CPT Code Changes 2015
2015 OIG Updates
Catherine Gray, RHIT, CPC, CPC-H
CCC, CEMC, CGIC
cagray85@yahoo.com
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2014 OIG Work Plan
Highlights for Hospitals, Physicians and
Health Plans
2015 OIG Work Plan
O The HHS Office of Inspector General (OIG) Work Plan
for Fiscal Year 2015 summarizes new and ongoing
reviews and activities that OIG plans to pursue with
respect to HHS programs and operations during the
current fiscal year and beyond.
O The Work Plan describes the primary objectives and
provides for each review its internal identification
code and the year in which we expect one or more
reports to be issued as a result of the review.
O When reports are issued, they are posted to OIG's
website. OIG's email list subscribers automatically
receive notification when new reports are posted to
the website.
2015 OIG Work Plan
O New Inpatient Admission Criteria
O We will determine the impact of new inpatient admission
criteria on hospital billing, Medicare payments, and
beneficiary copayments.
O Previous OIG work identified millions of dollars in
overpayments to hospitals for short inpatient stays that
should have been billed as outpatient stays.
O Beginning in FY 2014, new criteria state that physicians
should admit for inpatient care those beneficiaries who are
expected to need at least 2 nights of hospital care (known
as the “two midnight policy”).
O Beneficiaries whose care is expected to last fewer than 2
nights should be treated as outpatients. The criteria
represent a substantial change in the way hospitals bill for
inpatient and outpatient stays.
2015 OIG Work Plan
O Medicare Costs Associated with
Defective Medical Devices
O We will review Medicare claims to identify the
costs resulting from additional use of medical
services associated with defective medical
devices and determine the impact of the cost on
the Medicare Trust Fund.
O CMS has previously expressed concerns about the
impact of the cost of replacement devices,
including ancillary cost, on Medicare payments for
inpatient and outpatient services.
2015 OIG Work Plan
O Medicare Oversight of Provider-based
Status
O We will determine the extent to which provider-
based facilities meet CMS’s criteria.
O Provider-based status allows facilities owned and
operated by hospitals to bill as hospital outpatient
departments. (POS 15 vs 22)
O Provider-based status can result in higher
Medicare payments for services furnished at
provider-based facilities and may increase
beneficiaries’ coinsurance liabilities.
2015 OIG Work Plan
O Comparison of Provider-based and
Free-standing Clinics
O We will review and compare Medicare payments
for physician office visits in provider-based clinics
and free-standing clinics to determine the
difference in payments made to the clinics for
similar procedures and assess the potential
impact on the Medicare program of hospitals'
claiming provider based status for such facilities.
O Provider-based facilities often receive higher
payments for some services than do freestanding
clinics.
2015 OIG Work Plan
O Inpatient Claims for Mechanical
Ventilation
O We will review Medicare payments for inpatient hospital claims
with certain MS-DRG assignments that require mechanical
ventilation to determine whether hospitals’ DRG assignments and
resultant Medicare payments were appropriate.
O Mechanical ventilation is the use of a ventilator or respirator to
take over active breathing for a patient. Claims must be
completed accurately to be processed correctly and promptly.
O For certain DRGs to qualify for Medicare coverage, a patient must
receive 96 or more hours of mechanical ventilation. Our review will
include claims for beneficiaries who received over 96 hours of
mechanical ventilation. Previous OIG reviews identified improper
payments made because hospitals inappropriately billed for
beneficiaries who did not receive 96 or more hours of mechanical
ventilation.
2015 OIG Work Plan
O Outpatient E/M Services Billed at the
New-patient Rate (G0463)
O We will review Medicare outpatient payments made to
hospitals for evaluation and management (E/M) services for
clinic visits billed at the new-patient rate to determine
whether they were appropriate and will recommend recovery
of overpayments.
O Preliminary work identified overpayments that occurred
because hospitals used new-patient codes when billing for
services to established patients.
O The rate at which Medicare pays for E/M services requires
hospitals to identify patients as either new or established,
depending on previous encounters with the hospital.
O According to Federal regulations, the meaning of “new” and
“established” pertains to whether the patient has been seen
as a registered inpatient or outpatient of the hospital within
the past 3 years.
2015 OIG Work Plan
O Nationwide Review of Cardiac Caths
and Endomyocardial Biopsies
O We will review Medicare payments for right heart
catheterizations (RHC) and endomyocardial biopsies
billed during the same operative session and
determine whether hospitals complied with
Medicare billing requirements.
O Previous OIG reviews have identified inappropriate
payments when hospitals were paid for separate
RHC procedures when the services were already
included in payments for endomyocardial biopsies.
To be processed correctly and promptly, a bill must
be completed accurately.
