CPT Changes for 2005
Julie A. Leu, CPC
December 16, 2004
9:30 – 11:30 a.m.
Overview of Changes for 2005
– One new symbol:
 Indicates a code which typically includes
conscious sedation
– Category I code changes:
•
•
•
130 codes added
26 codes deleted
60 code descriptors revised
Overview of Changes for 2005
– Category II code changes:
•
•
11 codes deleted
14 codes added
– Category III Codes:
•
•
•
27 codes added
9 codes deleted
1 code descriptor revised
Overview of Changes for 2005
– No modifiers deleted or revised
– Four new appendices:
•
•
•
•
Appendix F - Summary of CPT Codes Exempt
from Modifier 63
Appendix G - Summary of CPT Codes which
Include Conscious Sedation
Appendix H - Alphabetic Index of Performance
Measures by Clinical Condition or Topic
Appendix I - Genetic Testing Code Modifiers
– Apply to pathology/laboratory codes only
Evaluation and Management
– Critical Care Services
•
Change in guidelines for the section with
reference to the age of the patient
– Neonate = 28 days of age or less
– Infant = 29 days through 24 months of age
•
Formerly CPT utilized 30 days of age or less,
and 31 days through 24 months
▲ 99293, 99294 revised to include “29 days
through 24 months of age”
▲ 99295, 99296 revised to include “28 days of
age or less”
Anesthesia
– Guidelines revised in conjunction with
creation of Appendix G
•
•
•
If sedation is provided by the surgeon, CPT
codes 99141, 99142 are to be reported.
If sedation/anesthesia is provided by another
physician (or under their supervision), the
anesthesia codes are to be reported.
CPT codes listed in Appendix G include the
provision of sedation by the operating
physician.
Anesthesia

One new code:
– 00561
Anesthesia for
procedures on heart,
pericardial sac, and
great vessels of chest;
with pump oxygenator,
under one year of
age.
Surgery – Integumentary System
– Four new codes in the Skin, Subcutaneous
and Accessory Structures Codes:
• 11004 Debridement of skin, subcutaneous tissue,
•
•
•
muscle and fascia for necrotizing soft tissue
infection; external genitalia and perineum
11005 abdominal wall, with or w/o fascial
closure
11006 external genitalia, perineum and
abdominal wall, with or w/o fascial closure
+11008 Removal of prosthetic material or mesh,
abdominal wall for necrotizing soft tissue infection
Surgery – Integumentary System
– One revised, three new Breast codes:
▲ 19160 Mastectomy,partial (eg, lumpectomy,
•
•
tylectomy, quadrantectomy, segmentectomy);
19296 Placement of radiotherapy afterloading
balloon catheter into the breast for interstitial
radioelement application following partial
mastectomy, includes imaging guidance; on
date separate from partial mastectomy
+19297
concurrent with partial
mastectomy
Surgery – Integumentary System
– One revised, three new Breast codes:
• 19298 Placement of radiotherapy afterloading
brachytherapy catheters . . . into the breast for
interstitial radioelement application following
(at the time of or subsequent to) partial
mastectomy, includes imaging guidance
• New guidelines at the beginning of Breast
Excision subsection
Surgery – Musculoskeletal System
–
–
Five new codes
Two new codes in the
Femur subsection:
• 27412 Autologous
•
chondrocyte
implantation, knee
27415 Osteochondral
allograft, knee, open
Surgery – Musculoskeletal System
– Three new codes in the Arthroscopy
subsection:
• 29866 Arthroscopy, knee, surgical;
•
•
osteochondral autografts (eg, mosaicplasty)
(includes harvesting of the autograft)
29867
osteochondral allograft
29868
meniscal transplantation,
(includes arthrotomy for meniscal insertion),
medial or lateral
Surgery – Respiratory System
– Two new codes in the Larynx/Endoscopy
subsection:
• 31545 Laryngoscopy, direct, operative, with
•
operating microscope or telescope, with
submucosal removal of non-neoplastic lesion(s)
of vocal cord; reconstruction with local tissue
flap(s)
31546
reconstruction with graft(s)
(includes obtaining autograft)
Surgery – Respiratory System
– Four new codes, two revised codes in the
Trachea and Bronchi/Endoscopy subsection:
• +31620 Endobronchial ultrasound (EBUS)
during bronchoscopic diagnostic or therapeutic
intervention(s)
▲ 31630 Bronchoscopy, rigid or flexible, with or
without fluoroscopic guidance; with
tracheal/bronchial dilation or closed reduction of
fracture
▲ 31631
with placement of tracheal stent(s)
Surgery – Respiratory System
– Trachea and Bronchi/Endoscopy subsection:
• 31636 Bronchoscopy, rigid or flexible, with or
•
•
without fluoroscopic guidance; with placement
of bronchial stent(s) (includes tracheal/bronchial
dilation as required), initial bronchus
+31637
each additional major bronchus
stented
31638
with revision of tracheal or
bronchial stent inserted at previous session
Surgery – Respiratory System
– Lungs and Pleura
– One new code in the Incision
subsection:
• 32019 Insertion of
indwelling tunneled
pleural catheter with
cuff
Surgery – Respiratory System
– Lungs and Pleura, con’t.
