2016 CPT
Changes
Tamara Carey, CPC, CPMA
Evaluation & Management
• Prolonged Services codes and guidelines
– Revised and updated for consistency
– “This service is reported in addition to the primary
procedure (i.e., the designated E/M services at any
level or psychotherapy, code 90837…”
• 99354 Prolonged evaluation and management
or psychotherapy services…
Evaluation & Management
• Prolonged Clinical Staff Services
– New title and subsection guidelines
• 2 new codes; 99415 and 99416
– 99415 – first hour
– +99416 – each additional 30 minutes (must surpass 15 min.)
• Prolonged service of less than 45 minutes in duration is
not reported separately
– Less than that is included in the E/M
Evaluation & Management
• E/M typical time is used to define when prolonged
services time begins;
– Example – prolonged clinical staff services would begin after 25
minutes , and 99415 is not reported until at least 70 minutes (25
+ 45) total face-to-face clinical staff time has been performed.
• Reported once per date of service, even if time spent is
not contiguous
– Add face-to-face time together
• Codes 99415, 99416 may be reported for no more than
two simultaneous patients.
Evaluation & Management
• Preventive Medicine – revisions to guidelines
– Clarify the Behavior Change Intervention codes
(99406 – 99409) are appropriately reported
separately in addition to the Preventive Medicine
codes (99381 – 99397)
• Aligns them with the original intent of the Behavior
Change Intervention code edits from 2008 which was to
allow separate reporting of an E/M service, which
includes Preventive Medicine codes
– Time spent providing the E/M service must be distinct
(25 modifier), and time spent providing the E/M may
not be used as a basis for the code selection.
Surgery
• New codes – 10035, +10036
• Used to report initial and additional lesion
placement of soft tissue localization device(s)
– Axilla and/or groin tissue
– Marking lesions prior to therapy
• Only reported once per target, regardless of how
many markers are used to mark the target
• Imaging guidance is bundled and not separately
reportable
Surgery
• Three new codes – 31652, 31653, 31654 have
been established in the Trachea and Bronchi
subsection
• To identify endobronchial ultrasound (EBUS)
guided procedures
– 31652 = one or two mediastinal and/or hilar node
stations or structures
– 31653 = 3 or more mediastinal and/or hilar node
stations or structures
• Reported once regardless of the number of aspiration or
biopsy procedures are needed to accomplish the service
– 31654 = peripheral lesions
Surgery
• Pacemaker or Implantable Defibrillator
– Guidelines were revised to include information on
new Category III codes for leadless cardiac
pacemaker systems
• 0387T – 0391T
– Include a pulse generator with built-in battery and
electrode for implantation in a cardiac chamber via a
transcatheter approach
Surgery
• Pulmonary Valve
– 0262T => 33477 a catheter based technique for the
implantation of a prosthetic valve using a
percutaneous approach
• Reported once per session
• Included in 33477;
– Access, placing the access sheath, advancing the
device delivery system, repositioning, deploying
– Angiography, radiological S&I, interpretation to guide
and report
– Cardiac catheterization
– Balloon angioplasty, stent placement within the
pulmonary conduit
Surgery
• Extracorporeal Membrane Oxygenation (ECMO)
or Extracorporeal Life Support Services (ECLS)
• Code series 33946 – 33989
• Procedure chart has been added to illustrate
and provide instructions for appropriate code
assignment
Surgery
• Arterial Mechanical Thrombectomy
• CPT codes 37184, 37185, 37186
– All have been revised to include the term “nonintracranial”
•
CPT code 37211
– Has been revised to exclude the term “nonintracranial”
Surgery
• Intravascular Ultrasound Services (IVUS)
noncoronary vessels
• New codes +37252, +37253
– Deleted codes 37250, 37251
• Radiological supervision and interpretation
services are included in these codes (75945 and
75946)
• Billed in conjunction with stent or stent graft
placement, angioplasty, atherectomy,
embolization, thrombolysis, transcatheter biopsy
Surgery
• Intravascular Ultrasound Services (IVUS)
noncoronary vessels
• What’s included;
– Transducer manipulations/repositioning before,
during, and after therapeutic/diagnostic services
– Intravascular vena cava filter insertion or repositioning
or removal
– Intravascular foreign body retrieval
• What can be separately reported;
– Diagnostic angiography
– Selective and non-selective catheterizations
– Therapeutic intervention
Surgery
• Guidelines
– Report one IVUS code for a lesion extending across
more than 1 vessel
• Example;
– IVUS for DVT extending from the popliteal vein
through the IVC, report with 37252
Surgery
• Esophagogastroduodenoscopy (EGD)
subsection
• New code #43210 for partial or complete,
transoral esophagogastric fundoplasty
– Also referred to an incisionless fundoplication or TIF
– Includes esophagoscopy