2015 OIG Work Plan
O Risk adjustment data—Sufficiency of
documentation supporting diagnoses
O We will review the medical record documentation to ensure
that it supports the diagnoses MA organizations submitted to
CMS for use in CMS’s risk-score calculations and determine
whether the diagnoses submitted complied with Federal
requirements.
O Prior OIG reviews have shown that medical record
documentation does not always support the diagnoses
submitted to CMS by MA organizations.
O MA organizations are required to submit risk adjustment data
to CMS in accordance with CMS instructions.
O Payments to MA organizations are adjusted on the basis of the
health status of each beneficiary, so inaccurate diagnoses may
cause CMS to pay MA organizations improper amounts.
2013 OIG Posted Audit Results
• Results have been posted to the OIG website for
six Medicare Advantage Organizations
• General Findings:
O The MAO did not have written policies and
procedures for obtaining, processing, and
submitting diagnoses to CMS.
O Practices were not effective in ensuring that
the diagnoses MAO submitted to CMS complied
with the requirements of the Risk Adjustment
Participant Guide.
2013 OIG Posted Audit Results
• Results have been posted to the OIG website
for 6 Medicare Advantage Organizations
• Coding/Claims specific issues
O Documentation did not support the claimed
diagnosis.
O Documentation did not include the
provider’s signature or credentials.
O No documentation was offered to support
diagnosis.
O Unconfirmed diagnoses
2013 OIG Posted Audit Results
• Results have been posted to the OIG website for
6 Medicare Advantage Organizations
• Coding/Claims specific issues
O No documentation that diagnosis affected the care,
treatment, or management provided during the
encounter.
O Taking diagnosis codes from problem lists or other
documentation that merely lists diagnoses with no
indication of evaluation and treatment for each
condition.
O Taking diagnoses from patient histories or history codes.
O Claiming a diagnosis code based solely on prescription
medication.
2013 OIG Posted Audit Results
O Audit Scrutiny of Medicare Risk Adjustment Payments-
(extrapolated)
O PacifiCare of Texas- $115,422,084 (43% not validated)
O http://oig.hhs.gov/oas/reports/region6/60900012.pdf
O Excellus Health Plan- $41,588,811 (46% coding not
validated)
O https://oig.hhs.gov/oas/reports/region2/20901014.pdf
O Pacific Care of California- $423,709,068- (45% not
validated)
O https://oig.hhs.gov/oas/reports/region9/90900045.pdf
2013 OIG Posted Audit Results
O Audit Scrutiny of Medicare Risk Adjustment Payments-
(extrapolated)
O Paramount Care (Promedica)- $18,216,541 (44% not
validated)
O https://oig.hhs.gov/oas/reports/region5/50900044.pdf
O Bravo Health Pennsylvania- $22,108,905 (65% not
validated)
O https://oig.hhs.gov/oas/reports/region3/30900003.pdf
O Cigna Healthcare of Arizona- $28,353,516 (40% not
validated)
O https://oig.hhs.gov/oas/reports/region7/71001082.pdf
2015 OPPS Update
Modifiers, G codes, Anesthesia,
Global Surgery Concepts
CMS- Modifier 59
O Previous OIG Report on Modifier 59
O On August 15, 2014 CMS released the final ruling for
appropriate Modifier 59 use. (Transmittal 1422,
CR8863)
O The changes will take effect on January 1, 2015.
O These modifiers, are referred to as X-EPSU modifiers,
and define specific subsets of the -59 modifier.
O CMS will not stop recognizing the -59 modifier but
notes that CPT instructions state that the -59
modifier should not be used when a more descriptive
modifier is available..
CMS- Modifier 59
O Transmittal 1422, CR8863 details new modifiers to be used
in place of modifier 59. The new modifiers will impact NCCI
(National Correct Coding Initiative) edits utilized by CMS MAC
Carriers.
O XE Separate Encounter: Service That Is Distinct Because It
Occurred During A Separate Encounter
O XP Separate Practitioner: Service That Is Distinct Because It
Was Performed By A Different Practitioner
O XS Separate Structure: Service That Is Distinct Because It Was
Performed On A Separate Organ/Structure
O XU Unusual Non-Overlapping Svc: Use Of A Service That Is
Distinct Because It Does Not Overlap usual components of the
main service
CMS- Modifier 59
O The new modifiers are to be used in place of modifier 59.
O
O
O
O
They will impact NCCI (National Correct Coding Initiative)
edits utilized by CMS MAC Carriers.
Studies have shown that the modifier 59 is both
commonly used and commonly abused.
According to the 2013 CERT report $2.4 billion was paid
on claims containing modifier 59 with a projected error
rate of $450 million.
The error rate is not exclusively attributed to modifier 59,
but if only 10% of those found to be in error were due to
the modifier 59, that would represent a $45 million
damage.
No word on recognition of these modifiers by other
payers.