– One revised and two new codes in the Lung
Transplantation subsection:
▲ 32850 Donor pneumonectomy (including cold
•
•
preservation), from cadaver donor
32855 Backbench standard preparation of cadaver
donor lung allograft prior to transplantation,
including dissection of allograft from surrounding
soft tissues to prepare pulmonary venous/atrial cuff,
pulmonary artery, and bronchus; unilateral
32856
bilateral
Surgery – Cardiovascular System
– Heart and Pericardium
– Two new codes, two revised codes in
Heart/Lung Transplantation subsection:
▲ 33930 Donor cardiectomy-pneumonectomy
•
(including cold preservation)
33933 Backbench standard preparation of cadaver
donor heart/lung allograft prior to transplantation,
including dissection of allograft from surrounding
soft tissues to prepare aorta, superior vena cava,
inferior vena cava, and trachea for implantation
Surgery – Cardiovascular System
– Two new codes, two revised codes in
Heart/Lung Transplantation subsection:
▲ 33940 Donor cardiectomy (including cold
•
preservation)
33944 Backbench standard preparation of cadaver
donor heart allograft prior to transplantation,
including dissection of allograft from surrounding
soft tissues to prepare aorta, superior vena cava,
inferior vena cava, pulmonary artery, and left atrium
for implantation
Surgery – Cardiovascular System
– Arteries and Veins
– Eight new codes, three deleted, one revised
• 34803 Endovascular repair of infrarenal abdominal
!
!
aortic aneurysm or dissection; using modular
bifurcated prosthesis ( two docking limbs)
Codes 35161 and 35162 have been deleted. A
parenthetical note has been added to instruct that
code 37799 should be reported for direct aneurysm
repair of other arteries, not otherwise specified.
Code 35582 has been deleted due to a confusing
redundancy of codes in the section.
Surgery – Cardiovascular System
– Arteries and Veins, con’t.
•
•
36475 Endovenous ablation therapy of
incompetent vein, extremity, inclusive of all
imaging guidance and monitoring,
percutaneous, radiofrequency; first vein treated
+36476
second and subsequent veins
treated in a single extremity, each through
separate access sites (List separately in
addition to code for primary procedure)
Surgery – Cardiovascular System
– Arteries and Veins, con’t.
•
•
36478 Endovenous ablation therapy of
incompetent vein, extremity, inclusive of all
imaging guidance and monitoring,
percutaneous, laser; first vein treated
+36479
second and subsequent veins
treated in a single extremity, each through
separate access sites (List separately in
addition to code for primary procedure)
Surgery – Cardiovascular System
– Arteries and Veins, con’t.
• 36818 Arteriovenous anastomosis, open, by upper
arm cephalic vein transposition
▲ 37205 Transcatheter placement of an intravascular
stent(s), (except coronary, carotid, and vertebral
vessel), percutaneous, initial vessel
• 37215 Transcatheter placement of intravascular
stent(s), cervical carotid artery, percutaneous; with
distal embolic protection
• 37216
without distal embolic protection
Surgery – Digestive System
– 18 new codes, five revised codes
• 43257 Upper gastrointestinal endoscopy . . . ; with
•
•
delivery of thermal energy to the muscle of lower
esophageal sphincter and/or gastric cardia, for
treatment of gastroesophageal reflux disease
43644 Laparoscopy, surgical, gastric restrictive
procedure; with gastric bypass and Roux-en-Y
gastroenterostomy (roux limb 150 cm or less)
43645
with gastric bypass and small
intestine reconstruction to limit absorption
Surgery – Digestive System
• 43845 Gastric restrictive procedure with partial
gastrectomy, pylorus-preserving
duodenoileostomy and ileoileostomy (50 to 100
cm common channel) to limit absorption
(biliopancreatic diversion with duodenal switch)
▲ 43846 Gastric restrictive procedure with gastric
bypass for morbid obesity; with short limb (150
cm or less) Roux-en-Y gastroenterostomy
Surgery – Digestive System
– Guidelines added to the Intestines/Excision subsection
to address intestinal allotransplantation.