– Includes duodenoscopy when performed
Surgery
• Biliary Tract
– Percutaneous Biliary Procedures
• 14 new codes – 47531 – 47544
– These codes are different from endoscopy because you aren’t
accessing the biliary tree via a hollow viscus
• Imaging guidance is included
• Diagnostic cholangiography is inherently
included
Surgery
• Biliary Stent Placement
• Term “stent” can mean two different things, often
not distinguished in a report
– Catheter placed for drainage, e.g., bridging an
occlusion, that can be accessed externally
• External drain
• Internal/external drain
• Referred to as a “drainage catheter” (47533 – 47537)
– Internally positioned device; not externally accessible
• Metal expanding stent placed to hold open an
stenosis/occlusion
• Internal plastic catheter that bridges an occlusion/stenosis
• CPT codes 47538, 47539, 47540
Surgery
• Biliary Stent Placement
• To be able to select the correct code(s) for stent
placement, you must know;
– If access for each stent placed were, single or
multiple punctures, and if it is an existing or new
access.
– The position of each stent
– If the biliary ductal anatomy, single or multiple ducts;
contiguous or separate ducts
– If a catheter drain was left in place
Surgery
• Biliary Stent Placement – Guidelines
– Reported once per session for one or more
overlapping/serial stents
– Reported once per session for bridging 1 ductal
segment through 1 access
• May be reported twice (modifier 59) when;
– Placing side by side stents in single bile duct
– Placing two or more stents into separate ducts via 1
access
– Placing stents via 2 or more percutaneous access
sites
Surgery
• Laparoscopy – Transhepatic cholangiography
w/w/o biopsy
– First parenthetical
– Codes 47560 and 47561 have been deleted
– Instructed to report 47579 (NOC)
• Per CPT rationale, laparoscopic
cholangiography is no longer standard practice,
as more advanced imaging techniques have
been developed (e.g. MRI and CT), therefore
the codes were deleted.
Surgery
• Abdomen, Peritoneum, Omentum
– Excision, Destruction
– New CPT code 49185, Sclerotherapy of a fluid
collection
• Examples provided within the code descriptor
• Parentheticals following the new code directs the
coder to the appropriate codes to use to report
drainage of other types of fluid collections.
• Multiple lesions in a single day, separate access,
use 59 for each additional lesion treated
Surgery
• Other Introduction (Injection/Change/Removal)
Procedures
– New guidelines to reflect intended use of codes
included within this section
– Imaging guidance is included (e.g. fluoroscopy,
ultrasound, CT or other modality)
– Diagnostic procedures (50430, 50431) include;
•
•
•
•
Contrast injections
Associated RS&I
Procedural image guidance
50430 also includes catheter or needle access into collecting
system and/or ureter access
Surgery
Nephrostomy Tube
Nephroureteral Stent
Ureteral Stent
50432 (placement)
50433 (placement)
50693 (placement,
existing nephrostomy)
50694 (placement, new
access, w/o neph tube in
addition
50435 (exchange)
50387 (exchange)
50695 (placement, new
access, w/additional
neph tube)
50389 (removal w/fluoro)
50434 (conversion of
nephrostomy to
nephroureteral stent)
50382 – 50386 (removal)
Surgery
50432 – Percutaneous nephrostomy
(neph tube)
A single transnephric catheter placed
into the renal pelvis for drainage
(drains to external bag)
50433 – Percutaneous nephroureteral
catheter, new access
A single transnephric catheter that
drains the kidney, but extends into the
bladder. It maintains external access
through the flank, and can drain
externally to bag and/or internally to
bladder
50434 – Convert neph tube to
nephroureteral catheter
System access through an existing
nephrostomy catheter (which is
removed) w/placement of
nephroureteral stent
50432 – Exchange neph tube
Existing neph tube exchanged for new
tube
Surgery
• Therapeutic procedures; 50432 – 50435
includes;
–
–
–
–
–
–
Access
Placement of drain
Catheter manipulation
Guidance
RS&I
Diagnostic study
Surgery
• New Ureter subsection; Incision and Biopsy
• New CPT code +50606
– Describes endoluminal biopsy procedures using nonendoscopic imaging guidance (reported once per
collecting system/ureter biopsied
– Includes; biopsy, image guidance for biopsy, RS&I for
biopsy
• Biopsies can be done via any non-endoscopic
access;
– De Novo (new) transrenal access
– Existing renal or ureteral access
– Transurethral access, ileal conduit, ureterostomy
Surgery
• Endoscopy – Cystoscopy, Urethroscopy,
Cystourethroscopy
– “Because cutaneous urinary diversions utilizing ileum
or colon serve as functional replacements of a native
bladder, endoscopy of such bowel segments, as well
as performance of secondary procedures can be
captured by using the cystourethroscopy codes. For
example, endoscopy of an ileal loop with removal of
ureteral calculus would be coded as
cystourethroscopy (including ureteral
catheterizations); with removal of ureteral calculus
(52320).”
