2010 ubo/ubu conference title: 2011 cpt©/hcpcs coding updates session: w-5-0800
TRANSCRIPT
2010 UBO/UBU Conference
Title: 2011 CPT©/HCPCS Coding Updates
Session: W-5-0800
2
Objectives
Review New 2011 CPT© Codes – 210 codes including Cat II and Cat III
Review Revised CPT© Codes – 98 Deleted – 110 codes Review New 2011 HCPCS Codes Review Revised and Deleted New in AMA
– Coding Tips throughout
3
Overview of Changes
Section New Revised
E&M 3 0
Anesthesia 0 0
Surgery 64 54
Radiology 5 6
Lab/Path 16 7
Medicine 39 23
Category II 31 6
Category III 52 2
Total 210 98
4
Introduction
New sub-heading in introduction “Time” standards for reporting time measurement Applies to all time based codes
– A unit of time is attained when the mid-point is passed.
Symbols
● New Procedure Code added
▲Code Revision
+ Add-on code (needs a mom)
►◄Revised guidelines
☉Code includes moderate sedation
~ Vaccine pending FDA approval
# Resequenced code
○ Reinstated or recycled code
5
Modifier 51 exempt
6
E&M Guidance Changes
New guidance regarding reporting time in “Definitions of Commonly Used Terms”– 2 new paragraphs– Intra-service– Face-to-face
New guidance for time in sub-section “Select the Appropriate Level of E/M Services based on the Following” in section “Instructions for Selecting a Level of E/M Service”– #3 When counseling and/or coordination of care
dominates (more than 50%)…
Evaluation and Management
New instructions in “Initial Observation Care” ►Subsequent Observation Care◄
– 3 New Codes
#●99224 Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components:– Problem focused interval history– Problem focused examination– Medical decision making that is straightforward or of
low complexity– (typically 15 minutes bedside and unit)
7
Evaluation and Management
#●99225 Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components:– Expanded problem focused interval history– Expanded problem focused examination– Medical decision making of high complexity– (typically 25 minutes bedside and unit)
#●99226 Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components:– Detailed interval history– Detailed examination– Medical decision making of high complexity– (typically 35 minutes bedside and unit)
8
Reporting Subsequent Observation Care
May not be reported on the same day as “initial” observation care
May not be reported on the same day as observation care discharge services
May not be reported on the same day as an office or other outpatient service…including emergency department services
9
E&M Errata
AMA manual Prolonged services with direct face-to-face patient
contact Parenthetical statement following code +99356
– (use 99356 in conjunction with 99221-99223, 99231-99233, 99251-99255, 99304-99310, 90822, 90829)
10
E&M Guidance Changes
Critical Care Services►For reporting by professionals, the following services are
included in critical care when performed during the critical period by the physician(s) providing critical care: the interpretation of cardiac output measurements (93561, 93562), chest X-rays (71010, 71015, 71020, pulse oximetry (94760, 94761, 94762), blood gases, information data stored in computers (e.g., ECGs, blood pressures, hematologic data [99090]); gastric intubation (43752, 43753); temporary transcutaneous pacing (92953); ventilatory management (94002-94004, 94660, 94662); and vascular access procedures (36000, 36410, 36415, 36591, 36600). Any services performed that are not included in this listing should be reported separately. Facilities may report the above services separately.◄
11
E&M Guidance Changes
Preventive Services►Vaccine/toxoid products, immunization administrations,
ancillary studies involving laboratory, radiology, other procedures, or screening tests (e.g., vision, hearing, developmental) identified with a specific CPT code are reported separately. For immunization administration and vaccine risk/benefit counseling, see 90460, 90461, 90470-90474. For vaccine/toxoid products, see 90476-90749.◄
12
E&M Guidance Changes
Pediatric Critical Care Patient Transport►For the definition of the critically injured pediatric patient, see the
Neonatal and Pediatric Critical Care Services section.◄
►The following services are included when performed during the pediatric patient transport by the physician providing critical care and may not be reported separately: routine monitoring evaluations (e.g., heart rate, respiratory rate, blood pressure, and pulse oximetry), the interpretation of cardiac output measurements (93562), chest X-rays (71010, 71015, 71020), pulse oximetry (94760, 94761, 94762), blood gases and information data stored in computers (e.g., ECGs, blood pressures, hematologic data) (99090); gastric intubation (43752, 43753); temporary transcutaneous pacing (92953); ventilatory management (94002, 94003, 94660, 94662); and vascular access procedures (36000, 36400, 36405, 36406, 36415, 36591, 36600). Any services performed that are not included in this listing should be reported separately.◄