• 44137 Removal of transplanted intestinal allograft,
complete
• 44715 Backbench standard preparation of cadaver or
living donor intestine allograft prior to transplantation,
including mobilization and fashioning of the superior
mesenteric artery and vein
• 44720 Backbench reconstruction of cadaver or living
donor intestine allograft prior to transplantation; venous
anastomosis, each
• 44721
arterial anastomosis, each
Surgery – Digestive System
•
•
•
•
45391 Colonoscopy, flexible, proximal to splenic
flexure; with endoscopic ultrasound examination
45392
with transendoscopic ultrasound
guided intramural or transmural fine needle
aspiration/biopsy(s)
46947 Hemorrhoidopexy (eg, for prolapsing internal
hemorrhoids), by stapling
New Liver Transplantation subsection


47133 and 47140 revised
Five new codes (47143 – 47147)
Surgery – Digestive System
▲ 48550 Donor pancreatectomy (including cold
•
•
preservation), with or without duodenal segment
for transplantation
48551 Backbench standard preparation of
cadaver donor pancreas allograft prior to
transplantation, . . .
48552 Backbench reconstruction of cadaver
donor pancreas allograft prior to transplantation,
venous anastomosis, each
Surgery – Urinary System
–
–
–
–
Seven new codes, five deleted, five revised
New Renal Transplantation subsection guidelines
Codes 50300, 50320, and 50360 were revised
New codes 50323 and 50325 report “standard”
backbench services performed on living or
cadaver donor renal allograft prior to
transplantation.
– New codes 50327, 50328, and 50329 report
backbench reconstruction procedures performed
on living or cadaver donor renal allograft prior to
transplantation.
Surgery – Urinary System
• 50391 Instillation of therapeutic agent into
renal pelvis and/or ureter through established
nephrostomy, pyelostomy or ureterostomy tube
(eg, anticarcinogenic or antifungal agent)
! Codes 50559, 50578, 50959, and 50978 have
been deleted and can be reported utilizing the
radiation oncology codes (eg, 77778)
▲ 52234 Cystourethroscopy, with fulguration . . .;
SMALL bladder tumor(s) (0.5 up to 2.0 cm)
• 52402 Cystourethroscopy with transurethral
resection or incision of ejaculatory ducts
Surgery – Female Genital System
– Five new codes, one revised
• +57267 Insertion of mesh or other prosthesis
for repair of pelvic floor defect, each site
(anterior, posterior compartment), vaginal
approach
▲ 57282 Colpopexy, vaginal; extra-peritoneal
approach (sacrospinous, iliococcygeus)
• 57283
intra-peritoneal approach
(uterosacral, levator myorrhaphy)
Surgery – Female Genital System
• 58356 Endometrial cryoablation with ultrasonic
•
•
guidance, including endometrial curettage,
when performed
58565 Hysteroscopy, surgical; with bilateral
fallopian tube cannulation to induce occlusion
by placement of permanent implants
58956 Bilateral salpingo-oophorectomy with
total omentectomy, total abdominal
hysterectomy for malignancy
Surgery – Nervous System
– Three new codes, three revised
• 63050 Laminoplasty, cervical, with
•
decompression of the spinal cord, two or more
vertebral segments;
63051
with reconstruction of the
posterior bony elements (including the application of bridging bone graft and non-segmental
fixation devices (eg, wire, suture, mini-plates),
when performed)
Surgery – Nervous System
• +63295 Osteoplastic reconstruction of dorsal
spinal elements, following primary intraspinal
procedure
▲ Codes 61685, 63685, and 64590 all were
revised to include the replacement of
stimulation or drug delivery devices.
Surgery – Eye and Ocular Adnexa
–
One new code, one revised
▲ 66710 Ciliary body destruction;
•
cyclophotocoagulation,
transscleral
66711 cyclophotocoagulation,
endoscopic
Radiology Code Changes
– Thirteen new codes, 14 revised, 11 deleted
– Introductory guidelines for the subsections
related to selective catheterization imaging
•
•
•
▲
Aorta and Arteries
Veins and Lymphatics
Transcatheter Procedures
75960 revision to the cross reference only
Radiology Code Changes
▲ 76075 Dual energy x-ray absorptiometry
(DXA), bone density study, one or more sites;
axial skeleton (eg, hips, pelvis, spine)
• 76077
vertebral fracture assessment
• 76510 Ophthalmic ultrasound, diagnostic; Bscan and quantitative A-scan performed during
the same patient encounter
▲ 76511
quantitative A-scan only
▲ 76512
B-scan (with or without
superimposed nonquantitative A-scan)
Radiology Code Changes
•
76820 Doppler velocimetry, fetal; umbilical artery
• 76821
middle cerebral artery
▲ 76827 Doppler echocardiography, fetal, pulsed
wave and/or continuous wave with spectral display;
complete
• Guidelines added for Non-Obstetrical Ultrasounds
▲ 77750 Infusion or instillation of radioelement
solution (includes three months follow-up care)
▲ 78267 Urea breath test, C-14 (isotopic); acquisition
for analysis
Radiology Code Changes
▲ Code descriptors for 78464 and 78465 were
revised to include attenuation correction, when
performed, for myocardial perfusion single photon
emission computed tomography (SPECT).
