CY 2016 CPT UPDATES - ICD

CY 2016 CPT

UPDATES

Webinar Presented – December 1, 2015

Presented By – Coding Strategies

Disclaimer

The material contained in this presentation is distributed under copyright by Coding Strategies, Inc.

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Changes to 2016 Code Set

Additions – > 125

Deletions – > 75

Revisions – > 115

Don’t Forget the Guidelines

Effective January 1, 2016

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Copyright 2015, Coding Strategies

Modifiers

Modifier

CT

Description

Computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association (NEMA)

XR-29-2013 standard http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Radiation%20

Safety/XR29%20FAQs_91015.pdf

HCPC Code Set

Code Description

G0296

Counseling visit to discuss need for lung cancer screening (LDCT) using low dose

CT scan (service is for eligibility determination and shared decision making)

G0297 Low dose CT scan (LDCT) for lung cancer screening


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Coding Guidance

Authoritative guidance

 American Medical Association





American Hospital Association

Insurance Payors

Opinions

 Specialty Societies







Other medical groups

Healthcare Consultants

Billing Companies

6


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Guideline Changes

Counseling Risk Factor Reduction and Behavior Change

Intervention

• Modifier 25 should be applied to any E/M code that is reported together with the risk factor reduction/behavior change intervention code.

• The E/M service must be distinct from the risk factor reduction/behavior change, and the time spent providing the risk factor reduction/behavior change cannot be used as a basis for

E/M code selection.


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Guideline Reminders

Surgery Guidelines - Imaging Guidance

“When imaging guidance or imaging supervision and interpretation is included in a surgical procedure, guidelines for image documentation and report, are included in the guidelines for

Radiology (Including Nuclear Medicine and

Diagnostic Ultrasound) will apply”


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Guideline Clarifications

Facet Joint Injection

A new guidelines paragraph has been added to clarify that:

• The facet joint codes are reported per joint, not per nerve.

• The codes are not to be used for non-thermal facet joint denervation by chemical, low grade thermal energy

(less than

80 degrees Celsius), or pulsed radiofrequency.

 These techniques are reported with the UPC 64999.

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Watch the Notes

• New note for SI Joint Neurolysis

Code

64636

Description

Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint; lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure)

 64640 (other peripheral nerve) should be used for destruction of individual nerves of the SI joint.


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Subtle Changes

• Code / description doesn’t change

 But now includes moderate sedation

• 2015 Code Description

Code

+31632

Description with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure)

• 2016 Code Description

Code Description with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure)


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Adapt to Technology

• Number of codes within radiology were revised to replace the term “films” with “images”

• For example:

Code

74240

2016 Description

Radiologic examination, gastrointestinal tract, upper; with or without delayed images , without KUB

2015 Description

Radiologic examination, gastrointestinal tract, upper; with or without delayed films , without

KUB

• For Screening Mammography – the word “film” was deleted, but not replaced with the word “image”


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Changes to the Intent

• Descriptions confirm not for use with intracranial procedures

Code

37184

37186

Description

Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial , arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel

Secondary percutaneous transluminal thrombectomy (e.g., nonprimary mechanical, snare basket, suction technique), noncoronary, nonintracranial , arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure)

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New Intracranial Codes

Code

61645

Description

Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis , intracranial , any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s)


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Deleted Services

• 2016 forward - report the service with 47399

Code

47136

Description

Liver allotransplantation; heterotopic, partial or whole, from cadaver or living donor, any age

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Deleted Services

• Refer to 67107, 67108, 67110, and 67113 for this procedure

Code

67112

Description

Repair of retinal detachment; by scleral buckling or vitrectomy, on patient having previous ipsilateral retinal detachment repair(s) using scleral buckling or vitrectomy techniques

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CPT

Errata


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Evaluation/Management

Additions – 2

Deletions – 2


Prolonged Clinical Staff Time

Code

+99415

Description

Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and

Management service)

+99416

Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additiona l 30 minutes (List separately in addition to code for prolonged service)

• Cannot be reported for more than 2 consecutive patients

• As an add-on code requires the base E/M to be time based

– Not billed on time, just includes time within the base description

– Reported after base time of E/M has been met

– Time does not have to be continuous


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For Example

• Patient is seen by physician or other qualified health care professional supporting a level 4 established patient encounter







99214 average time = 25

Prolonged requires more than 45 minutes beyond the average time

99415 would only be added if more than 70 minutes of clinical support staff were spent in prolonged service

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Prolonged Clinical Staff Time

Total Duration of Prolonged

Service

Less than 45 min.

