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Final

Summary of Data Changes

Integrated OCE v 12.0

Effective January 1, 2011

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Table of Contents

CPT codes, descriptions, and material only are Copyright 2010 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for

the data contained herein. Applicable FARS/DFARS restrictions apply to government use. DEFINITIONS .................................................................................................................................... APC CHANGES ................................................................................................................................. 4

Added APCs.................................................................................................................................... 4 Deleted APCs .................................................................................................................................. APC Description Changes .............................................................................................................. 6APC Status Indicator Changes ........................................................................................................ 6

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HCPCS/CPT PROCEDURE CODE CHANGES ............................................................................... Added HCPCS/CPT Procedure Codes............................................................................................ Deleted HCPCS/CPT Procedure Codes ........................................................................................ HCPCS Description Changes ....................................................................................................... 21

30 HCPCS Changes- APC, Status Indicator and/or Edit Assignments ............................................. 23 Hcpcs Edit Changes ...................................................................................................................... HCPCS Approval and/or Termination Date Changes .................................................................. 30 Procedure/ Device Pair Changes ................................................................................................... Device/Procedure Pair Changes ....................................................................................................

MODIFIERS ..................................................................................................................................... 33Added Modifiers ...........................................................................................................................

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DEFINITIONS

• A blank in a field indicates ‘no change’

• The “old” column describes the attribute prior to the change being made in the current update, which is indicated in the “new” column. If the effective date of the change is the same as the effective date of the new update, ‘old’ describes the attribute up to the last day of the previous quarter. If the effective date is retroactive, then ‘old’ describes the attribute for the same date in the previous release of the software.

• “Unassigned”, “Pre-defined” or “Placeholder” in APC or HCPCS descriptions indicates that the APC or HCPCS code is inactive. When the APC or HCPCS code is activated, it becomes valid for use in the OCE, and a new description appears in the “new description” column, with the appropriate effective date.

• Activation Date (ActivDate) indicates the mid-quarter date of FDA approval for a drug, or the mid-quarter date of a new or changed code resulting from a National Coverage Determination (NCD). The Activation Date is the date the code becomes valid for use in the OCE. If the Activation Date is blank, then the effective date takes precedence.

• Termination Date (TermDate) indicates the mid-quarter date when a code or change becomes inactive. A code is not valid for use in the OCE after its termination date.

• For codes with SI of “Q1, Q2, and Q3”, the APC assignment is the standard APC to which the code would be assigned if it is paid separately.

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APC CHANGES

Added APCs The following APC(s) were added to the IOCE, effective 01-01-11 APC APCDesc StatusIndicator 00175 Level I Partial Hospitalization (3 services) for Hospital-based PHPs P 00176 Level II Partial Hospitalization (4 or more services) for Hospital-based PHPs P 00255 Level II Anterior Segment Eye Procedures T 00318 Implantation of Cranial Neurostimulator Pulse Generator and Electrode S 00319 Endovascular Revascularization of the Lower Extremity T 01302 Inj benztropine mesylate K 01304 Perphenazine injeciton K 01306 Urea injection K 01307 Oral busulfan K 01308 Mecasermin injection K 01309 Paclitaxel injection K 01311 Canakinumab injection K 01312 Hizentra injection K 01327 Imiglucerase injection K 01331 Olanzapine long-acting inj K 01332 Antithrombin recombinant K 01338 Methyl aminolevulinate, top K 01339 Oral fludarabine phosphate G 01340 Collagenase, clost hist inj G 01342 Matristem micromatrix K 01345 Theraskin K 01346 Penicillin g procaine inj K 01347 Oxacillin sodium injeciton K 01348 Sincalide injection K 01349 Anidulafungin injection K 01350 Topotecan injection K 09274 Crotalidae Poly Immune Fab G 09275 Hexaminolevulinate HCl G 09276 Cabazitaxel injection G 09277 Lumizyme, 1 mg G 09278 Incobotulinumtoxin A G 09279 Injection, ibuprofen G

