peripheral cannula(e), open, 6 years and older

 33955 insertion of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age

23


Cardiovascular

New Codes:

 33956

 33957

 33958

 33959 insertion of central cannula(e) by sternotomy or thoracotomy, 6 years and older reposition peripheral cannula(e), percutaneous, birth through 5 years of age reposition peripheral cannula(e), percutaneous,

6 years and older reposition peripheral cannula(e), open, birth through 5 years of age

24


Cardiovascular

New Codes:

 33962

 33963

 33964

 33965 reposition peripheral cannula(e), open, 6 years and older reposition of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age reposition of central cannula(e) by sternotomy or thoracotomy, 6 years and older removal of peripheral cannula(e), percutaneous, birth through 5 years of age

25


Cardiovascular

New Codes:

 33966

 33969

 33984

 33985

 33986 removal of peripheral cannula(e), percutaneous, 6 years and older removal of peripheral cannula(e), open, birth through 5 years of age removal of peripheral cannula(e), open, 6 years and older removal of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age removal of central cannula(e) by sternotomy or thoracotomy, 6 years and older

26


Cardiovascular

New Codes:

 33987 Arterial exposure with creation of graft conduit to facilitate arterial perfusion for ECMO/ECLS (add on code)

 33988 Insertion of left heart vent by thoracic incision for

ECMO/ECLS

 33989 Removal of left heart vent by thoracic incision for

ECMO/ECLS

27


Cardiovascular

New Codes:





34839 Physician planning of a patient-specific fenestrated visceral aortic endograft requiring a minimum of 90 minutes of physician time

37218 Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation

**If these services are relevant to your specialty recommend additional coding education

28


Cardiovascular

Revised Codes:

 33215 Repositioning of preciously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode

 33216 Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator

 33217 Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator

 33218 Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator

29


Cardiovascular

Revised Codes:

 33220 Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator

 33223 Relocation of skin pocket for implantable defibrillator

 33224 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator

30


Cardiovascular

Revised Codes:

 33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator

(add on code)

 33240 Insertion of implantable defibrillator pulse generator only; with existing single lead





33230

33231 with existing dual leads with existing multiple leads

 33241 Removal of implantable defibrillator pulse generator only

31


Cardiovascular

Revised Codes:

 33243 Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy

 33244 by transvenous extraction

 33249 Insertion or replacement of permanent implantable defibrillator system with transvenous lead(s), single or dual chamber electrode(s); by transvenous extraction

32


Cardiovascular

Revised Codes:





33262 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system

33263 dual lead system







33264

37216 multiple lead system

37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection without distal embolic protection

33


Cardiovascular

Revised Codes:





37217 Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation

37236 Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease , cervical carotid, extracranial vertebral, or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and all angioplasty within the same vessel, when performed; initial artery

 37237 each additional artery (add on code)

** these codes will not be allowed when a stent is placed in the lower extremity for reasons other than occlusive disease

34


Digestive



•

•

•

•

Gastroenterology

Restructured section into 3 subsections

• Esophagoscopy

•

• Esophagogastroduodenoscopy (EGD)

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Changes have been made to intestines and rectum endoscopy section for the same purpose

Colonoscopy tree has been added

Endoscopy, small intestine and stomal subsection has been divided into two sections – one for small intestine and one for stomal endoscopy

**Recommend additional education for the changes in this section

35


Digestive

New Codes:

 43180 Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus, with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed

 44381 Ileostomy, through stoma; with transendoscopic balloon dilation

 44384 with placement of endoscopic stent

36


Digestive

New Codes:

 44401 Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s)





44402

44403 with endoscopic stent placement with endoscopic mucosal resection

 44404

 44405 with directed submucosal injection(s), any substance with transendoscopic balloon dilation

37


Digestive

New Codes:

 44406

 44407 with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/ biopsy(s), includes endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures

38


Digestive

New Codes:

 44408 with decompression, including placement of decompression tube, when performed