45 – 74 min.

75 – 104 min.

105 min. or more

Code(s) Reported

Time is not reported separately

99145 x 1

99145 x 1 and 99146 x 1

99145 x 1 and 99416 x 2 or more for each additional 30 min.

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Surgery

Additions – > 45

Deletions – > 20

Revisions – > 15


Soft tissue localization

Code

10035

+10036

New codes for image-guided localization

Description

Placement of soft tissue localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion

Placement of soft tissue localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; each additional lesion (List separately in addition to code for primary procedure)

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Bronchoscopy

New codes bundle additional techniques into base procedure

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Code

31652

Description

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/ biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures

; 3 or more mediastinal and/or hilar lymph node stations or structures

31653

+31654

; with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s) (List separately in addition to code for primary procedure[s])


Heart Valve Repair / Replacement

• Category III Code 0262T deleted - replaced with:

Code

33477

Description

Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed

– Percutaneous access and sheath placement

– Positioning and repositioning of device delivery system and deployment of device

– Angiography, contrast injections, imaging guidance, radiological S&I

– Cardiac catheterization (some exceptions)

– Angioplasty of the conduit/treatment zone

– Valvuloplasty of the pulmonary valve conduit

– Stent deployment within the conduit or an existing bioprosthetic valve


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Don’t Bundle Everything

• Separately report:













Coronary artery interventions and interventions in pulmonary artery branches

Pulmonary artery angioplasty remote from the valve delivery site.

Use of a ventricular assist device (33990, 33991, 33992, 33993)

ECMO or extracorporeal life support (33946-33989)

Balloon pump insertion

Cardiopulmonary bypass

(33967, 33970, 33973)

(33367, 33368, 33369)

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Non-Thrombolytic Infusion

• Deleted

Code

37202

75896

Description

Transcatheter therapy, infusion other than for thrombolysis, any type

(e.g., spasmolytic, vasoconstrictive)

Transcatheter therapy, infusion, other than for thrombolysis, radiological supervision and interpretation

• There is a note to see 61650-61651 for intracranial arterial administration of pharmacologic agent(s) other than for thrombolysis.

 There is no mention of non-thrombolytic peripheral artery infusions.


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Thrombolysis

• Clarification of use -

Code

37211

2016 Description

Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day

2015 Description

Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day

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Intravascular Ultrasound

• Component codes

(37250-37251, 75945-75946) have been deleted and replaced with two new comprehensive addon codes:

Code

+37252

+37253

Description

Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure)

Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel

(List separately in addition to code for primary procedure)


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Intravascular Ultrasound

• Can be used with diagnostic procedures

• Can be used with therapeutic interventions

• Cannot be used with IVC filter procedures

• Cannot be used with FB retrieval


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Mediastinoscopy

• Deleted the only existing code 39400

Code

39401

39402

Description

Mediastinoscopy; includes biopsy(ies) of mediastinal mass (eg, lymphoma), when performed

Mediastinoscopy; with lymph node biopsy(ies) (eg, lung cancer staging)

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EGD w/Fundoplasty

Code

43210

Description

Esophagogastroduodenoscopy, flexible, transoral ; with esophagogastric fundoplasty, partial or complete , includes duodenoscopy when performed

• New code to clarify the approach

 Transoral approach to a surgical esophagogastric fundoplasty procedure

Chronic GERD that cannot be managed w/pharmacological or medical management

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Biliary System

Deleted

Biliary Procedures

Percutaneous transhepatic cholangiogram (PTC)

T-tube cholangiogram

External biliary drainage

Internal and external biliary drainage

Internal biliary stent with dilation

Internal biliary stent without dilation

Change biliary drainage catheter

Change T-tube drainage catheter

RS&I

74320

74305

75980

75982

74363

75982

75984

75984

Surgery

47500

47505

47510

47511

47801

47801

47525

47530

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Also Deleted

Biliary Procedures

Laparoscopy, surgical; w/guided transhepatic cholangiography, w/o biopsy

Laparoscopy, surgical; w/guided transhepatic cholangiography with biopsy

Postoperative biliary duct calculus removal, percutaneous via T-tube tract, basket, or snare (eg, Burhenne technique), radiological supervision and interpretation