! Code 78810 has been eliminated and six new
codes, 78811- 78816, added for reporting tumor
imaging by positron emission tomography (PET).
! Code 78990 has been deleted. HCPCS Level II
codes may be used to report the diagnostic
radiopharmaceuticals used.
Radiology Code Changes
• 79005 Radiopharmaceutical therapy, by oral
admninistration
• 79101 Radiopharmaceutical therapy, by
intravenous administration
▲ 79200 Radiopharmaceutical therapy, by
intracavitary administration
▲ 79300 Radiopharmaceutical therapy, by interstitial
radioactive colloid administration
▲ 79440 Radiopharmaceutical therapy, by intraarticular administration
• 79445 Radiopharmaceutical therapy, by intraarterial particulate administration
Pathology Code Changes
Chemistry Section – six new codes and
three revised:
•
•
•
82045 Albumin; ischemia modified
82656 Elastase, pancreatic (EL-1), fecal,
quantitative or semi-quantitative.
83009 Helicobacter pylori, blood test
analysis for urease activity, non-radioactive
isotope
Pathology Code Changes
▲
83013 Helicobacter pylori, breath test
analysis for urease activity, nonradioactive
isotope.
▲ 83014 Helicobacter pylori, drug
administration
• 83630 Lactoferrin, fecal, qualitative
• 84163 Pregnancy-associated plasma
protein-A
(PAPP-A)
Pathology Code Changes
▲ 84165 Protein; electrophoretic
fractionation and quantitation
• 84166 Protein; electrophoretic
fractionation and quantitation, other fluids
with concentration (eg, urine, CSF)
• Genetic Testing Modifiers (Appendix I) for
use with molecular diagnostic procedures,
CPT codes 83890 through 83912.
Pathology Code Changes
Hematology and Coagulation section
one revised code:
▲ 85046 Blood count; reticulocytes,
automated, including one or more cellular
parameters (eg, reticulocyte hemoglobin
content, immature reticulocyte fraction,
reticulocyte volume, RNA content), direct
measurement
Pathology Code Changes
Immunology section, four new codes
and one revised code:
• 86064
• 86379
• 86587
B cells, total count
Natural killer (NK) cells, total count
Stem cells (ie, CD34), total count
Pathology Code Changes
Immunology section, four new codes
and one revised code:
▲
•
86334 Immunofixation electrophoresis;
serum
other fluids with concentration (eg,
urine, CSF)
Pathology Code Changes
Microbiology section, one new code
and one revised code:
▲
•
87046 Culture, bacterial; stool, aerobic,
additional pathogens, isolation and
presumptive identification of isolates,
each plate
87807 Infectious agent antigen detection
by immunoassay with direct optical
observation; repiratory syncytial virus.
Pathology Code Changes
Cytopathology section, one deleted
code (88180) and five new codes:
• 88184
Flow cytometry, cell surface,
cytoplasmic, or nuclear marker, technical
component only; first marker
•+88185
each additional marker
• 88187 Flow cytometry, interpretation; 2 to
8 markers
• 88188
9 to 15 markers
• 88189
16 or more markers
Pathology Code Changes
Cytogenetic Studies Section
• Genetic Testing Modifiers (Appendix I) for
use with cytogenetic studies procedures,
CPT codes 88230 through 88299.
