cpt and hcpcs revisions today’s challenges for … · 1 2010 chargemaster update cpt® &...

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2010 Chargemaster Update CPT® & HCPCS Codes

Presented by Glenda J Schuler, RHIT, CPC, CPC-H

2010 Chargemaster CPT and HCPCS Updates for Hospitals

• CPT and HCPCS Revisions

• Today’s Challenges for 2010• Laboratory Category III Codes• Radiology Cardiology• E/M Codes Physician• Clinic Coding Rehabilitation• Medicine Codes

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• Pharmacy Revisions

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Publisher’s NoticeAlthough we have tried to include accurate and comprehensive information in this

i l b i i i d d l l h f i lpresentation, please remember it is not intended as legal or other professional advice.

American Medical Association NoticeCPT codes, descriptions, and other material only copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein


contained or not contained herein.

CPT is a registered trademark of the American Medical Association.

Summary of CPT/HCPCS Changes

• CPT Code Changes • HCPCS Code Changes

• New Codes 240

• Deleted Codes 77

• Description 155 Changes

• Grammatical 143

• New Codes 36

• Deleted Codes 44

• Description 3 Changes


Changes

• TOTAL 615

• Status Indicator Revisions 10

• TOTAL 93

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Resequencing – New Concept, Added Confusion

• The American Medical Association (AMA) has employed a new numbering methodology ofemployed a new numbering methodology of resequencing. According to the AMA, there are instances where a new code is needed within an existing grouping of codes and an unused code number is not available. In the instance where the existing codes will not be changed or have minimal changes, the AMA will assign a code that is not in


numeric sequence with the related codes.


• The resequenced codes and descriptions are placed with their related codes out of numeric sequence. Inwith their related codes out of numeric sequence. In the CPT® manual, resequenced codes appear in numeric order, referring users to their resequenced location.


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There are 27 CPT codes that are “out of numerical sequence” for 2010. All but one are in the surgical code section.

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• Although the codes appear in numeric sequence, they will appear in print with the pp pconcepts with which they are related, using the content within the code descriptor to determine print placement and offering flexibility for code assignment beyond the capability of the traditional

b i ti


numbering convention.

Printed Resource in 2009 CPT Book

10 www.shopingenix.comCPT only © 2008 American Medical Association. All Rights Reserved.

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Appendix M – Different Format for 2010


Printed Resource in 2010 CPT Book


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CPT Changes in 2010 CPT Book

• Grammatical Changes• Revised descriptors containing no content changes• More grammatically consistent with other codesg y• Standardization of format

• Biopsy now reads Biopsy/Aspiration• “For” now reads “of”

• Descriptor Revisions• Most do not have an impact on how code is reported• Other changes do change the use of code


CPT Changes in 2010 CPT Book


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Chargemaster 2010 and Revenue Codes

Hospitals must continue to report HCPCS codes and charges with an appropriate UB revenue code

i t t ith NUBC i t Wh ticonsistent with NUBC requirements. When reporting the appropriate revenue code for services, hospitals should choose the most precise revenue code, or subcode, if appropriate. As NUBC guidelines dictate, “It is recommended that providers use the more detailed subcategory when applicable/available rather than revenue codes that end in “0” (General)


rather than revenue codes that end in 0 (General) or “9” (Other).”

Transmittal 1599, Effective October 1, 2008

Chargemaster 2010 and Revenue Codes

• Transmittal 1599 also brings up another interesting topic for discussion. CMS states: We rely on hospitals to fully comply with the revenue codehospitals to fully comply with the revenue code reporting instructions and Medicare cost apportionment policies because we use a revenue code to cost center crosswalk to estimate the service costs that underpin OPPS payment rates. The current revenue code to cost center crosswalk that we use for setting annual hospital outpatient


we use for setting annual hospital outpatient payments may be found on the CMS web site at: http://www.cms.hhs.gov/HospitalOutpatient PPS/03_crosswalk.asp#TopOfPage .

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Quote from CMS

• “We understand that the OPPS is a complex payment system……”system……

• OPPS 2009, page 125


Laboratory 2010 UpdatesAdds Deletes Descriptions

16 4 17

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Laboratory - Chemistry Updates

SI Year ActionRev

Code CPT Long Description0300,

OE 2009 Desc 0301 80055 Obstetric panel

Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Hepatitis B surface antigen (HBsAg) (87340) Antibody, rubella (86762) Syphilis test, non-


E 2010 Desc0300, 0301 80055

(87340) Antibody, rubella (86762) Syphilis test, nontreponemal antibody; qualitative (eg, VDRL, RPR, ART) (86592) Antibody screen, RBC, each serum technique (86850) Blood typing, ABO (86900) AND Blood typing, Rh (D) (86901)


SI Year ActionRev

Code CPT Long Description0300

A 2009 Desc0300, 0301 82306 Calcifediol (25-OH Vitamin D-3)

A 2010 Desc0300, 0301 82306

Vitamin D; 25 hydroxy, includes fraction(s), if performed

A 2009 Del0300, 0301 82307 Calciferol (Vitamin D)

2010 82306 Replaced with Revised CPT 82306 above


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SI Year ActionRev


A 2009 Desc0300, 0301 82652 Dihydroxyvitamin D, 1, 25-

A 2010 Desc0300, 0301 82652

Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed

A 2009 Desc0300, 0301 82784 Gammaglobulin; IgA, IgD, IgG, IgM, each

A 2010 Desc0300, 0301 82784

Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each

A 2009 D0300, 0301 82785 Gammaglobulin; IgE


A 2009 Desc 0301 82785 Gammaglobulin; IgE

A 2010 Desc0300, 0301 82785 Gammaglobulin (immunoglobulin); IgE


SI Year ActionRev

Code CPT Long Description

A 2009 D0300, 0301 82 8

Gammaglobulin; immunoglobulin subclasses (IgG1, 2, 3 4) hA 2009 Desc 0301 82787 3, or 4), each

A 2010 Desc0300, 0301 82787

Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each


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SI Year ActionRev


A 2009 Desc0300, 0301 83516

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or semiquantitative; multiple step method

A 2010 Desc0300, 0301 83516

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or


A 2009 Desc0300, 0301 83518

antibody or infectious agent antigen, qualitative or semiquantitative; single step method (eg, reagent strip)

A 2010 Desc0300, 0301 83518

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, single step method (eg, reagent strip)


SI Year Action CPT Long Description

A 2009 Desc0300, 0301 83519

Immunoassay, analyte, quantitative; by radiopharmaceutical technique (eg, RIA)A 2009 Desc 0301 83519 radiopharmaceutical technique (eg, RIA)

A 2010 Desc0300, 0301 83519

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, by radioimmunoassay (eg, RIA)

A 2009 Desc0300, 0301 83520

Immunoassay, analyte, quantitative; not otherwise specified

0300, Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not


A 2010 Desc 0301 83520 otherwise specified

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SI Year ActionRev


A 2009 Desc,

0301 83986 pH, body fluid, except blood

A 2010 Desc0300, 0301 83986 pH; body fluid, not otherwise specified

A 2010 New0300, 0301 83987 pH; exhaled breath condensate

A 2010 New0300, 0301 84431

Thromboxane metabolite(s), including thromboxane if performed, urine



SI Year ActionRev

Code CPT Long DescriptionStatus 0300,

E 2010 Chg 0301 80100 Drug screen, qualitate/multi

E 2010Status Chg

0300, 0301 80101 Drug screen, single

A 2010 New0300, 0301 G0430 Drug screen multi class

A 2010 New0300, 0301 G0431 Drug screen single class

Rev


Warfarin Responsiveness Testing by Genetic Technique Using Any Method, Any number of specimen(s)

SI Year Action Code CPT Long Description

A 2010 New0300, 0309 G9143 Warfarin respon genetic test

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G0430 - DRUG SCREEN, QUALITATIVE; MULTIPLE DRUG CLASSES OTHER THAN CHROMATOGRAPHICDRUG CLASSES OTHER THAN CHROMATOGRAPHIC METHOD, EACH PROCEDURE

G0431 - DRUG SCREEN, QUALITATIVE; SINGLE DRUG CLASS METHOD (E.G., IMMUNOASSAY, ENZYME ASSAY), EACH DRUG CLASS

80100 D lit ti lti l d l


80100 - Drug screen, qualitative; multiple drug classes chromatographic method, each procedure80101 - Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class

Laboratory - Immunology Updates

SI Year ActionRev


A 2010 New0300, 0302 86305 Human epididymis protein 4 (HE4)

A 2009 Desc0300, 0302 86592 Syphilis test; qualitative (eg, VDRL, RPR, ART)

A 2010 Desc0300, 0302 86592

Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART)