 45346 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s)







45347

45349

45350 with placement of endoscopic stent with endoscopic mucosal resection with band ligation(s)

39


Digestive

New Codes:

 45388 Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s)





45389

45390 with endoscopic stent placement with endoscopic mucosal resection

 45393

 45398 with decompression, including placement of decompression tube, when performed with band ligation(s)

 45399 Unlisted procedure, colon

40


Digestive

New Codes:

 46601 Anoscopy; diagnostic, with high-resolution magnification (HRA) and chemical agent enhancement, including collection of specimen(s) by brushing or washing, when performed

 46607 diagnostic, with high-resolution magnification

(HRA) and chemical agent enhancement, with biopsy, single or multiple

 47383 Ablation, 1 or more liver tumor(s), percutaneous, cryoablation (image guidance will be reported separately)

41


Digestive

Revised Codes:

 43194 Esophagoscopy, rigid, transoral; with removal of foreign body (s)

 43197 Esophagoscopy, flexible, transnasal; diagnostic including collection of specimen(s) by brushing or washing, when performed (separate procedure)

 43215 Esophagoscopy, flexible, transoral; with removal of foreign body (s)

 43216 with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

42


Digestive

Revised Codes:

 43247 Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body (s)


 44360 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

 44363 with removal of foreign body (s)

43


Digestive

Revised Codes:

 44380 Ileostomy, through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

 44385 Endoscopic evaluation of small intestinal pouch ; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

 44386 with biopsy, single or multiple

44


Digestive

Revised Codes:

 44388 Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)






44391

44392 with control of bleeding, any method with removal of tumor(s), polyp(s) or other lesion(s) by hot biopsy forceps

 44799 Unlisted procedure, small intestine

45


Digestive

Revised Codes:





45330 Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

45332 with removal of foreign body (s)

 45333

 45334

 45337

 45340 with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps with control of bleeding, any method with decompression, including placement of decompression tube, when performed with transendoscopic balloon dilation

46


Digestive

Revised Codes:

 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)


 45380 with biopsy, single or multiple

 45381

 45382 with directed submucosal injection(s), any substance with control of bleeding, any method


47


Digestive

Revised Codes:

 45385

 45386

 45391 with removal of tumor(s), polyp(s), or other lesion(s) by snare technique with transendoscopic balloon dilation with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures

48


Digestive

Revised Codes:

 45392 with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures

 46600 Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed

(separate procedure)

49


Urinary

New Codes:

 52441 Cystourethroscopy with insertion of permanent adjustable transprostatic implant; single implant

 52442 each additional permanent adjustable transprostatic implant (add on code)

50


Maternity

 Guidelines in Maternity Care/Delivery section have been revised to clarity that pregnancy confirmation during a problem-oriented or preventative visit is not considered part of the antepartum care and can/should be reported separately using the appropriate E/M code

 Further classification in Guidelines state that antepartum care also includes the initial prenatal history and physical exam

 Post partum guidelines have been moved to reflect chronological order of events.

51


Nervous

New Codes:

 62302 Myelography via lumbar injection, including radiological supervision and interpretation; cervical







62303

62304

62305 thoracic lumbosacral

2 or more regions

52


Nervous

New Codes:

 64486 Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s)

(includes imaging guidance, when performed)

 64487 by continuous infusion(s) (includes imaging guidance, when performed)

 64488 Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance when performed)

 64489 by continuous infusions (includes imaging guidance when performed)

** added to indicate provision of anesthesia of the abdominal wall primarily for post op pain control

53


Nervous

Revised Codes:

 61055 Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment

 62284 Injection procedure for myelography and/or computed tomography, lumbar (other than C1-C2 and posterior fossa)

54


Eye and Ear

New Codes:

 66179 Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft

 66184 Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft

**These codes were found to be reported 73% of the time, new codes were developed to reflect with or without grafts

55


Eye and Ear

Revised Codes:

