2015 CPT Changes
Tamara Carey, CPC, CPMA
Evaluation and Management
• Numerous changes were made;
– Addition of “military history” to the social history
element (pg. 7)
– Revision of inpatient neonatal and pediatric critical
care guidelines (pg. 42)
– Deletion of intensive care codes 99481, 99482;
addition of 99184 which combines the services
(guideline pg. 43)
– Section title change; “Complex Chronic Care
Coordination => “Care Management Services”
– New subsection; “Chronic Care Management”,
“Complex Chronic Care Management”. (pg. 45)
Evaluation and Management
• Maternity Care and Delivery Guidelines (pg.
342)
– Pregnancy confirmation during a problem-oriented or
preventive visit is not considered a part of antepartum
care.
– Report using the appropriate E/M code for that visit.
– Antepartum care includes the initial prenatal history
and physical examination.
Evaluation and Management
• 2014 Complex Chronic Care Coordination
Services
– 99487 – no face-to-face visit, first hour
– 99488 – one face-to-face visit, first hour
– 99489 – each additional 30 minutes
• 2015
– New section heading (Care Management Services,
pg. 45)
– Two new subsections
– Deletion of code 99488
– Addition of code 99490
Evaluation and Management
• Care Management Services
– Chronic Care Management Services
• 99490 (pg. 46)
• At least 20 minutes of clinical staff time is spent, directed by
a physician or QHP, per calendar month
– Complex Chronic Care Management Services
• 99487, at least 60 minutes
• 99489, each additional 30 minutes (pg. 47)
Evaluation and Management
• CCM – Incident-to
– CMS/Medicare will allow incident to billing for CCM
with “general supervision” for services provided by
clinical staff
– All other incident-to regulations apply
Evaluation and Management
• Advance Care Planning (pg. 49)
• New section in E/M
– Guidelines
– Two new codes; 99497 and 99498
• No active management of problem(s) is
undertaken during the time period reported.
• An E/M may be reported separately on the same
day except for;
– Critical care, inpatient neonatal and pediatric critical
care, initial and continuing intensive care services.
Surgical Package Definition
• Page 62
• Revised to address the inclusive E/M
• Clarification as to who can perform these
services
Musculoskeletal
• Pg. 101
• 3 new codes for Arthrocentesis, aspiration
and/or injection – small, intermediate, major joint
or bursa with ultrasound
– 20604, 20606, 20611
• Existing codes were revised – without ultrasound
– 20600, 20605, 20610
Musculoskeletal
• Pg. 105
• One revised and one new code for bone tumor
ablation via radiofrequency or cryoablation
– 20982 (RF)
– 20983 (cryo)
• Pg. 110
– 3 new codes for open treatment of rib fracture(s)
• 21811, 21812, 21813
• Number of ribs
Musculoskeletal
• Pg. 114 – Percutaneous Vertebroplasty and
Vertebral Augmentation
– Coded 22520, 22521, 22522, 22523, 22524, 22525 were
deleted
– New codes 22510, 22511, 22512, 22513, 22514, 22515
• New codes includes moderate sedation.
• Old codes addressed Kyphoplasty/Vertebroplasty
of the thoracic or lumbar areas
– Procedures in the cervical area were reported with an
unlisted code.
Musculoskeletal
• Pg. 120
• Total Disc Arthroplasty/Additional level
– Revised code 22856 (parent code), single interspace
cervical
– New code 22858, second level, cervical
• three or more levels code 0375T, only (pg. 677)
• Pg. 142
• Arthrodesis – sacroiliac joint
– New code 27279
– Revised code 27280
Cardiovascular
• Pg. 185, Pacemaker or Implantable Defibrillator
section.
– Many Cat III codes => Cat I codes
– Guidelines distinguish between implantable defibrillators
w/transvenous leads from those w/subcutaneous leads
• Two categories of Implantable Defibrillators
– Transvenous implantable pacing cardioverterdefibrillators (ICD)
• Leads are intra-cardiac placed via veins
• Has pacemaker capabilities
• Uses a combination of anti-tachycardia pacing, low-energy
cardioversion, or defibrillating shocks to treat ventricular
tachycardia or ventricular fibrillation
Cardiovascular
• Subcutaneous Implantable defibrillator (S-ICD)
– One lead – located subcutaneously
– Lacks pacemaker capabilities
– Only provides defibrillating shocks – cannot provide
anti-tachycardia pacing
– New codes 33270 – 33273 (pg. 191)
• Transvenous revised codes 33215 – 33220,
33233 - 33225, 33240, 33230, 33231, 33241,
33262 (pg. 188)
Cardiovascular
• “Battery Change” (pg. 186)
– Do not report 33233 or 33241
– Report based on the number of final existing leads
• Revision of Skin Pocket
– Included in 33206 – 33249, 33262, 33263, 33264,
33270, 33271, 33272, 33273
• Relocation of Skin Pocket
– Includes all work associated w/the initial pocket
(opening, I&D, and closure
• Defibrillator Threshold Testing (DFT)
– Separately reported w/transvenous system, but not
subcutaneous
Cardiovascular
• Pg. 195 – Transcatheter Mitral Valve Repair
• Converted Cat III codes => Cat I
– 33418 and 33419
• Guidelines specify that 33419 is only reported once per
session
– Include the work, when performed, of percutaneous
access, placing the access sheath, transseptal
puncture, advancing the repair device delivery system
into position, repositioning the device as needed, and
deploying the device.