A 2009 Desc0300, 0302 86593 Syphilis test; quantitative

A 2010 Desc0300, 0302 86593 Syphilis test, non-treponemal antibody; quantitative

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Rev SI Year Action Code CPT Long Description

A 2010 New0300, 0302 86352

Cellular function assay involving stimulation (eg, mitogen or antigen) and detection of biomarker (eg, ATP)

A 2010 New0300, 0302 86825

Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometry); first serum sample or dilution

Human leukocyte antigen (HLA) crossmatch, non-t t i ( i fl t t ) h dditi l


A 2010 New0300, 0302 86826

cytotoxic (eg, using flow cytometry); each additional serum sample or sample dilution (List separately in addition to primary procedure)

Under Tissue typing section, revenue code may be bestReported with RC 0309


SI Year ActionRev

Code CPT Long Description0300, 0302

Antibody; Treponema pallidum, confirmatory test (eg, FTA b )A 2010 Del 0302 86781 FTA-abs)

A 2010 New0300, 0302 86780 Antibody; Treponema pallidum


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SI Year ActionRev

Code CPT Long DescriptionSI Year Action Code CPT Long Description

A 2010 Del0300, 0301 0194T Procalcitonin (PCT)

A 2010 New0300, 0301 84145 Procalcitonin (PCT)


Laboratory - Hematology Updates

SI Year ActionRev


A 2010 New 305 88738 Hemoglobin (Hgb), quantitative, transcutaneous

Subheading in the laboratory section of the CPT book was introduced in 2009 entitled “In Vivo” (eg, Transcutaneous) LaboratoryProcedures. In Vivo (taking place inside an organism) represents threelaboratory procedures CPT 88720 88740 and 88741 In 2010 an


laboratory procedures, CPT 88720, 88740 and 88741. In 2010 an additional procedure has been included in this section.

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Laboratory - Bacteriology Updates

SI Year ActionRev


A 2009 Desc,

0306 87149 Culture, typing; identification by nucleic acid probe

A 2010 Desc0300, 0306 87149

Culture, typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each organism probed


Laboratory - Bacteriology Updates

SI Year ActionRev


A 2010 New0300, 0306 87150

Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed

A 2010 New0300, 0306 87153

Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16S rRNA gene)

A 2010 New0300, 0306 87493

Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique


A 2010 New 0306 87493 probe technique

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Pathology/Cytology/Histology

• Effective on or after January 1, 2010, only the hospital may bill for the TC (technical component) of a physician pathology service to an inpatient or outpatient. In addition, the hospital cannot bill under the OPPS for the TC of physician pathology services if the independent laboratory that services that hospital outpatient is receiving payment from its carrier under the physician fee schedule

• Claims Processing Manual, Chapter 16, Section 80.2.1



Work with the independent laboratory or pathologist to establish a system for providing the facility with accurate CPT/HCPCS codes.

Update the facility’s laboratory chargemaster to include the appropriate CPT/HCPCS codes, revenue codes and descriptions for the technical component of anatomical pathology services.

Establish a process to review documentation from the facility’s independent laboratory or pathologist to verify the accuracy of the CPT/HCPCS codes reported. The facility will be held


the CPT/HCPCS codes reported. The facility will be held responsible should any of the codes reported be determined to be incorrect.

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SI Year ActionRev


X 2009 Desc0310, 0312 88312

Special stains (List separately in addition to code for primary service); Group I for microorganisms (eg, Gridley, acid fast, methenamine silver), each

X 2010 Desc0310, 0312 88312

Special stains; Group I for microorganisms (eg, Gridley, acid fast, methenamine silver), including interpretation and report, each

Special stains (List separately in addition to code for primary service); Group II, all other (eg, iron,


X 2009 Desc0310, 0312 88313

primary service); Group II, all other (eg, iron, trichrome), except immunocytochemistry and immunoperoxidase stains, each

X 2010 Desc0310, 0312 88313

Special stains; Group II, all other (eg, iron, trichrome), except immunocytochemistry and immunoperoxidase stains, including interpretation and report, each


SI Year ActionRev

Code CPT Long DescriptionSpecial stains (List separately in addition to code for

X 2009 Desc0310, 0312 88314

p ( p yprimary service); histochemical staining with frozen section(s)

X 2010 Desc0310, 0312 88314

Special stains; histochemical staining with frozen section(s), including interpretation and report (List separately in addition to code for primary procedure)


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SI Year ActionRev


Macroscopic examination, dissection, and preparation f ti f i i l ti l t di (

N 2010 New0310, 0319 88387

of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); each tissue preparation (eg, a single lymph node)

0310,

Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (eg, a single lymph node) (List separately in addition to code for


The study of the structures of the body that can be seen with the naked eye, also called macroscopic anatomy

N 2010 New0310, 0319 88388

lymph node) (List separately in addition to code for primary procedure)


SI Year ActionRev


X 2010 Del0310, 0319 0087T Sperm evaluation, Hyaluronan sperm binding test

X 2010 New0310, 0319 89398 Unlisted reproductive medicine laboratory procedure


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Respiratory/Pulmonary TherapyAdds Deletes Descriptions

3 1 0

Respiratory/Pulmonary Changes

SI Y A tiRev


X 2010 New0460, 0469 94011

Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age

X 2010 New0460, 0469 94012

Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age

M t f l l (i


X 2010 New0460, 0469 94013

Measurement of lung volumes (ie, functional residual capacity [FRC], forced vital capacity [FVC], and expiratory reserve volume [ERV]) in an infant or child through 2 years of age

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Respiratory/Pulmonary Changes

SI Year ActionRev


X 2009 Del0460, 0469 0064T

Spectroscopy, expired gas analysis (eg, nitric oxide/carbon dioxide test)

X 2010 Existing0460, 0469 94799 Unlisted pulmonary service or procedure


Rehabilitation TherapiesAdds Deletes Descriptions

9 2 0

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Rehabilitation Coding Updates

SI Year ActionRev


A 2009 DEL

0420, 0430, 0440 29220 Strapping; low back

A 2010 Exist

0420, 0430, 0440 29799 Unlisted procedure, casting or strapping


A 2010 New

0420, 0430, 0440 29581

Application of multi-layer venous wound compression system, below knee


• CPT 29580 – Strapping, Unna boot

The professional prepares this semi-rigid dressing by first making a paste of zinc oxide, gelatin, and glycerin. This is applied to the skin of the leg. A spiral or figure eight bandage is wrapped evenly over the leg. Paste is reapplied and further bandages are applied in the same fashion until the desired rigidity is obtained. Elastic bandages are often added to the dressings for reinforcement


added to the dressings for reinforcement. The dressing is typically replaced at least once a week or more often as needed.

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The multi-layer compression bandage system has been

ifi ll d i d f thspecifically designed for the management of venous leg ulcers and associated conditions.

Profore® Dyna-Flex®

Surepress® Setopress®



• When hospital outpatient staff provide a prosthetic or orthotic device, and the HCPCS code that describesorthotic device, and the HCPCS code that describes that device includes the fitting, adjustment, or other services necessary for the patient’s use of the item, the hospital should not bill a visit or procedure HCPCS code to report the charges associated with the fitting, adjustment, or other related services. Instead, the HCPCS code for the device already includes the fitting,


adjustment or other similar services.

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• For example, if the hospital outpatient staff provides the orthotic device described by HCPCS code L1830 (KO,orthotic device described by HCPCS code L1830 (KO, immobilizer, canvas longitudinal, prefabricated, includes fitting and adjustment), the hospital should only bill HCPCS code L1830 and should not bill a visit or procedure HCPCS code to describe the fitting and adjustment.


Audiology Services

SI Year ActionRev

Code CPT Long DescriptionX 2010 DEL 0471 92569 Acoustic reflex testing; decayX 2010 DEL 0471 92569 Acoustic reflex testing; decay

X 2010 New 0471 92570

Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing


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X 2010 Ne

0420, 0430, 0440, 0920, 0929 92540

Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test with recording


X 2010 New 0929 92540 oscillating tracking test, with recording


Examining the Nystagmus Patient Patients with nystagmus have many unique problems thatPatients with nystagmus have many unique problems that

should be evaluated by a low vision specialist or eye doctor skilled in treating nystagmus. Simple tests like visual acuity can be misleading as the vision may decrease if the patient is under stress or has latent nystagmus which causes an increase in nystagmus in both eyes when one eye is covered. The visual acuity testing requires special steps to insure an accurate measurement.


Low Vision specialists also use special testing techniques during the refraction to measure the eyeglass prescription and prevent inaccurate results from latent nystagmus. Reducing stress during testing is another method used by Low Vision Specialists to obtain the best results.

