January 2014
Jean C. Russell, MS, RHIT jrussell@epochhealth.com
Richard Cooley, BA, CCS rcooley@epochhealth.com
Matthew H. Lawney MSPT, MBA, CHC, mlawney@epochhealth.com
518-430-1144
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Agenda
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Breast Biopsy Procedures
Pacemaker, Cardiac Defibrillators
Angiography
Vascular Embolism and Occlusion
Questions and Discussion
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Increased Packaging for Imaging Guidance
 CMS is considering conditionally packaging all
imaging services performed with a surgical
procedure
 Comments have been requested
 This is also an increasing pattern under CPT
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Breast Biopsy Changes –
Pre-Op Needle Localization
Procedures
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Pre-Op Needle Localization
• The following codes are deleted:
– 19290 – Preoperative needle placement,
breast
– 19291 – Each additional
– 77031 - Stereotactic guidance for breast
bx or needle placement, each lesion
– 77032 – Mammo guidance for needle
placement, each lesion
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Pre-Op Needle Localization
• The following codes are not deleted, but cannot
be reported for breast biopsy guidance:
– 76942 – US guidance for needle placement or
biopsy
– 77021 – MRI guidance for needle placement
of biopsy
• The following codes are not deleted, but cannot
be reported for breast biopsy specimen exams:
– 76098 – Radiologic exam of surgical
specimen
– 76999 – US exam of surgical specimen
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Placement of Localization
Devices w/o the Biopsy
 The following codes are new in 2014:
 19281 – Placement of localization device (e.g., clip, wire), first
lesion, using mammographic guidance
 19282 – Each additional lesion
 19283 – Placement of localization device (e.g., clip, wire), first
lesion, using stereotactic guidance
 19284 – Each additional
 19285 – Placement of localization device (e.g., clip, wire), first
lesion, using ultrasound guidance
 19286 – Each additional
 19287 – Placement of localization device (e.g., clip, wire), first
lesion, using MRI guidance
 19288 – Each additional
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Pre-Op Needle Localization
Breast Bx
• 19125 and 19126+, excision breast lesion
identified by pre-op needle loc, open, have not
been changed
• Pre-op needle placement (19290/19291) has
been replaced:
– 19281/19282, stereotactic guidance replaces
19290/19291/19295/77032
• 19283/19284, ultrasound guidance replaces
19290/19291/19295/77031
• 19285/19286, MRI guidance replaces
19290/19291/77021
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Breast Biopsy Changes –
Needle Core and Vacuum
Assisted Bx Under Guidance
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Breast Bx Under Guidance
• The following codes are deleted:
– 19102 – Bx of breast, needle core, using
imaging
– 19103 – Bx of breast, vacuum assisted, using
imaging
– 19295 – Image guided placement of a clip
during breast bx/aspiration, report in addition
to primary procedure
– 77031 - Stereotactic guidance for breast bx or
needle placement, each lesion
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Breast Bx Under Guidance
• The following codes are not deleted, but cannot be
reported for breast biopsy guidance:
– 76942 – US guidance for needle placement or
biopsy
– 77021 – MRI guidance for needle placement of
biopsy
• The following codes are not deleted, but
cannot be reported for breast biopsies:
– 76098 – Rad exam of surgical specimen
– 76999 – Us exam of surgical specimen
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Breast Bx Under Guidance
• The following codes are new in 2014 (19102/19103):
– 19081 – Bx breast, w/ placement of localization device (e.g., clip),
and imaging of the biopsy specimen, first lesion, using
stereotactic guidance
• 19082 – Each additional lesion
– 19083 – Bx breast, w/ placement of localization device (e.g., clip),
and imaging of the biopsy specimen, first lesion, using
ultrasound guidance
• 19084 – Each additional
– 19085 – Bx breast, w/ placement of localization device (e.g., clip),
and imaging of the biopsy specimen, first lesion, using MRI
guidance
• 19086 – Each additional
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Breast Bx Under Guidance
 New codes include:
 Image guided biopsy
 Placement of localization device
 Guidance – whether stereotactic, US, or MRI
 Placement of post-op clip (19295)
 Imaging of the biopsy specimen (76098)
 If more than one imaging is performed, report the
additional procedure for each additional modality
 If an open, incisional biopsy is performed after image
guided biopsy, report 19101, bx breast, open,
incisional
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Breast Bx Without Guidance
 Breast biopsies without image guidance are still
reported with:
 19000, breast bx; percutaneous, needle core, not
using imaging (separate procedure)
 19101, … open/incisional
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Bx Under Guidance
 Modified NCCI Policy:
 “If a breast biopsy, needle localization wire, metallic
localization clip, or other breast procedure is
performed with mammographic guidance (e.g.,
19281,19282), the physician should not separately
report a post procedure mammography code (e.g.,
77051, 77052, 77055-77057, G0202-G0206) for the
same patient encounter.