CMS- Updates
O G codes for new CPT codes- If the new CPT
codes are unavailable at the time the OPPS
final rule is published, CMS will be issuing G
codes for these services and they will be
valued accordingly.
O The 2015 rates of the created G codes will
be based on the comparable 2014 CPT
codes.
CMS- Updates
O Anesthesia for Screening Colonoscopies- in the
O
O
O
O
past moderate sedation was included in
endoscopy services.
Anesthesia is now being used more frequently
with these services.
For 2015, all anesthesia will be included in
screening colonoscopy codes.
This will result in coinsurance and deductible
being waived for the patient.
Anesthesiologist should bill with -33 to show it is
for screening service.
CMS- Updates
O Global Surgery- Transforming all 10 day and
90 day global periods into 0 day global
periods. Goal is:
O 10 day in CY 2017
O 90 day in CY 2018
O Goal is to value all services appropriately
taking into consideration each component,
pre-operative, intra-operative and postoperative components.
2015 CPT Changes
All Rights Reserved 2012
2015 CPT Changes
O 542 Total Code Changes
O 266 New Codes
O 147 Deleted Codes
O 129 Revised Codes
O Guideline Changes
Evaluation and Management
99000-99499
Evaluation and Management
O Evaluation and Management Workgroup
O Created in response from AMA members regarding
O
O
O
O
increased use of templates and EMRs creating over
documentation and inflation of E/M services.
Define the importance of making MDM a required key
component in determining E/M code
Determined to be a more substantial change than
anticipated.
Unable to be implemented at this time, assigning
appropriate values
Work tabled for use in the future.
Evaluation and Management
O Social History- The social history element of
history documentation in the E/M guidelines
has been revised to include any history of
military service. The addition of this
element will assist with diagnosing,
assessing, and treating service members,
veterans and their families.
Evaluation and Management
O Deleted 99481- Total body systemic hypothermia in
a critically ill neonate per day
O Deleted 99482- Selective head hypothermia in a
critically ill neonate per day
O New Code (in the medicine section) 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
Evaluation and Management
O Care Management Services- Guidelines
clarified
O Chronic Care Management Services
O Complex Chronic Care Management
Services
O Transitional Care Management Services
O Advanced Care Planning
Evaluation and Management
O Chronic Care Management Services (Revised Code)O 99490- Chronic care management services, at least
20 minutes of clinical staff time directed by a
physician or other qualified health care professional,
per calendar month, with the following required
elements: multiple (two or more) chronic conditions
expected to last at least 12 months, or until the
death of the patient; chronic conditions place the
patient at significant risk of death, acute
exacerbation/decompensation, or functional
decline; comprehensive care plan established,
implemented, revised, or monitored
O CCMS of less than 20 minutes duration are not
reported separately.
Evaluation and Management
O Maternity Care and Delivery Guidelines
Clarifications
O The services normally provided in uncomplicated
maternity cases include antepartum care, delivery
and postpartum care. Pregnancy confirmation
during a problem oriented or preventive visit is not
considered a part of antepartum care and should
be reported using the appropriate E/M service
code for that visit.
Anesthesia
00100-01999
Anesthesia
O Codes deleted due to low utilization:
O 00452- Anesthesia for procedures on clavicle
and scapula; radical surgery
O 00622- Anesthesia for procedures on
thoracic cord and spine; thoracolumbar
sympathectomy
O 00634- Anesthesia for procedures in lumbar
region; lumbar sympathectomy
General Surgery
Surgery Guidelines
10021-10022
General Surgery
O CPT Surgical Package Definition- By their very nature, the
services to any patient are variable. The CPT codes that
represent a readily identifiable surgical procedure thereby
include, a variety of services. The following services related to
the surgery when furnished by the physician or other qualified
health care professional who performs the surgery are
included:
O E/M services subsequent to the decision for surgery on the day
O
O
O
O
O
before and/or day of surgery (including H&P)
Local infiltration, digital block or topical anesthesia
Immediate PO care including dictation of operative note, talking
with family and other physicians
Writing orders
Evaluating the patient in the recovery area
Typical postoperative follow up care
O Addresses inclusive E/M services, clarifies who can perform
services, clarifies what services are included.
Integumentary
10030-19499
No Changes for 2015!!