Code

47560

47561

74327

Percutaneous transhepatic biliary drainage with contrast monitoring, radiological supervision and interpretation

Percutaneous placement of drainage catheter for combined internal and external biliary drainage or of a drainage stent for internal biliary drainage in patients with an inoperable mechanical biliary obstruction, radiological supervision and interpretation

75980

75982


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Cholangiograms

• Code assigned based on access

Code

47531

47532

Description

Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; existing access

Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; new access (e.g., percutaneous transhepatic cholangiogram)

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Percutaneous Cholecystostomy

• Existing code 47490 still active for 2016

• 10 day global period

• Contrast exam of tube = 47531

• Tube change = 47536


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Catheter Conversion

• Includes







Removal of existing external drainage catheter

Placement of internal-external drainage catheter

Cholangiography and radiologic S&I

• Can be reported twice if more than one conversion is performed

Code

47535

Description

Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation


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Catheter exchange

• Exchange of two catheters can be reported twice

 Modifiers will be payer driven

• Exchange may not be reported together with stent placement

(47538) via the same access.

Code

47536

Description

Exchange of biliary drainage catheter (e.g., external, internalexternal, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (e.g., fluoroscopy), and all associated radiological supervision and interpretation


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Catheter Exchange

• 47536 is used for:

 Removal of an existing external drainage catheter with insertion of a new external drainage catheter via the same access

 Removal of an existing internal-external drainage catheter with insertion of a new internal-external drainage catheter via the same access

 Removal of an existing internal-external drainage catheter with insertion of a new external drainage catheter via the same access

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Catheter Removal

• Code requires guidance

 No guidance, use an E/M code based on supporting documentation

• Do not assign in conjunction with stent placement via the same access

Code

47537

Description

Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (e.g., with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging guidance (e.g., fluoroscopy), and all associated radiological supervision and interpretation

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Insertion of Biliary Stent

• Stent(s) – usually implies one or more than one . . . but definition remains “each stent”

Code

47538

47539

47540

Description

Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (e.g., fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each stent; existing access

; new access, without placement of separate biliary drainage catheter

; new access, with placement of separate biliary drainage catheter

(e.g., external or internal-external)


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Coding Considerations

• Stent placed via new puncture (access)





47539 or

47540 (if also placing external / internal-external drainage catheter)

• Stent placed via existing access

 47538

• Codes 47538 – 47540 reported once per percutaneous access

 Overlapping, serial, bridging : one access – one code


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• Codes 47538 – 47540 - once per percutaneous access

 Overlapping, serial, bridging

• Unless :







Placement of double-barrel (side-by-side) stents in the same bile duct

Placement of two or more stents in separate bile ducts through a single access

Placement of stents via two or more percutaneous access sites

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Rendezvous Procedure

Objective – advance the ERCP scope into the common bile duct

New Code – 47541

Placement of access through the biliary tree and into small bowel to assist with an endoscopic biliary procedure (e.g., rendezvous procedure ), percutaneous, including diagnostic cholangiography when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation, new access


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• Code 47541cannot be reported if:





There is an existing biliary access

Existing access see conversion, exchange, removal

Cholangiography (47531,47532) or biliary drainage procedures (47533-

47540) were also reported

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Bile Duct Dilation

Code

+47542

Description

Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (e.g., fluoroscopy), and all associated radiological supervision and interpretation, each duct (List separately in addition to code for primary procedure)

• Can report along with Cannot report along with -

• Cholangiography

• Placement of drainage cath

• Conversion, exchange, removal of drainage cath

• Rendezvous procedure

• Stent placement codes



• Any of the codes for endoscopic dilation

• If a balloon catheter is used to remove stones or sludge from bile duct



Dilation included in placement

See 47544


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Bile Duct Biopsy

• Any part of the biliary tree

• Includes biopsy by brush, forceps and/or needle

• One unit regardless of the # of areas or samples

Code

+47543

Description

Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (e.g., brush, forceps, and/or needle), including imaging guidance (e.g., fluoroscopy), and all associated radiological supervision and interpretation, single or multiple (List separately in addition to code for primary procedure)

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Stone Extraction

• If a device is used in an attempt to remove suspected stones, but no stones or debris are retrieved, code 47544 should not be assigned.

Code

+47544

Description

Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method

(e.g., mechanical, electrohydraulic, lithotripsy) when performed, imaging guidance (e.g., fluoroscopy), and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

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Stone Extraction

• This code can be reported in conjunction with:









Cholangiography (47531-47532)

Placement of drainage catheter (47533-47534)

Conversion, exchange, or removal of drainage catheter (47535-47537)

Stent placement (47538-47540)

• It should not be reported with 47531-47543 for “incidental removal of debris.”