Deleted APCs The following APC(s) were deleted from the IOCE, effective 01-01-11 APC APCDesc 00225 Implantation of Neurostimulator Electrodes, Cranial Nerve 00379 Injection adenosine 6 MG 00689 Level II Electronic Analysis of Devices 00730 Pamidronate disodium 00732 Mesna injection

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APC APCDesc 00760 Anidulafungin injection 00834 Interferon alfa-2a inj 00852 Topotecan injection 00891 Tacrolimus oral 00904 Gamma globulin 4 CC inj 00916 Injection imiglucerase /unit 00920 Gamma globulin 6 CC inj 00921 Gamma globulin 7 CC inj 00922 Gamma globulin 8 CC inj 00923 Gamma globulin 9 CC inj 00924 Gamma globulin 10 CC inj 01204 Cyclosporin parenteral 01209 Diethylstilbestrol injection 01216 Lyme disease vaccine, im 01225 Somatrem injection 01233 Mitomycin 20 MG inj 01234 Mitomycin 40 MG inj 01257 Enfuvirtide injection 01260 Nandrolone decanoate 100 MG 01271 Cholera vaccine, injectable 01273 Dimecaprol injection 01276 Fondaparinux sodium 01277 Insulin for insulin pump use 01282 Gamma globulin 2 CC inj 01283 Gamma globulin 3 CC inj 01284 Gamma globulin 5 CC inj 01286 Nandrolone decanoate 200 MG 01292 Cyclosporine oral 100 mg 01293 Bladder calculi irrig sol 01294 Cyclosporine oral 25 mg 01436 Etidronate disodium inj 01682 Aprotonin, 10,000 kiu 03030 Sumatriptan succinate 07005 Gonadorelin hydroch 07045 Inj trimetrexate glucoronate 09015 Mycophenolate mofetil oral 09020 Sirolimus, oral 09238 Inj, levetiracetam 09241 Injection, doripenem 09246 Gadoxetate disodium inj 09262 Oral Fludarabine phosphate 09266 Collagenase clostridum histo 09356 TenoGlide tendon prot, cm2 09359 Implnt,bon void filler-putty

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APC Description Changes The following APC(s) had description changes, effective 01-01-11

APC Old Description New Description 00017 Level VI Debridement & Destruction Level V Debridement & Destruction 00099 Electrocardiograms Electrocardiograms/Cardiography 00172 Level I Partial Hospitalization (3 services) Level I Partial Hospitalization (3 services) for

CMHCs 00173 Level II Partial Hospitalization (4 or more services) Level II Partial Hospitalization (4 or more services)

for CMHCs 00229 Transcatherter Placement of Intravascular Shunts Transcatherter Placement of Intravascular Shunt and

Stents 00233 Level II Anterior Segment Eye Procedures Level III Anterior Segment Eye Procedures 00234 Level III Anterior Segment Eye Procedures Level IV Anterior Segment Eye Procedures 00293 Level V Anterior Segment Eye Procedures Level VI Anterior Segment Eye Procedures 00673 Level IV Anterior Segment Eye Procedures Level V Anterior Segment Eye Procedures 00691 Level IV Electronic Analysis of Devices Level III Electronic Analysis of Devices 00692 Level III Electronic Analysis of Devices Level II Electronic Analysis of Devices 01749 Endo, colon,retro imaging Endo, colon, retro imaging 09256 Dexamethasone intravitreal Dexamethasone intra implant 09267 Injection, Wilate Wilate injection 09268 Capsaicin patch Capsaicin 8% patch 09273 Sipuleucel-T, per fusion Sipuleucel-T, per infusion

APC Status Indicator Changes The following APC(s) had Status Indicator changes, effective 01-01-11 APC Old SI New SI 00946 G K 01138 G K 01142 G K 01214 G K 01251 G K 01711 G K 09240 G K 09242 G K 09243 G K 09244 G K 09245 G K 09248 G K 09358 G K