Musculoskeletal
20005-29999
Musculoskeletal
O Joint Procedures
O The existing code series was updated to indicate with/without
Ultrasound guidance
O 20600- Arthrocentesis, aspiration and/or injection; small joint or
bursa (eg, fingers, toes); without ultrasound guidance
O 20604- Arthrocentesis, aspiration and/or injection, small
joint or bursa (eg, fingers, toes); with ultrasound guidance,
with permanent recording and reporting
O 20605- Arthrocentesis, aspiration and/or injection, intermediate
joint or bursa (eg, temporomandibular, acromioclavicular, wrist,
elbow or ankle, olecranon bursa); without ultrasound guidance
O 20606 Arthrocentesis, aspiration and/or injection,
intermediate joint or bursa (eg, temporomandibular,
acromioclavicular, wrist, elbow or ankle, olecranon bursa);
with ultrasound guidance, with permanent recording and
reporting
Musculoskeletal
O Joint Procedures
O 20610- Arthrocentesis, aspiration and/or injection, major joint or
bursa (eg, shoulder, hip, knee, subacromial bursa); without
ultrasound guidance
O 20611 Arthrocentesis, aspiration and/or injection, major
joint or bursa (eg, shoulder, hip, knee, subacromial bursa);
with ultrasound guidance, with permanent recording and
reporting
O Parenthetical notes restricts use of 76942 with these codes.
O If Flouroscopic, MRI or CT guidance used, report codes 20600,
20605 or 20610 for the procedure, and then code guidance
77002, 77012, 77021.
Musculoskeletal
O Ablation Therapy
O The existing code for radiofrequency bone ablation
has been updated to include adjacent soft tissue
and radiologic guidance. In addition, a new code
has been added for cryoablation of bone tumors.
O 20982- Ablation therapy for reduction or eradication
of 1 or more bone tumors (eg, metastasis), including
adjacent soft tissue when involved by tumor
extension, percutaneous, including
imaging guidance when performed;
radiofrequency
O 20983- cryoablation
Musculoskeletal
O Vertebroplasty/Kyphoplasty
O The existing codes have been deleted and new codes
have been created to include all imaging guidance. It
was found imaging guidance was used 75% of the
time.
O 22510 - Percutaneous vertebroplasty (bone biopsy
included when performed), 1 vertebral body, unilateral or
bilateral injection, inclusive of all imaging guidance;
cervicothoracic
O 22511- lumbosacral
O +22512- each additional cervicothoracic or lumbosacral
vertebral body (List separately in addition to code for
primary procedure)
Musculoskeletal
O Vertebroplasty/Kyphoplasty- cont
O 22513- Percutaneous vertebral augmentation, including
cavity creation (fracture reduction and bone biopsy
included when performed) using mechanical device (eg,
kyphoplasty), 1 vertebral body, unilateral or bilateral
cannulation, inclusive of all imaging guidance; thoracic
O 22514- lumbar
O +22515- each additional thoracic or lumbar vertebral
body (List separately in addition to code for primary
procedure)
O Current codes 22520, 22521, 22522, 22523,
22524, 22525, 72291 and 72292 have been
deleted
Musculoskeletal
Vertebroplasty
Kyphoplasty
Musculoskeletal
O Sacroplasty
O
Sacroplasty did not yet receive a new code, but the existing
Category III code has been revised to include all imaging
guidance.
O 0200T Percutaneous sacral augmentation (sacroplasty),
unilateral injection(s), including the use of a balloon or
mechanical device, when used, 1 or more needles,
includes imaging guidance and bone biopsy, when
performed
O 0201T Percutaneous sacral augmentation (sacroplasty),
unilateral injection(s), including the use of a balloon or
mechanical device, when used, 2 or more needles,
includes imaging guidance and bone biopsy, when
performed
Musculoskeletal
O Open Treatment of Rib Fractures
O 21800, 21810, 0245T, 0246T, 0247T, 0248T have
been deleted
O 21811- Open treatment of rib fracture(s) with internal
fixation, includes thoracoscopic visualization when
performed, unilateral; 1-3 ribs
O 21812- 4-6 ribs
O 21813- 7 or more ribs
O Codes selected based on the number of ribs treated
Musculoskeletal
O Total Disc Arthroplasty
O
22856 Revised to be the parent code for 22858
O 22856- Total disc arthroplasty (artificial disc), anterior
approach, including discectomy with end plate preparation
(includes osteophytectomy for nerve root or spinal cord
decompression and microdissection), single interspace,
cervical
O 22858- second level, cervical (List separately in addition to
code for primary procedure)
O 0375T- cervical, three or more levels
Musculoskeletal
Musculoskeletal
O Arthrodesis of Sacroiliac Joint
O 27279- Arthrodesis, sacroiliac joint, percutaneous or
minimally invasive (indirect visualization), with image
guidance, includes obtaining bone graft when
performed, and placement of transfixing device
O 27280- Arthrodesis, sacroiliac joint (including
obtaining graft), open
O Codes are unilateral, use -50 if bilateral
Respiratory
30000-32999
Respiratory
O Ablation Pulmonary Tumors
O A Category III code has been created for
cryoablation of pulmonary tumors.
