CPT Updates 2015

Report
CPT UPDATES 2015
MARYLAND AAHAM
DARLENE HELMER, CMA, CPC, ACS-AN, CMPE, MBA
APPROVED AHIMA ICD-10 TRAINER
JANUARY 16, 2015
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Disclaimer
Anesthesia Business Consultants, LLC (“ABC”) has provided this In-Service
presentation, handouts and supplemental documentation and information (collectively,
the “Presentation”) as a service to its clients. The Presentation is for general
informational purposes only and should not be taken as legal advice or understood to
create a legal contract or other covenant or agreement of any kind between ABC.
Although the information found in this Presentation is believed to be reliable, no
warranty, expressed or implied, is made regarding the accuracy, adequacy,
completeness, legality, reliability, or usefulness of any information, either isolated or in
the aggregate. The information in the Presentation is supplemental to, and not a
substitute for, the AMA CPT-4 Codebook, any federal or state regulations, or
payer/carrier contract or policies. There is no guarantee that the use of this material
will prevent differences of opinion with payers/carriers/or regulators in payment and/or
reimbursement disputes. It is further noted that any and all liability arising from the
use of materials or information and/or presented at the seminar is the sole
responsibility of the participant, and his/her respective employer(s) who, by their
attendance at this Presentation, evidences agreement to hold harmless the
aforementioned parties, their employees and affiliates. The Presentation is intended
to be used as a teaching “tool”. CPT® Codes are copyright by the American Medical
Association.
2
Anesthesia Business Consultants, LLC Confidential Presentation Materials
CPT Updates 2015
Key new and deleted CPT code coming in 2015
 Impact of changes on provider coding and billing
 Inside the numbers:
•
•
261 new codes, 128 revised codes and 146 deleted
codes
Significant changes in
• E/M section
• Spinal Procedures
• Cardiovascular
• Pathology/Lab
• Digestive
3
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Common Themes
 Clarification of devices
• Pacemaker section – were pacing cardioverter defibrillators now
implantable defibrillators
 New methods/approaches
• Electrophysiologic evaluation for single or dual chamber
transvenous pacing cardioverter-defibrillators
 Deletion of low utilization codes
• Application of turnbuckle jacket
 Codes created for recognition of work
• New code 34819 created for “physician planning”
 Clarification when codes should not be billed together
 Electromyography codes in Urology section
4
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Social History
Age appropriate review of past and current activities that
includes significant information about:
 Marital status and/or living arrangements
 Current employment
 Occupational history
 Military history (NEW for 2015)
 Use of drugs, alcohol, and tobacco
 Level of education
 Sexual history
 Other relevant social factors
5
Anesthesia Business Consultants, LLC Confidential Presentation Materials
E/M Changes
New Codes:
 99490 Chronic care management, at least 20 minutes of
clinical staff time directed by a physician or other qualified
health care professional per calendar month
•
•
Code reported once per month
Provided by clinical staff under direction of physician
• At home, assisted living or rest home
• Include face to face and non face to face
• Activities are located in the guidelines
6
Anesthesia Business Consultants, LLC Confidential Presentation Materials
E/M Changes
 99497 Advance care planning; first 30 minutes
 99498
each additional 30 minutes (add on code)
 Face to face services between physician/healthcare
practitioner and family to discuss advanced directives
 Patient does not need to be present
 No active management of medical issues need to be
present
 Some E//M services may be reported but no critical care
7
Anesthesia Business Consultants, LLC Confidential Presentation Materials
E/M Changes
Revised Codes:
 99487 Complex chronic care management with moderate
or high medical decision-making; 60 minutes per month
 99489
each additional 30 minutes (add on code)
8
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Anesthesia
Deleted:
 00452 Anesthesia for procedures on clavicle or scapula;
radical surgery
 00622 Anesthesia for procedure on thoracic spine and
cord; thoracolumbar sympathectomy
 00634 Anesthesia for procedures in lumbar region;
chemonucleolysis
9
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Surgery
 Surgery
• New guidelines for vertebroplasty/vertebral augmentation
• New codes for open treatment of rib fractures
• New codes added/revised for arthrocentesis and ablation therapy
procedures
 Cardiovascular System
• Changes to guidelines for pacemaker and implantable defibrillator
• Subsection for extracorporeal membrane oxygenation
• Revised guidelines/codes for endovascular revascularization
services
10
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Surgery
 Digestive
• Extensive changes for lower endoscopy procedures with new
guidelines and codes for Stomal Endoscopy
• Renamed colon and rectal section
 Nervous system
• New injection codes for myelography
• New codes for transversus abdominus plane block
11
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Surgery
 Global package definition
• Definition was revised to clarify who can perform these services and
identify what services are included in addition to the operation
• Furnished by physician or other qualified health care professional
• E/M services subsequent to the decision for surgery (use to say
“one E/M service”)
• Further changes – CMS has approved final rule• CMS will transition post op days to ZERO
• Current 10 day procedures = CY 2017
• Current 30 day procedures = CY2018
• Surgical RVU’s will be reevaluated to account for surgery only
12
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Musculoskeletal
New Codes:
 20604 Arthrocentesis, aspiration and/or injection, small joint
or bursa; without ultrasound guidance**
 20606 Arthrocentesis, aspiration and/or injection,
intermediate joint or bursa with ultrasound guidance, with
permanent recording and reporting**
 20611 Arthrocentesis, aspiration and/or injection, major
joint or bursa; with ultrasound guidance, with permanent
recording and reporting**
**when codes are changed to include ultrasound guidance you can no longer bill
13
for the guidance separately
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Musculoskeletal
New Codes:
 20983 Ablation therapy for reduction or eradication of 1 or
more bone tumors including adjacent soft tissue when
involved by tumor extension, percutaneous, including
imagining guidance when performed; cryoablation
 21811 Open treatment of rib fracture(s) with internal
fixation, includes thoracoscopic visualization when
performed, unilateral; 1-3 ribs
 21812
4-6 ribs
 21813
7 or more ribs
**codes include moderate sedation so anesthesia cannot be billed separately as
well as image guidance
14
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Musculoskeletal
New Codes:
 22510 Percutaneous vertebroplasty, 1 vertebral body,
unilateral or bilateral injection, inclusive of all imaging
guidance; cervicothoracic
 22511
lumbosacral
 22512
each additional cervicothoracic or lumbosacral
vertebral body (add on code)
15
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Musculoskeletal
New Codes:
 22513 Percutaneous vertebral augmentation, including
cavity creation using mechanical device, 1 vertebral body,
unilateral or bilateral cannulation, inclusive of all imaging
guidance; thoracic
 22514
lumbar
 22515
each additional thoracic or lumbar vertebral
body (add on code)
16
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Musculoskeletal
New Codes:
 22858 Total disc arthroplasty, anterior approach, including
discectomy with end plate preparation; second level
cervical (add on code)**
 27279 Arthrodesis, sacroiliac joint, percutaneous or
minimally invasive, with image guidance, incudes obtaining
bone graft when performed, and placement of transfixing
device **
**Category III code deleted to create Category I code
17
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Musculoskeletal
Revised Codes:
 20600 Arthrocentesis, aspiration and/or injection, small
joint or bursa; without ultrasound guidance
 20605 Arthrocentesis, aspiration and/or injection,
intermediate joint or bursa; without ultrasound guidance
 20610 Arthrocentesis, aspiration and/or injection, major
joint or bursa; without ultrasound guidance
18
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Musculoskeletal
Revised Codes:
 20982 Ablation, therapy for reduction or eradication of 1
or more bone tumors including adjacent soft tissue
when involved by tumor extension, percutaneous,
including image guidance when performed;
radiofrequency
 27280 Arthrodesis, open, sacroiliac joint, including
instrumentation when performed
 27370 Injection of contrast for knee arthrography
19
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
New Codes:
 33270 Insertion or replacement of permanent
subcutaneous implantable defibrillator system, with
subcutaneous electrode, including defibrillation threshold
evaluation, induction of arrhythmia, evaluation of sensing
for arrhythmia termination, and programming or
reprogramming of sensing or therapeutic parameters when
performed**
 33271 Insertion of subcutaneous implantable defibrillator
electrode**
**Category III code deleted to make Category I code. Check guidelines
20
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
New Codes:
 33272 Removal of subcutaneous implantable defibrillator
electrode
 33273 Repositioning of previously implanted subcutaneous
implantable defibrillator electrode
 33418 Transcatheter mitral valve repair, percutaneous
approach, including transseptal puncture when performed;
initial prosthesis**
 33419
additional prosthesis(es) during same session
(add on code)**
**Category III code deleted to make Category I code. Codes include angiography and
radiological supervision/interpretation to guide the repair
21
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
New Codes:
 33946 Extracorporeal membrane oxygenation