13
Surgery
General Section New parenthetical statement following 10022 FNA
w/imaging guidance
►(For percutaneous needle biopsy other than fine needle aspiration, see 20206 for muscle, 32400 for pleura, 32405 for lung or mediastinum, 42400 for salivary gland, 47000 for liver, 48102 for pancreas, 49180 for abdominal or retroperitoneal mass, 50200 for kidney, 54500 for testis, 54800 for epididymis, 60100 for thyroid, 62267 for nucleus pulposus, intervertebral disc, or paravertebral tissue, 62269 for spinal cord.)◄
14
Surgery
Integumentary System New sub-section under “Skin, Subcutaneous, and
Accessory Structures”
►Debridement◄ Paragraph discusses wound debridement codes 11042-
11047– Injuries, wounds and chronic ulcers– Reference for pressure ulcers, see 15920-15999
New and revised codes
15
Surgery
▲11010 Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (e.g., excisional debridement); skin and subcutaneous tissues
▲11011 skin, subcutaneous tissue, muscle fascia, and muscle
▲11012 skin, subcutaneous tissue, muscle fascia, muscle, and bone
▲11042 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less
#+●11045 each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
16
Surgery
▲11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less
#+●11046 each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
▲11044 Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less
#+●11047 each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
17
Surgery
Revised instructions “Repair (Closure)”►Complex Repair includes the repair of wounds requiring more
than layered closure, viz, scar revision, debridement (e.g., traumatic lacerations or avulsions), extensive undermining, stents or retention sutures. Necessary preparation includes creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions. Complex repair does not include excision of benign(11400-11446) or malignant (11600-11646) lesions, excisional preparation of a wound bed (15002-15005) or debridement of an open fracture or open dislocation.◄
New instructions in the guidelines for listing services at time of wound repair.
#3 and #4 are revised
18
Surgery
New instructions for “Surgical Preparation” in “Skin Replacement Surgery and Skin Substitutes” section
New subsection follows:►Application of Skin Replacements and Skin Substitutes◄ This subsection has new instructions regarding codes
15100-15431 New instructional paragraph “Flaps(Skin and/or Deep
Tissues)”
19
Surgery
Musculoskeletal System General Section
– 20000 was deleted– Instructions for I&D procedures see 10060, 10061
▲20005 Incision and drainage of soft tissue abscess, subfacial (i.e., involves the soft tissue below the deep fascia)
Introduction or Removal▲20664 Application of halo, including removal, cranial, 6 or more
pins placed, for thin skull osteology (e.g., pediatric patients, hydrocephalus, osteogenesis imperfecta)– Revision removed “requiring general anesthesia”
20
Surgery
Grafts (or Implants)+▲20930 Allograft, morselized, or placement of osteopromotive
material, for spine surgery only (List separately in addition to code for primary procedure)
+▲20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure)
Spine (Vertebral Column)– Fracture and/or Dislocation
▲22315 Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or traction– Deleted “with or without anesthesia”
21
Surgery
Arthrodesis●22551 Arthrodesis, anterior interbody, including disc space
preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2
+●22552 cervical below C2, each additional interspace (List separately in addition to code for separate procedure)
Spinal Instrumentation+▲ 22851 Application of intervertebral biomechanical device(s)
(e.g., synthetic cage(s), methylmethacrylate) to vertebral defect or interspace (List separately in addition to code for separate procedure)
22
Surgery
Pelvis and Hip Joint– Excision
▲27065 Excision of bone cyst or benign tumor; wing of ilium, symphysis pubis, or greater trochanter of femur, superficial, includes autograft, when performed
▲27066 deep (subfascial), includes autograft, when performed
▲27067 with autograft requiring separate incision
▲27070 Partial excision, wing of ilium, symphysis pubis, or greater trochanter of femur, (craterization, saucerization) (e.g., osteomyelitis or bone abscess); superficial
▲27071 deep (subfascial or intramuscular)
23
Surgery
Endoscopy/Arthroscopy– 3 new codes added to hip arthroscopy reconstructive
procedures#●29914 with femoroplasty (i.e., treatment of cam lesion)
#●29915 with acetabuloplasty (i.e., treatment of pincer lesion)
#●29916 with labral repair
24
Surgery
Respiratory System– Accessory Sinuses– Endoscopy – new instructions– 3 new codes
►A surgical sinus endoscopy includes a sinusotomy (when appropriate) and diagnostic endoscopy. Codes 31295-31297 describe dilation of sinus ostia by displacement of tissue, any method, and include fluoroscopy if performed.