 The radiologic guidance codes include all imaging by
the defined modality required to perform the
procedure.”
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Changes in APC Reimbursement
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Changes in APC Reimbursement
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Pacemaker/Pacing Cardiodefibrillator (ICD)
Changes
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Modified Guidelines
 Revision of a skin pocket is included in 33206-
33249, 33262-33264
 Pocket revisions that include I&D of
hematoma/wound infection or debridement may be
separately reported
 Relocation of a skin pocket – when performed as
part of an explant of an existing generator followed
by replacement with a new generator, the pocket
relocation is reported separately
 33222 – Revision/relocation of skin pocket, pacemaker
 33223 - … ICD
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Subcutaneous ICDs
 Category III codes 0319T-0328T
 These are for subcutaneous ICDs (S-ICDs)
 FDA recently approved a new type
 “A subcutaneous implantable defibrillator system
is an implantable technology that uses a
subcutaneous pulse generator attached to a
single subcutaneous electrode to treat ventricular
tachy-arrhythmias.”
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Angiography/Embolism
Changes
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Angiography Changes
 CPT is moving to bundled imaging codes for
angiography when the procedures are performed
under guidance more than 75% of the time
 The codes for endovascular revascularization were
previously bundled with the guidance when
performed on peripheral vessels in the lower
extremity
 The new change is for intravascular stenting of
vessels other than the lower extremity, cervical
carotid, intracranial, intracoronary, extracranial
or intrathoracic
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Lower Extremity
Revascularization
 New combination codes created in 2011:
 37220-37235
 Reported for lower extremity revascularization
services performed for occlusive disease
 Built on progressive hierarchy with more intensive
services inclusive of less intensive services
 Includes: accessing/selectively catheterizing the
vessel, traversing the lesion, radiology S&I directly
related, embolic protection, closure of the
arteriotomy, imaging to document completion
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Transcatheter Stent
Placement Changes
 The following codes have been deleted:
 37205 – Transcath placement of a stent,
percutaneous, initial vessel
 37206 – Each additional
 37207 – Transcath placement of a stent, open,
initial vessel
 37208 – Each additional
 75960 – Guidance of stent placement
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Transcatheter Stent
Placement Changes
 The following codes have been added:
 37236 – Transcath placement of a stent, open
or percutaneous, initial artery, including
imaging and angioplasty within the same
vessel
 37237 – Each additional
 37238 – Transcath placement of a stent, open
or percutaneous, initial vein, including imaging
and angioplasty within the same vessel
 37239 – Each additional
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Transcatheter Stent
Placement Changes
 Code selection based on:
 Arterial versus venous
 Initial “vessel” versus additional “vessel”
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Transcatheter Stent
Placement Changes
 The new codes not for areas where other, more
specific codes exist
 Report just one code when there is more than one
stent in a single vessel
 New codes include:
 PTA [percutaneous angioplasty] in the treated vessel
 Any pre-dilation
 Post dilation
 Radiological S&I
 Closure by pressure or closure device or suture
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Transcatheter Stent
Placement Changes
 New codes do not include:
 PTA in a separate vessel
 Both selective and non-selective vascular
catheterization
 Extensive repair of a artery (e.g., 35228,
35286)
 US guidance for vascular access (e.g., 76937)
 Initial dx angiography (as defined by CPT)
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Vascular Embolization and