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Audiology Services

RevSI Year Action

Rev Code CPT Long Description

X 2010 New 047X 92550 Tympanometry and reflex threshold measurements

X 2010 New 047X 0208T

Pure tone audiometry (threshold) automated (includes use of computer-assisted device); air only


Audiology Services


X 2010 New 047X 0209T

Pure tone audiometry (threshold) automated (includes use of computer-assisted device); air and bone

X 2010 New047X, 044X 0210T

Speech audiometry threshold, automated (includes use of computer-assisted device);

X 2010 New047X, 044X 0211T

Speech audiometry threshold, automated (includes use of computer-assisted device); with speech recognition


X 2010 New 044X 0211T recognition

X 2010 New047X, 044X 0212T

Comprehensive audiometry threshold evaluation and speech recogniition (0209T and 0211T combined), automated (includes use of computer-assisted device)

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Cardiac/Pulmonary RehabilitationAdds Deletes Descriptions

3 0 2

Cardiac/Pulmonary Rehabilitation

SI Year ActionRev

Code CPT Long DescriptionsIntensive cardiac rehabilitation; with or without

S 2010 New 0943 G0422

;continuous ECG monitoring, with exercise, per hour, per session

S 2010 New 0943 G0423

Intensive cardiac rehabilitation; with or without continuous ECG monitoring, without exercise, per hour, per session

With respect to ICR, section 144(a)(1) of Pub. L. 100-275 authorizescoverage of ICR programs in a series of 72 one-hour sessions up to


coverage of ICR programs in a series of 72 one-hour sessions, up to 6 sessions per day, over a period of 18 weeks.

Program approved through the NCD process, details to follow

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As stated in Transmittal 1417/ CR 5912, in order to report more than one session for a givento report more than one session for a given date of service, each session must last a minimum of 60 minutes. For example, if the services provided on a given day total 1 hour and 50 minutes, then only one session should be billed to report the cardiac rehabilitation


pservices provided on that day.


SI Year ActionRev

Code CPT Long Descriptions

Our claims data show that, in most cases patients furnished the pulmonary therapy services reported by HCPCS codes G0237, G0238, and G0239 in the HOPD on a single date of service received some

S 2010 New 0943 G0424Pulmonary rehabilitation, including exercise (includes monitoring), per hour, per session


individual and some group services (approximately 2.4 units of service per day) and, less often, associated assessments and tests.

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• We are adopting new HCPCS code G0424 (Pulmonary rehabilitation, including exercise (includes monitoring),rehabilitation, including exercise (includes monitoring), per hour, per session) and are assigning the G-code to new APC 0102 (Level II Pulmonary Treatment), with a simulated “per-session” median cost of approximately $50.

• As discussed in the CY 2010 MPFS final rule with comment period PR is covered for up to 36 one-hour


comment period, PR is covered for up to 36 one-hour sessions, with a maximum of 2 sessions per day, and with contractor discretion to approve to up to 72 sessions.

Anesthesia ServicesAdds Deletes Descriptions

0 1 0

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Anesthesia Services

SI Year ActionRev

Code CPT Long DescriptionAnesthesia for open or surgical arthroscopic

N 2010 DEL0963, 0964 01632

Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; radical resection

N 2010Existing

Code0963, 0964 01630

Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; not otherwise specified

Anesthesia for open or surgical arthroscopic


N 2010Existing

Code0963, 0964 01638

p g pprocedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; total shoulder replacement

CardiologyAdds Deletes Descriptions

1 3 10

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Cardiology Updates

SI Year ActionRev


Programming device evaluation with iterative

S 2009 Desc 0480 93279

Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; single lead pacemaker system

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 physician analysis, review and


Same descriptor changes are effective for the following CPT codes:93280, 93281, 93282, 93283, 93284, 93285, 93286 and 93287

S 2010 Desc 0480 93279 report; single lead pacemaker system

Cardiology Updates

SI Year ActionRev

Code CPT Long DescriptionS 2009 Desc 0480 93701 Bioimpedance thoracic electricalS 2009 Desc 0480 93701 Bioimpedance, thoracic, electrical

S 2010 Desc 0480 93701Bioimpedance-derived physiologic cardiovascular analysis

Currently, there are two FDA-approved electrical bioimpedance devices in the marketplace: Bio Z® (Cardiodynamics, Inc.), and TEBCO (Thoracic Electrical Bioimpedance Cardiac Output, Hemo Sapiens, Inc.).


( p p , p , )

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Noninvasive Hemodynamic Monitoring:Impedance Cardiography (ICG)

• 4 dual sensors with 8 lead wires placed on neck and chest

• Current transmitted by outer electrodes and seeks path of least resistance: blood filled aorta

• Baseline impedance (resistance) is measured using inner electrodes

• With each heartbeat, blood volume and velocity in the aorta change

• Corresponding change in impedance is measured


is measured

• Baseline and changes in impedance are used to measure and calculate hemodynamic parameters

Cardiology Updates

SI Year ActionRev


S 2010 New 0480 93750

Interrogation of ventricular assist device (VAD), in person, with physician analysis of device parameters (eg, drivelines, alarms, power surges), review of device function (eg, flow and volume status, septum status, recovery), with programming, if performed, and report


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Ventricular Assist Device

•


Cardiology Updates

SI Year ActionRev

Code CPT Long Description0730 A ti h t d di d t l i

B 2009 DEL0730, 0739 0068T

Acoustic heart sound recording and computer analysis; with interpretation and report

N 2009 DEL0730, 0739 0069T

Acoustic heart sound recording and computer analysis; acoustic heart sound recording and computer analysis only

B 2009 DEL0730, 0739 0070T

Acoustic heart sound recording and computer analysis; interpretation and report only

S 2010 Exist 0480 93799 Unlisted cardiovascular service or procedure


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GI LaboratoryAdds Deletes Descriptions

3 5 23

GI Laboratory

SI Y A tiRev C d CPT L D i tiSI Year Action Code CPT Long Descriptions

T 2009 Desc0360, 0750 31622

Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing (separate procedure)

T 2010 Desc0360, 0750 31622

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)


Same description change noted in the following CPT codes:

31641, 31643, 31645, 31646, and 31656

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GI Laboratory

SI Year ActionRev Code CPT Long Descriptions

T 2010 New0360, 0750 31626

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple

T 2010 New0360, 0750 31627

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s])


GI Laboratory


T 2009 Desc036X, 075X 43761

Repositioning of the gastric feeding tube, through the duodenum for enteric nutrition

T 2010 Desc036X, 075X 43761

Repositioning of a naso- or oro-gastric feeding tube, through the duodenum for enteric nutrition


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GI Laboratory


T 2009 DEL036X, 075X 46210 Cryptectomy; single

Cryptectomy-Excision of a cryptCrypt-One of a number of small indentations lying immediately behind the junction of the anal skin and rectal mucosa

T 2009 DEL036X, 075X 46211 Cryptectomy; multiple (separate procedure)

T 2010 Exist036X, 075X 46999 Unlisted procedure, anus


anal skin and rectal mucosa

GI Laboratory

RevSI Year Action

Rev Code CPT Long Descriptions

T 2009 Desc036X, 075X 46200 Fissurectomy, with or without sphincterotomy

T 2010 Desc036X, 075X 46200

Fissurectomy, including sphincterotomy, when performed

T 2009 Desc036X, 075X 46220

Papillectomy or excision of single tag, anus (separate procedure)

036X, 0 f


T 2010 Desc 075X 46220 Excision of single external papilla or tag, anus

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GI Laboratory

SI Year ActionRev Code CPT Long DescriptionsSI Year Action Code CPT Long Descriptions

T 2009 Desc036X, 075X 46221

Hemorrhoidectomy, by simple ligature (eg, rubber band)

T 2010 Desc036X, 075X 46221

Hemorrhoidectomy, internal, by rubber band ligation(s)

T 2009 Desc036X, 075X 46230

Excision of external hemorrhoid tags and/or multiple papillae

T 2010 Desc036X, 075X 46230 Excision of multiple external papillae or tags, anus


T 2009 Desc036X, 075X 46250 Hemorrhoidectomy, external, complete

T 2010 Desc036X, 075X 46250

Hemorrhoidectomy, external, 2 or more columns/groups

GI Laboratory


T 2009 Desc036X, 075X 46255 Hemorrhoidectomy, internal and external, simple;

T 2010 Desc036X, 075X 46255

Hemorrhoidectomy, internal and external, single column/group;

T 2009 Desc036X, 075X 46258

Hemorrhoidectomy, internal and external, simple; with fistulectomy, with or without fissurectomy