O 0340T- Ablation, pulmonary tumor(s),
including pleura or chest wall when involved
by tumor extension, percutaneous,
cryoablation, unilateral, includes imaging
guidance
Respiratory
Cardiovascular
33010-36556
Cardiovascular
O Subcutaneous Pacemaker or Implantable
Defibrillator
O Category III codes 0319T, 0320T, 0321T,
0322T, 0323T, 0324T, 0326T, 0327T have
been deleted and replaced with Category I
codes.
O Revisions have been made to the established
codes, guidelines and the table has been
updated with the new codes
Cardiovascular
O Subcutaneous Pacemaker or Implantable
Defibrillator
O 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
Cardiovascular
O Subcutaneous Pacemaker or Implantable
Defibrillator
O 33271- Insertion of subcutaneous implantable
defibrillator electrode
O 33272- Removal of subcutaneous implantable
defibrillator electrode
O 33273- Repositioning of previously implanted
subcutaneous implantable defibrillator electrode
Cardiovascular
O Transcatheter Mitral Valve Repair
O Category III codes 0343T and 0344T have been
deleted and replaced with Category I codes.
O 33418- Transcatheter mitral valve repair,
percutaneous approach, including transseptal
puncture when performed; initial prosthesis
O 33419- additional prosthesis(es) during same
session (List separately in addition to code for
primary procedure)
O 0345T- Transcatheter mitral valve repair
percutaneous approach via the coronary sinus
Cardiovascular
Cardiovascular
O Extracorporeal Membrane Oxygenation
(ECMO)
O 33960, 33961, 36822 have been deleted
O New category and guidelines created
O New codes include: Initiation of ECMO, daily
management, cannulation, repositioning,
adding, removing of cannula
Cardiovascular
Cardiovascular
O Extracorporeal Membrane Oxygenation
(ECMO)
O 33946- Extracorporeal membrane oxygenation
(ECMO)/extracorporeal life support (ECLS) provided
by physician; initiation, veno-venous
O 33947- initiation, veno-arterial
O 33948- daily management, each day, veno-venous
O 33949- daily management, each day, veno-arterial
Cardiovascular
O Extracorporeal Membrane Oxygenation
(ECMO)
O 33951- Extracorporeal membrane oxygenation
(ECMO)/extracorporeal life support (ECLS) provided
by physician; insertion of peripheral (arterial and/or
venous) cannula(e), percutaneous, birth through 5
years of age (includes fluoroscopic guidance, when
performed)
O 33952- 6 years or older
O 33953- open, birth-5 years
O 33954- open, 6 years or older
Cardiovascular
O Extracorporeal Membrane Oxygenation
(ECMO)
O 33955- insertion of central cannula(e) by sternotomy
or thoracotomy, birth through 5 years of age
O 33956- 6 years or older
O 99357- reposition peripheral (arterial and/or venous)
cannula(e), percutaneous, birth through 5 years of
age (includes fluoroscopic guidance, when
performed)
O 33958- 6 years or older
Cardiovascular
O Extracorporeal Membrane Oxygenation
(ECMO)
O 33959- reposition peripheral (arterial and/or venous)
cannula(e), open, birth through 5 years of age
(includes fluoroscopic guidance, when performed)
O 33962- 6 years or older
O 33963- by sternotomy or thoracotomy, birth through
5 years of age
O 33964- 6 years or older
Cardiovascular
O Extracorporeal Membrane Oxygenation
(ECMO)
O 33965- removal peripheral (arterial and/or venous)
cannula(e), percutaneous, birth through 5 years of
age (includes fluoroscopic guidance, when
performed)
O 33966- 6 years or older
O 33969- open, birth-5 years of age
O 33984- open, 6 years or older
Cardiovascular
O Extracorporeal Membrane Oxygenation
(ECMO)
O 33985- removal peripheral (arterial and/or venous)
cannula(e), by sternotomy or thoracotomy, birth
through 5 years of age (includes fluoroscopic
guidance, when performed)
O 33986- 6 years or older
Cardiovascular
O Transcatheter Placement of Intravascular Stents
O A multispecialty society request was made to
establish a new code to report the transcatheter
placement of an intrathoracic carotid vascular stent.
O Editorial revision of cervical carotid artery stent codes
37215-37216 and codes 0075T-0076T also was
requested to differentiate these codes from the new
code and to make them consistent with all other
endovascular bundled coding.
Cardiovascular
O Transcatheter Placement of Intravascular Stents
O Existing codes for carotid stent placement have
been revised to include angioplasty and radiologic
supervision and interpretation. These codes
should also be used for open or percutaneous
approach, which is a change for 2015.
O 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
O 37216- without distal embolic protection
Cardiovascular
O Transcatheter Placement of Intravascular
Stents
O 37217- Transcatheter placement of an intravascular
stent(s), intrathoracic common carotid artery or
innominate artery by retrograde treatment, via open
ipsilateral cervical carotid artery exposure, including
angioplasty, when performed, and radiological
supervision and interpretation
Cardiovascular
O Transcatheter Placement of Intravascular Stents
O Previously a Category III code, there is now a CPT
code for placement of intrathoracic common
carotid or innominate artery stent. This code
includes angioplasty and imaging.