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AMA Technical Correction

• 47544 should only be used for removal of gallstones and/or solid debris, not for sludge

• Should not be assigned for “incidental removal of sludge and/or debris” during cholangiography

• Should not be assigned if a device is used in an attempt to remove suspected stones, but no stones or debris are retrieved

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Sclerotherapy

• Lymphocele, cyst, and seroma are examples (“e.g.”) of fluid collections, but don’t report with







Sclerotherapy of lymphatic or vascular malformations (37241)

Treatment of incompetent extremity veins (36468, 36470, 36471, 36475, 36476,

36478, 36479)

Pleurodesis

(32560)

Code

49185

Description

Sclerotherapy of a fluid collection (e.g., lymphocele, cyst, or seroma), percutaneous, including contrast injection(s), sclerosant injection(s), diagnostic study, imaging guidance (e.g., ultrasound, fluoroscopy) and radiological supervision and interpretation when performed


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What’s Included

• To determine the ‘components’ break down the description:

• Sclerotherapy of a fluid collection percutaneous,









 including contrast injection(s), sclerosant injection(s), diagnostic study, imaging guidance (eg, ultrasound, fluoroscopy) and radiological supervision and interpretation when performed

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• Code 49185 can be reported





 once per day for each lesion that is treated via a separate catheter .

Separate access – Golden Rule for modifier(s)

Only one unit of 49185 can be reported for treatment of multiple interconnected lesions via the same catheter.

Should not be reported together with tube check (49424) or fistulogram

(76080).

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May Be Separately Reported

• Guidelines state access and drainage “ may be ” reported separately according to location





For access/drainage using a needle, report code 10160 (puncture aspiration) or 50390 (aspiration of renal cyst or pelvis).

For access/drainage using a catheter, report code 10030 (catheter drainage of soft tissue), 49405 (visceral catheter drainage), 49406

(peritoneal/retroperitoneal catheter drainage), 49407 (transvaginal / transrectal catheter drainage), or 50390 (aspiration of renal cyst or pelvis).

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Urinary System

Deleted

Urinary Procedures

Antegrade pyelogram

Place percutaneous nephrostomy

Nephrostogram

Dilation of nephrostomy

Change nephrostomy tube

Ureteral catheter or stent

RS&I

74425

74475

74425

74485

75984

74480

Surgery

50390

50392

50394

50395

50398

50393

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Just to Clarify

Urinary Tract Imaging

The following component codes have NOT been deleted for 2015:

 74425 – Urography, antegrade (pyelostogram, nephrostogram, loopogram), RS&I

Listed as S&I code for 50390, 50684, 50690





74470 – Radiologic examination, renal cyst study, translumbar, contrast visualization, RS&I

Listed as S&I code for 50390

74485 – Dilation of nephrostomy, ureters, or urethra, RS&I

Listed as S&I code for cystoscopy code 52351

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Device Type

Nephrostomy catheter

Nephroureteral catheter

Placement

50432

50433 (new access)

50434 (PCN conversion)

Exchange

50435

50387

Ureteral stent

50693 (existing tract)

50694 (new access)

50695 (new access with separate PCN catheter)

50382

(percutaneous)

50385

(transurethral)

Removal

50389 (only if fluoro required)

50389 (if fluoro required)

50384

(percutaneous)

50386

(transurethral)

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Antegrade Pyelogram

New codes:

Code

50430

50431

Description

Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (e.g., ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access

Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (e.g., ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access

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Percutaneous Nephrostomy

• Placement includes:

– access, diagnostic imaging , imaging guidance

Code

50432

Description

Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance

(eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation

– Patient undergoes left antegrade pyelogram, which reveals an obstruction … imaging still included with this new code.