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HCPCS/CPT PROCEDURE CODE CHANGES

Added HCPCS/CPT Procedure Codes The following new HCPCS/CPT code(s) were added to the IOCE, effective 10-01-10 HCPCS CodeDesc SI APC Edit ActivDate TermDate Q2035 Afluria vacc, 3 yrs & >, im L 00000 Q2036 Flulaval vacc, 3 yrs & >, im L 00000 Q2037 Fluvirin vacc, 3 yrs & >, im L 00000 Q2038 Fluzone vacc, 3 yrs & >, im L 00000 Q2039 NOS flu vacc, 3 yrs & >, im L 00000 The following new HCPCS/CPT code(s) were added to the IOCE, effective 01-01-11 HCPCS CodeDesc SI APC Edit ActivDate TermDate 0058T Cryopreservation ovary tiss X 00344 0059T Cryopreservation oocyte X 00344 0234T Trluml perip athrc renal art T 00082 0235T Trluml perip athrc visceral C 00000 0236T Trluml perip athrc abd aorta T 00082 0237T Trluml perip athrc brchiocph T 00082 0238T Trluml perip athrc iliac art T 00082 0239T Bioimpedance spectroscopy S 00099 0240T Esoph motility 3d topography X 00361 0241T Esoph motility w/stim/perf X 00361 0242T Gi tract transit & pres meas X 00361 0243T Intm msr bronchodil wheeze S 00078 0244T Cont msr bronchodil wheeze X 00369 0245T Opn tx rib fx 1-2 ribs T 00062 0246T Opn tx rib fx 3-4 ribs T 00062 0247T Opn tx rib fx 5-6 ribs T 00062 0248T Opn tx rib fx 7+ ribs T 00062 0249T Ligation hemorrhoid w/us T 00155 0250T Insert bronchial valve T 00415 0251T Remov bronchial valve addl T 00076 0252T Bronchscpc rmvl bronch valve T 00076 0253T Insert aqueous drain device T 00234 0254T Evasc rpr iliac art bifur C 00000 0255T Evasc rpr iliac art bifr s&i C 00000 0256T Evasc aortic hrt valve C 00000 0257T Opn tthrc aortic hrt valve C 00000 0258T Aortic hrt valv w/o card byp C 00000 0259T Aortic hrt valve w/card byp C 00000 0260T Hypthrm bdy neonate 28d/< N 00000 0261T Hypthrm head neonate 28d/< N 00000 11045 Deb subq tissue add-on T 00016 11046 Deb musc/fascia add-on T 00016 11047 Deb bone add-on T 00020 1400F Prkns diag rviewed E 00000 28 22551 Neck spine fuse&remove addl C 00000