O 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
Cardiovascular
O Transcatheter Placement of Intravascular
Stents
O 0075T- Transcatheter placement of extracranial
vertebral or intrathoracic carotid artery stent(s),
including radiologic supervision and interpretation,
percutaneous; initial vessel
O 0076T- each additional vessel
Digestive
40490-49999
Digestive
O Esophagoscopy
O 1 new code, 6 revised codes
O 43180- Esophagoscopy, rigid, transoral with
diverticulectomy of hypopharynx or cervical
esophagus (eg, Zenker's diverticulum), with
cricopharyngeal myotomy, includes use of telescope
or operating microscope and repair, when performed
O 43194- Esophagoscopy, rigid, transoral; with removal
of foreign body
O 43197- Esophagoscopy, flexible, transnasal;
diagnostic, includes collection of specimen(s) by
brushing or washing when performed (separate
procedure)
Digestive
O Esophagoscopy
O 43215- Esophagoscopy, flexible, transoral; with
removal of foreign body
O 43216- with removal of tumor(s), polyp(s), or other
lesion(s) by hot biopsy forceps or bipolar cautery
O 43217- with removal of tumor(s), polyp(s), or other
lesion(s) by snare technique
O 43250- with removal of tumor(s), polyp(s), or other
lesion(s) by hot biopsy forceps or bipolar cautery
O 43350 was deleted
Digestive
O Endoscopy
O Parent codes 44360, 44376, 44380, 44385,
44388, 45330 and 45378 are now designated as
separate procedures.
O Editorial change to: “including collection of
specimens by brushing or washing, when performed”
replaces “with or without collection of specimens” for
consistency with other codes.
O Control of bleeding instruction: Control of bleeding
that occurs as a result of the endoscopic procedure
is not separately reportable during the same
operative session
O Further Clarification of modifiers 52 and 53
Digestive
O Endoscopy, Small Intestine
O Divided into two separate subcategories:
Endoscopy, Small Intestine and Endoscopy,
Stomal
O New Section Guidelines have been added
O 44360- Small intestinal endoscopy, enteroscopy
beyond second portion of duodenum, not including
ileum; diagnostic, with or without collection of
specimen(s) by brushing or washing (separate
procedure)
O 44363- with removal of foreign body
Digestive
O Endoscopy, Stomal
O 44380- Ileoscopy, through stoma; diagnostic, with or
without collection of specimen(s) by brushing or
washing (separate procedure)
O 44381- with transendoscopic balloon dilation
O 44382- with biopsy, single or multiple
O 44383 deleted
O 44384- with placement of endoscopic stent (includes
pre- and post-dilation and guide wire passage, when
performed)
Digestive
O Endoscopy, Stomal
O 44385- Endoscopic evaluation of small intestinal
(abdominal or pelvic) pouch; diagnostic, with or
without collection of specimen(s) by brushing or
washing (separate procedure)
O 44386- with biopsy, single or multiple
Digestive
Digestive
O Endoscopy Stomal (Colon)- revised
O 44388- Colonoscopy through stoma; diagnostic, with
or without collection of specimen(s) by brushing or
washing (separate procedure)
O 44390- with removal of foreign body
O 44391- with control of bleeding, any method
O 44392- with removal of tumors, polyps or other
lesions by hot biopsy forceps
Digestive
O Endoscopy Stomal (Colon)- new
O 44401- Colonoscopy through stoma; with
ablation of tumor(s), polyp(s), or other lesion(s)
(includes pre-and post-dilation and guide wire
passage, when performed)
O 44402- with endoscopic stent placement
(including pre- and post-dilation and guide wire
passage, when performed)
O 44403- with endoscopic mucosal resection
O 44404- with directed submucosal injection(s),
any substance
Digestive
O Endoscopy Stomal (Colon)- new
O 44405- Colonoscopy through stoma; with
transendoscopic balloon dilation
O 44406- with endoscopic ultrasound examination, limited
to the sigmoid, descending, transverse, or ascending
colon and cecum and adjacent structures
O 44407- 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
O 44408- with decompression (for pathologic distention)
(eg, volvulus, megacolon), including placement of
decompression tube, when performed
Digestive
Digestive
O Endoscopy- Sigmoidoscopy
O 45346- Sigmoidoscopy, flexible; with ablation of
tumor(s), polyp(s), or other lesion(s) (includes
pre- and post-dilation and guide wire passage,
when performed)
O 45347- with placement of endoscopic stent
(includes pre- and post-dilation and guide wire
passage, when performed)
O 45349- with endoscopic mucosal resection
O 45350- with band ligation(s) (eg, hemorrhoids)
Digestive
O Endoscopy- Colonoscopy
O 45388- Colonoscopy, flexible; with ablation of tumor(s),
O
O
O
O
polyp(s), or other lesion(s) (includes pre- and postdilation and guide wire passage, when performed)
45389- with endoscopic stent placement (includes preand post-dilation and guide wire passage, when
performed)
45390- with endoscopic mucosal resection
45393- with decompression (for pathologic distention)
(eg, volvulus, megacolon), including placement of
decompression tube, when performed
45398- with band ligation(s) (eg, hemorrhoids)
Digestive
O Endoscopy- Anus
O 46600- Anoscopy; diagnostic, with or without
collection of specimen(s) by brushing or washing
(separate procedure)(revised)
O 0226T and 0227T have been deleted
O 46601- Anoscopy; diagnostic, with high-
resolution magnification (HRA) (eg, colposcope,
operating microscope) and chemical agent
enhancement, including collection of
specimen(s) by brushing or washing, when
performed
O 46607- with biopsy, single or multiple
Digestive
O Colonoscopy and Modifier 52
O For therapeutic examinations that do not
reach the cecum, report the appropriate
therapeutic colonoscopy code with modifier
52 with appropriate documentation.