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Nephrostomy Exchange

• Exchange also includes the diagnostic nephrostomy when performed

Code

50435

Description

Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation

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Nephroureteral Catheter

• New Code:

Code

50433

Description

Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access

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Conversion

• New code when using the same tract

Code

50434

Description

Convert nephrostomy catheter to nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, via pre-existing nephrostomy tract

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Exchange

• Existing code – revised language

Code

50387

2016 Description

Removal and replacement of externally accessible nephroureteral catheter (e.g., external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation

2015 Description

Removal and replacement of externally accessible transnephric ureteral stent (e.g., external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation

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Ureteral Stent

• Three new codes:

Code

50693

Description

Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; pre-existing nephrostomy tract

50694 ; new access, without separate nephrostomy catheter

50695 ; new access, with separate nephrostomy catheter

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BIOPSY - URETER OR RENAL PELVIS

• New add-on code:

Code

+50606

Description

Endoluminal biopsy of ureter and/or renal pelvis, nonendoscopic, including imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

 Only one unit can be reported per ureter per DOS

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• 50606 Includes • Report separately w/ 50606

• Imaging guidance

• Radiological RS&I

• Biopsies thru new transrenal access, an existing renal or ureteral access, transurethral access, ileal conduit, or ureterostomy

• Access

• Diagnostic pyelography or ureterography

• Other interventions or catheter placements

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• Biopsy of ureter or renal pelvis can be reported with:

























Ureteral stent exchange (50382, 50385) or removal (50384, 50386)

Nephroureteral catheter exchange (50387)

Nephrostomy tube removal (50389)

Antegrade pyelogram, nephrostogram, or ureterogram (50430, 50431)

Place nephrostomy catheter or nephroureteral catheter (50432, 50433)

Conversion of nephrostomy to nephroureteral catheter (50434)

Nephrostomy catheter exchange (50435)

Contrast injection via ureterostomy/ indwelling ureteral catheter (50684)

Ureterostomy tube or ureteral stent change via ileal conduit (50688)

Ileal conduit injection (50690)

Placement of ureteral stent (50693, 50694, 50695)

Retrograde urethrocystography (51610)


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Ureteral Embolization

• Non-endoscopic image-guided procedure

Code

+50705

Description

Ureteral embolization or occlusion, including imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

 Separately report access, diagnostic imaging, other interventions or catheter placements

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Separately Report

• Ureteral embolization is an add-on to:

– Ureteral stent exchange

(50382, 50385) or removal

(50384, 50386)

– Nephroureteral catheter exchange

(50387)

– Nephrostomy tube removal

(50389)

– Antegrade pyelogram, nephrostogram, or ureterogram

(50430, 50431)

– Place nephrostomy catheter or nephroureteral catheter

(50432, 50433)

– Conversion of nephrostomy to nephroureteral catheter

(50434)

– Nephrostomy catheter exchange

(50435)

– Contrast injection via ureterostomy/ indwelling ureteral catheter

(50684)

– Ureterostomy tube or ureteral stent change via ileal conduit

(50688)

– Ileal conduit injection (50690)

– Placement of ureteral stent (50693, 50694, 50695)

– Retrograde urethrocystography (51610)


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Ureteral dilation

• New code:

Code

+50706

Description

Balloon dilation, ureteral stricture, including imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

 Report once per ureter per day

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Separately Report

• Balloon dilation, ureteral stricture is an add-on to:

– Ureteral stent exchange

(50382, 50385) or removal

(50384, 50386)

– Nephroureteral catheter exchange

(50387)

– Nephrostomy tube removal

(50389)

– Antegrade pyelogram, nephrostogram, or ureterogram

(50430, 50431)

– Place nephrostomy catheter or nephroureteral catheter

(50432, 50433)

– Conversion of nephrostomy to nephroureteral catheter

(50434)

– Nephrostomy catheter exchange

(50435)

– Contrast injection via ureterostomy/ indwelling ureteral catheter

(50684)

– Ureterostomy tube or ureteral stent change via ileal conduit

(50688)

– Ileal conduit injection (50690)

– Placement of ureteral stent (50693, 50694, 50695)

– Retrograde urethrocystography (51610)


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Watch the Notes

• Urinary Diversions

 Important new note in the cystoscopy section

the cystoscopy codes can be used for endoscopy of bowel segments that are being used as urinary diversions, such as an ileal loop.


| 74

Penis repair

• Two new codes

Code Description

54437 Repair of traumatic corporeal tear(s)

54438 Replantation, penis, complete amputation including urethral repair

• Rupture of the urethra is not always involved with the fracture, it may be reported separately with 53410 or 53415 if performed.