036XHemorrhoidectomy, internal and external, single

l / ith fi t l t i l di


T 2010 Desc036X, 075X 46258

column/group; with fistulectomy, including fissurectomy, when performed

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GI Laboratory

Rev SI Year Action Code CPT Long Descriptions

T 2009 Desc036X, 075X 46260

Hemorrhoidectomy, internal and external, complex or extensive;

T 2010 Desc036X, 075X 46260

Hemorrhoidectomy, internal and external, 2 or more columns/groups;

T 2009 Desc036X, 075X 46262

Hemorrhoidectomy, internal and external, complex or extensive; with fistulectomy, with or without fissurectomy


T 2010 Desc036X, 075X 46262

Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fistulectomy, including fissurectomy, when performed

GI Laboratory

SI Year ActionRev Code CPT Long Descriptionsg p

T 2009 Desc036X, 075X 46275

Surgical treatment of anal fistula (fistulectomy/fistulotomy); submuscular

T 2010 Desc036X, 075X 46275

Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric

T 2009 Desc036X, 075X 46280

Surgical treatment of anal fistula (fistulectomy/fistulotomy); complex or multiple, with or without placement of seton


T 2010 Desc036X, 075X 46280

Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or multiple, including placement of seton, when performed

40

GI Laboratory


T 2009 Desc036X, 075X 46320

Enucleation or excision of external thrombotic hemorrhoid

T 2010 Desc036X, 075X 46320 Excision of thrombosed hemorrhoid, external

T 2009 DEL036X, 075X 46937 Cryosurgery of rectal tumor; benign

T 2009 DEL036X, 075X 46938 Cryosurgery of rectal tumor; malignant


T 2010 Exist036X, 075X 45190

Destruction of rectal tumor (eg, electrodesiccation, electrosurgery, laser ablation, laser resection, cryosurgery) transanal approach

GI Laboratory

SI Year ActionRev Code CPT Long Descriptions036X,

T 2009 Desc,

075X 46945 Ligation of internal hemorrhoids; single procedure

T 2010 Desc036X, 075X 46945

Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group

T 2009 Desc036X, 075X 46946

Ligation of internal hemorrhoids; multiple procedures

036X, 0 X

Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid

l /


T 2010 Desc 075X 46946 columns/groups

T 2009 DEL036X, 075X 0170T

Repair of anorectal fistula with plug (eg, porcine small intestine submucosa [SIS])

2010 New036X, 075X 46707

Repair of anorectal fistula with plug (eg, porcine small intestine submucosa [SIS])

41

GI Laboratory

SI Year ActionRev

Code CPT Long Descriptiong

T 2009 Desc0940, 0949 96570

Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); first 30 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and esophagus)

Photodynamic therapy by endoscopic application


T 2010 Desc0940, 0949 96570

Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); first 30 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract)

GI Laboratory

SI Year ActionRev

Code CPT Long DescriptionSI Year Action CPT g p

T 2009 Desc0940, 0949 96571

Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); each additional 15 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and esophagus)

Photodynamic therapy by endoscopic application


T 2010 Desc0940, 0949 96571

Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); each additional 15 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract)

42

Neurology UpdatesAdds Deletes Descriptions

3 0 1

Neurology Updates

SI Year ActionRev


0519 Sleep study simultaneous recording of ventilation

S 2009 Desc

0519, 0920, 0929 95806

Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, unattended by a technologist

S 2010 Desc

0519, 0920, 0929 95806

Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)


43

Neurology Updates


S 2010 New

0519, 0920, 0929 0203T

Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone) and sleep time

S 2010 New

0519, 0920, 0929 0204T

Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone)


S 2010 New

0519, 0920, 0929 95905

Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report

Radiology ServicesService Adds Deletes DescriptionsRad S&I 13 19 2Surg Codes 22 7 1

44

CT Scan Updates

SI Year ActionRev


Computed tomography, heart, without contrast

S 2010 DEL0350, 0352 0144T

p g p ymaterial, including image postprocessing and quantitative evaluation of coronary calcium

S 2010 DEL0350, 0352 0145T

Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; cardiac structure and morphology


CT Scan Updates

SI Year ActionRev

Code CPT Long DescriptionComputed tomography heart with contrast

S 2010 DEL0350, 0352 0146T

Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), without quantitative evaluation of coronary calcium

Computed tomography, heart, with contrast material(s), including noncontrast images, if


S 2010 DEL0350, 0352 0147T

material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), with quantitative evaluation of coronary calcium

45

CT Scan Updates

SI Year ActionRev


Computed tomography, heart, with contrast

S 2010 DEL0350, 0352 0148T

material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; cardiac structure and morphology and computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), without quantitative evaluation of coronary calcium

Computed tomography, heart, with contrast material(s) including noncontrast images if


S 2010 DEL0350, 0352 0149T

material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; cardiac structure and morphology and computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), with quantitative evaluation of coronary calcium

CT Scan Updates

SI Year ActionRev


S 2010 DEL0350, 0352 0150T

Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; cardiac structure and morphology in congenital heart diseaseComputed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing function evaluation (left and right


S 2010 DEL0350, 0352 0151T

postprocessing, function evaluation (left and right ventricular function, ejection-fraction and segmental wall motion) (List separately in addition to code for primary procedure)

46

CT Scan Updates

RSI Year Action


SI 2010 New0350, 0352 75571

Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium

SI 2010 New0350, 0352 75572

Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)


CT Scan Updates

SI Year ActionRev

Code CPT Long DescriptionComputed tomography, heart, with contrast material, for

SI 2010 New0350, 0352 75573

p g p y, , ,evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment of LV cardiac function, RV structure and function and evaluation of venous structures, if performed)

0350,

Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac


SI 2010 New 0352 75574 function, and evaluation of venous structures, if performed)

47

CT Scan Update

SI Y A tiRev

C d CPT L D i tiSI Year Action Code CPT Long Description

E 2009 DEL

0350, 0352, 0750 0066T

Computed tomographic (CT) colonography (ie, virtual colonoscopy); screening

E 2010 New

0350, 0352, 0750 74263

Computed tomographic (CT) colonography, screening, including image postprocessing


E 2010 New 0750 74263 including image postprocessing

CT Scan Update

SI Year ActionRev


Q3 2009 DEL

0350, 0352, 0750 0067T

Computed tomographic (CT) colonography (ie, virtual colonoscopy); diagnostic

Q3 2010 New

0350, 0352, 0750 74261

Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material

0350, Computed tomographic (CT) colonography, diagnostic,


Q3 2010 New0352, 0750 74262

including image postprocessing; with contrast material(s) including non-contrast images, if performed

48

MRI Updates

SI Year ActionRev


0610Cardiac magnetic resonance imaging for morphology and f ti ith t t t t i l ith fl / l it

E 2009 DEL0610, 0614 75558

function without contrast material; with flow/velocity quantification

E 2009 DEL0610, 0614 75560

Cardiac magnetic resonance imaging for morphology and function without contrast material; with flow/velocity quantification and stress

E 2009 DEL0610, 0614 75562

Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with flow/velocity quantificationCardiac magnetic resonance imaging for morphology and


E 2009 DEL0610, 0614 75564

function without contrast material(s), followed by contrast material(s) and further sequences; with flow/velocity quantification and stress

E 2010 New0610, 0614 75565

Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary procedure)

MRA - Contrast

Rev

• FDA approves gadofosveset trisodium (Vasovist) as first contrast agent for magnetic resonance

SI Year Action Code CPT Long DescriptionG 2010 New 636 A9583 Gadofosveset trisodium inj, 1 ml


first contrast agent for magnetic resonance angiography (MRA)

49

Nuclear Medicine Updates

SI Y A tiRev


S 2009 DEL0340, 0341 78460

Myocardial perfusion imaging; (planar) single study, at rest or stress (exercise and/or pharmacologic), with or without quantification

S 2010 New0340, 0341 78453

Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)



SI Year ActionRev

Code CPT Long DescriptionMyocardial perfusion imaging; multiple studies (planar), at

d/ ( i d/ h l i ) d

S 2009 DEL0340, 0341 78461

rest and/or stress (exercise and/or pharmacologic), and redistribution and/or rest injection, with or without quantification

S 2010 New0340, 0341 78454

Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection


50


SI Year ActionRev


S 2009 DEL0340, 0341 78464

Myocardial perfusion imaging; tomographic (SPECT), single study (including attenuation correction when performed), at rest or stress (exercise and/or pharmacologic), with or without quantification

S 2010 New0340, 0341 78451

Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)


S 2010 New 0341 78451 rest or stress (exercise or pharmacologic)


SI Year ActionRev


S 2009 DEL0340, 0341 78465

Myocardial perfusion imaging; tomographic (SPECT), multiple studies (including attenuation correction when performed), at rest and/or stress (exercise and/or pharmacologic) and redistribution and/or rest injection, with or without quantification

Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique,


S 2010 New0340, 0341 78452

wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection

51


SI Year ActionRev


0340, Myocardial perfusion study with wall motion, qualitative or quantitative study (List separately in addition to code for

N 2009 DEL 0341 78478 primary procedure)

N 2009 DEL0340, 0341 78480

Myocardial perfusion study with ejection fraction (List separately in addition to code for primary procedure)

S 2010 NEW0340, 0341 78451

Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)


S 2010 NEW0340, 0341 78452

Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection


SI Year ActionRev

Code CPT Long DescriptionMyocardial perfusion study with wall motion qualitative or

N 2009 DEL0340, 0341 78478

Myocardial perfusion study with wall motion, qualitative or quantitative study (List separately in addition to code for primary procedure)

N 2009 DEL0340, 0341 78480


S 2010 NEW0340, 0341 78453

Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study at rest or stress (exercise or pharmacologic)


S 2010 NEW 0341 78453 single study, at rest or stress (exercise or pharmacologic)

S 2010 NEW0340, 0341 78454

Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection

52


CPT 78465Myocardial perfusion imaging; tomographic (SPECT) multiple studies

CPT 78452Myocardial perfusion imaging, tomographic (SPECT) (including

What is reportable in 2009: In 2010 one code will be reportable:

tomographic (SPECT), multiple studies (including attenuation correction when performed), at rest and/or stress (exercise and/or pharmacologic) and redistribution and/or rest injection, with or without quantification

CPT 78478Myocardial perfusion study with wall motion, qualitative or quantitative study (List separately in addition to code for primary procedure)

tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection


primary procedure)CPT 78480


Nuclear Medicine-Radiopharmaceutical Updates


H 2009 Del 0344 A9605Samarium Sm-153 lexidronamm, therapeutic, per 50 millicuries

H 2010 New 0344 A9604

Samarium MS-153 Lexidronam Therapeutic per Treatment Dose up to 150 millicuries

G 2009 Del 0343 C9246 Injection, gadoxetate disodium, per mlG 2010 New 0343 A9581 Gadoxetate disodium inj per 1 ml


G 2010 New 0343 A9581 Gadoxetate disodium inj per 1 ml

G 2009 Del 0343 C9247Iobenguane, I-123, diagnostic, per study dose, up to 10 millicuries

G 2010 New 0343 A9582 Iodine I-123 iobenguane up to 15 millicurie

53

Interventional Radiology

SI Year ActionRev


N 2009 Desc 032X 72291

Radiological supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation including cavity creation, per vertebral body; under fluoroscopic guidance

Radiological supervision and interpretation percutaneous


N 2010 Desc 032X 72291

Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance


SI Year ActionRev


Q2 2009 DEL 032X 75790Angiography, arteriovenous shunt (eg, dialysis patient), radiological supervision and interpretation

Q2 2010 New 032X 75791

Angiography, arteriovenous shunt (eg, dialysis patient fistula/graft), complete evaluation of dialysis access, including fluoroscopy, image documentation and report (includes injections of contrast and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava), radiological supervision and interpretation


54


SI Year ActionRev


N 2009 Desc 032X 77003

Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint), including neurolytic agent destructionFluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, or sacroiliac joint), including neurolytic agent


N 2010 Desc 032X 77003 destruction

Interventional Radiology-Surgical Procedures

RevSI Year Action


N 2009 Desc

0360, 0361, 032X 19295

Image guided placement, metallic localization clip, percutaneous, during breast biopsy (List separately in addition to code for primary procedure)

N 2010 Desc

0360, 0361, 032X 19295

Image guided placement, metallic localization clip, percutaneous, during breast biopsy/aspiration (List separately in addition to code for primary procedure)


55


SI Year ActionRev


E 2009 DEL

0360, 0361, 032X 0062T

Percutaneous intradiscal annuloplasty, any method except electrothermal, unilateral or bilateral including fluoroscopic guidance; single level

E 2010 Exist

0360, 0361, 032X 22526

Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level

0360, 0361,

Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional


E 2010 Exist 032X 22527 levels (List separately in addition to code for primary procedure)

T 2010 Exist

0360, 0361, 032X 22899 Unlisted procedure, spine


SI Year ActionRev


0360Percutaneous intradiscal annuloplasty, any method except electrothermal unilateral or bilateral including fluoroscopic

E 2009 DEL

0360, 0361, 032X 0063T

electrothermal, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (List separately in addition to 0062T for primary procedure)

E 2010 Exist

0360, 0361, 032X 22526

Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level

E 2010 Exist

0360, 0361, 032X 22527

Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (List separately in addition to code for primary procedure)


E 2010 Exist 032X 22527 levels (List separately in addition to code for primary procedure)

T 2010 Exist

0360, 0361, 032X 22899 Unlisted procedure, spine

56


SI Year ActionRev


N 2009 DEL

0360, 0361, 032X 36145

Introduction of needle or intracatheter; arteriovenous shunt created for dial sis (cann la fist la or graft)N 2009 DEL 032X 36145 created for dialysis (cannula, fistula, or graft)

T 2010 New

0360, 0361, 032X 36147

Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection[s] of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava)

0360Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); additional access for therapeutic


N 2010 New

0360, 0361, 032X 36148

created for dialysis (graft/fistula); additional access for therapeutic intervention (List separately in addition to code for primary procedure)


SI Y A tiRev


T 2009 DEL

0360, 0361, 032X, 0350 64470

Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level

T 2010 New

0360, 0361, 032X, 0350 64490

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level


57



T 2009 DEL

0360, 0361, 032X, 0350 64472

Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, each additional level (List separately in addition to code for primary procedure)

T 2010 New

0360, 0361, 032X, 0350 64491

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure)


T 2010 New

0360, 0361, 032X, 035X 64492

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure)


SI Year ActionRev

Code CPT Long Descriptiong p

T 2009 DEL

0360, 0361, 032X, 035X 64475

Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level

T 2010 New

0360, 0361, 032X, 035X 64493

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level


58


SI Year ActionRev


0360, Injection, anesthetic agent and/or steroid, paravertebral facet joint

T 2009 DEL0361, 032X 64476

or facet joint nerve; lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

T 2010 New

0360, 0361, 032X, 035X 64494

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)

0360, 0361,

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any


T 2010 New032X, 035X 64495

additional level(s) (List separately in addition to code for primary procedure)


SI Year ActionRev


T 2010 N

0360, 0361, 032X 0200T

Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device,

h d 1 dlT 2010 New 032X 0200T when used, 1 or more needles

T 2010 New

0360, 0361, 032X 0201T

Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles

C 2010 New

0360, 0361, 032X 0202T

Posterior vertebral joint(s) arthroplasty (eg, facet joint[s] replacement), including facetectomy, laminectomy, foraminotomy, and vertebral column fixation, injection of bone cement, when performed, including fluoroscopy, single level, lumbar spine


59


SI Year ActionRev


T 2010 New

0360, 0361, 0402 0213T

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level

T 2010 New

0360, 0361, 0402 0214T

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; second level (List separately in addition to code for primary procedure)


T 2010 New 0214T p y p y p )


SI Year ActionRev


T 2010 New

0360, 0361, 0402 0215T

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; third or any additional level (s) (List separately in addition to code for primary procedure)

T 2010 New

0360, 0361, 0402 0216T

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level


T 2010 New

0360, 0361, 0402 0217T

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; second level

60


SI Y A tiRev


T 2010 New

0360, 0361, 0402 0218T

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)

C 2010 New

0360, 0361, 032X 0219T

Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; cervical

0360 Pl t f t i i t f t i l t( ) il t l


C 2010 New

0360, 0361, 032X 0220T

Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; thoracic


SI Year ActionRev


T 2010 New

0360, 0361, 032X 0221T

Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; lumbar

T 2010 New

0360, 0361, 032X 0222T

Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; each additional vertebral segment (List separately in addition to code for primary procedure)


T 2010 New 032X 0222T procedure)

61


SI Year ActionRev


T 2009 Del0361, 032X G0392

Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; arterial

T 2009 Del

0360, 0361, 032X G0393

Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; venous

T 2010 Exist

0360, 0361, 032X 35475

Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel

0360, 0361,


T 2010 Exist,

032X 35476 Transluminal balloon angioplasty, percutaneous; venous

Radiation OncologyAdds Deletes Descriptions

3 0 3

62

Radiation Oncology Updates

RevSI Year Action


S 2009 Desc 0333 77371

Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 basedRadiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi


S 2010 Desc 0333 77371of cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 based

What changed in this code’s description?