O Report flexible sigmoidoscopy (4533045347) for endoscopic examination during
which the endoscope is not advanced
beyond the splenic flexure.
Digestive
O Colonoscopy and Modifier 53
O When performing a screening or diagnostic
endoscopy on a patient who is scheduled
and prepared for a total colonoscopy, if the
physician is unable to advance the
colonoscope to the cecum or colon-small
intestine anastomosis due to unforeseen
circumstances, report 45378 with modifier
53 with appropriate documentation.
Urinary
50010-53899
Urinary
O 2 new Cystoscopy codes
O 52441- Cystourethroscopy, with insertion of
permanent adjustable transprostatic implant; single
implant
O 52442- each additional permanent adjustable
transprostatic implant (List separately in addition to
code for primary procedure)
Nervous System
61000-64999
60000 Neurological
O Myelography
O New myelography codes were created which include the
supervision and interpretation. The existing code for
myelogram injection has been revised and 4 new codes
have been added
O 62284- Injection procedure for myelography and/or
computed tomography, spinal lumbar (other than C1-C2
and posterior fossa)
O 62302- Myelography via lumbar injection, including
radiological supervision and interpretation; cervical
O 62303 - thoracic
O 62304 - lumbosacral
O 62305 - 2 or more regions (eg, lumbar/thoracic,
cervical/thoracic, lumbar/cervical,
lumbar/thoracic/cervical)
Radiology
70010-77086
Radiology
O Breast Imaging
O New codes have been introduced for breast
O
O
O
O
O
tomosynthesis. Also, the existing code for breast
ultrasound was deleted and two new codes have been
introduced for limited and complete ultrasound.
76641 Ultrasound, breast, unilateral, real time with image
documentation, including axilla when performed; complete
76642 Ultrasound, breast, unilateral, real time with image
documentation, including axilla when performed; limited
77061 Digital breast tomosynthesis; unilateral
77062 Digital breast tomosynthesis; bilateral
77063 Screening digital breast tomosynthesis, bilateral
(List separately in addition to code for primary procedure)
(77057)
O 76445 has been deleted
Radiology
Radiology
O Vertebral Fracture Assessment
O The existing code for vertebral fracture assessment
(VFA) has been deleted and 2 new codes have been
introduced for 2015. One code represents VFA done
as part of a bone density study and the other is for
VFA alone. .
O 77085 Dual-energy X-ray absorptiometry (DXA), bone
density study, 1 or more sites; axial skeleton (eg,
hips, pelvis, spine), including vertebral fracture
assessment
O 77086 Vertebral fracture assessment via dualenergy X-ray absorptiometry (DXA)
O 77082 was deleted
Radiology
O New Category III* codes have been introduced for
radiostereometric analysis.
O 0348T Radiologic examination, radiostereometric
analysis (RSA); spine, (includes cervical, thoracic and
lumbosacral, when performed)
O 0349T Radiologic examination, radiostereometric
analysis (RSA); upper extremity(ies), (includes
shoulder, elbow, and wrist, when performed)
O 0350T Radiologic examination, radiostereometric
analysis (RSA); lower extremity(ies), (includes hip,
proximal femur, knee, and ankle, when performed)
Radiation Oncology
77261-77799
Radiation Oncology
O Radiation Therapy
O
Radiation therapy codes underwent significant changes for
2015. Teletherapy isodose planning and brachytherapy codes now
include the basic dosimetry calculation and IMRT codes now include
guidance and tracking. Also radiation treatment delivery codes were
deleted in 2015.