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Mechanical Thrombectomy and/or Infusion

• Once per territory

Code

61645

Description

Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial , any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s)

• Not for intended for treatment of intracranial veins – see code(s) 37187, 37188, 37212, 37214

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Intracranial Interventions

• Will be reported once per vascular territory

• AMA defined three intracranial vascular territories







Right carotid circulation

Left carotid circulation

Vertebro-basilar circulation


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Administration Non-Thrombolytic Agent

• 2 new codes for intracranial procedures

Code

61650

+61651

Description

Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory

Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; each additional vascular territory (List separately in addition to code for primary procedure)

• Spasmolytic agents (Papverine) and/or Chemotherapy drugs


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Prolonged Administration

• Not used to report routine used substances:

-

-

Heparin

Nitroglycerin

Saline solution

• No infusion pump required

• Drug administration must last at least 10 minutes in order to report

61650

Discontinuous blocks of time may be added

• Assigned once per territory (3 total)

• No more than 2 units of 61651 per day

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Intracranial Interventions

• Three new codes for mechanical thrombectomy and infusion therapy include:













Selective catheterization

Diagnostic angiography

All subsequent angiography within the vascular territory, including radiological S&I

Fluoroscopic guidance

Neurologic and hemodynamic monitoring

Arteriotomy closure by pressure, closure device, or suture

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Nerve Blocks

Code 64412

(Injection, anesthetic agent; spinal accessory nerve)

• Replaced with -

Code

64461

+64462

64463

Description

Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)

Paravertebral block (PVB) (paraspinous block), thoracic; second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary procedure)

Paravertebral block (PVB) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging guidance, when performed)


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• Add-on code (64462) is only reported once per day

 (second and any additional injection sites)

• None of the three new codes can be reported with











Cervical or thoracic epidural injection or catheter infusion (62310, 62318)

Intercostal nerve block (64420, 64421)

Cervical or thoracic transformational epidural (64479, 64480)

Cervical or thoracic facet joint block (64490, 64491, 64492)

Ultrasound or fluoroscopic guidance (76942, 77002, 77003)

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“Upgraded” Codes

• Deleted Category III

Code Description

0099T Implantation of intrastromal corneal ring segments

• Replaced with Category I

Code Description

65785 Implantation of intrastromal corneal ring segments


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Remove Impacted Cerumen

• New code:

Code Description

69209 Removal impacted cerumen using irrigation/lavage, unilateral

• Not to be reported with (or confused with)

Code Description

69210 Removal impacted cerumen requiring instrumentation, unilateral

• E/M will still be used for non impacted cerumen


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Radiology

Additions – > 20

Deletions – > 25

Revisions – > 10


“Written” Reports

• Guidelines have been expanded

• 2015 version:

 A written report signed by the interpreting individual should be considered an integral part of a radiologic procedure or interpretation.

• 2016 version:

 A written report (e.g., handwritten or electronic) signed by the interpreting individual should be considered an integral part of a radiologic procedure or interpretation .

• With regard to CPT descriptors for radiography services,

“images” refer to those acquired in either an analog (i.e., film) or digital (i.e., electronic) manner.


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Replacements

• Spine X-rays

 Codes deleted , with notes referring the reader to the new series 72081-

72084:

-

-

72010 – Radiologic examination, spine, entire, survey study, anteroposterior and lateral To report, use 72082.

72069 – Radiologic examination, spine, thoracolumbar, standing (scoliosis)

To report, use 72081-72084 .

72090 – Radiologic examination, spine; scoliosis study, including supine and erect studies To report, use 72081-72084.

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Spine X-Rays

• Four new codes for scoliosis exams have been added. These codes require exam of the entire thoracic and lumbar spine regions, and they include (but do not require) exam of the skull, cervical spine, and sacral spine if performed.

Code

72081

Description

Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (e.g., scoliosis evaluation); one view

72082 ; 2 or 3 views

72083 ; 4 or 5 views

72084 ; minimum of 6 views

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Spine X-rays

• Revisions to remaining code(s)

Code

72080

2016 Description

Radiologic examination, spine; thoracolumbar junction, minimum of 2 views

2015 Description

Radiologic examination, spine; thoracolumbar, 2 views

• Single thoracolumbar junction view – see 72020

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In Summary

Region

Any region

Cervical

Thoracic

Thoracolumbar junction

Entire thoracic and lumbar

Lumbosacral

Views

1 view

2 or 3 views

4 or 5 views

6 or more views

2 views

3 views

4 or more views

2 or more views

1 view

2 or 3 views

4 or 5 views

6 or more views

2 or 3 views

4 or more views

Complete, min 6 w/bending

Bending only, 2-3 views


72080

72081

72082

72083

72084

72100

72110

72114

Code

72020

72040

72050

72052

72070

72072

72074

72120

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Replacements

• Hip X-rays

 Codes deleted , with notes referring the reader to the new series 73501 – 73523

-

-

-

-

73500 – X-ray, hip, unilateral; 1 view –

See 73501

.