Codes 31233-31297 are used to report unilateral procedures unless otherwise specified.◄
25
Surgery
●31295 Nasal/sinus endoscopy, surgical; with dilation of maxiallary sinus ostium (e.g., balloon dilation), transnasal or via canine fossa
●31296 with dilation of frontal sinus ostium (e.g., balloon dilation)
●31297 with dilation of sphenoid sinus ostium (e.g., balloon dilation)
Trachea and Bronchi●☉ 31634 with balloon occlusion, with assessment of air leak, with administration of occlusive substance (e.g., fibrin glue), if performed
26
Surgery
Cardiovascular System Heart and Pericardium
– Cardiac Valves▲33411 Replacement, aortic valve; with aortic annulus
enlargement, noncoronary sinus Single Ventricle and other Complex Cardiac Anomalies●33620 Application of right and left pulmonary artery bands (e.g.,
hybrid approach stage 1)
●33621 Transthoracic insertion of catheter for stent placement with catheter removal and closure (e.g., hybrid approach stage 1)
27
Surgery
●33622 Reconstruction of complex cardiac anomaly (e.g., single ventricle of hyoplastic left heart) with palliation of single ventricle with aortic outflow obstruction and aortic arch hypoplasia, creation of cavopulmonary anastomosis, and removal of right and left pulmonary bands (e.g., hybrid approach stage 2, Norwood, bidirectional Glenn, pulmonary artery debanding)
Thoracic Aortic Aneurysm▲33860 Ascending aorta graft, with cardiopulmonary bypass,
includes valve suspension, when performed
►(33861 has been deleted. To report, use 33864)◄
▲33863 Ascending aorta graft, with cardiopulmonary bypass, with aortic root replacement using valved conduit and coronary reconstruction (e.g., Bentall)
28
Surgery
▲33864 Ascending aorta graft, with cardiopulmonary bypass with valve suspension, with coronary reconstruction and valve-sparing aortic root remodeling (e.g., David Procedure, Yacoub Procedure)
Arteries and Veins Endovascular Repair of Iliac Aneurysm▲34900 Endovascular repair of iliac artery (e.g., aneurysm,
pseudoaneurysm, arteriovenous malformation, trauma) using ilio-iliac tube endoprosthesis
29
Surgery
Transluminal Angioplasty– Percutaneous
▲☉ 35471 Transluminal balloon angioplasty, percutaneous; renal or visceral artery
Bypass Graft– Vein
▲35526 aortosubclavian, aortoinnominate, or aortocarotid In-Situ Vein
– Other Than Vein
▲35626 aortosubclavian, aortoinnominate, or aortocarotid
30
Surgery
Transcatheter Procedures Other Procedures▲37205 Transcatheter placement of an intravascular stent(s)
(except coronary, carotid, vertebral, iliac, and lower extremity arteries), percutaneous; initial vessel
+▲37206 each additional vessel (List separately in addition to code for primary procedure)
▲37207 Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity arteries), open; initial vessel
+▲37208 each additional vessel (List separately in addition to code for primary procedure)
31
Surgery
New sub-section Transcatheter Procedures ►Endovascular Revascularization (Open or
Percutaneous, Transcatheter)◄ Over one page of instructions follow this sub-section title Describes 16 new codes for lower extremity endovascular
revascularization services
32
Surgery
●☉ 37220 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty
●☉ 37221 with transluminal stent placement(s), includes angioplasty within same vessel, when performed
☉+●37222 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)
☉+●37223 with transluminal stent placement(s), includes angioplasty within same vessel, when performed (List separately in addition to code for primary procedure)
33
Surgery
●☉ 37224 Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty
●☉ 37225 with atherectomy, includes angioplasty within the same vessel, when performed
●☉ 37226 with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
●☉ 37227 with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
34
Surgery
●☉ 37228 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
●☉ 37229 with atherectomy, includes angioplasty within the same vessel, when performed
●☉ 37230 with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
●☉ 37231 with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
35
Surgery
☉+●37232 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)
☉+●37233 with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
☉+●37234 with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
☉+●37235 with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
36
Surgery
Another correction 38205 Blood-derived hematopoietic progenitor cell
harvesting for transplantation, per collection; allogeneic– Changed spelling from allogenic
Same change for parenthetical statement following 38230 and code descriptor for 38240
37
Surgery