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HCPCS CodeDesc SI APC Edit ActivDate TermDate 22552 Addl neck spine fusion C 00000 29914 Hip arthro w/femoroplasty T 00042 29915 Hip arthro acetabuloplasty T 00042 29916 Hip arthro w/labral repair T 00042 31295 Sinus endo w/balloon dil T 00075 31296 Sinus endo w/balloon dil T 00075 31297 Sinus endo w/balloon dil T 00075 31634 Bronch w/balloon occlusion T 00076 33620 Apply r&l pulm art bands C 00000 33621 Transthor cath for stent C 00000 33622 Redo compl cardiac anomaly C 00000 3700F Psych disorders assessed E 00000 28 3720F Cognit impairment assessed E 00000 28 37220 Iliac revasc T 00083 37221 Iliac revasc w/stent T 00083 37222 Iliac revasc add-on T 00083 37223 Iliac revasc w/stent add-on T 00083 37224 Fem/popl revas w/tla T 00083 37225 Fem/popl revas w/ather T 00229 37226 Fem/popl revasc w/stent T 00229 37227 Fem/popl revasc stnt & ather T 00319 37228 Tib/per revasc w/tla T 00083 37229 Tib/per revasc w/ather T 00229 37230 Tib/per revasc w/stent T 00229 37231 Tib/per revasc stent & ather T 00319 37232 Tib/per revasc add-on T 00083 37233 Tibper revasc w/ather add-on T 00229 37234 Revsc opn/prq tib/pero stent T 00083 37235 Tib/per revasc stnt & ather T 00083 38900 Io map of sent lymph node N 00000 4324F Pt queried prkns complic E 00000 28 4325F Med txmnt options rvwd w/pt E 00000 28 4326F Pt asked re symp auto dysfxn E 00000 28 43283 Lap esoph lengthening C 00000 4328F Pt asked re sleep disturb E 00000 28 43327 Esoph fundoplasty lap C 00000 43328 Esoph fundoplasty thor C 00000 43332 Transab esoph hiat hern rpr C 00000 43333 Transab esoph hiat hern rpr C 00000 43334 Transthor diaphrag hern rpr C 00000 43335 Transthor diaphrag hern rpr C 00000 43336 Thorabd diaphr hern repair C 00000 43337 Thorabd diaphr hern repair C 00000 43338 Esoph lengthening C 00000 43753 Tx gastro intub w/asp X 00340 43754 Dx gastr intub w/asp spec X 00340 43755 Dx gastr intub w/asp specs S 00097 43756 Dx duod intub w/asp spec X 00272 43757 Dx duod intub w/asp specs X 00272 4400F Rehab thxpy options w/pt E 00000 28 49327 Lap ins device for rt T 00130

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HCPCS CodeDesc SI APC Edit ActivDate TermDate 49412 Ins device for rt guide open C 00000 49418 Insert tun ip cath perc T 00652 53860 Transurethral rf treatment T 00165 57156 Ins vag brachytx device T 00189 6080F Pt/caregiver queried falls E 00000 28 6090F Pt/caregiver counsel safety E 00000 28 61781 Scan proc cranial intra N 00000 61782 Scan proc cranial extra N 00000 61783 Scan proc spinal N 00000 64566 Neuroeltrd stim post tibial T 00204 64568 Inc for vagus n elect impl S 00318 64569 Revise/repl vagus n eltrd T 00687 64570 Remove vagus n eltrd T 00221 64611 Chemodenerv saliv glands T 00204 65778 Cover eye w/membrane T 00239 65779 Cover eye w/membrane stent T 00255 66174 Translum dil eye canal T 00673 66175 Trnslum dil eye canal w/stnt T 00673 74176 Ct abd & pelvis w/o contrast Q3 00332 74177 Ct abdomen&pelvis w/contrast Q3 00283 74178 Ct abd&pelv 1+ section/regns Q3 00333 76881 Us xtr non-vasc complete S 00266 76882 Us xtr non-vasc lmtd S 00265 80104 Drug scrn 1+ class nonchromo E 00000 9 82930 Gastric analy w/ph ea spec A 00000 83861 Microfluid analy tears A 00000 84112 Placenta alpha micro ig c/v A 00000 85598 Hexagnal phosph pltlt neutrl A 00000 86481 Tb ag response t-cell susp A 00000 86902 Blood type antigen donor ea X 00345 87501 Influenza dna amp prob 1+ A 00000 87502 Influenza dna amp probe A 00000 87503 Influenza dna amp prob addl A 00000 87906 Genotype dna hiv reverse t A 00000 88120 Cytp urne 3-5 probes ea spec X 00344 88121 Cytp urine 3-5 probes cmptr X 00344 88177 Cytp c/v auto thin lyr addl X 00342 88363 Xm archive tissue molec anal X 00342 88749 In vivo lab service A 00000 90460 Imadm any route 1st vac/tox B 00000 62 90461 Inadm any route addl vac/tox B 00000 62 90654 Flu vaccine no preserv, ID B 00000 62 90867 Tcranial magn stim tx plan S 00216 90868 Tcranial magn stim tx deli S 00216 91013 Esophgl motil w/stim/perfus X 00361 91117 Colon motility 6 hr study T 00156 92132 Cmptr ophth dx img ant segmt S 00230 92133 Cmptr ophth img optic nerve S 00230 92134 Cptr ophth dx img post segmt S 00230 92227 Remote dx retinal imaging X 00035 92228 Remote retinal imaging mgmt X 00035