(ECMO)/extracorporeal life support (ECLS) provided by a
physician; initiation, veno-venous
33947
initiation, veno-arterial
33948
daily management, each day, veno-venous
33949
daily management, each day, veno-arterial
33951
insertion of peripheral cannula(e),
percutaneous, birth through 5 years of age
22
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
New Codes:
 33952
 33953
 33954
 33955
insertion of peripheral cannula(e),
percutaneous, 6 years and older
insertion of peripheral cannula(e), open, birth
through 5 years of age
insertion of peripheral cannula(e), open, 6 years
and older
insertion of central cannula(e) by sternotomy or
thoracotomy, birth through 5 years of age
23
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
New Codes:
 33956
 33957
 33958
 33959
insertion of central cannula(e) by sternotomy or
thoracotomy, 6 years and older
reposition peripheral cannula(e), percutaneous,
birth through 5 years of age
reposition peripheral cannula(e), percutaneous,
6 years and older
reposition peripheral cannula(e), open, birth
through 5 years of age
24
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
New Codes:
 33962
 33963
 33964
 33965
reposition peripheral cannula(e), open, 6 years
and older
reposition of central cannula(e) by sternotomy
or thoracotomy, birth through 5 years of age
reposition of central cannula(e) by sternotomy
or thoracotomy, 6 years and older
removal of peripheral cannula(e),
percutaneous, birth through 5 years of age
25
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
New Codes:
 33966
 33969
 33984
 33985
 33986
removal of peripheral cannula(e),
percutaneous, 6 years and older
removal of peripheral cannula(e), open, birth
through 5 years of age
removal of peripheral cannula(e), open, 6 years
and older
removal of central cannula(e) by sternotomy or
thoracotomy, birth through 5 years of age
removal of central cannula(e) by sternotomy or
thoracotomy, 6 years and older
26
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
New Codes:
 33987 Arterial exposure with creation of graft conduit to
facilitate arterial perfusion for ECMO/ECLS (add on code)
 33988 Insertion of left heart vent by thoracic incision for
ECMO/ECLS
 33989 Removal of left heart vent by thoracic incision for
ECMO/ECLS
27
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
New Codes:
 34839 Physician planning of a patient-specific fenestrated
visceral aortic endograft requiring a minimum of 90 minutes
of physician time
 37218 Transcatheter placement of intravascular stent(s),
intrathoracic common carotid artery or innominate artery,
open or percutaneous antegrade approach, including
angioplasty, when performed, and radiological supervision
and interpretation
**If these services are relevant to your specialty recommend additional
coding education
28
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
Revised Codes:
 33215 Repositioning of preciously implanted transvenous
pacemaker or implantable defibrillator (right atrial or right
ventricular) electrode
 33216 Insertion of a single transvenous electrode,
permanent pacemaker or implantable defibrillator
 33217 Insertion of 2 transvenous electrodes, permanent
pacemaker or implantable defibrillator
 33218 Repair of single transvenous electrode, permanent
pacemaker or implantable defibrillator
29
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
Revised Codes:
 33220 Repair of 2 transvenous electrodes for permanent
pacemaker or implantable defibrillator
 33223 Relocation of skin pocket for implantable
defibrillator
 33224 Insertion of pacing electrode, cardiac venous
system, for left ventricular pacing, with attachment to
previously placed pacemaker or implantable defibrillator
pulse generator
30
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
Revised Codes:
 33225 Insertion of pacing electrode, cardiac venous
system, for left ventricular pacing, at time of insertion of
implantable defibrillator or pacemaker pulse generator
(add on code)
 33240 Insertion of implantable defibrillator pulse generator
only; with existing single lead
 33230
with existing dual leads
 33231
with existing multiple leads
 33241 Removal of implantable defibrillator pulse generator
only
31
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
Revised Codes:
 33243 Removal of single or dual chamber implantable
defibrillator electrode(s); by thoracotomy
 33244
by transvenous extraction
 33249 Insertion or replacement of permanent implantable
defibrillator system with transvenous lead(s), single or dual
chamber electrode(s); by transvenous extraction
32
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
Revised Codes:
 33262 Removal of implantable defibrillator pulse generator