 66180 Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft

 66185 Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft

 67399 Unlisted procedure, extraocular muscle

56


Radiology

New Codes:

 76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete**

 76642 limited**

**New codes to report limited and complete breast ultrasound procedures

**Both include axilla if performed

**Many changes to parenthetical notes and cross references to reflect changes throughout CPT

57


Radiology

 New Codes

• 77061 Digital breast tomosynthesis; unilateral**

•

• 77062 bilateral**

77063 Screening digital breast tomosynthesis, bilateral (add on code)

**Cannot report with regular screening mammo codes

**Medicare using G codes for screening

**Codes do not include coverage

•

•

CMS will pay for diagnostic tomo

Unclear how commercial payors will handle

58


Radiology

New Codes:

 77085 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton, including vertebral fracture assessment**

 77086 Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA)

 77306 Teletherapy isodose plan; simple, includes basic dosimetry calculation(s)

 77307 complex, includes basic dosimetry calculation(s)

**combo code for assessment and bone density

59


Radiology

New Codes:

 77316 Brachytherapy isodose plan; simple, includes basic dosimetry calculation(s)

 77317

 77318 intermediate, includes basic dosimetry calculation(s) complex, includes basic dosimetry calculation(s)

60


Radiology

New Codes:

 77385 Intensity modulated radiation treatment delivery

(IMRT), includes guidance and tracking, when performed; simple

 77386 complex

 77387 Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed

61


Radiology

Revised Codes:

 77401 Radiation treatment delivery, superficial and/or ortho voltage, per day

 77402 Radiation treatment delivery, >1MeV ; simple

 77407

 77412 intermediate complex

62


Radiology

 Significant changes to the code set for these services

•

•

•

• New codes established to report combined teletherapy isodose with basic dosimetry calculations as well as combine codes for brachytherapy isodose planning with basic dosimetry

May codes deleted and parenthetical notes added to direct users to appropriate codes.

All new guidelines added as well as Radiation

Management and Treatment table added to provider clarity

Recommend extra education for this specialty

63


Pathology

New Codes:

 80163 Digoxin; free

 80165 Valproic acid dipropylacetic acid); free

 80300 Drug screen, any number of drug classes from Drug

Class List A; any number of non-TLC devices or procedures, capable of being read by direct optical observation, including instrumental-assisted when performed, per date of service

 80301 single drug class method, by instrumented test systems, per date of service

64


Pathology

New Codes:

 80302 Drug screen, presumptive, single drug class from

Drug Class List B, by immunoassay or non-TLC chromatography without mass spectrometry, each procedure

 80303 Drug screen, any number of drug classes, presumptive, single or multiple drug class method; thin layer chromatography procedure(s) (TLC), per date of service

 80304 not otherwise specified presumptive procedure, each procedure

65


Pathology

 Drug Testing

• Presumptive

•

•

Used to determine possible use or non-use of a drug

May be followed by definitive testing to determine specific drug

• Definitive

•

•

Qualitative or Quantitative tests to identify possible use or non use of a drug

Identifies specific drugs

•

•

•

Presumptive is not required

Any specimen can be used

More than one test requires 59 modifier

66


Pathology

New Codes:

 80320 Alcohols

 80321 Alcohol biomarkers; 1 or 2

 80322 3 or more

 80323 Alkaloids, not otherwise specified

 80324 Amphetamines; 1 or 2

 80325 3 or 4

 80326

 80328

5 or more

 80327 Anabolic steroids; 1 or 2

3 or more

67


Pathology

New Codes:

 80329 Analgesics, non-opioid; 1 or 2

 80330

 80331

3-5

6 or more

 80332 Antidepressants, serotonergic class; 1 or 2





80333

80334

3-5

6 or more

 80335 Antidepressants, tricyclic and other cyclicals; 1 or 2

 80336

 80337

3-5

6 or more

68


Pathology

New Codes:

 80338 Antidepressants, not otherwise specified

 80339 Antiepileptics, not otherwise specified; 1-3





80340

80341

4-6

7 or more

 80342 Antipsychotics, not otherwise specified; 1-3

 80343 4-6

 80344 7 or more

 80345 Barbiturates

69


Pathology

New Codes:

 80346 Benzodiazepines; 1-12









80347 13 or more

80348 Buprenorphine

80349 Cannabinoids, natural

80350 Cannabinoids, synthetic; 1-3









80351

80352

4-6

7 or more

80353 Cocaine

80354 Fentanyl

 80355 Gabapentin, non-blood

70


Pathology

New Codes:

 80356 Heroin metabolite

 80357 Ketamine and norketamine

 80358 Methadone

 80359 Methylenedioxyamphetamines

 80360 Methylphenidate

 80361 Opiates, 1 or more

 80362 Opioids and opiate analogs; 1 or 2

 80363

 80364

3 or 4

5 or more

71


Pathology

New Codes:

 80365 Oxycodone

 80366 Pregabalin

 80367 Propoxyphene

 80368 Sedative hypnotics (non-benzodiazepines)

 80369 Skeletal muscle relaxants; 1or 2

 80370 3 or more

 80371 Stimulants, synthetic

 80372 Tapentadol

72


Pathology

New Codes:

 80373 Tramadol

 80374 Stereoisomer (enantiomer) analysis, single drug class

 80375 Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 1-3

 80376 4-6

 80377 7 or more

 81246 FLT3, gene analysis; tyrosine kinase domain (TKD) variants (eg, D835, I836)

73


Pathology

New Codes:

 81288 MLH1 (mutL homolog1, colon cancer, nonpolyposis type 2)(eg, hereditary non-polyposis colorectal cancer,

Lynch syndrome) gene analysis; promoter methylation analysis

 81313 PCA3/KLK3 (prostate cancer antigen 3 [non-protein coding]/kallikrein-related peptidase 3 [prostate specific antigen]) ratio (eg, prostate cancer)

74


Pathology

New Codes:

 81410 Aortic dysfunction or dilation (eg, Marfan syndrome,

Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); genomic sequence analysis panel, must include sequencing of at least 9 genes, including FBN1, TGFBR1, TGFBR2, COL3A1, MYH11,

ACTA2, SLC2A10, SMAD3, and MYLK

 81411 duplication/deletion analysis panel, must include analyses for TGFBR1, TGFBR2,

COL3A1, MYH11

75


Pathology

New Codes:

 81415 Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis







81416 sequence analysis, each comparator exome

(eg, parents, siblings) (add on code)

81417 reevaluation of previously obtained exome sequence (eg, updated knowledge or unrelated condition/syndrome)

81420 Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21

76


Pathology

New Codes:

 81425 Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis

 81426

 81427 sequence analysis, each comparator genome(eg, parents, siblings) (add on code) reevaluation of previously obtained genome sequence (eg, updated knowledge or unrelated condition/syndrome)

77


Pathology

New Codes:

 81430 Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome, Pendred syndrome); genomic sequence analysis panel, must include sequencing of at least 60 genes, including CDH23, CLRB1, GJB2, GPR98,

MTRNR1, MY07A, MY015A, PCDH15, OTOF, SLC26A4,

TMC1, TMPRSS3, USH1C, USH1G, USH2A, and WFS1

 81431 duplication/deletion analysis panel, must include copy number analyses for STRC and

DFNB1 deletions in GJB2 and GJB6 genes

78


Pathology

New Codes:

 81435 Hereditary colon cancer syndromes (eg, Lynch syndrome, familial adenomatosis polyposis); genomic sequence analysis panel, must include analysis of at least

7 genes, including APC, CHEK2, MLH1, MSH2, MSH6,

MUTYH, and PMS2

 81436 duplication/deletion gene analysis, must include analysis of at least 8 genes, including APC,