SI Year ActionRev


X 2010 New 0333 77338

Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan


63


SI Year ActionRev


Placement of interstitial device(s) for radiation

X 2009 Desc0361, 0333 55876

Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple

X 2010 Desc0361, 0333 55876

Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, prostate, single or multiple



SI Year ActionRev

Code CPT Long DescriptionsPl f i i i l d i ( ) f di i

X 2010 New0361, 0333 49411

Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple

X 2010 New0361, 0333 32553

Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple


p , , g p

64


SI Year ActionRev


N 2010 New 0333 0197T

Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg, 3D positional tracking, gating, 3D surface tracking), each fraction of treatment


Evaluation & Management CPT UpdatesAdds Deletes Descriptions

3 0 10

65

Evaluation & Management CPT Updates




66


SI Year Action CPT Long Descriptions

Initial nursing facility care per day Physicians typicallyB 2009 Desc 99304

Initial nursing facility care, per day,....... Physicians typically spend 25 minutes with the patient and/or family or care

Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the


B 2010 Desc 99304

p p ( )patient’s and/or family’s needs. Usually, the problem(s) requiring admission are of low severity. Physicians typically spend 25 minutes at the bedside and on the patient's facility floor or unit.

Same descriptor change is made to the following CPT codes:99305, 99306, 99307, 99308, 99309. 99310 and 99318


SI Year Action CPT Long Descriptions

B 2009 Desc 99358

Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); first hour (List separately in addition to code(s) for other physician service(s) and/or inpatient or outpatient Evaluation and Management service)

B 2010 Desc 99358Prolonged evaluation and management service before and/or after direct (face-to-face) patient care; first hour


67


SI Year Action CPT Long DescriptionsProlonged evaluation and management service before and/or after direct

B 2009 Desc 99359

Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); each additional 30 minutes (List separately in addition to code for prolonged physician service)

Prolonged evaluation and management service before and/or after direct (face-to-face) patient care; each additional 30 minutes (List separately in


B 2010 Desc 99359 addition to code for prolonged physician service)

Physician Reporting

SI Year Action CPT Long DescriptionsC 2010 N G0425 I t t l h lth lt 30C 2010 New G0425 Inpt telehealth consult 30mC 2010 New G0426 Inpt telehealth consult 50mC 2010 New G0427 Inpt telehealth con 70/>m

Status indicator “C” representing “Inpatient Only”Professional Component billing. Not new codes, however, changed


From SI of “M” in 2009 to “C” for 2010

68

Clinic UpdateAdds Deletes Descriptions

5 3 3

Clinic Updates - Urology

SI Year ActionRev

Code CPT Long Descriptors

T 2009 Desc

0510, 0361, 0920 51726

Complex cystometrogram (eg, calibrated electronic equipment)

T 2010 Desc

0510, 0361, 0920 51726

Complex cystometrogram (ie, calibrated electronic equipment);


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SI Year ActionRev


0510

T 2009 DEL

0510, 0361, 0920 51772

Urethral pressure profile studies (UPP) (urethral closure pressure profile), any technique

T 2010 New

0510, 0361, 0920 51727

Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique



SI Year ActionRev

Code CPT Long Descriptors0510,

T 2009 DEL0361, 0920 51795

Voiding pressure studies (VP); bladder voiding pressure, any technique

T 2010 New

0510, 0361, 0920 51729

Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile), any technique


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SI Year ActionRev


T 2009 Desc

0510, 0361, 0920 51797

Voiding pressure studies (VP); intra-abdominal voiding pressure (AP) (rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure)

T 2010 Desc

0510, 0361, 0920 51797

Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure)



SI Year ActionRev

Code CPT Long Descriptors0510, 0361

T 2009 Desc0361, 0920 52282 Cystourethroscopy, with insertion of urethral stent

T 2010 Desc

0510, 0361, 0920 52282

Cystourethroscopy, with insertion of permanent urethral stent

T 2009 DEL

0510, 0361, 0920 0084T Insertion of a temporary prostatic urethral stent0510, 0361, Insertion of a temporary prostatic urethral stent, including


T 2010 New0361, 0920 53855

Insertion of a temporary prostatic urethral stent, including urethral measurement

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Clinic Updates - Ocular

SI Year ActionRev


Meibomian glands-Glands in the eyelid that secrete a sebaceous b t th t k th lid f dh i t h th

SI Year Action CPT g p

S 2010 New

0510, 0361, 0920 0198T

Measurement of ocular blood flow by repetitive intraocular pressure sampling, with interpretation and report

S 2010 New

0510, 0361, 0920 0207T

Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral


substance that keeps the lids from adhering to each other

Meibomian glands


72

Specialized Clinics/ Outpatient New CPT Code(s)


Specialized Clinics/ Outpatient New CPT Code(s)

Rev SI Year Code CPT Long Descriptions

A 2090051X, 0761 95992 Canalith repositioning proc

E 2010 NR 95992 Canalith repositioning proc


73

Cardiac Catheterization UpdatesAdds Deletes Descriptions

3 0 3

Cardiac Catheterization Updates

SI Year ActionRev


T 2009 Desc036X, 048X 33216

Insertion of a transvenous electrode; single chamber (1 electrode) permanent pacemaker or single chamber pacing cardioverter-defibrillator

T 2010 Desc036X, 048X 33216

Insertion of a single transvenous electrode, permanent pacemaker or cardioverter-defibrillator


74


SI Year ActionRev


T 2009 Desc036X, 048X 33217

Insertion of a transvenous electrode; dual chamber (2 electrodes) permanent pacemaker or dual chamber pacing cardioverter-defibrillator

T 2010 Desc036X, 048X 33217

Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverter-defibrillator

T 2009 Desc036X, 048X 33223

Revision of skin pocket for single or dual chamber pacing cardioverter-defibrillator


T 2010 Desc036X, 048X 33223 Revision of skin pocket for cardioverter-defibrillator


RevSI Year Action


C 2010 New036X, 048X 33782

Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (ie, Nikaidoh procedure); without coronary ostium reimplantation

C 2010 New036X, 048X 33783

Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (ie, Nikaidoh procedure); with reimplantation of 1 or both coronary ostia


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Aortic Root Translocation



SI Year ActionRev


N 2010 New036X, 048X 0205T

Intravascular catheter-based coronary vessel or graft spectroscopy (eg, infrared) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation, and report, each vessel (List separately in addition to code for primary procedure)


76

Miscellaneous Code ChangesAdds Deletes Descriptions

0 2 0

Miscellaneous Code Changes


N 2010 DEL0940, 0949 99185 Hypothermia; regional

N 2010 DEL0940, 0949 99186 Hypothermia; total body

B 2010 Exist ?? 99199 Unlisted special service, procedure or report


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Educational Services

SI Year ActionRev

Code CPT Long Descriptorsg p

A 2010 New 0942 G0420

Educational services related to the care of chronic kidney disease; individual per session, per hour, face-to-face

A 2010 New 0942 G0421

Educational services related to the care of chronic kidney disease; group, per session, per hour, face-to-face


A 2010 New 0942 G0421 face


Pay under the MPFS for covered KDE services furnished by qualified persons that are hospitals, CAHs, SNFs,by qualified persons that are hospitals, CAHs, SNFs, CORFs, HHAs, or hospices that are located in a rural area or are treated as being rural under §412.103.

We have adjusted the final CY 2010 values for HCPCS codes G0420 and G0421 to reflect not only the final specification of the time of one hour for an individual or group KDE session but also to reflect the appropriate


group KDE session but also to reflect the appropriate supplies and equipment without duplication.

78


Pay under the MPFS for covered KDE services furnished by qualified persons:by qualified persons:

Physician

Physician Assistant (PA)

Nurse Practitioner (NP)

Clinical Nurse Specialist (CNS)


We are defining stage IV CKD as “kidney damage with a severe decrease in glomerular filtration rate (GFR) quantitatively defined by a GFR value of 15-29 ml/min/1.73m2, using the MDRD Study formula,” and required that the beneficiary obtain a referral from the physician managing the beneficiary’s kidney condition.

Pharmacy Updates

Adds Deletes DescriptionsStatus Changes

26 17 3 10

79

Pharmacy Updates

SI Year ActionRev


E 2009 DEL0250, 0636 90379

Respiratory syncytial virus immune globulin (RSV-IgIV), human, for intravenous use

K 2009 Desc 0636 90378Respiratory syncytial virus immune globulin (RSV-IgIM), for intramuscular use, 50 mg, each

K 2010 Desc 0636 90378

Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each


Pharmacy Updates

SI Year ActionRev


L 2009 Desc 0636 90669

Pneumococcal conjugate vaccine, polyvalent, when administered to children younger than 5 years, for intramuscular use

L 2010 Desc 0636 90669Pneumococcal conjugate vaccine, 7 valent, for intramuscular use

E 2010 New0250, 0636 90670

Pneumococcal conjugate vaccine, 13 valent, for intramuscular use


80

Pharmacy Updates

SI Year ActionRev


M 2009 Desc 0250 90738Japanese encephalitis virus vaccine, inactivated, for intramuscular use

M 2010 Desc 0250 90738Japanese encephalitis virus vaccine, inactivated, for intramuscular use

What changed?