New code in Hemic and Lymphatic Systems Lymph Nodes and Lymphatic Channels
– Other Procedures+●38900 Intraoperative identification (e.g., mapping) of sentinel
lymph node(s), includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure)
38
Surgery
Digestive System Esophagus
– Laparoscopy+●43283 Laparoscopy, surgical, esophageal lengthening
procedure (e.g., Collis gastroplasty or wedge gastroplasty) (List separately in addition to code for primary procedure)– Repair
●43327 Esophagogastric fundoplasty partial or complete; laparotomy
●43328 thoracotomy
39
Surgery
●43332 Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; without implantation of mesh or other prosthesis
●43333 with implantation of mesh or other prosthesis
●43334 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; without implantation of mesh or other prosthesis
●43335 with implantation of mesh or other prosthesis
●43336 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracoabdominal incision, except neonatal; without implantation of mesh or other prosthesis
●43337 with implantation of mesh or other prosthesis
40
Surgery
+●43338 Esophageal lengthening procedure (e.g., Collis gastroplasty or wedge gastroplasty) (List separately in addition to code for primary procedure)
Stomach– Excision
▲43605 Biopsy of stomach, by laparotomy – Introduction
●43753 Gastric intubation and aspiration(s) therapeutic, necessitating physician’s skill (e.g., for gastrointestinal hemorrhage), including lavage if performed
41
Surgery
●43754 Gastric intubation and aspiration, diagnostic; single specimen (e.g., acid analysis)
●43755 collection of multiple fractional specimens with gastric stimulation, single or double lumen tube (gastric secretory study) (e.g., histamine, insulin, pentagastrin, calcium, secretin), includes drug administration
●43756 Duodenal intubation and aspiration, diagnostic, includes image guidance; single specimen (e.g., bile study for crystals or afferent loop culture)
●43757 collection of multiple fractional specimens with pancreatic or gallbladder stimulation, single or double lumen tube, includes drug administration
42
Surgery
Biliary Tract– Incision
▲47480 Cholecystotomy or cholecystostomy, open with exploration, drainage, or removal of calculus (separate procedure)
►(For percutaneous cholecystostomy, use 47490)◄– Introduction
▲47490 Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation
Error – delete the parenthetical statement (For radiological supervision and interpretation, use 75989) following 47490
43
Surgery
Abdomen, Peritoneum, and Omentum– Laparoscopy
▲49324 with insertion of tunneled intraperitoneal catheter
+●49327 with placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure)
44
Surgery
– Introduction, Revision, Removal+●49412 Placement of interstitial device(s) for radiation therapy
guidance (List separately in addition to code for primary procedure)
●☉ 49418 Insertion of tunneled intraperitoneal catheter (e.g., dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous
▲49419 Insertion of tunneled intraperitoneal catheter, with subcutaneous port (i.e., totally implantable)
45
Surgery
49420 was deleted to accommodate the development of codes specific to the type of procedure being performed▲49421 Insertion of tunneled intraperitoneal catheter for dialysis,
open
▲49422 Removal of tunneled intraperitoneal catheter
46
Surgery
Urinary System Kidney
– Excision▲50250 Ablation, open, 1 or more renal mass lesion(s),
cryosurgical, including intraoperative ultrasound guidance and monitoring, if performed– Laparoscopy
▲50542 ablation of renal mass lesion(s), including intraoperative ultrasound guidance and monitoring, when performed
47
Surgery
Urethra– Other Procedures
●53860 Transurethral radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence
Male Genital System Prostate
– Laparoscopy▲55866 Laparoscopy, surgical prostatectomy, retropubic radical,
including nerve sparing, includes robotic assistance, when performed
48
Surgery
– Other Procedures▲55876 Placement of interstitial device(s) for radiation therapy
guidance (e.g., fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple
Female Genital System Vagina
– Introduction▲☉ 57155 Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy
●57156 Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy
49
Surgery
Nervous System Skull, Meninges, and Brain
– Stereotaxis+●61781 Stereotactic computer-assisted (navigational procedure);
cranial, intradural (List separately in addition to code for primary procedure)
+●61782 cranial, extradural (List separately in addition to code for primary procedure)
+●61783 spinal (List separately in addition to code for primary procedure)
50
Surgery
Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System– Introduction/Injection of Anesthetic Agent (Nerve Block),
Diagnostic or Therapeutic▲64479 Injection(s), anesthetic agent and/or steroid, transforaminal
epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level
+▲64480 cervical or thoracic, each additional level (List separately in addition to code for primary procedure)
▲64483 lumbar or sacral, single level
+▲64484 lumbar or sacral, each additional level (List separately in addition to code for primary procedure)
51
Surgery
– Paravertebral Spinal Nerves and Branches
►(Imaging guidance [fluoroscopy CT] and any injection of contrast are inclusive components of 64490-64495. Imaging guidance and localization are required for the performance of paravertebral facet joint injections described by 64490-64495. If imaging guidance is not used, report 20552-20553. If ultrasound guidance is used, report 0213T-0218T)– Neurostimulators (Peripheral Nerve)
●64566 Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming
●64568 Incision for implantation of cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator
52
Surgery
●64569 Revision or replacement of cranial nerve (e.g., vagus nerve) neurostimulator electrode array, including connection to existing pulse generator
●64570 Removal of cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator
▲64575 Incision for implantation of neurostimulator electrodes; peripheral nerve (excludes sacral nerve)
Destruction by Neurolytic Agent (e.g., Chemical, Thermal, Electrical or Radiofrequency)– Somatic Nerves
●64611 Chemodenervation of parotid and submandibular salivary glands, bilateral
53
Surgery
Neuroplasty (Exploration, Neurolysis or Nerve Decompression)
►Neuroplasty is the surgical decompression or freeing of intact nerve from scar tissue, including external neurolysis and/or transposition to repair or restore the nerve.◄
▲64708 Neuroplasty, major peripheral nerve, arm or leg, open; other than specified
▲64712 sciatic nerve
▲64713 brachial plexus
▲64714 lumbar plexus
54
Surgery
Eye and Ocular Adnexa Anterior Segment
– CorneaOther Procedures
●65778 Placement of amniotic membrane on the ocular surface for wound healing; self-retaining
●65779 single layer, sutured
▲65780 Ocular surface reconstruction; amniotic membrane transplantation, multiple layers
55
Surgery
Anterior Sclera– Excision
●66174 Transluminal dilation of aqueous outflow canal; without retention of device or stent
●66175 with retention of device or stent Iris, Ciliary Body
– Destruction▲66761 Iridotomy/iridectomy by laser surgery (e.g., for glaucoma)
(per session)
56
Surgery
Auditory System Inner Ear
– Incision and/or Destruction▲69801 Labryinthotomy, with perfusion of vestibuloactive drug(s);
transcanal
▲69802 with mastoidectomy Operating Microscope Guidance revised to reflect that 69990 should not be
reported in addition to anterior interbody arthrodesis procedures – 22551-22552
Also excludes 69990 with 0226T-0227T because it’s a component of the code definitions
57
Radiology
●74176 Computed tomography, abdomen and pelvis; without contrast material
●74177 with contrast material(s)
●74178 without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions
▲75954 Endovascular repair of iliac artery aneurysm, pseudoaneurysm, arteriovenous malformation, or trauma, using ilio-iliac tube endoprosthesis, radiological supervision and interpretation
▲75960 Transcatheter introduction of intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity artery) percutaneous and/or open, radiological supervision and interpretation, each vessel
58
Radiology
▲75962 Transluminal balloon angioplasty, peripheral artery other than cervical carotid, renal or other visceral artery, iliac or lower extremity, radiological supervision and interpretation
+▲75964 Transluminal balloon angioplasty, each additional peripheral artery other than cervical carotid, renal or other visceral artery, iliac or lower extremity, radiological supervision and interpretation (List separately in addition to code for primary procedure)
Correction – note following 76513 deleted 0187T and added 92132
●76881 Ultrasound, extremity, nonvascular, real-time with image documentation; complete
●76882 limited, anatomic specific59
Radiology
▲77003 Flouroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, subarachnoid, or sacroiliac joint), including neurolytic agent destruction
Radiation Oncology Radiation Treatment Management Guidelines
– Revised to clarify requirements for reporting each radiation treatment management service
– Clarifies required services that are included in the Radiation Treatment Management codes
60
Pathology and Laboratory