CHEK2, MLH1, MSH2, MSH6, MUTYH, PMS2, and EPCAM

79


Pathology

New Codes:

 81440 Nuclear encoded mitochondrial genes, genomic sequence panel, must include analysis of at least 100 genes, including BCS1L, C10orf2, COQ2, COX10,

DGUOK, MPV17, OPA1, PDSS2, POLG, POLG2, RRM2B,

SCO1, SCO2, SLC25A4, SUCLA2, SUCLG1, TAZ, TK2,

AND TYMP

 81445 Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, 5-50 genes, interrogation for sequence variants and copy number variants or rearrangements, if performed

80


Pathology

New Codes:





81450 Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, DNA and RNA analysis when performed, 5-50 genes, interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels if performed

81455 Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, DNA and

RNA analysis when performed, 51 or greater, interrogation for sequence variants and copy number variants or rearrangements, if performed

81


Pathology

New Codes:

 81460 Whole mitochondrial genome (eg, Leigh syndrome, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes [MELAS], myoclonic epilepsy with ragged-red fibers [MERFF], neuropathy, ataxia, and retinitis pigmentosa [NARP], Leber hereditary optic neuropathy

[LHON]), genomic sequence, must include sequence of analysis of entire mitochondrial genome with heteroplasmy detection

 81465 Whole mitochondrial genome large sequence deletion analysis panel (eg, Kearns-Sayre syndrome, chronic progressive external ophthalmoplegia), including heteroplasmy detection, if performed

82


Pathology

New Codes:





81470 X-linked intellectual disability (XLID) (eg, syndromic and non-syndromic XLID); genomic sequence analysis panel, must include sequencing of at least 60 genes, including ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1,

IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL,

RPS6KA3, AND SLC16A2

81471 duplication/deletion gene analysis, must include analysis of at least 60 genes, including ARX,

ATRX, CDKL5, FGD1, FMR1, HUWE1,

IL1RAPL, KDM5C, L1CAM, MECP2, MED12,

MID1, OCRL, RPS6KA3, AND SLC16A2

83


Pathology

New Codes:





81519 Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score

83006 Growth stimulation expressed gene 2 (ST2,

Interleukin 1 receptor like-1)

 87505 Infectious agent detection by nucleic acid (DNA or

RNA); gastrointestinal pathogen (eg, Clostridium difficile,

E.coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets

84


Pathology

New Codes:

 87506

 87507 gastrointestinal pathogen, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 6-11 targets gastrointestinal pathogen, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets

85


Pathology

New Codes:

 87623

 87624

Human Papillomavirus (HPV), low-risk types

Human Papillomavirus (HPV), high-risk types

 87625 Human Papillomavirus (HPV), types 16 and 18 only, includes type 45 , if performed

 87806 Infectious agent antigen detection by immunoassay with direct optical observation; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies

86


Pathology

New Codes:

 88341 Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure

(add on code)

 88344 each multiplex antibody stain procedure

 88364 In situ hybridization (eg. FISH), per specimen; each additional single probe stain procedure (add on code)

 88366 each multiplex probe stain procedure

87


Pathology

New Codes:

 88369 Morphometric analysis, in situ hybridization

(quantitative or semi-quantitative) manual, per specimen; each additional single probe stain procedure (add on code)



(quantitative or semi-quantitative) using computer-assisted technology, per specimen; each additional single probe stain procedure (add on code)


 89337 Cryopreservation, mature oocyte(s)

88


Pathology

Revised Codes:

 80162 Digoxin; total

 80164 Valproic acid ( dipropylacetic acid); total

 80171 Gabapentin, whole blood, serum, or plasma

 80299 Quantitation of therapeutic drug, not elsewhere specified

 81402 Molecular pathology procedure, Level 3




89


Pathology

Revised Codes:

 82541 Column chromatography/mass spectrometry (eg,

GC/MS, or HPLC/MS), non-drug analyte not elsewhere specified; qualitative, single stationary and mobile phase