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HCPCS CodeDesc SI APC Edit ActivDate TermDate 93451 Right heart cath T 00080 93452 Left hrt cath w/ventrclgrphy T 00080 93453 R&l hrt cath w/ventriclgrphy T 00080 93454 Coronary artery angio s&i T 00080 93455 Coronary art/grft angio s&i T 00080 93456 R hrt coronary artery angio T 00080 93457 R hrt art/grft angio T 00080 93458 L hrt artery/ventricle angio T 00080 93459 L hrt art/grft angio T 00080 93460 R&l hrt art/ventricle angio T 00080 93461 R&l hrt art/ventricle angio T 00080 93462 L hrt cath trnsptl puncture T 00080 93463 Drug admin & hemodynmic meas N 00000 93464 Exercise w/hemodynamic meas N 00000 93563 Inject congenital card cath N 00000 93564 Inject hrt congntl art/grft N 00000 93565 Inject l ventr/atrial angio N 00000 93566 Inject r ventr/atrial angio N 00000 93567 Inject suprvlv aortography N 00000 93568 Inject pulm art hrt cath N 00000 95800 Slp stdy unattended S 00213 95801 Slp stdy unatnd w/anal S 00213 96446 Chemotx admn prtl cavity S 00439 99224 Subsequent observation care B 00000 62 99225 Subsequent observation care B 00000 62 99226 Subsequent observation care B 00000 62 A4566 Should sling/vest/abrestrain E 00000 28 A7020 Interface, cough stim device Y 00000 61 A9273 Hot/cold h2obot/cap/col/wrap E 00000 9 C9274 Crotalidae Poly Immune Fab G 09274 55 C9275 Hexaminolevulinate HCl G 09275 55 C9276 Cabazitaxel injection G 09276 55 C9277 Lumizyme, 1 mg G 09277 55 C9278 Incobotulinumtoxin A G 09278 55 C9279 Injection, ibuprofen G 09279 55 D1352 Prev resin rest, perm tooth E 00000 28 D3354 Pulpal regeneration E 00000 28 D5992 Adjust max prost appliance E 00000 28 D5993 Main/clean max prosthesis E 00000 28 D6254 Interim pontic E 00000 28 D6795 Interim retainer crown E 00000 28 D7251 Coronectomy E 00000 28 D7295 Bone harvest,auto graft proc E 00000 28 E0446 Topical Ox Deliver sys, nos E 00000 28 E1831 Static str toe dev ext/flex Y 00000 61 E2622 Adj skin pro w/c cus wd<22in Y 00000 61 E2623 Adj skin pro wc cus wd>=22in Y 00000 61 E2624 Adj skin pro/pos cus<22in Y 00000 61 E2625 Adj skin pro/pos wc cus>=22 Y 00000 61 G0157 HHC PT assistant ea 15 B 00000 62 G0158 HHC OT assistant ea 15 B 00000 62