with replacement of implantable defibrillator pulse
generator; single lead system
33263
dual lead system
33264
multiple lead system
37215 Transcatheter placement of intravascular stent(s),
cervical carotid artery, open or percutaneous, including
angioplasty, when performed, and radiological
supervision and interpretation; with distal embolic
protection
37216
without distal embolic protection
33
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Cardiovascular
Revised Codes:
 37217 Transcatheter placement of intravascular stent(s), intrathoracic
common carotid artery or innominate artery by retrograde treatment,
open ipsilateral cervical carotid artery exposure, including angioplasty,
when performed, and radiological supervision and interpretation
 37236 Transcatheter placement of an intravascular stent(s) (except
lower extremity artery(s) for occlusive disease, cervical carotid,
extracranial vertebral, or intrathoracic carotid, intracranial, or coronary),
open or percutaneous, including radiological supervision and
interpretation and all angioplasty within the same vessel, when
performed; initial artery
 37237
each additional artery (add on code)
** these codes will not be allowed when a stent is placed in the lower extremity for reasons
other than occlusive disease
34
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
 Gastroenterology
• Restructured section into 3 subsections
• Esophagoscopy
• Esophagogastroduodenoscopy (EGD)
• Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Changes have been made to intestines and rectum endoscopy
section for the same purpose
• Colonoscopy tree has been added
• Endoscopy, small intestine and stomal subsection has been divided
into two sections – one for small intestine and one for stomal
endoscopy
**Recommend additional education for the changes in this section
35
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
New Codes:
 43180 Esophagoscopy, rigid, transoral with
diverticulectomy of hypopharynx or cervical esophagus,
with cricopharyngeal myotomy, includes use of telescope or
operating microscope and repair, when performed
 44381 Ileostomy, through stoma; with transendoscopic
balloon dilation
 44384 with placement of endoscopic stent
36
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
New Codes:
 44401 Colonoscopy through stoma; with ablation of




tumor(s), polyp(s), or other lesion(s)
44402
with endoscopic stent placement
44403
with endoscopic mucosal resection
44404
with directed submucosal injection(s), any
substance
44405
with transendoscopic balloon dilation
37
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
New Codes:
 44406
 44407
with endoscopic ultrasound examination, limited
to the sigmoid, descending, transverse, or
ascending colon and cecum and adjacent
structures
with transendoscopic ultrasound guided
intramural or transmural fine needle aspiration/
biopsy(s), includes endoscopic ultrasound
examination, limited to the sigmoid,
descending, transverse, or ascending colon and
cecum and adjacent structures
38
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
New Codes:
 44408




with decompression, including placement of
decompression tube, when performed
45346 Sigmoidoscopy, flexible; with ablation of tumor(s),
polyp(s), or other lesion(s)
45347
with placement of endoscopic stent
45349
with endoscopic mucosal resection
45350
with band ligation(s)
39
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
New Codes:
 45388 Colonoscopy, flexible; with ablation of tumor(s),





polyp(s), or other lesion(s)
45389
with endoscopic stent placement
45390
with endoscopic mucosal resection
45393
with decompression, including placement of
decompression tube, when performed
45398
with band ligation(s)
45399 Unlisted procedure, colon
40
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
New Codes:
 46601 Anoscopy; diagnostic, with high-resolution
magnification (HRA) and chemical agent enhancement,
including collection of specimen(s) by brushing or washing,
when performed
 46607
diagnostic, with high-resolution magnification
(HRA) and chemical agent enhancement, with
biopsy, single or multiple
 47383 Ablation, 1 or more liver tumor(s), percutaneous,
cryoablation (image guidance will be reported separately)
41
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
Revised Codes:
 43194 Esophagoscopy, rigid, transoral; with removal of
foreign body(s)
 43197 Esophagoscopy, flexible, transnasal; diagnostic
including collection of specimen(s) by brushing or
washing, when performed (separate procedure)
 43215 Esophagoscopy, flexible, transoral; with removal of
foreign body(s)
 43216
with removal of tumor(s), polyp(s), or other
lesion(s) by hot biopsy forceps
42
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
Revised Codes:
 43247 Esophagogastroduodenoscopy, flexible, transoral;
with removal of foreign body(s)
 43250
with removal of tumor(s), polyp(s), or other
lesion(s) by hot biopsy forceps
 44360 Small intestinal endoscopy, enteroscopy beyond
second portion of duodenum, not including ileum;
diagnostic, including collection of specimen(s) by brushing
or washing, when performed (separate procedure)
 44363
with removal of foreign body(s)
43
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
Revised Codes:
 44380 Ileostomy, through stoma; diagnostic, including
collection of specimen(s) by brushing or washing, when
performed (separate procedure)
 44385 Endoscopic evaluation of small intestinal pouch;
diagnostic, including collection of specimen(s) by brushing
or washing, when performed (separate procedure)
 44386
with biopsy, single or multiple
44
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
Revised Codes:
 44388 Colonoscopy through stoma; diagnostic, including




collection of specimen(s) by brushing or washing, when
performed (separate procedure)
44390
with removal of foreign body(s)
44391
with control of bleeding, any method
44392
with removal of tumor(s), polyp(s) or other
lesion(s) by hot biopsy forceps
44799 Unlisted procedure, small intestine
45
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
Revised Codes:
 45330 Sigmoidoscopy, flexible; diagnostic, including





collection of specimen(s) by brushing or washing, when
performed (separate procedure)
45332
with removal of foreign body(s)
45333
with removal of tumor(s), polyp(s), or other
lesion(s) by hot biopsy forceps
45334
with control of bleeding, any method
45337
with decompression, including placement of
decompression tube, when performed
45340
with transendoscopic balloon dilation
46
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
Revised Codes:
 45378 Colonoscopy, flexible; diagnostic, including