 82542 quantitative, single stationary and mobile phase

 82543

 82544 stable isotope dilution, single analyte, quantitative, single stationary and mobile phase stable isotope dilution, multiple analyte, quantitative, single stationary and mobile phase

90


Pathology

Revised Codes:

 84600 Volatiles (eg, acetic anhydride, diethylether)

 86900 Blood typing, serologic ; ABO

 86901 Rh (D)

 86902 antigen testing of donor blood using reagent serum, each antigen test

 86904 antigen screening for compatible unit using patient serum, per unit screened

 86905

 86906

RBC antigens, other than ABO or Rh (D), each

Rh phenotyping, complete

91


Pathology

Revised Codes:

 87501 Infectious agent detection by nucleic acid (DNA or

RNA); influenza virus, includes reverse transcription, when performed , and amplified probe technique, each type or subtype

 87502 influenza virus, for multiple types or sub-types, includes multiplex reverse transcription and multiplex amplified probe technique, first 2 types or sub-types

 87503 influenza virus, for multiple types or sub-types, includes multiplex reverse transcription and multiplex amplified probe technique, each additional influenza virus type or sub-type beyond 2 (add on code)

92


Pathology

Revised Codes:





87631

87632 respiratory virus, includes multiplex reverse transcription, when performed , and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets respiratory virus, includes multiplex reverse transcription, when performed , and multiplex amplified probe technique, multiple types or subtypes, 6-11 targets

 87633 respiratory virus, includes multiplex reverse transcription, when performed , and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets

93


Pathology

Revised Codes:

 88342 Immunohistochemistry or immunocytochemistry, per specimen ; initial single antibody stain procedure



•

88360 Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, per specimen , each single antibody stain procedure; manual

88361 using computer-assisted technology

94


Pathology

Revised Codes:

 88365 In situ hybridization (eg. FISH), per specimen; initial single probe stain procedure


(quantitative or semi-quantitative), using computer-assisted technology, per specimen ; initial single probe stain procedure


(quantitative or semi-quantitative), manual, per specimen ; initial single probe stain procedure

95


Medicine

New Codes:

 90630 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use

 90651 Human Papilloma virus vaccine types 6, 11, 16, 18,

31, 33, 42, 52, 58, nonavalent (HPV), 3 dose schedule, for intramuscular use





91200 Liver elastography, mechanically induced shear wave (eg, vibration), without imaging, with interpretation and report

92145 Corneal hysteresis determination, by air impulse stimulation, unilateral or bilateral, with interpretation and report

96


Medicine



Medicine services15 new and 16 revised

•

•

•

•

•

• Changes to:

Vaccine codes: especially new flu vaccine code

Psychiatry subsections and parenthetical notes and new adaptive behavior treatment codes (Category III)

Cardiovascular subsection guidelines and definitions updated

New Echocardiography codes

Subsection change in several areas.

97


Medicine

New Codes:





93260 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead defibrillator system

93261 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator system

98


Medicine

New Codes:

 93355 Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s), real-time image acquisition and documentation, guidance with quantitative measurements, probe manipulation, interpretation, and report, including diagnostic transesophageal echocardiography and, when performed, administration of ultrasound contrast, Doppler, color flow, and 3D

** New code to report TEE during interventional cardiac procedures

**New guidance and parenthetical notes added to provider additional instruction

99


Medicine

New Codes:

 93644 Electrophysiologic evaluation of subcutaneous implantable defibrillator

 93702 Bioimpedance spectroscopy (BIS), extracellular fluid analysis for lymphedema assessment(s)

 93895 Quantitative carotid intima media thickness and carotid atheroma evaluation, bilateral

 96127 Brief emotional/behavioral assessment, with scoring and documentation, per standardized instrument

100


Medicine

New Codes:





97607 Negative pressure wound therapy, utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters

97608 total wound(s) surface area greater than 50 square centimeters

** new codes intended for negative pressure therapy using disposable non-DME; therefore existing codes revised to stipulate use of DME