#●80104 multiple drug classes other than chromatographic method, each procedure
Correction – revised note following 82013 to “gastric acid” not “acid gastric”
●82930 Gastric acid analysis, includes pH if performed, each specimen
+▲82952 tolerance test, each additional beyond 3 specimens (List separately in addition to code for primary procedure)
●83861 Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity
●84112 Placental alpha microglobulin-1 (PAMG-1), cervicovaginal secretion, qualitative
61
Pathology and Laboratory
▲85597 Phospholipid neutralization; platelet
●85598 hexagonal phospholipid
▲86480 Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon
●86481 enumeration of gamma interferon-producing T-cells in cell suspension
●86902 antigen testing of donor blood using reagent serum, each antigen test
●87501 influenza virus, reverse transcription and amplified probe technique, each type or subtype
●87502 influenza virus, for multiple types or sub-types, reverse transcription and amplified probe technique, first 2 types or sub-types
62
Pathology and Laboratory
+●87503 influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, each additional influenza virus type or sub-type beyond 2 (List separately in addition to code for primary procedure)
▲87901 Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, reverse transcriptase and protease regions
#●87906 HIV-1, other region (e.g., integrase, fusion)
●88120 Cytopathology, in situ hybridization (e.g., FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual
●88121 using computer-assisted technology
63
Pathology and Laboratory
▲88172 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site
#+●88177 immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (List separately in addition to code for primary procedure)
+▲88332 each additional tissue block with frozen section(s) (List separately in addition to code for primary procedure)
+▲88334 cytologic examination (e.g., touch prep, squash prep), each additional site (List separately in addition to code for primary procedure)
64
Pathology and Laboratory
●88363 Examination and selection of retrieved archival (i.e., previously diagnosed) tissue(s) for molecular analysis (e.g., KRAS mutational analysis)
●88749 Unlisted in vivo (e.g., transcutaneous) laboratory service
65
Medicine
Immunization Administration for Vaccines/Toxoids Revised Guidelines for Immunization Administration 90465-90468 were deleted
►Codes 90460 and 90461 must be reported in addition to the vaccine and toxoid code(s) 90476-90749.
Report codes 90460 and 90461 only when the physician or qualified health care professional provides face-to-face counseling of the patient and family during the administration of a vaccine. For immunization administration of any vaccine that is not accompanied by face-to-face physician or qualified health care professional counseling to the patient/family or for administration of vaccines to patients over 18 years of age, report codes 90471-90474◄
66
Medicine
►A component refers to each antigen in a vaccine that prevents disease(s) caused by one organism (see codes 90460 and 90461). Combination vaccines are those vaccines that contain multiple vaccine components.◄
●90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component
+●90461 each additional vaccine/toxoid component (List separately in addition to code for primary procedure)
●90470 H1N1 immunization administration (intramuscular, intranasal), including counseling when performed
67
Medicine
Vaccines, Toxoids
►Codes 90476-90748 identify the vaccine product only. To report the administration of a vaccine/toxoid, the vaccine/toxoid product codes 90476-90749 must be used in addition to an immunization administration code(s). Modifier 51 should not be reported for the vaccine, toxoids when performed with these administration procedures.◄
~●90644 Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCY-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use
▲90650 Human Papilloma virus (HPV) vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use
68
Medicine
▲90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
▲90663 Influenza virus vaccine, pandemic formulation, H1N1
~●90664 Influenza virus vaccine, pandemic formulation, live, for intranasal use
~●90666 Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use
~●90667 Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use
~●90668 Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use
▲90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use
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Medicine
Psychiatry Guidance on Consultation for psychiatric evaluations Guidance on reporting the appropriate psychotherapy
codes.