Occlusion
 The following code has been deleted:
 37204 – Tranacath occlusion/embolization (e.g, tumor
destruction, to achieve hemostasis, to occlude a
vascular malformation), percutaneous, an method,
non-central nervous system, non-head / neck
 Was frequently reported with these codes:
 75894 - Transcatheter therapy, embolization, any
method, radiological supervision and interpretation
 75898 - Angiography through existing catheter for
follow-up study for transcatheter therapy, embolization
or infusion, other than for thrombolysis
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Vascular Embolization and
Occlusion
 37204 is now bundled with 75894 and 75898
 Head/neck embolization remains the same:
 61626 - Transcatheter permanent occlusion or
embolization (eg, for tumor destruction, to achieve
hemostasis, to occlude a vascular malformation),
percutaneous, any method; non-central nervous
system, head or neck (extracranial, brachiocephalic
branch)
 75894
 75898
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Vascular Embolization and
Occlusion
 New Codes:
 37241-Vascular embolization or occlusion, inclusive of all
radiological supervision and interpretation, intraprocedural
roadmapping, and imaging guidance necessary to complete the
intervention; venous, other than hemorrhage (eg, congenital or
acquired venous malformations, venous and capillary
hemangiomas, varices, varicoceles) - AV access branch
embolization
 37242 - … arterial, other than hemorrhage or tumor (eg,
congenital or acquired arterial malformations, arteriovenous
malformations, arteriovenous fistulas, aneurysms,
pseudoaneurysms) – translumbar AAA sac coil embolization or
splenic artery aneurysm embolization
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Vascular Embolization and
Occlusion
 New Codes
 37243- Vascular embolization or occlusion, inclusive of
all radiological supervision and interpretation,
intraprocedural roadmapping, and imaging guidance
necessary to complete the intervention; for tumors,
organ ischemia, or infarction (e.g., uterine fibroid
embolization, tumor embolization, chemoembolization)
 37244 - …for arterial or venous hemorrhage or
lymphatic extravasation (e.g., embolization of vessel
perforation or GI bleeding source embolization)
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Vascular Embolization and
Occlusion
 Embolization includes:
 All radiological S&I
 Intra-procedural guidance and road mapping
necessary to document completion of the procedure
 Embolization does not include:
 Selective and non-selective vascular catheterization(s)
 US guidance for vascular access (76937)
 Intravascular ultrasound (37250, 37251)
 Initial dx angiography (as defined by CPT)
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Vascular Embolization and
Occlusion
 Stenting and Embolization for Aneurysm Treatment:
 When stent is placed for providing a latticework for
deployment of embolization coils (e.g., aneurysm
embolization), the embolization code is reported rather
than the stent code
 If a covered stent is deployed as the sole management
of an aneurysm, extra-vascularisation, then he stent
deployment code should be reported rather than the
embolization code
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Questions and Discussion
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Contact Us
Richard Cooley
Phone:
Email:
518-430-1144
RCooley@EpochHealth.Com
Matthew Lawney
Phone:
Email:
845-642-6462
mlawney@EpochHealth.Com
Jean Russell
Phone:
Email:
518-369-4986
JRussell@EpochHealth.Com
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http://www.EpochHealth.com/
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CPT®
Current Procedural Terminology (CPT®)
Copyright 2013 American Medical
Association
All Rights Reserved
Registered trademark of the AMA
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Disclaimer
Information and opinions included in this
presentation are provided based on our
interpretation of current available regulatory
resources. No representation is made as to the
completeness or accuracy of the information. Please
refer to your payer or specific regulatory guidelines
as necessary.