collection of specimen(s) by brushing or washing, when
performed (separate procedure)
45379
with removal of foreign body(s)
45380
with biopsy, single or multiple
45381
with directed submucosal injection(s), any
substance
45382
with control of bleeding, any method
45384
with removal of tumor(s), polyp(s), or other
lesion(s) by hot biopsy forceps
47
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
Revised Codes:
 45385
 45386
 45391
with removal of tumor(s), polyp(s), or other
lesion(s) by snare technique
with transendoscopic balloon dilation
with endoscopic ultrasound examination limited
to the rectum, sigmoid, descending,
transverse, or ascending colon and cecum,
and adjacent structures
48
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Digestive
Revised Codes:
 45392
with transendoscopic ultrasound guided
intramural or transmural fine needle
aspiration/biopsy(s), includes endoscopic
ultrasound examination limited to the
rectum, sigmoid, descending, transverse, or
ascending colon and cecum, and adjacent
structures
 46600 Anoscopy; diagnostic, including collection of
specimen(s) by brushing or washing, when performed
(separate procedure)
49
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Urinary
New Codes:
 52441 Cystourethroscopy with insertion of permanent
adjustable transprostatic implant; single implant
 52442
each additional permanent adjustable
transprostatic implant (add on code)
50
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Maternity
 Guidelines in Maternity Care/Delivery section have been
revised to clarity that pregnancy confirmation during a
problem-oriented or preventative visit is not considered part
of the antepartum care and can/should be reported
separately using the appropriate E/M code
 Further classification in Guidelines state that antepartum
care also includes the initial prenatal history and physical
exam
 Post partum guidelines have been moved to reflect
chronological order of events.
51
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Nervous
New Codes:
 62302 Myelography via lumbar injection, including
radiological supervision and interpretation; cervical
 62303
thoracic
 62304
lumbosacral
 62305
2 or more regions
52
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Nervous
New Codes:
 64486 Transversus abdominis plane (TAP) block (abdominal
plane block, rectus sheath block) unilateral; by injection(s)
(includes imaging guidance, when performed)
 64487
by continuous infusion(s) (includes imaging
guidance, when performed)
 64488 Transversus abdominis plane (TAP) block (abdominal
plane block, rectus sheath block) bilateral; by injections (includes
imaging guidance when performed)
 64489
by continuous infusions (includes imaging
guidance when performed)
53
** added to indicate provision of anesthesia of the abdominal wall primarily for post op pain control
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Nervous
Revised Codes:
 61055 Cisternal or lateral cervical (C1-C2) puncture; with
injection of medication or other substance for diagnosis or
treatment
 62284 Injection procedure for myelography and/or
computed tomography, lumbar (other than C1-C2 and
posterior fossa)
54
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Eye and Ear
New Codes:
 66179 Aqueous shunt to extraocular equatorial plate
reservoir, external approach; without graft
 66184 Revision of aqueous shunt to extraocular equatorial
plate reservoir; without graft
**These codes were found to be reported 73% of the time, new codes were developed to
reflect with or without grafts
55
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Eye and Ear
Revised Codes:
 66180 Aqueous shunt to extraocular equatorial plate
reservoir, external approach; with graft
 66185 Revision of aqueous shunt to extraocular equatorial
plate reservoir; with graft
 67399 Unlisted procedure, extraocular muscle
56
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Radiology
New Codes:
 76641 Ultrasound, breast, unilateral, real time with image
documentation, including axilla when performed;
complete**
 76642
limited**
**New codes to report limited and complete breast ultrasound procedures
**Both include axilla if performed
**Many changes to parenthetical notes and cross references to reflect changes
throughout CPT
57
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Radiology
 New Codes
• 77061 Digital breast tomosynthesis; unilateral**
• 77062
bilateral**
• 77063 Screening digital breast tomosynthesis, bilateral (add on
code)
**Cannot report with regular screening mammo codes
**Medicare using G codes for screening
**Codes do not include coverage
•
•
CMS will pay for diagnostic tomo
Unclear how commercial payors will handle
58
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Radiology
New Codes:
 77085 Dual-energy X-ray absorptiometry (DXA), bone
density study, 1 or more sites; axial skeleton, including
vertebral fracture assessment**
 77086 Vertebral fracture assessment via dual-energy X-ray
absorptiometry (DXA)
 77306 Teletherapy isodose plan; simple, includes basic
dosimetry calculation(s)
 77307
complex, includes basic dosimetry
calculation(s)
**combo code for assessment and bone density
59
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Radiology
New Codes:
 77316 Brachytherapy isodose plan; simple, includes basic
dosimetry calculation(s)
 77317
intermediate, includes basic dosimetry
calculation(s)
 77318
complex, includes basic dosimetry
calculation(s)
60
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Radiology
New Codes:
 77385 Intensity modulated radiation treatment delivery
(IMRT), includes guidance and tracking, when performed;
simple
 77386
complex
 77387 Guidance for localization of target volume for
delivery of radiation treatment delivery, includes
intrafraction tracking, when performed
61
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Radiology
Revised Codes:
 77401 Radiation treatment delivery, superficial and/or ortho
voltage, per day
 77402 Radiation treatment delivery, >1MeV; simple
 77407
intermediate
 77412
complex
62
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Radiology
 Significant changes to the code set for these services
•
•
•
•
New codes established to report combined teletherapy
isodose with basic dosimetry calculations as well as
combine codes for brachytherapy isodose planning with
basic dosimetry
May codes deleted and parenthetical notes added to
direct users to appropriate codes.
All new guidelines added as well as Radiation
Management and Treatment table added to provider
clarity
Recommend extra education for this specialty
63
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 80163 Digoxin; free
 80165 Valproic acid dipropylacetic acid); free
 80300 Drug screen, any number of drug classes from Drug
Class List A; any number of non-TLC devices or
procedures, capable of being read by direct optical
observation, including instrumental-assisted when
performed, per date of service
 80301
single drug class method, by instrumented test
systems, per date of service
64
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 80302 Drug screen, presumptive, single drug class from
Drug Class List B, by immunoassay or non-TLC
chromatography without mass spectrometry, each
procedure
 80303 Drug screen, any number of drug classes,
presumptive, single or multiple drug class method; thin
layer chromatography procedure(s) (TLC), per date of
service
 80304
not otherwise specified presumptive procedure,
each procedure
65
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
 Drug Testing
•
•
Presumptive
• Used to determine possible use or non-use of a drug
• May be followed by definitive testing to determine specific
drug
Definitive
• Qualitative or Quantitative tests to identify possible use or
non use of a drug
• Identifies specific drugs
• Presumptive is not required
• Any specimen can be used
• More than one test requires 59 modifier
66
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 80320 Alcohols
 80321 Alcohol biomarkers; 1 or 2
 80322