Correction – AMA “Other Psychiatric Services or Procedures”, delete the parenthetical note preceding 90862 that references deleted codes 0160T-0161T
●90867 Therapeutic repetitive transcranial magnetic stimulation treatment; planning
●90868 delivery and management, per session
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Medicine
Gastroenterology
▲91010 Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; 2-dimensional data
+●91013 with stimulation or perfusion during 2-dimensional data study (e.g., stimulant, acid or alkali perfusion) (List separately in addition to code for primary procedure)
●91117 Colon motility (manometric) study, minimum 6 hours continuous recording (including provocation tests, e.g., meal intracolonic balloon distension, pharmacologic agents, if performed), with interpretation and report
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Medicine
Ophthalmology Special Ophthalmological Services
●92132 Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral
●92133 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve
●92134 retina
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Medicine
Ophthalmoscopy
●92227 Remote imaging for detection of retinal disease (e.g., retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral
●92228 Remote imaging for monitoring and management of active retinal disease (e.g., diabetic retinopathy) with physician review, interpretation and report, unilateral or bilateral
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Medicine
Cardiovascular Therapeutic Services and Procedures New instructional paragraph following +92981 describing
the services inclusive in coronary artery stenting New Section Revises the cardiac monitoring device codes
►Cardiovascular Monitoring Services◄
New section = new section guidance
Correction – AMA manual…first paragraph, end of the last sentence should read “…and requires attended surveillance.
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Medicine
▲93224 External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, physician review and interpretation
▲93225 recording (includes connection, recording and disconnection)
▲93226 scanning analysis with report
▲93227 physician review and interpretation
►(for less than 12 hours of continuous recording, use modifier 52)◄
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Medicine
▲93228 External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; physician review and interpretation with report
▲93229 technical support for connection and patient instructions for use, attended surveillance, analysis and physician prescribed transmission of daily and emergent data reports
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Medicine
►(93230-93237 have been deleted. To report external electrocardiographic rhythm derived monitoring for up to 48 hours, see 93224-93227)◄
▲93268 External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, physician review and interpretation
▲93270 recording (includes connection, recording and disconnection)
▲93271 transmission download and analysis
▲93272 physician review and interpretation
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Medicine
Implantable and Wearable Cardiac Device Evaluations– Added new definitions in instructions
Cardiac Catheterization– All new guidance– Many new codes
●☉ 93451 Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed
●☉ 93452 Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
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Medicine
●☉ 93453 Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
●☉ 93454 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation;
●☉ 93455 with catheter placement(s) in bypass graft(s) (internal mammary, free arterial venous grafts) including intraprocedural injection(s) for bypass graft angiography
●☉ 93456 with right heart catheterization
●☉ 93457 with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization
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Medicine
●☉ 93458 with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed
●☉ 93459 with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography
●☉ 93460 with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed
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Medicine
●☉ 93461 with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography
☉+●93462 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure)
☉+●93463 Pharmacologic agent administration (e.g., inhaled nitric oxide, intravenous infusion of nitropursside, dobutamine, milrinone, or other agent), including assessing hemodynamic measurements before, during, after, and repeat pharmacologic agent administration, when performed (List separately in addition to code for primary procedure)
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Medicine
☉+●93464 Physiologic exercise study (e.g., bicycle or arm ergometry) including assessing hemodynamic measurements before and after (List separately in addition to code for primary procedure)
Injection Procedures– All new instructions– 6 new codes
►(93539-93545 have been deleted. To report, see 93451-93461, 93563-93568)◄
►(93555, 93556 have been deleted. See introductory guidelines for Cardiac Catheterization and Injection Procedures)◄
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Medicine
☉+●93563 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective coronary angiography during congenital heart catheterization (List separately in addition to code for primary procedure)
☉+●93564 for selective opacification of aortocoronary venous or arterial bypass graft(s) (e.g., aortocoronary saphenous vein, free radial artery, or free mammary artery graft) to one or more coronary arteries and in situ arterial conduits (e.g., internal mammary), whether native or used for bypass to one or more coronary arteries during congenital heart catheterization, when performed (List separately in addition to code for primary procedure)
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Medicine
☉+●93565 for selective left ventricular or left atrial angiography (List separately in addition to code for primary procedure)