Surgery
• Endovascular Therapy
• New CPT codes 61645, 61650, and +61651
– Used for cerebral endovascular therapeutic
interventions in any intracranial artery which includes;
•
•
•
•
•
•
•
Selective catheterization
Diagnostic angiography
All subsequent angiography
Associated RS&I within the treated vascular territory
Fluoroscopic guidance
Neurologic and hemodynamic monitoring of the patient
Closure of the arteriotomy by manual pressure, an
arterial closure device or suture
Surgery
• Paravertebral Blocks
– 3 new CPT codes, 64461, +64462, 64463 to identify
paravertebral blocks using single/multiple injection(s)
or continuous infusion using a catheter
– The intent is to provide a dense, ipsilateral somatic
and sympathetic blockade as an analgesic alternative
to a neuraxial blockade (which is performed as an
epidural or via access to the spine)
• Dermatomal coverage from T2 – L1
Surgery
• 64461 – initial injection
• +64462 – second and any additional injection(s)
site(s)
– Report only once per day
• 64463 – continuous infusion by catheter
– Continuous infusion is performed through a
percutaneous indwelling catheter that is left in place
during the course of the infusion
– The infusion may be either repeated intermittent
boluses through the catheter or an interrupted
infusion by a pump at a set infusion rate
Surgery
• New CPT code 65785 – Implantation of
intrastromal corneal ring segments
– Category III code 0099T
• Used to reshape and improve the functionality of
the cornea
– Patients with chronic/progressive keratoconus
– Thinning and protrusion of the cornea
– Can no longer focus on an image and cannot be corrected with
glasses or contact lens(es)
– Worst case get scarring and may require corneal transplant
Surgery
• Laser Trabeculoplasty – 65855
– Treatment of glaucoma
• 2016 revised to removed “1 or more treatment
sessions..”
– 65855 was identified by RUC as a potentially misvalued code for
more than 1.5 postoperative visits in a 10-day global
– The code was changed from a 90-day to a 10-day global period
when it was last valued in 2000. However the descriptor wasn’t
updated to reflect the change
– Code 65855 describes multiple laser applications to the
trabecular meshwork through a contact lens to reduce
intraocular pressure. Current practice is to perform only one
treatment session of the laser for glaucoma and wait 10 days for
the effect on the intraocular pressure
Surgery
• WE HAVE A NEW CERUMEN REMOVAL
CODE!!!!
• 69209 Removal impacted cerumen using
irrigation/lavage, unilateral.
Radiology
• “Written Report(s)” revised to reflect current
practice
– Written report = handwritten or electronic
– “images” = analog, i.e. film or digital, i.e. electronic
• Editorial changes have been made throughout
the Radiology section to replace the word “film”
with “images”
Radiology
• 72080 revised to include # of views
– New codes 72081 – 72084 = more views
– COUNT THE NUMBER OF VIEWS
– New codes include skull, C-spine and sacrum, when
performed
– Parenthetical sends you to 72020 for a single view
thoracolumbar (single view examination of the
thoracolumbar junction)
• Single view that includes the entire thoracic and lumber
spine, use 72081
Radiology
• Hip, Pelvis, & Femur
– New family of six bundled codes 73501-73503,
73521-73523 has been established to replace deleted
codes 73500, 73510, 73520, 73530, 73540, and
73550
– RUC flagged codes 72170, 73500, 73520 and 73550
for restructuring as bundled
• 73500 and 72170 were identified on a screen showing
that they were performed together more than 75% of
the time
• Two new codes for femur x-rays; 73551 and
73552
Radiology
• Gynecological and Obstetrical subsection - Fetal
MRI
– Two new codes for to report fetal MRI; 74712 and
74713 (typically performed at 16 weeks gestation or
later)
– Allow for accurate reporting of the fetus, placenta and
the maternal pelvis (previously 72195, 72196, 72197)
– Very challenging to image a baby in the womb to look
for fetal anomalies
• Reported per fetus;
– 74712 is reported for a single or first fetus imaged
– 74713 is reported for each additional fetus imaged
mghradrounds.org
Radiology
• Clinical Brachytherapy
– Five new CPT codes added for HDR interstitial
brachytherapy
• 77767 Remote afterloading HDR radionuclide skin
surface brachytherapy…lesion diameter up to 2.0 cm or
1 channel
• 77768 lesion diameter over 2.0 cm….