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HCPCS CodeDesc SI APC Edit ActivDate TermDate G0159 HHC PT maint ea 15 min B 00000 62 G0160 HHC Occup Therapy ea 15 B 00000 62 G0161 HHC SLP ea 15 min B 00000 62 G0162 HHC RN E&M plan svs, 15 min B 00000 62 G0163 HHC LPN/RN obs/asses ea 15 B 00000 62 G0164 HHC lis nurse train ea 15 B 00000 62 G0434 Drug screen multi drug class A 00000 G0436 Tobacco-use counsel 3-10 min X 00031 G0437 Tobacco-use counsel>10min X 00031 G0438 PPPS, initial visit A 00000 G0439 PPPS, subseq visit A 00000 G0440 Skin/dermal subs init 25or< B 00000 62 G0441 Skin/dermal subs each additi B 00000 62 G8629 Doc antibio order b/4 surg M 00000 72 G8630 Doc antibio given b/4 surg M 00000 72 G8631 Pt no elg 4 order antbi give M 00000 72 G8632 Doc no antibi order b/4 surg M 00000 72 G8633 Pharm ther osteo rx M 00000 72 G8634 Pt no elg phar ther osteo M 00000 72 G8635 No pharm ther osteo rx M 00000 72 G8636 Flu immun admin/prev rec M 00000 72 G8637 Pt no elg receiv flu immun M 00000 72 G8638 Flu immun no admin/prev rec M 00000 72 G8639 Flu immun admin or prev rec M 00000 72 G8640 Pt no elg rec flu immun M 00000 72 G8641 Flu immun not admin/pre rec M 00000 72 G8642 Hrdshp rural w/o internet M 00000 72 G8643 Hrdshp w/o suff pharm w/eRx M 00000 72 G8644 EP no prescribe priv M 00000 72 G8645

Asthma measures grp M 00000 72 G8646 Asthma MG qual act perform M 00000 72 G8647 Fun stat score knee >= 0 M 00000 72 G8648 Fun stat score knee < 0 M 00000 72 G8649 Fun stat score knee pt noelg M 00000 72 G8650 Fun stat score knee not done M 00000 72 G8651 Fun stat score hip >= 0 M 00000 72 G8652 Fun stat score hip < 0 M 00000 72 G8653 Fun stat score hip pt no elg M 00000 72 G8654 Fun stat score hip not done M 00000 72 G8655 Fun stat score LE >= 0 M 00000 72 G8656 Fun stat score LE < 0 M 00000 72 G8657 Fun stat score LE pt no elg M 00000 72 G8658 Fun stat score LE not done M 00000 72 G8659 Fun stat score LS >= 0 M 00000 72 G8660 Fun stat score LS < 0 M 00000 72 G8661 Fun stat score LS pt no elg M 00000 72 G8662 Fun stat score LS not done M 00000 72 G8663 Fun stat score shdl >=0 M 00000 72 G8664 Fun stat score shdl < 0 M 00000 72 G8665 Fun stat score shdl pt no el M 00000 72 G8666 Fun stat score shdl not done M 00000 72