☉+●93566 for selective right ventricular or right atrial angiography (List separately in addition to code for primary procedure)
☉+●93567 for supravalvular aortography (List separately in addition to code for primary procedure)
☉+●93568 for pulmonary angiography (List separately in addition to code for primary procedure)
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Medicine
Noninvasive Vascular Diagnostic Studies– Substantially revised guidelines– Revised 3 codes
Extremity Arterial Studies (Including Digits)
▲93922 Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (e.g., for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 1-2 levels)
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Medicine
▲93923 Complete bilateral noninvasive physiologic studies of the upper or lower extremity arteries, 3 or more levels (e.g., for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more levels, or single level study with provocative functional maneuvers (e.g., measurements with postural provocative tests, or measurements with reactive hyperemia)
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Medicine
▲93924 Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (i.e., bidirectional Doppler waveform or volume plethysmography recording and analysis at rest with ankle/brachial indices immediately after and at timed intervals following performance of a standardized protocol on a motorized treadmill plus recording of time of onset of claudication or other symptoms, maximal walking time, and time to recovery) complete bilateral study
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Medicine
Neurology and Neuromuscular Procedures– In guidance…AMA error: deleted parenthetical
statement (For repetitive transcranial magnetic stimulation for treatment of clinical depression, see Category III codes 0160T, 0161T)
– Sleep Testing– New parenthetical under 95806 needs corrected to
say ►(For unattended sleep study that measures a minimum heart rate, oxygen saturation, and respiratory analysis, use 95801)◄
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Medicine
#●95800 Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
#●95801 minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)– Muscle and Range of Motion Testing
▲95857 Cholinesterase inhibitor challenge test for myasthenia gravis– Intraoperative Neurophysiology– Added guidance clarifying instructions for use of
+95920
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Medicine
– Special EEG Tests– Additional guidance for use
▲95953 Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic (EEG) recording and interpretation, each 24 hours, unattended
▲95956 Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG) recording and interpretation, each 24 hours, attended by a technologist or nurse
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Medicine
Central Nervous System Assessments/Tests (e.g., Neuro-Cognitive, Mental Status, Speech Testing)– Clarified guidelines noting that a minimum of 31 minutes
must be provided to report any of these “per hour” codes – 96101, 96116, 96118, and 96125…time is described as face-to-face time with the patient and the time spent interpreting testing and preparing the report
Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration– Other Injection and Infusion Services
●96446 Chemotherapy administration into the peritoneal cavity via indwelling port or catheter
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Medicine
Physical Medicine and Rehabilitation– Additional Guidance
►The work of the qualified healthcare professional consists of face-to-face time with the patient (and caregiver, if applicable) delivering skilled services. For the purpose of determining the total time of service, incremental intervals of treatment at the same visit may be accumulated.◄
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Medicine
Active Wound Care Management
▲97597 Debridement (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm) including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per sessions, total wound(s) surface area; first 20 sq cm or less
+▲97598 each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
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Category II Codes
31 New Codes 4 New clinical conditions 6 Revised clinical conditions
– Performance measures with Cat II codes not mandatory in MHS
94
Category III Codes
Emerging technologies, services and procedures 52 New Codes 12 Deleted codes
– Majority were converted to Cat I codes
95
HCPCS
158 New Codes– 3 “A” Codes (transportation, supplies) – 18 “C” Codes (outpatient PPS [devices])– 81 “G” Codes (temp professional services, no CPT)– 28 “J” Codes (drugs [not oral])– 4 “L” Codes (orthotic supplies/procedures)– 15 “Q” Codes (temporary, no CPT)– 2 “S” Codes (temporary non-Medicare)– 1 “T” Code (State Medicaid)
96
HCPCS
New Codes of Interest
G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
G0437 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
Q2035 Influenza virus vaccine, split virus, when administered to individual 3 years of age and older, for intramuscular use (AFLURIA)
Q2036 Influenza virus vaccine, split virus, when administered to individual 3 years of age and older, for intramuscular use (FLULAVAL)
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HCPCS
Q2037 Influenza virus vaccine, split virus, when administered to individual 3 years of age and older, for intramuscular use (FLUVIRIN)
Q2038 Influenza virus vaccine, split virus, when administered to individual 3 years of age and older, for intramuscular use (Fluzone)
Q2039 Influenza virus vaccine, split virus, when administered to individual 3 years of age and older, for intramuscular use (not otherwise specified)
98
HCPCS
82 Revised Codes– 10 “A” Codes (transportation, supplies) – 3 “B” Codes (enteral & parenteral therapy)– 12 “C” Codes (outpatient PPS [devices])– 3 “E” Codes (DME)– 26 “G” Codes (temp professional services, no CPT)– 2 “J” Codes (drugs [not oral])– 3 “L” Codes (orthotic supplies/procedures)– 18 “Q” Codes (temporary, no CPT)– 5 “S” Codes (temporary non-Medicare)
99
HCPCS
290 Deleted Codes– Majority in temporary G codes for PQRI
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101
Questions