Pathology Code Changes
Surgical pathology section, three new
codes and two revised codes:
•
•
88360 Morphometric analysis, tumor
immunohistochemistry (eg, Her-2/neu,
estrogen receptor/progesterone receptor),
quantitative or semiquantitative, each
antibody; manual
88361
using computer assisted
technology
Pathology Code Changes
▲ 88365 In situ hybridization (eg, FISH),
•
•
each probe
88367 Morphometric analysis, in situ
hybridization, (quantitative or semiquantitative), each probe; using computer
assisted technology
88368
manual
Pathology Code Changes
– Reproductive Medicine Procedures,
one revised code:
▲
89346 Storage, (per year); oocyte(s)
Medicine Section Changes
•
•
•
•
90465 Immunization administration under 8 years
of age (includes percutaneous, intradermal,
subcutaneous or intramuscular injections), when
the physician counsels the patient/family; first
injection (single or combination vaccine/toxoid),
per day
+90466
each additional injection, per day
90467 Immunization administration under age 8
years (includes intranasal or oral routes of
administration.) . . . .; first administration (single
or combination vaccine/toxoid), per day
+90468
each additional administration, per day
Medicine Section Changes
•
90656 Influenza virus vaccine, split virus,
preservative free, for use in individuals 3
years and above, for intramuscular use
▲ 90700 Diphtheria, tetanus toxoids, and
acellular pertussis vaccine (DTaP), for
use in individuals younger than 7 years,
for intramuscular use
Medicine Section Changes
–
Gastroenterology Subsection:
•
•
91034 Esophagus, gastroesophageal
reflux test; with nasal catheter pH
elecrode(s) placement; recording, analysis
and interpretation
91035
with mucosal attached
telemetry pH electrode placement,
recording, analysis and interpretation
Medicine Section Changes
• 91037 Esophageal function test,
•
•
•
gastroesophageal reflux test with nasal
catheter intraluminal impedance electrode(s)
placement, recording, analysis and
interpretation
91038
prolonged (>1 hr, up to 24 hrs)
91040 Esophageal balloon distension
provocation study
91120 Rectal sensation, tone, and compliance
test
Medicine Section Changes
–
Special Otorhinolaryngologic Services:
• 92620 Evaluation of central auditory
•
•
function, with report; initial 60 minutes
92621
each additional 15 minutes
92625 Assessment of tinnitus (includes
pitch, loudness matching, and masking)
Medicine Section Changes
▲ 93741 Electronic analysis of pacing
cardioverter-defibrillator . . .; single chamber or
wearable cardioverter-defibrillator system,
without reprogramming
▲ 93742
single chamber or wearable
cardioverter-defibrillator system, with
reprogramming.
• 93745 Initial set-up and programming by a
physician of wearable cardioverter-defibrillator
includes initial programming of system, establishing baseline electronic ECG, transmission of data
to data repository, patient instruction in wearing
system and patient reporting of problems or events
Medicine Section Changes
–
Noninvasive Vascular Diagnostic Studies
•
•
•
93890 Transcranial Doppler study of the
intracranial arteries; vasoreactive study
93892
emboli detection without
intravenous microbubble injection
93893
emboli detection with intravenous
microbubble injection
Medicine Section Changes
▲ 94060 Bronchodilation responsiveness,
spirometry as in 94010, pre- and postbronchodilator administration
▲ 94070 Bronchospasm provocation evaluation,
multiple spirometric determinations as in 94010,
with administered agents (eg, antigen(s), cold
air, methacholine)
• 94452 High altitude simulation test (HAST), with
physician interpretation and report
• 94453
with supplemental oxygen titration
Medicine Section Changes
• 95928 Central motor evoked
•
potential study (transcranial motor
stimulation); upper limbs
95929
lower limbs
Medicine Section Changes
•
95978 Eletronic analysis of implanted
neurostimulator pulse generator system . .
complex deep brain neurostimulator pulse
generator/transmitter, with initial or
subsequent programming; first hour
• +95979
each additional 30 minutes
after first hour
▲ Codes 95971, 95972, and 95973 have
been revised to exclude brain stimulation
Medicine Section Changes
▲
96111 Developmental testing; extended
(includes assessment of motor,
language, social, adaptive and/or
cognitive functioning by standardized
developmental instruments) with
interpretation and report
Medicine Section Changes
Physical Medicine and Rehabilitation
– One code deleted (97601) and four added
(97597, 97598, 97605, 97606) to the
Active Wound Care Management
subsection
Accupuncture
– Two codes deleted (97780, 97781) and
four added ( 97810, 97811, 97813,
97814) to this new subsection.
Category II Codes
– For 2005, all of the 2004 Category II
codes have been deleted and
renumbered.
– Four new codes have been added to
represent Maternity Care Management.
– Eight new categories of codes have been
added to accommodate the addition and
organization of the existing and future
Category II codes.
Category III Codes
– Eight Category II codes have been
deleted and converted to Category I
codes for 2005.
– Twenty-seven Category III codes were
added for 2005, including a code for
online evaluation and management
service with guidelines specifically to
instruct for appropriate coding (0074T)
– One Category III code, revised