• 77770 Remote afterloading HDR radionuclide
interstitial or intracavitary brachytherapy…1 channel
• 77771 2 – 12 channels
• 77772 over 12 channels
Path & Lab
• Tier 1 MoPath
– Represent gene-specific and genomic procedures
– Now contains 119 codes
– For 2016, 9 new codes were added, and 3 codes
were revised
• Tier 2 MoPath
– For 2016 revisions to existing codes include; addition
of analytes, revised analyte names, and deleted
analytes
• 81401 revised 1 analyte, added 2 analytes; 81402
removed 1 analyte; 81403 removed 3 analytes; 81404
removed 3 analytes; 81405 revised 1 analyte; 81406
revised 1 analyte, added 1 analyte
Path & Lab
• Obstetric Panel
– New code 80081 Obstetric Panel (includes HIV
testing)
• Differs from existing code 80055 because it includes
HIV testing
Path & Lab
• Immunofluorescence
– 88346 was revised to describe per specimen, initial
single antibody stain procedure
– If additional single antibody stain procedures are
performed, report 88350 for each additional single
antibody stain procedure
Path & Lab
• Hepatitis A Antibody
– Code 86708 was revised and now only allows
reporting the detection of an IgG antibody to hepatitis
A
– Code 86709 allows reporting of IgM antibody
detection
Path & Lab
• Enzyme Immunoassay Infectious Agent
Detection
– Microbiology codes 87301- 87451
– The revisions broadens the intent of these codes to
include immunoassays other than enzyme
immunoassays
– The revised codes now allow reporting of infectious
agent antigen detection by any immunoassay
technique.
Medicine
• Immune Globulins, Serum….
– Several codes have been added to the range of
administration codes, i.e.
• 96366, 96367, 96369, 96370, and 96371
• Previously, 96365, 96368, 96372, 96374, 96375
• Vaccine, Toxoids
– Revised codes listed have been updated to
incorporate the Advisory Committee on Immunization
Practices (ACIP), US Vaccine Abbreviations
Medicine
• 90697 – new hexavalent vaccine, includes;
–
–
–
–
Diptheria, tetanus, acellular pertusis (DTaP)
Poliomyelitis (IPV)
Haemophilus influenza type b (Hib), and
Hepatitis B (HepB)
• Effective 1/1/2015, printed in 2016 code book
with () = FDA approval pending
• 90620 and 90621 – two new Meningococcal
recombinant vaccines
Medicine
• Code 91040 was revised to remove the
provocation requirement and to specify the study
as diagnostic.
– Uses balloon catheter with barostat capability
– Measures distensibility of esophageal lumen via
inflation and deflation of the balloon
– Reported once per session
Medicine
• Exclusionary notes following 92002, 92004,
92012 and 92014
– Precludes reporting of screening codes 99173, 99174
and 99177
– Located on pg. 665
• 99173 – Screening test of visual acuity, quantitative,
bilateral
• 99174 – Instrument-based ocular screening (eg,
photoscreening, automated-refraction), bilateral; with
remote analysis
• 99177 - with on-site analysis
Medicine
• Vestibular Function Tests
– Two new CPT codes 92537 and 92538
– Used to report bilateral caloric vestibular testing both
bithermal (92537) and monothermal (92538)
– Code 92543 has been deleted
Medicine
• Special Dermatological Procedures
– Six new codes 96931 – 96936
– Created to report reflectance confocal microscopy for
cellular and subcellular imaging of the skin
• Prior to 2016, 43206 and 43252
Questions????
THANK YOU FOR YOUR TIME!!