101


Medicine

New Codes:

 99184 Initiation of selective head or total body hypothermia in the critically ill neonate, includes appropriate patient selection by review of clinical, imaging and laboratory data, confirmation of esophageal temperature probe location, evaluation of amplitude EEG, supervision of controlled hypothermia, and assessment of patient tolerance of cooling**

 99188 Application of topical fluoride varnish by a physician or other qualified health care professional

**Codes 99481abd 99482 deleted new code includes all components

102


Medicine

Revised Codes:

 90654 Influenza virus vaccine, trivalent (IIV3) , split virus, preservative-free, for intradermal use

 90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine,

(DTaP-HepB-IPV), for intramuscular use

 90734 Meningococcal conjugate vaccine, serogroups A, C,

Y and W-135, quadrivalent , for intramuscular use

103


Medicine

Revised Codes:

 93282 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system

 93283

 93284 dual lead transvenous implantable defibrillator system multiple lead transvenous implantable defibrillator system

104


Medicine

Revised Codes:





93287 Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system

93289 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements

105


Medicine

Revised Codes:

 93295 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional

 93296 single, dual, or multiple lead pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support

106


Medicine

Revised Codes:

 93642 Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator

 95972 Electronic analysis of implanted neurostimulator pulse generator system; complex spinal cord, or peripheral

(except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, up to 1 hour

107


Medicine

Revised Codes:

 96110 Developmental screening, with scoring and documentation , per standardized instrument**

 97605 Negative pressure wound therapy, utilizing durable medical equipment (DME) , including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters

 97606 total wound(s) surface area greater than 50 square centimeters

**specifically excludes the emotional/behavioral assessment

108


Category II



Claims based performance measures reporting



Revision and new codes for esophageal biopsy



Revision of esophageal biopsies with dx of

Barrett’s esophagus



New codes for identification of adenoma and other neoplasm detection



New footnote measures developed by GI societies

109


Category III

 Codes for new technology may or may not be covered









39 new codes added

6 codes revised

•

•

26 codes deleted

3 codes deleted

23 codes changed to Category I codes

•

Also 3 new subsections, guidelines and 16 codes added for assessment and treatment in the Adaptive Behavioral subsection

Codes created for assessment and treatment of patients of any age with deficient adaptive or maladaptive behaviors, i.e. autism spectrum disorders, developmental disabilities, head trauma

110


Category III

New Codes:

 0340T Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance

 0341T Quantitative pupillometry with interpretation and report, unilateral or bilateral

 0342T Therapeutic apheresis with selective HDL delipidation and plasma reinfusion

 0345T Transcatheter mitral valve repair percutaneous approach via the coronary sinus

111


Category III

New Codes:

 0346T Ultrasound, elastography (add on code)

 0347T Placement of interstitial device(s) in bone for radiostereometric analysis (RSA)

 0348T Radiologic examination, radiostereometric analysis

(RSA); spine





0349T

0350T upper extremity(ies) lower extremity(ies)

112


Category III

New Codes:

 0351T Optical coherence tomography of breast or axillary lymph node, excised tissue, each specimen; real-time intraoperative

 0352T interpretation and report, real-time or referred

 0353T Optical coherence tomography of breast, surgical cavity; real-time intraoperative

 0354T interpretation and report, real-time or referred

113


Category III

New Codes:

 0355T Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report

 0356T Insertion of drug-eluting implant (including punctal dilation and implant removal when performed) into lacrimal canaliculus, each

 0357T Cryopreservation; immature oocyte(s)

 0358T Bioelectrical impedance analysis whole body composition assessment, supine position, with interpretation and report

114


Category III

New Codes:

 0359T Behavior identification assessment, by the physician or other qualified health care professional, face-to-face with patient and caregivers), includes administration of standardized and non-standardized tests, detailed behavioral history, patient observation and caregiver interview, interpretation of test results, discussion of findings and recommendations with the primary guardian(s)/caregiver(s), and preparation of report