– Angiography, radiological S&I, and interpretation
performed to guide TMVR are included.
Cardiovascular
• Pg. 205 – Extracorporeal Membrane
Oxygenation (ECMO) or Extracorporeal Life
Support Services (ECLS)
– Deleted codes 33960 and 33961, identified by CMS
as potentially misvalued codes
– Patient population has changed from premature
neonates to adults with severe influenza, pneumonia
and respiratory distress syndrome
– Specialty societies submitted a code change proposal
– CPT Editorial Panel created an entirely new family of
codes
Cardiovascular
• ECMO/ECLS Definition
– This is a procedure that provides cardiac and/or
respiratory support to the heart and/or lungs
– Two methods can be used;
• Veno-arterial, will support both the heart and lungs.
Requires that two cannula(e) are placed – one in a large vein
and one in a large artery
• Veno-venous, is used for lung support only and requires one
or two cannula(e), which are placed in a vein
– CPT code series 33946 – 33989 (some resequenced
codes)
Cardiovascular
• ECMO Code Grouping
– Initiation
– Daily Management
– Cannulation (further defined by age and method)
• Insertion
• Repositioning
• Removal
Cardiovascular
• Pg. 212
• Fenestrated Endovascular Repair (FEVAR)
• New code created to report the physician
planning for a patient-specific manufactured
fenestrated visceral aortic endograft
• CPT code 34839
– Requires a minimum of 90 minutes of physician time
– Code guidelines specify what is included in this code;
• Review of high resolution cross-sectional images (eg, CT,
CTA, MRI, and the utilization of 3D software for iterative
modeling of the aorta and device in multi-planar views and
center line of flow analysis
Digestive
• Variety of changes throughout this chapter
– Addition of “separate procedure” designation
– Editorial change – “with or without collection of
specimen” => “including collection of specimen(s)
when performed”
– Control of bleeding instruction
– Endoscopy, ablation or stent – includes pre/post
dilation, and guide wire passage, if performed
– Definition of Colonoscopy, revised
• “…examination of the entire colon, from the rectum to the
cecum, and may include the examination of the terminal
ileum or small intestine proximal to an anastomsis”
Digestive
• Pg. 278 – Endoscopy, Small Intestine
– Antegrade transoral small intestinal endoscopy
(enteroscopy) is defined by the most distal segment
of small intestine that is examined
• Guidelines showing code assignment based on visualizing
the esophagus through the jejunum or ileum
• Guidelines showing code assignment based on how far down
the endoscope can be passed
• Retrograde exam of the small intestine via anus or colon
stoma, use 44799
Digestive
• Colonoscopy and modifiers 52 and 53 (pg. 279)
– “When performing a screening or diagnostic
endoscopy on a patient who is scheduled or 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…”
– “For therapeutic examinations that do not reach the
cecum, report the appropriate therapeutic
colonoscopy code with modifier 52…”
Digestive
• CPT has provided a colonoscopy decision tree
to assist coders in selecting the appropriate
code. (pg. 284)
– Typo in bottom row, far right box.
• “Colonoscopy (45379-45398 No Modifier”)
• CMS delayed publishing wRVUs for the lower
endoscopy codes
– Ileoscopy, pouchoscopy, flexible sigmoidoscopy,
colonoscopy, colonoscopy through stoma
• Identification of some of the codes as potentially
misvalued
Digestive
• How to report lower GI codes in 2015, if the
patient has Medicare (Original, Advantage);
– If the code has not changed from 2014 to 2015
• Physicians report the CPT code
– If the code has changed from 2014 to 2015
• Physicians report the G code
– If the code is new for 2015
• Physicians report the CPT code
Digestive
• How to report lower GI codes in 2015, if the
patient has Commercial Medicaid, Exchange,
etc.