3 or more
80323 Alkaloids, not otherwise specified
80324 Amphetamines; 1 or 2
80325
3 or 4
80326
5 or more
80327 Anabolic steroids; 1 or 2
80328
3 or more
67
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 80329 Analgesics, non-opioid; 1 or 2
 80330







3-5
80331
6 or more
80332 Antidepressants, serotonergic class; 1 or 2
80333
3-5
80334
6 or more
80335 Antidepressants, tricyclic and other cyclicals; 1 or 2
80336
3-5
80337
6 or more
68
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 80338 Antidepressants, not otherwise specified
 80339 Antiepileptics, not otherwise specified; 1-3
 80340





4-6
80341
7 or more
80342 Antipsychotics, not otherwise specified; 1-3
80343
4-6
80344
7 or more
80345 Barbiturates
69
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 80346 Benzodiazepines; 1-12
 80347








13 or more
80348 Buprenorphine
80349 Cannabinoids, natural
80350 Cannabinoids, synthetic; 1-3
80351
4-6
80352
7 or more
80353 Cocaine
80354 Fentanyl
80355 Gabapentin, non-blood
70
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 80356 Heroin metabolite
 80357 Ketamine and norketamine
 80358 Methadone
 80359 Methylenedioxyamphetamines
 80360 Methylphenidate
 80361 Opiates, 1 or more
 80362 Opioids and opiate analogs; 1 or 2
 80363
 80364
3 or 4
5 or more
71
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 80365 Oxycodone
 80366 Pregabalin
 80367 Propoxyphene
 80368 Sedative hypnotics (non-benzodiazepines)
 80369 Skeletal muscle relaxants; 1or 2
 80370
3 or more
 80371 Stimulants, synthetic
 80372 Tapentadol
72
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 80373 Tramadol
 80374 Stereoisomer (enantiomer) analysis, single drug




class
80375 Drug(s) or substance(s), definitive, qualitative or
quantitative, not otherwise specified; 1-3
80376
4-6
80377
7 or more
81246 FLT3, gene analysis; tyrosine kinase domain (TKD)
variants (eg, D835, I836)
73
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 81288 MLH1 (mutL homolog1, colon cancer, nonpolyposis
type 2)(eg, hereditary non-polyposis colorectal cancer,
Lynch syndrome) gene analysis; promoter methylation
analysis
 81313 PCA3/KLK3 (prostate cancer antigen 3 [non-protein
coding]/kallikrein-related peptidase 3 [prostate specific
antigen]) ratio (eg, prostate cancer)
74
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 81410 Aortic dysfunction or dilation (eg, Marfan syndrome,
Loeys Dietz syndrome, Ehler Danlos syndrome type IV,
arterial tortuosity syndrome); genomic sequence analysis
panel, must include sequencing of at least 9 genes,
including FBN1, TGFBR1, TGFBR2, COL3A1, MYH11,
ACTA2, SLC2A10, SMAD3, and MYLK
 81411
duplication/deletion analysis panel, must
include analyses for TGFBR1, TGFBR2,
COL3A1, MYH11
75
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 81415 Exome (eg, unexplained constitutional or heritable
disorder or syndrome); sequence analysis
 81416
sequence analysis, each comparator exome
(eg, parents, siblings) (add on code)
 81417
reevaluation of previously obtained exome
sequence (eg, updated knowledge or unrelated
condition/syndrome)
 81420 Fetal chromosomal aneuploidy (eg, trisomy 21,
monosomy X) genomic sequence analysis panel,
circulating cell-free fetal DNA in maternal blood, must
include analysis of chromosomes 13, 18, and 21
76
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 81425 Genome (eg, unexplained constitutional or heritable
disorder or syndrome); sequence analysis
 81426
sequence analysis, each comparator
genome(eg, parents, siblings) (add on code)
 81427
reevaluation of previously obtained genome
sequence (eg, updated knowledge or unrelated
condition/syndrome)
77
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 81430 Hearing loss (eg, nonsyndromic hearing loss, Usher
syndrome, Pendred syndrome); genomic sequence
analysis panel, must include sequencing of at least 60
genes, including CDH23, CLRB1, GJB2, GPR98,
MTRNR1, MY07A, MY015A, PCDH15, OTOF, SLC26A4,
TMC1, TMPRSS3, USH1C, USH1G, USH2A, and WFS1
 81431
duplication/deletion analysis panel, must
include copy number analyses for STRC and
DFNB1 deletions in GJB2 and GJB6 genes
78
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 81435 Hereditary colon cancer syndromes (eg, Lynch
syndrome, familial adenomatosis polyposis); genomic
sequence analysis panel, must include analysis of at least
7 genes, including APC, CHEK2, MLH1, MSH2, MSH6,
MUTYH, and PMS2
 81436
duplication/deletion gene analysis, must include
analysis of at least 8 genes, including APC,
CHEK2, MLH1, MSH2, MSH6, MUTYH, PMS2,
and EPCAM
79
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 81440 Nuclear encoded mitochondrial genes, genomic
sequence panel, must include analysis of at least 100
genes, including BCS1L, C10orf2, COQ2, COX10,
DGUOK, MPV17, OPA1, PDSS2, POLG, POLG2, RRM2B,
SCO1, SCO2, SLC25A4, SUCLA2, SUCLG1, TAZ, TK2,
AND TYMP
 81445 Targeted genomic sequence analysis panel, solid
organ neoplasm, DNA analysis, 5-50 genes, interrogation
for sequence variants and copy number variants or
rearrangements, if performed
80
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 81450 Targeted genomic sequence analysis panel,
hematolymphoid neoplasm or disorder, DNA and RNA
analysis when performed, 5-50 genes, interrogation for
sequence variants and copy number variants or
rearrangements, or isoform expression or mRNA
expression levels if performed
 81455 Targeted genomic sequence analysis panel, solid
organ or hematolymphoid neoplasm or disorder, DNA and
RNA analysis when performed, 51 or greater, interrogation
for sequence variants and copy number variants or
rearrangements, if performed
81
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 81460 Whole mitochondrial genome (eg, Leigh syndrome,
mitochondrial encephalomyopathy, lactic acidosis, and
stroke-like episodes [MELAS], myoclonic epilepsy with
ragged-red fibers [MERFF], neuropathy, ataxia, and retinitis
pigmentosa [NARP], Leber hereditary optic neuropathy
[LHON]), genomic sequence, must include sequence of
analysis of entire mitochondrial genome with heteroplasmy
detection
 81465 Whole mitochondrial genome large sequence
deletion analysis panel (eg, Kearns-Sayre syndrome,
chronic progressive external ophthalmoplegia), including
heteroplasmy detection, if performed
82
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 81470 X-linked intellectual disability (XLID) (eg, syndromic
and non-syndromic XLID); genomic sequence analysis
panel, must include sequencing of at least 60 genes,
including ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1,
IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL,
RPS6KA3, AND SLC16A2
 81471
duplication/deletion gene analysis, must include
analysis of at least 60 genes, including ARX,
ATRX, CDKL5, FGD1, FMR1, HUWE1,
IL1RAPL, KDM5C, L1CAM, MECP2, MED12,
MID1, OCRL, RPS6KA3, AND SLC16A2
83
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 81519 Oncology (breast), mRNA, gene expression profiling
by real-time RT-PCR of 21 genes, utilizing formalin-fixed
paraffin embedded tissue, algorithm reported as recurrence
score
 83006 Growth stimulation expressed gene 2 (ST2,
Interleukin 1 receptor like-1)
 87505 Infectious agent detection by nucleic acid (DNA or
RNA); gastrointestinal pathogen (eg, Clostridium difficile,
E.coli, Salmonella, Shigella, norovirus, Giardia), includes
multiplex reverse transcription, when performed, and
multiplex amplified probe technique, multiple types or
84
subtypes, 3-5 targets
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 87506
 87507
gastrointestinal pathogen, includes multiplex
reverse transcription, when performed, and
multiplex amplified probe technique, multiple
types or subtypes, 6-11 targets
gastrointestinal pathogen, includes multiplex
reverse transcription, when performed, and
multiplex amplified probe technique, multiple
types or subtypes, 12-25 targets
85
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 87623
Human Papillomavirus (HPV), low-risk types
 87624
Human Papillomavirus (HPV), high-risk types
 87625
Human Papillomavirus (HPV), types 16 and 18
only, includes type 45 , if performed
 87806 Infectious agent antigen detection by immunoassay
with direct optical observation; HIV-1 antigen(s), with HIV-1
and HIV-2 antibodies
86
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 88341 Immunohistochemistry or immunocytochemistry, per
specimen; each additional single antibody stain procedure
(add on code)
 88344
each multiplex antibody stain procedure
 88364 In situ hybridization (eg. FISH), per specimen; each
additional single probe stain procedure (add on code)
 88366
each multiplex probe stain procedure
87
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
New Codes:
 88369 Morphometric analysis, in situ hybridization