115


Category III

New Codes:

 0360T Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; first 3o minutes of technician time, face-to-face with the patient

 0361T each additional 30 minutes of technician time, face-to-face with the patient (add on code)

116


Category III

New Codes:

 0362T Exposure behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by physician or other qualified health care professional with the assistance of one or more technicians; first 30 minutes of technician(s) time, face-to-face with the patient

 0363T each additional 30 minutes of technician(s) time, face-to-face with the patient (add on code)

117


Category III

New Codes:

 0364T Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; first 30 minutes of technician time

 0365T each additional 30 minutes of technician time

(add on code)

 0366T Group adaptive behavior treatment by protocol, administered by technician, face-to-face with two or more patients; first 30 minutes of technician time

 0367T each additional 30 minutes of technician time

(add on code)

118


Category III

New Codes:

 0368T Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional with one patient; first 30 minutes of patient face-to-face time

 0369T each additional 30 minutes of patient face-toface time (add on code)

119


Category III

New Codes:

 0370T Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present)

 0371T Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present)

120


Category III

New Codes:

 0372T Adaptive behavior treatment social skills group, administered by physician or other qualified health care professional face-to-face with multiple patients

 0373T Exposure adaptive behavior treatment with protocol modification requiring two or more technicians for sever maladaptive behavior(s); first 60 minutes of technicians' time, face-to-face with patient

 0374T each additional 30 minutes of technicians' time, face-to-face with patient (add on code)

121


Category III

New Codes:







0375T Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation

(includes osteophytectomy for nerve root or spinal cord decompression and microdissection), cervical, three or more levels

0376T Insertion of anterior aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; each additional device insertion (add on code)

0377T Anoscopy with directed submucosal injection of bulking agent for fecal incontinence

122


Category III

New Codes:

 0378T Visual field assessment, with concurrent real time data analysis and accessible data storage with patient initiated data transmitted to a remote surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional

 0379T technical support and patient instructions, surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional

123


Category III

New Codes:

 0380T Computer-aided animation and analysis of time series retinal images for the monitoring of disease progression, unilateral or bilateral, with interpretation and report

124


Category III

Revised Codes:

 0075T Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; initial vessel

 0076T each additional vessel (add on code)

 0191T Insertion of anterior aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork ; initial insertion

125


Category III

Revised Codes:

 0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or a mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed

 0201T Percutaneous sacral augmentation (sacroplasty), bilateral injection(s), including the use of a balloon or a mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed

126


HCPCs Modifier Changes



•

•

•

Modifier 59 is the most widely used

Often utilized to bypass NCCI edits

Modifier is associated with the most abuse, leading to audits, reviews and even fraud and abuse.

4 new modifiers created X(EPSU) modifiers









XE -Separate encounter, a service that is distinct because it occurred during a separate encounter

XS - Separate structure, a service that is distinct because it was performed on a separate organ/structure

XP - Separate practitioner, a service that is distinct because it was performed by a different practitioner

XU - Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service

127


References

 2015 CPT Professional Edition Codebook

 2015 CPT Changes Insiders View

128


Questions

129


CPT Updates 2015

PDATES

ARYLAND

New Codes:

Medicine services15 new and 16 revised

Claims based performance measures reporting

Revision and new codes for esophageal biopsy

Revision of esophageal biopsies with dx of

Barrett’s esophagus

New codes for identification of adenoma and other neoplasm detection

New footnote measures developed by GI societies

Related documents

Products

Support

CPT Updates 2015

PDATES

ARYLAND

New Codes:

Medicine services15 new and 16 revised

Claims based performance measures reporting

Revision and new codes for esophageal biopsy

Revision of esophageal biopsies with dx of

Barrett’s esophagus

New codes for identification of adenoma and other neoplasm detection

New footnote measures developed by GI societies

Related documents

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