– Physicians should report the 2015 CPT code, unless
instructed otherwise by the payor
– Facilities report the 2015 CPT code regardless if the
code as changed, and regardless of payer
• G codes are not valued in the OPPS fee schedule
Digestive
2014 CPT
Code
2015 G
Code
Descriptor
44383
G6018
Ileoscopy, thru stoma; with transendoscopic stent placement
(includes predilation)
44393
G6019
Colonoscopy thru stoma; w/ablation of tumor(s)…..not amenable
to removal by hot biopsy forceps, bipolar cautery or snare
44397
G6020
Colonoscopy thru stoma; w/transendoscopic stent placement
(includes predilation)
44799
G6021
Unlisted procedure, intestine
45339
G6022
Sigmoidoscopy, flexible; w/ablation of tumor(s)...not amenable to
removal by hot biopsy forceps, bipolar cautery or snare
45345
G6023
Sigmoidoscopy, flexible; w/transendoscopic stent placement
45383
G6024
Colonoscopy, flexible, proximal to splenic flexure; w/ablation of
tumor(s)…not amenable to removal by hot biopsy forceps,
bipolar cautery or snare
45387
G6025
Colonoscopy, flexible, proximal to splenic flexure;
w/transendoscopic stent placement (includes predilation)
Digestive
• Cologard test
– CMS established HCPCS code G0464 for the
Cologard test
• Colorectal cancer screening; stool-based DNA and fecal
occult hemoglobin (e.g., KRAS, NDRG4 and BMP3)
Nervous
• Pg. 363
• Myelography – 4 new codes
–
–
–
–
62302 - cervical
62303 - thoracic
62304 - lumbosacral
62305 – 2 or more regions
• Complete procedure codes
Radiology
• Pg. 428
• Chest
– New introductory guidelines
– Two new codes
• 76641, 76642
– 76641 represents a complete ultrasound exam of all
four quadrants of the breast and the retroareolar
region
• Includes US of the axilla if performed
– 76642 represents a focused US exam of the breast
limited to the assessment of one or more, but not all
• US exam of axilla included if performed
Radiology
• Pg. 434
• Digital Breast Tomosynthesis
– 77061 (unilateral), 77062 (bilateral), and +77063
(screening bilateral)
• CMS is delaying valuing 77061, 77062
– CMS will recognize +77063 to be reported when
tomosynthesis is used in addition to 2-D mammogram
– CMS created G2079, Diagnostic digital breast
tomosynthesis, unilateral or bilateral (List separately
in addition to G0204 or G0206)
Path & Lab
• Changes for 2015
– Drug Testing (pg. 467)
• Major revision of entire area
• Pg. 471, Presumptive Drug Class (80300 – 80304)
– Drug Class List A
– Drug Class List B
• Pg. 472, Definitive Drug Class
– Table provided starting on page 474
– Select based on the type of drug, and for some, the number of
drug
– Example, 80330 Analgesics, non-opioid; 3-5
Medicine
• Pg. 552
– Revision to the immunization injection instructions
• Modifier 51 is not required when reporting 90476 – 90479
and 90460 – 90474
• Pg. 553
– Two new codes 90651 and 90630
• 90651 has been established for a vaccine that protects
against nine (nonavalent) types of HPV (6, 11, 16, 18, 31, 33,
45, 52, 58)
• 90630 was established for a quadrivalent intradermal
influenza virus vaccine anticipated to receive FDA approval
by the end of 2014, and available for use in the 2015/2016 flu
season
Medicine
• Pg. 620
– Code 96110 was revised to better distinguish it from
the new brief emotional/behavioral assessment code
96127
• 96110 describes an assessment that is focused on
identification of childhood and adolescent developmental
levels (eg, fine and gross motor skills, cognitive level,
receptive/expressive and pragmatic language abilities, etc.)
• 96127 has been established to report the service associated
with the administration of a standardized behavioral and
emotional assessment instrument (eg, depression inventory,
attention-deficit/hyperactivity disorder [ADHD] scale) primarily
for, but not limited to children and adolescents.
Medicine
• Pg. 637
– Instruction regarding the use of selective head or total
body hypothermia code 99184.
– Includes all of the service components required of this
procedure, the review of;
•
•
•
•
•
•
Imaging
Laboratory data
Confirmation of esophageal temperature probe location
Evaluation of amplitude EEG
Supervision of controlled hypothermia, and
Assessment of patient tolerance of cooling
Medicine
• Pg. 637
– Code 99188 was established to report the application
of topical fluoride varnish by a physician or QHP for
the prevention of dental caries
– This code is intended for use only by a physician or
QHP, and only for patients that are at high risk for
caries
– When performed by clinical staff, i.e. RN, LPN, etc.
this service cannot be reported
– CMS will not cover this service for 2015
Questions????
THANK YOU FOR YOUR TIME!