(quantitative or semi-quantitative) manual, per specimen;
each additional single probe stain procedure (add on code)
88377
each multiplex probe stain procedure
88373 Morphometric analysis, in situ hybridization
(quantitative or semi-quantitative) using computer-assisted
technology, per specimen; each additional single probe
stain procedure (add on code)
88374
each multiplex probe stain procedure
89337 Cryopreservation, mature oocyte(s)
88
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
Revised Codes:
 80162 Digoxin; total
 80164 Valproic acid (dipropylacetic acid); total
 80171 Gabapentin, whole blood, serum, or plasma
 80299 Quantitation of therapeutic drug, not elsewhere




specified
81402 Molecular pathology procedure, Level 3
81403 Molecular pathology procedure, Level 4
81404 Molecular pathology procedure, Level 5
81405 Molecular pathology procedure, Level 6
89
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
Revised Codes:
 82541 Column chromatography/mass spectrometry (eg,
GC/MS, or HPLC/MS), non-drug analyte not elsewhere
specified; qualitative, single stationary and mobile phase
 82542
quantitative, single stationary and mobile phase
 82543
stable isotope dilution, single analyte,
quantitative, single stationary and mobile phase
 82544
stable isotope dilution, multiple analyte,
quantitative, single stationary and mobile phase
90
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
Revised Codes:
 84600 Volatiles (eg, acetic anhydride, diethylether)
 86900 Blood typing, serologic; ABO
 86901
 86902
 86904
 86905
 86906
Rh (D)
antigen testing of donor blood using reagent
serum, each antigen test
antigen screening for compatible unit using
patient serum, per unit screened
RBC antigens, other than ABO or Rh (D), each
Rh phenotyping, complete
91
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
Revised Codes:
 87501 Infectious agent detection by nucleic acid (DNA or
RNA); influenza virus, includes reverse transcription,
when performed, and amplified probe technique, each
type or subtype
 87502 influenza virus, for multiple types or sub-types,
includes multiplex reverse transcription and multiplex
amplified probe technique, first 2 types or sub-types
 87503 influenza virus, for multiple types or sub-types,
includes multiplex reverse transcription and multiplex
amplified probe technique, each additional influenza virus
type or sub-type beyond 2 (add on code)
92
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
Revised Codes:
 87631
 87632
 87633
respiratory virus, includes multiplex reverse
transcription, when performed, and multiplex
amplified probe technique, multiple types or
subtypes, 3-5 targets
respiratory virus, includes multiplex reverse
transcription, when performed, and multiplex
amplified probe technique, multiple types or
subtypes, 6-11 targets
respiratory virus, includes multiplex reverse
transcription, when performed, and multiplex
amplified probe technique, multiple types or
subtypes, 12-25 targets
93
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
Revised Codes:
 88342 Immunohistochemistry or immunocytochemistry, per
specimen; initial single antibody stain procedure
 88360 Morphometric analysis, tumor
immunohistochemistry, quantitative or semiquantitative, per
specimen, each single antibody stain procedure; manual
•
88361 using computer-assisted technology
94
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Pathology
Revised Codes:
 88365 In situ hybridization (eg. FISH), per specimen;
initial single probe stain procedure
 88367 Morphometric analysis, in situ hybridization
(quantitative or semi-quantitative), using computer-assisted
technology, per specimen; initial single probe stain
procedure
 88368 Morphometric analysis, in situ hybridization
(quantitative or semi-quantitative), manual, per specimen;
initial single probe stain procedure
95
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Medicine
New Codes:
 90630 Influenza virus vaccine, quadrivalent (IIV4), split
virus, preservative free, for intradermal use
 90651 Human Papilloma virus vaccine types 6, 11, 16, 18,
31, 33, 42, 52, 58, nonavalent (HPV), 3 dose schedule, for
intramuscular use
 91200 Liver elastography, mechanically induced shear
wave (eg, vibration), without imaging, with interpretation
and report
 92145 Corneal hysteresis determination, by air impulse
stimulation, unilateral or bilateral, with interpretation and
report
96
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Medicine
 Medicine services15 new and 16 revised
• Changes to:
• Vaccine codes: especially new flu vaccine code
• Psychiatry subsections and parenthetical notes and new
adaptive behavior treatment codes (Category III)
• Cardiovascular subsection guidelines and definitions
updated
• New Echocardiography codes
• Subsection change in several areas.
97
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Medicine
New Codes:
 93260 Programming device evaluation (in person) with
iterative adjustment of the implantable device to test the
function of the device and select optimal permanent
programmed values with analysis, review and report by a
physician or other qualified health care professional;
implantable subcutaneous lead defibrillator system
 93261 Interrogation device evaluation (in person) with
analysis, review and report by a physician or other qualified
health care professional, includes connection, recording
and disconnection per patient encounter; implantable
subcutaneous lead defibrillator system
98
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Medicine
New Codes:
 93355 Echocardiography, transesophageal (TEE) for
guidance of a transcatheter intracardiac or great vessel(s)
structural intervention(s), real-time image acquisition and
documentation, guidance with quantitative measurements,
probe manipulation, interpretation, and report, including
diagnostic transesophageal echocardiography and, when
performed, administration of ultrasound contrast, Doppler,
color flow, and 3D
**New code to report TEE during interventional cardiac procedures
**New guidance and parenthetical notes added to provider additional
instruction
99
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Medicine
New Codes:
 93644 Electrophysiologic evaluation of subcutaneous
implantable defibrillator
 93702 Bioimpedance spectroscopy (BIS), extracellular fluid
analysis for lymphedema assessment(s)
 93895 Quantitative carotid intima media thickness and
carotid atheroma evaluation, bilateral
 96127 Brief emotional/behavioral assessment, with scoring
and documentation, per standardized instrument
100
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Medicine
New Codes:
 97607 Negative pressure wound therapy, utilizing disposable,
non-durable medical equipment including provision of exudate
management collection system, topical application(s), wound
assessment, and instructions for ongoing care, per session; total
wound(s) surface area less than or equal to 50 square
centimeters
 97608
total wound(s) surface area greater than 50
square centimeters
** new codes intended for negative pressure therapy using disposable non-DME;
therefore existing codes revised to stipulate use of DME
101
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Medicine
New Codes:
 99184 Initiation of selective head or total body hypothermia
in the critically ill neonate, includes appropriate patient
selection by review of clinical, imaging and laboratory data,
confirmation of esophageal temperature probe location,
evaluation of amplitude EEG, supervision of controlled
hypothermia, and assessment of patient tolerance of
cooling**
 99188 Application of topical fluoride varnish by a physician
or other qualified health care professional
**Codes 99481abd 99482 deleted new code includes all components
102
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Medicine
Revised Codes:
 90654 Influenza virus vaccine, trivalent (IIV3), split virus,
preservative-free, for intradermal use
 90723 Diphtheria, tetanus toxoids, acellular pertussis
vaccine, hepatitis B, and inactivated poliovirus vaccine,
(DTaP-HepB-IPV), for intramuscular use
 90734 Meningococcal conjugate vaccine, serogroups A, C,
Y and W-135, quadrivalent, for intramuscular use
103
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Medicine
Revised Codes:
 93282 Programming device evaluation (in person) with
iterative adjustment of the implantable device to test the
function of the device and select optimal permanent
programmed values with analysis, review and report by a
physician or other qualified health care professional; single
lead transvenous implantable defibrillator system
 93283
dual lead transvenous implantable defibrillator
system
 93284
multiple lead transvenous implantable
defibrillator system
104
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Medicine
Revised Codes:
 93287 Peri-procedural device evaluation (in person) and
programming of device system parameters before or after a
surgery, procedure, or test with analysis, review and report
by a physician or other qualified health care professional;
single, dual, or multiple lead implantable defibrillator
system
 93289 Interrogation device evaluation (in person) with
analysis, review and report by a physician or other qualified
health care professional, includes connection, recording
and disconnection per patient encounter; single, dual, or
multiple lead transvenous implantable defibrillator system,
including analysis of heart rhythm derived data elements 105
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Medicine
Revised Codes:
 93295 Interrogation device evaluation(s) (remote), up to 90
days; single, dual, or multiple lead implantable defibrillator
system with interim analysis, review(s) and report(s) by a
physician or other qualified health care professional
 93296
single, dual, or multiple lead pacemaker
system, or implantable defibrillator system,
remote data acquisition(s), receipt of
transmissions and technician review, technical
support
106
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Medicine
Revised Codes:
 93642 Electrophysiologic evaluation of single or dual
chamber transvenous pacing cardioverter-defibrillator
 95972 Electronic analysis of implanted neurostimulator
pulse generator system; complex spinal cord, or peripheral
(except cranial nerve) neurostimulator pulse
generator/transmitter, with intraoperative or subsequent
programming, up to 1 hour
107
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Medicine
Revised Codes:
 96110 Developmental screening, with scoring and
documentation, per standardized instrument**
 97605 Negative pressure wound therapy, utilizing durable
medical equipment (DME), including topical
application(s), wound assessment, and instruction(s) for
ongoing care, per session; total wound(s) surface area less
than or equal to 50 square centimeters
 97606
total wound(s) surface area greater than 50
square centimeters
**specifically excludes the emotional/behavioral assessment
108
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category II
 Claims based performance measures reporting
 Revision and new codes for esophageal biopsy
 Revision of esophageal biopsies with dx of
Barrett’s esophagus
 New codes for identification of adenoma and
other neoplasm detection
 New footnote measures developed by GI
societies
109
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
 Codes for new technology may or may not be covered
 39 new codes added
 6 codes revised
 26 codes deleted
• 3 codes deleted
• 23 codes changed to Category I codes
 Also 3 new subsections, guidelines and 16 codes added for
assessment and treatment in the Adaptive Behavioral
subsection
•
Codes created for assessment and treatment of patients of any age
with deficient adaptive or maladaptive behaviors, i.e. autism
spectrum disorders, developmental disabilities, head trauma
110
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0340T Ablation, pulmonary tumor(s), including pleura or
chest wall when involved by tumor extension,
percutaneous, cryoablation, unilateral, includes imaging
guidance
 0341T Quantitative pupillometry with interpretation and
report, unilateral or bilateral
 0342T Therapeutic apheresis with selective HDL
delipidation and plasma reinfusion
 0345T Transcatheter mitral valve repair percutaneous
approach via the coronary sinus
111
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0346T Ultrasound, elastography (add on code)
 0347T Placement of interstitial device(s) in bone for
radiostereometric analysis (RSA)
 0348T Radiologic examination, radiostereometric analysis
(RSA); spine
 0349T
upper extremity(ies)
 0350T
lower extremity(ies)
112
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0351T Optical coherence tomography of breast or axillary
lymph node, excised tissue, each specimen; real-time
intraoperative
 0352T
interpretation and report, real-time or referred
 0353T Optical coherence tomography of breast, surgical
cavity; real-time intraoperative
 0354T
interpretation and report, real-time or referred
113
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0355T Gastrointestinal tract imaging, intraluminal (eg,
capsule endoscopy), colon, with interpretation and report
 0356T Insertion of drug-eluting implant (including punctal
dilation and implant removal when performed) into lacrimal
canaliculus, each