Pharmacy Updates - MRA

Rev

• FDA approves gadofosveset trisodium (Vasovist) as first contrast agent for magnetic resonance

SI Year Action Code CPT Long DescriptionG 2010 New 636 A9583 Gadofosveset trisodium inj, 1 ml


first contrast agent for magnetic resonance angiography (MRA)

81

Pharmacy Updates – Nuclear Medicine

RevSI Year Action


H 2009 Del 0344 A9605Samarium Sm-153 lexidronamm, therapeutic, per 50 millicuries

H 2010 New 0344 A9604Samarium MS-153 Lexidronam Therapeutic per Treatment Dose up to 150 millicuries

G 2009 Del 0343 C9246 Injection, gadoxetate disodium, per mlG 2010 New 0343 A9581 Gadoxetate disodium inj per 1 ml


G 2010 New 0343 A9581 Gadoxetate disodium inj per 1 ml

G 2009 Del 0343 C9247Iobenguane, I-123, diagnostic, per study dose, up to 10 millicuries

G 2010 New 0343 A9582 Iodine I-123 iobenguane up to 15 millicuries

Pharmacy Updates

SI Year ActionRev

Code CPT Long DescriptionG 2009 Del 0636 C9245 Injection, romiplostim, 10 mcgG 2010 New 0636 J2796 Romiplostim injection 10 mcg

G 2009 Del 0636 C9249 Injection, certolizumab pegol, 1 mgG 2010 New 0636 J0718 Certolizumab pegol inj per 1 mg

Injection C1 esterase inhibitor (human)


G 2009 Del 0636 C9251Injection, C1 esterase inhibitor (human), 10 units

G 2010 New 0636 J0598 C1 esterase inhibitor inj, 10 units

82

Pharmacy Update

SI Year ActionRev

Code CPT Long DescriptionG 2009 Del 0636 C9252 Injection, plerixafor, 1 mgG 2010 New 0636 J2562 Plerixafor injection, 1 mg

G 2009 Del 0636 C9253 Injection, temozolomide, 1mgG 2010 New 0636 J9328 Temozolomide injection, 1 mg

K 2009 Del 0636 J0835 Injection, cosyntropin, per 0.25 mg


K 2009 Del 0636 J0835 Injection, cosyntropin, per 0.25 mgK 2010 New 0636 J0833 Cosyntropin injection NOS, 0.25 mgK 2010 New 0636 J0834 Cosyntropin cortrosyn inj, 0.25 mg

Pharmacy Updates

SI Year ActionRev

Code CPT Long DescriptionHyaluronan or derivative Synvisc for

K 2009 Del 0636 J7322Hyaluronan or derivative, Synvisc, for intra-articular injection, per dose

K 2010 New 0636 J7325Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection, 1 mg

K 2009 Del 0636 J9170 Injection, docetaxel, 20 mgK 2010 New 0636 J9171 Docetaxel injection, 1 mg

Injection, factor VIII (antihemophilic


K 2009 Del 0636 Q2023 factor, recombinant) (Xyntha), per IU

K 2010 New 0636 J7185Factor VIII (Antihemophilic Factor, Recombinant) (Xyntha) Per I.U.

K 2009 Del 0636 Q2024 Injection, bevacizumab, 0.25 mgK 2010 New 0636 C9257 Bevacizumab injection, 0.25 MG

83

Pharmacy Update

SI Year ActionRev


N 2009 Del0250, 0636 J0460 Injection, atropine sulfate, up to 0.3 mg

N 2010 New0250, 0636 J0461 Atropine sulfate injection, 0.01 mg

N 2009 Del0250, 0636 J0530

Injection, penicillin G benzathine and penicillin G procaine, up to 600,000 units

N 2009 Del0250, 0636 J0540

Injection, penicillin G benzathine and penicillin G procaine up to 1 200 000


N 2009 Del 0636 J0540 penicillin G procaine, up to 1,200,000

N 2009 Del0250, 0636 J0550

Injection, penicillin G benzathine and penicillin G procaine, up to 2,400,000

N 2010 New0250, 0636 J0559 PenG benzathine/procaine inj, 2500 Units

Pharmacy Update


K 2009 Del 0636 J1565Injection, respiratory syncytial virus immune globulin, intravenous, 50 mg

K 2010 New 0636 C9254 Injection, lacosamide, 1 mgG 2010 New 0636 C9255 Paliperidone palmitate inj, 1 mgK 2010 New 0636 J0586 Abo botulinum toxin type A, 5 UnitsG 2010 New 0636 J1680 Human fibrinogen conc inj, 100 mg


84

Pharmacy Update

Rev SI Year Action Code CPT Long DescriptionK 2010 New 0636 J2793 Rilonacept injection, 1 mgG 2010 New 0636 J9155 Degarelix injection, 1 mg

G 2010 New 0636 Q0138Ferumoxytol, for treatment of iron deficiency anemia, 1 mg (NON-ESRD use)

A 2010 New 0636 Q0139Ferumoxytol, for treatment of iron deficiency anemia 1 mg (For Non ESRD on Dialysis)


A 2010 New 0636 Q0139 anemia, 1 mg (For Non-ESRD on Dialysis)

G 2010 New 0636 C9256 Dexamethasone intravitreal implant 0.1mg

Pharmacy Update

SI YearRev

Code CPT Long DescriptionsSI Year Code CPT Long Descriptions

K 20090250, 0636 90296 Diphtheria antitoxin

E 2010 NR 90296 Diphtheria antitoxin

N 20090250, 0636 90393 Vaccina ig, im

E 2010 NR 90393 Vaccina ig im


E 2010 NR 90393 Vaccina ig, im

N 20090250, 0636 90477 Adenovirus vaccine, type 7

E 2010 NR 90477 Adenovirus vaccine, type 7

85

Pharmacy Update

Rev C d L D i tiSI Year Code CPT Long Descriptions

N 20090250, 0636 90581 Anthrax vaccine, sc

E 2010 NR 90581 Anthrax vaccine, sc

N 20090250, 0636 90727 Plague vaccine, im


E 2010 NR 90727 Plague vaccine, im

K 20090250, 0636 J0128 Abarelix injection

E 2010 NR J0128 Abarelix injection

Pharmacy Update

SI YearRev

Code CPT Long Descriptions0250,

N 20090250, 0636 J0350 Injection anistreplase 30 u

E 2010 NR J0350 Injection anistreplase 30 u

N 20090250, 0636 J0395 Arbutamine hcl injection

E 2010 NR J0395 Arbutamine hcl injection

N 20090250, 0636 J1452 Intraocular Fomivirsen na


N 2009 0636 J1452 Intraocular Fomivirsen naE 2010 NR J1452 Intraocular Fomivirsen na

N 20090250, 0636 J2460 Oxytetracycline injection

E 2010 NR J2460 Oxytetracycline injection

86

DMEPOS/DME Devices/Supplies

Medical Devices/Implantables

SI YearRev

Code CPT Long DescriptionsSI Year CPT g pB 2009 L8680 Implt neurostim elctr eachN 2010 027X L8680 Implt neurostim elctr each

Code now reportable for hospital reporting under OPPS


87


SI Year ActionRev

Code CPT Long DescriptionA 2010 DEL 0274 L0210 Thoracic, rib beltA 2010 0 0 0 o ac c, b be t

A 2010 DEL 0274 L1800Knee orthotic (KO), elastic with stays, prefabricated, includes fitting and adjustment

A 2010 DEL 0274 L1815

Knee orthotic (KO), elastic or other elastic type material with condylar pad(s), prefabricated, includes fitting and adjustment

A 2010 DEL 0274 L1825Knee orthotic (KO), elastic knee cap, prefabricated, includes fitting and adjustment

A 2010 DEL 0274 L1901Ankle orthotic, elastic, prefabricated, includes fitting and adjustment (e.g., neoprene, Lycra)



SI Year ActionRev


A 2010 DEL 0274 L2770Addition to lower extremity orthotic, any material, per bar or joint

A 2010 DEL 0274 L3651

Shoulder orthotic (SO), single shoulder, elastic, prefabricated, includes fitting and adjustment (e.g., neoprene, Lycra)Shoulder orthotic (SO), double shoulder, elastic, prefabricated, includes fitting and adjustment (e.g.,


A 2010 DEL 0274 L3652prefabricated, includes fitting and adjustment (e.g., neoprene, Lycra)