73510 – X-ray, hip, unilateral; complete, minimum of 2 views

See

73502, 73503

.

73520 – X-ray, hips, bilateral, minimum of 2 views of each hip, including anteroposterior view of pelvis -

See73521, 73522, 73523.

73530 – X-ray, hip, during operative procedure -

See 73501, 73502, 73503.

73540 – X-ray, pelvis and hips, infant or child, minimum of 2 views

–

See 73501, 73502, 73503

.

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New Codes for Hips

• Full description for all six new codes include the pelvis when performed

Description

Radiologic examination, hip, 1 view

Radiologic examination, hip, 2-3 views

Radiologic examination, minimum of 4 views

Unilateral Bilateral

73501

73502

73503

73521

73522

73523

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Femur X-Rays

• Deleted

Code Description

73550 Radiologic examination, femur, 2 views

• Created

Code Description

73551 Radiologic examination, femur; 1 view

73552 Radiologic examination, femur; minimum 2 views


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Fetal MRI

• New codes

Code

74712

Description

Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single or first gestation

+74713

Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; each additional gestation (List separately in addition to code for primary procedure)

 Do not report MRI of the pelvis with a fetal MRI


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Radiation Oncology

Radiation Oncology

• The following codes have been deleted:













77776 – Interstitial radiation source application; simple

77777 – Interstitial radiation source application; intermediate

77785 – Remote afterloading high dose rate radionuclide brachytherapy; 1 channel

77786 – Remote afterloading high dose rate radionuclide brachytherapy; 2-12 channels

77787 – Remote afterloading high dose rate radionuclide brachytherapy; over 12 channels

0182T – High dose rate electronic brachytherapy, per fraction


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Bundling Alert

• Codes do not change – details do

Code

77778

2016 Description

Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when performed

2015 Description

Interstitial radiation source application; complex

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Nuclear medicine

• Gastric emptying study revisions

Code

78264

78265

2016 Description

Gastric emptying imaging study (eg, solid, liquid, or both);

Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit

2015 Description

Gastric emptying study n/a – new code for 2016

78266

Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days n/a – new code for 2016

• Code to be reported once per imaging study

| 98


Laboratory

Additions – > 25

Deletions – > 10

Revisions – > 45


Continuing the Tradition

Code Changes

• 2 full pages of path/lab changes in Appendix B. Items of Note













New code for OB panel (80081)

Numerous new and revised molecular pathology codes

New and revised codes for genomic sequencing

New codes for multianalyte assays with algorithmic analysis (MAAAs)

New, revised, and deleted codes for column chromatography and mass spectrometry

Revisions to the infectious agent immunoassay codes

| 100


Medicine Services

Additions – > 10

Deletions – > 20

Revisions – > 50


Continuing the Tradition

• Over 45 revised vaccine/toxoid code descriptions

 may not significantly impact intent/use

Code

90655

90633

2016 Description

Influenza virus vaccine, trivalent

(IIV3) , split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use

Hepatitis A vaccine ( HepA) , pediatric/adolescent dosage-2 dose schedule, for intramuscular use

2015 Description

Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use

Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use


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New Vaccine / Toxoid Codes

Code

90697

90620

90621

90625

Description

Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenza type b

PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-

IPV-Hib-HepB), for intramuscular use

Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB), 2 dose schedule, for intramuscular use

Meningococcal recombinant lipoprotein vaccine, serogroup B

(MenB), 3 dose schedule, for intramuscular use

Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use


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Category III

Additions – > 25

Deletions – > 10

Additional Examples

• Six codes (0381T – 0386T) added for external heart rate and 3-axis accelerometer data recording

• Two codes (0392T – 0393T) added for placement or removal of the esophageal sphincter augmentation device

• Single code (0398T) added to distinguish between the Stereotactic radiosurgery methodology for treating medically refractory movement disorders – the new code reflects a combination of a conventional MRI and focused ultrasound delivery system.

• Two codes (0400T – 0401T) added for multi-spectral digital skin lesion analysis

• Single code (0403T) added to address the delivery of a DM prevention program in a group format


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Wrap Up

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