 0357T Cryopreservation; immature oocyte(s)
 0358T Bioelectrical impedance analysis whole body
composition assessment, supine position, with
interpretation and report
114
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0359T Behavior identification assessment, by the physician
or other qualified health care professional, face-to-face with
patient and caregivers), includes administration of
standardized and non-standardized tests, detailed
behavioral history, patient observation and caregiver
interview, interpretation of test results, discussion of
findings and recommendations with the primary
guardian(s)/caregiver(s), and preparation of report
115
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0360T Observational behavioral follow-up assessment,
includes physician or other qualified health care
professional direction with interpretation and report,
administered by one technician; first 3o minutes of
technician time, face-to-face with the patient
 0361T
each additional 30 minutes of technician time,
face-to-face with the patient (add on code)
116
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0362T Exposure behavioral follow-up assessment, includes
physician or other qualified health care professional
direction with interpretation and report, administered by
physician or other qualified health care professional with
the assistance of one or more technicians; first 30 minutes
of technician(s) time, face-to-face with the patient
 0363T
each additional 30 minutes of technician(s)
time, face-to-face with the patient (add on code)
117
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0364T Adaptive behavior treatment by protocol,
administered by technician, face-to-face with one patient;
first 30 minutes of technician time
 0365T
each additional 30 minutes of technician time
(add on code)
 0366T Group adaptive behavior treatment by protocol,
administered by technician, face-to-face with two or more
patients; first 30 minutes of technician time
 0367T
each additional 30 minutes of technician time
(add on code)
118
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0368T Adaptive behavior treatment with protocol
modification administered by physician or other qualified
health care professional with one patient; first 30 minutes of
patient face-to-face time
 0369T
each additional 30 minutes of patient face-toface time (add on code)
119
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0370T Family adaptive behavior treatment guidance,
administered by physician or other qualified health care
professional (without the patient present)
 0371T Multiple-family group adaptive behavior treatment
guidance, administered by physician or other qualified
health care professional (without the patient present)
120
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0372T Adaptive behavior treatment social skills group,
administered by physician or other qualified health care
professional face-to-face with multiple patients
 0373T Exposure adaptive behavior treatment with protocol
modification requiring two or more technicians for sever
maladaptive behavior(s); first 60 minutes of technicians'
time, face-to-face with patient
 0374T
each additional 30 minutes of technicians' time,
face-to-face with patient (add on code)
121
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0375T Total disc arthroplasty (artificial disc), anterior
approach, including discectomy with end plate preparation
(includes osteophytectomy for nerve root or spinal cord
decompression and microdissection), cervical, three or
more levels
 0376T Insertion of anterior aqueous drainage device,
without extraocular reservoir, internal approach, into the
trabecular meshwork; each additional device insertion (add
on code)
 0377T Anoscopy with directed submucosal injection of
bulking agent for fecal incontinence
122
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0378T Visual field assessment, with concurrent real time
data analysis and accessible data storage with patient
initiated data transmitted to a remote surveillance center for
up to 30 days; review and interpretation with report by a
physician or other qualified health care professional
 0379T
technical support and patient instructions,
surveillance, analysis and transmission of daily
and emergent data reports as prescribed by a
physician or other qualified health care
professional
123
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
New Codes:
 0380T Computer-aided animation and analysis of time
series retinal images for the monitoring of disease
progression, unilateral or bilateral, with interpretation and
report
124
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
Revised Codes:
 0075T Transcatheter placement of extracranial vertebral
artery stent(s), including radiologic supervision and
interpretation, open or percutaneous; initial vessel
 0076T
each additional vessel (add on code)
 0191T Insertion of anterior aqueous drainage device,
without extraocular reservoir, internal approach, into the
trabecular meshwork; initial insertion
125
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Category III
Revised Codes:
 0200T Percutaneous sacral augmentation (sacroplasty),
unilateral injection(s), including the use of a balloon or a
mechanical device, when used, 1 or more needles,
includes imaging guidance and bone biopsy, when
performed
 0201T Percutaneous sacral augmentation (sacroplasty),
bilateral injection(s), including the use of a balloon or a
mechanical device, when used, 2 or more needles,
includes imaging guidance and bone biopsy, when
performed
126
Anesthesia Business Consultants, LLC Confidential Presentation Materials
HCPCs Modifier Changes
 Modifier 59 is the most widely used
• Often utilized to bypass NCCI edits
• Modifier is associated with the most abuse, leading to audits, reviews
and even fraud and abuse.
• 4 new modifiers created X(EPSU) modifiers
 XE -Separate encounter, a service that is distinct because it
occurred during a separate encounter
 XS - Separate structure, a service that is distinct because it was
performed on a separate organ/structure
 XP - Separate practitioner, a service that is distinct because it
was performed by a different practitioner
 XU - Unusual non-overlapping service, the use of a service that
is distinct because it does not overlap usual components of the
main service
127
Anesthesia Business Consultants, LLC Confidential Presentation Materials
References
 2015 CPT Professional Edition Codebook
 2015 CPT Changes Insiders View
128
Anesthesia Business Consultants, LLC Confidential Presentation Materials
Questions
129
Anesthesia Business Consultants, LLC Confidential Presentation Materials

similar documents