A 2010 DEL 0274 L3700Elbow orthotic (EO), elastic with stays, prefabricated, includes fitting and adjustment

88


SI Year ActionRev


A 2010 DEL 0274 L3701Elbow orthotic (EO), elastic, prefabricated, includes fitting and adjustment (e.g., neoprene, Lycra)

A 2010 DEL 0274 L3909Wrist orthotic (WO), elastic, prefabricated, includes fitting and adjustment (e.g., neoprene, Lycra)Wrist hand finger orthotic (WHFO), elastic, prefabricated, includes fitting and adjustment (e.g.,


A 2010 DEL 0274 L3911p , g j ( g ,neoprene, Lycra)

A 2010 DEL 0274 L6639Upper extremity addition, heavy-duty feature, any elbow


SI Year ActionRev

Code CPT Long DescriptionA 2010 NEW 0274 L8031 Breast prosthesis w adhesiveA 2010 NEW 0274 L8032 Reusable nipple prosthesisA 2010 NEW 0274 L8627 CID ext speech process replA 2010 NEW 0274 L8628 CID ext controller replA 2010 NEW 0274 L8629 CID transmit coil and cableA 2010 NEW 0274 L5973 Ank-foot sys dors-plant flex


89


SI Year ActionRev

Code CPT Long DescriptionSI Year Action Code CPT Long DescriptionE 2010 NEW 0290 A4264 Intratubal occlusion deviceA 2010 NEW 0290 A4336 Urethral insertA 2010 NEW 0290 A4360 Disposable ext urethral devY 2010 NEW 0290 E0433 Portable liquid oxygen sysY 2010 NEW 0290 E1036 Patient transfer system >300E 2010 NEW 0290 A4466 Elastic garment/covering



SI Year ActionRev

Code CPT Long DescriptionA 2009 DEL 0290 A4365 Adhesive remover wipes any type per 50A 2009 DEL 0290 A4365 Adhesive remover wipes, any type, per 50A 2010 NEW 0290 A4456 Adhesive remover, wipes

Y 2009 DEL 0290 Q4080

Iloprost, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, 20 mcg

Y 2010 NEW 0290 Q4074 Iloprost non-comp unit dose


90


SI Year ActionRev

Code CPT Long Descriptiong pE 2010 NEW 0290 L2861 Torsion mechanism knee/ankleE 2010 NEW 0290 L3891 Torsion mechanism wrist/elboE 2010 NEW 0290 L8692 Non-osseointegrated snd procA 2010 NEW 0290 Q0506 Lith-ion batt elec/pneum VAD



SI Year ActionRev

Code CPT Long DescriptionComposite dressing, pad size 16 sq in or less,

E 2009 DEL 0290 A6200p g, p q ,

without adhesive border, each dressing

E 2009 DEL 0290 A6201

Composite dressing, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing

E 2009 DEL 0290 A6202Composite dressing, pad size more than 48 sq in, without adhesive border, each dressing

E 2009 DEL 0290 A6542 G di t i t ki t d


E 2009 DEL 0290 A6542 Gradient compression stocking, custom made

E 2009 DEL 0290 A6543 Gradient compression stocking, lymphedema

91



Y 2009 DEL 0290 E2223Manual wheelchair accessory, valve, any type, replacement only, each

Y 2009 DEL 0290 E2393Power wheelchair accessory, valve for pneumatic tire tube, any type, replacement only, each

Y 2009 DEL 0290 E2399

Power wheelchair accessory, not otherwise classified interface, including all related electronics and any type mounting hardware


Clinical Discussions

92

Direct Supervision

• Services furnished at a department of a facility, that has provider based status in relation to athat has provider-based status in relation to a hospital must be under the direct supervision of a physician


Physician Supervision

• The definition of direct supervision in existing §410 27(f) has included and would continue§410.27(f) has included and would continue to specify under our CY 2010 proposal that the physician or nonphysician practitioner must be available to furnish assistance and direction throughout the performance of the procedure. This means that the physician or


nonphysician practitioner must be prepared to step in and perform the service, not just to respond to an emergency.

93


We originally stated in the April 2000 OPPS final rule (65 FR 18525) that the physicianfinal rule (65 FR 18525) that the physician does not “necessarily need to be of the same specialty as the procedure or service that is being performed.” We also have stated in manual guidance that hospital medical staff that supervises the services “need not be in


the same department as the ordering physician” •(Section 20.5.1 of Chapter 6 of the Medicare Benefits Policy Manual).


• However, in order to furnish appropriate assistance and direction for any given serviceassistance and direction for any given service or procedure, we believed the supervisory physician or nonphysician practitioner must have, within his or her State scope of practice and hospital-granted privileges, the ability to perform the service or procedure.


94


• We stated that we continue to believe that it would be inappropriate to allow one physicianwould be inappropriate to allow one physician or nonphysician practitioner to supervise all services being provided in all PBDs at a particular off-campus outpatient location.



• Hospitals provide a wide variety of complex services to their outpatients who may or mayservices to their outpatients who may or may not have an established relationship with the supervising physician or nonphysician practitioner and hospital staff on the day the hospital outpatient services are furnished. A treating physician or nonpractitioner in the community may not even be aware that


ordered outpatient services are being furnished by the hospital on a given day.

95


• Therefore, we believe it is appropriate for CMS to set requirements for the safe andCMS to set requirements for the safe and effective diagnosis and treatment of Medicare beneficiaries, including standards for the appropriate supervision of hospital outpatient services by a physician or nonphysician practitioner, in accordance with the statutory basis for payment of hospital outpatient


services in section 1861(s)(2)(B) of the Act, which is “incident to physicians’ services rendered to outpatients.”

Direct Supervision

• Physician must be present and on the premises of the location and immediately available to furnishthe location and immediately available to furnish assistance and direction throughout the performance of the procedure• Does not mean the physician must be present in

the room where the procedure is performed•Applicable to on-campus and off-campus


departments

96

Direct Supervision

• Medicare assumes the physician supervision requirement is met on hospital premises becauserequirement is met on hospital premises because staff physicians would always be nearby within the hospital• Page 933


Direct Supervision

• “It has been our expectation that hospital outpatient therapeutic services are provided underoutpatient therapeutic services are provided under the direct supervision of physicians in the hospital and in all PBDs of the hospital, specifically, both on-campus and off-campus departments of the hospital.”


97

Direct Supervision

• Definition:“In the hospital” Main building(s) that areIn the hospital – Main building(s) that are under the ownership, financial, and administrative control of the hospital;

Operated as part of the hospitalHospital bills the services furnished under the hospital’s provider number


hospital s provider number

Direct Supervision

• Types of “non-physician” practitioners who may provide “supervision” for outpatient therapeutic p o de supe s o o outpat e t t e apeut cservices that they may perform themselves or within their Scope of practice and hospital-granted privileges:

•Clinical psychologist•Licensed Clinical Social Workers•Physician Assistants


•Physician Assistants•Nurse practitioners•Clinical nurse specialists•Certified nurse midwives

98

Direct Supervision

• Hospital outpatient “diagnostic” services provided directly or under arrangement whether provided indirectly or under arrangement, whether provided in the hospital, in a PBD of the hospital, or at a nonhospital location• Same requirement as for therapeutic services,

meaning that the physician would be present on the same campus and immediately available to


furnish assistance and direction throughout the performance of the procedure

Direct Supervision

• For services, including CR, ICR and PR• Provided in the hospital and in an on campus• Provided in the hospital and in an on-campus

department of the hospital:•Direct Supervision would mean that the physician must be present on the same campus, in the hospital or the on-campus department of the hospital


• Immediately available to furnish assistance and direction throughout the performance of the procedure

99

Direct Supervision

• For services, including CR, ICR and PR• Provided in an off campus department of the• Provided in an off-campus department of the

hospital •Physician must be in the off-campus department• immediately available to furnish assistance and direction throughout the performance of


and direction throughout the performance of the procedure

Final Thoughts

• Mastering change is key element forkey element for success

• 2010 offers new challenges• Good luck!!!


100

Biography

• Glenda J. Schuler, RHIT, CPC, CPC-H• Senior chargemaster consultant for Ingenix• Over 30 years of experience in billing, coding, chargemaster, y p g g g

CPT • Past National speaker for AAPC, AHIMA, state hospital

associations, state HIMA chapters, VHA, HFMA, Ingenix and other organizations specific for:

• Ambulatory payment classifications• Chargemasters• OCE Editor and CCI reporting


OCE Editor and CCI reporting • Modifiers

E-mail: [email protected]

cpt and hcpcs revisions today’s challenges for … · 1 2010 chargemaster update cpt® &...

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