O 77306 Teletherapy isodose plan; simple (1 or 2 unmodified ports
directed to a single area of interest), includes basic dosimetry
calculation(s)
O 77307 Teletherapy isodose plan; complex (multiple treatment
areas, tangential ports, the use of wedges, blocking, rotational
beam, or special beam considerations), includes basic dosimetry
calculation(s)
O 77316 Brachytherapy isodose plan; simple (calculation[s] made
from 1 to 4 sources, or remote afterloading brachytherapy, 1
channel), includes basic dosimetry calculation(s)
O
77305, 77310, 77315, 77326, 77327, 77238 have been deleted
Radiation Oncology
O Radiation Therapy
O 77317 Brachytherapy isodose plan; intermediate
O
O
O
O
(calculation[s] made from 5 to 10 sources, or remote
afterloading brachytherapy, 2-12 channels), includes basic
dosimetry calculation(s)
77318 Brachytherapy isodose plan; complex (calculation[s]
made from over 10 sources, or remote afterloading
brachytherapy, over 12 channels), includes basic dosimetry
calculation(s)
77385 Intensity modulated radiation treatment delivery (IMRT),
includes guidance and tracking, when performed; simple
77386 Intensity modulated radiation treatment delivery (IMRT),
includes guidance and tracking, when performed; complex
77387 Guidance for localization of target volume for delivery of
radiation treatment delivery, includes intrafraction tracking,
when performed
Pathology and Laboratory
80047-89398
Pathology and Laboratory
O The new section in the AMA book includes the addition
of guidelines, parentheticals, and tables that are used
to direct reporting within the 2 new subsections.
O The codes included within these subsections identify
drug procedures according to the purpose of the
procedure and type of patient results obtained.
O The Presumptive Drug Class Screening section includes
Guidelines for the Presumptive Drug Class Screening
section, Drug Class List A (which itemizes commonly
assayed drugs within the listing), and Drug Class List B
(which itemizes assays that require more resources than
Class A).
O This section also includes guidelines that explain the
intended use for the listing and the codes.
Pathology and Laboratory
O The updated reporting mechanism has been
designed to address the following:
O ability to be easily modified for future
changes and technological advances
O identification of updated clinical settings
O identification of “sources” for specimen(s).
Pathology and Laboratory
O Microbiology Changes
O Along with several other changes, codes 87623,
87624, 87625 have been added to report
human papilloma virus (HPV) genotyping to
differentiate high and low risk HPV types.
O HPV genotyping is used in conjunction with or as
follow-up to an abnormal cytology report.
O The existing HPV codes 87620, 87621 and
87622 have been deleted and replaced with
genotyping codes that describe the specific
types test
Pathology and Laboratory
O Surgical Pathology Changes
O Immunocytochemistry and immunohistochemistry CPT codes
O
O
O
O
O
have undergone additional changes for 2015.
The histomorphometry codes 88360, 88361 for reporting
detection of protein receptors for diagnosing the development
of tumor(s) and cancer have been revised.
The in situ hybridization codes 88365, 88367, 88368 have
been revised and expanded into three separate families of
codes that identify;
1) the initial single probe stain procedure (88365, 88367,
88368)
2) each additional single probe stain procedure (88364,
88373, 88369)
3) each multiplex probe stain procedure (88366, 88374,
88377
Medicine
90281-99607
Medicine
O Vaccines
O 90651- Human Papillomavirus vaccine types 6, 11, 16, 18, 31,
O
O
O
O
O
33, 45, 52, 58, nonavalent (HPV), 3 dose schedule, for
intramuscular use
90654- Influenza virus vaccine, split virus, preservative-free,
for intradermal use
90630- Influenza virus vaccine, quadrivalent (IIV4), split virus,
preservative free, for intradermal use
90721- Diphtheria, tetanus toxoids, and acellular pertussis
vaccine and Hemophilus influenza B vaccine (DTaP-Hib), for
intramuscular use
90723- Diphtheria, tetanus toxoids, acellular pertussis
vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DTaPHepB-IPV), for intramuscular use
90734- Meningococcal conjugate vaccine, serogroups A, C, Y
and W-135 (tetravalent), for intramuscular use
Medicine
O 92541: Spontaneous nystagmus test, including
O
O
O
O
gaze and fixation nystagmus, with recording
92542: Positional nystagmus test, minimum of 4
positions, with recording
92543: Caloric vestibular test, each irrigation
(binaural, bithermal stimulation constitutes 4
tests), with recording
92544: Optokinetic nystagmus test,
bidirectional, foveal or peripheral stimulation,
with recording
92545: Oscillating tracking test, with recording
Medicine
O 97607- Negative pressure wound therapy, (eg,
vacuum assisted drainage collection), 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
O 97608- total wound(s) surface area greater
than 50 square centimeters
Medicine
O 99188- Application of topical fluoride
varnish by a physician or other qualified
health care professional