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HCPCS CodeDesc SI APC Edit ActivDate TermDate G8667 Fun stat score UE >=0 M 00000 72 G8668 Fun stat score UE < 0 M 00000 72 G8669 Fun stat score UE pt no elg M 00000 72 G8670 Fun stat score UE not done M 00000 72 G8671 Fun stat score neck/TS >=0 M 00000 72 G8672 Fun stat score neck/TS < 0 M 00000 72 G8673 Fun stat scor nek/TS pt no e M 00000 72 G8674 Fun stat scor nek/TS not don M 00000 72 G8675 BP Syst >= 140 mmHg M 00000 72 G8676 BP Diast >= 90 mmHg M 00000 72 G8677 BP Syst < 130 mmHg M 00000 72 G8678 BP Syst >=130 - 139 mmHg M 00000 72 G8679 BP Diast < 80 mmHg M 00000 72 G8680 BP Diast 80-89 mmHg M 00000 72 G8681 Pt hosp w/HF M 00000 72 G8682 LVG test perf M 00000 72 G8683 Pt not elig for LVF test M 00000 72 G8684 Pt not hosp w/HF M 00000 72 G8685 LVF test not perf M 00000 72 G8686 Toba smkr curr or 2 hand exp M 00000 72 G8687 No tob smkr cur no 2 hnd exp M 00000 72 G8688 Smkls tob cur; no 2 hnd exp M 00000 72 G8689 Toba use not assess M 00000 72 G8690 Curr toba smkr or 2 hand exp M 00000 72 G8691 No cur tob smkr no 2 hnd exp M 00000 72 G8692 Curr smkls tob; no 2 hnd exp M 00000 72 G8693 Tobacco no assess M 00000 72 J0171 Adrenalin epinephrine inject N 00000 J0558 PenG benzathine/procaine inj N 00000 J0561 Penicillin g benzathine inj N 00000 J0597 C-1 esterase, berinert G 09269 J0638 Canakinumab injection K 01311 J0775 Collagenase, clost hist inj G 01340 J1290 Ecallantide injection G 09263 J1559 Hizentra injection K 01312 J1599 Ivig non-lyophilized, NOS N 00000 J1786 Imuglucerase injection K 01327 J1826 Interferon Beta-1A inj E 00000 28 J2358 Olanzapine long-acting inj K 01331 J2426 Paliperidone palmitate inj G 09255 J3095 Telavancin injection G 09258 J3262 Tocilizumab injection G 09264 J3357 Ustekinumab injection G 09261 J3385 Velaglucerase alfa G 09271 J7184 Wilate injection G 09267 J7196 Antithrombin recombinant K 01332 J7309 Methyl aminolevulinate, top K 01338 J7312 Dexamethasone intra implant G 09256 J7335 Capsaicin 8% patch G 09268 J7686 Treprostinil, non-comp unit M 00000 72 J8562 Oral fludarabine phosphate G 01339

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HCPCS CodeDesc SI APC Edit ActivDate TermDate J9302 Ofatumumab injection G 09260 J9307 Pralatrexate injection G 09259 J9315 Romidepsin injection G 09265 J9351 Topotecan injection K 01350 L3674 SO airplane w/wo joint CF A 00000 L4631 Afo, walk boot type, cus fab A 00000 L5961 Endo poly hip, pneu/hyd/rot A 00000 L8693 Aud osseo dev, abutment A 00000 Q0478 Power adapter, combo vad A 00000 Q0479 Power module combo vad, rep A 00000 Q4117 Hyalomatrix E 00000 28 Q4118 Matristem micromatrix K 01342 Q4119 Matristem wound matrix E 00000 28 Q4120 Matristem burn matrix E 00000 28 Q4121 Theraskin K 01345 T1505 Elec med comp dev, noc E 00000 28

Deleted HCPCS/CPT Procedure Codes The following HCPCS/CPT code(s) were deleted from the IOCE, effective 01-01-11 HCPCS CodeDesc 0016T Thermotx choroid vasc lesion 0017T Photocoagulat macular drusen 0104T At rest cardio gas rebreathe 0105T Exerc cardio gas rebreathe 0130T Chron care drug investigatn 0140T Exhaled breath condensate ph 0160T Tcranial magn stim tx plan 0161T Tcranial magn stim tx deliv 0176T Aqu canal dilat w/o retent 0177T Aqu canal dilat w retent 0187T Ophthalmic dx image anterior 0193T Rf bladder neck microremodel 0203T Unattend sleep study w/time 0204T Unattended sleep study 11040 Debride skin, partial 11041 Debride skin, full 20000 Incision of abscess 33861 Ascending aortic graft 35454 Repair arterial blockage 35456 Repair arterial blockage 35459 Repair arterial blockage 35470 Repair arterial blockage 35473 Repair arterial blockage 35474 Repair arterial blockage 35480 Atherectomy, open 35481 Atherectomy, open 35482 Atherectomy, open 35483 Atherectomy, open

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HCPCS CodeDesc 35484 Atherectomy, open 35485 Atherectomy, open 35490 Atherectomy, percutaneous 35491 Atherectomy, percutaneous 35492 Atherectomy, percutaneous 35493 Atherectomy, percutaneous 35494 Atherectomy, percutaneous 35495 Atherectomy, percutaneous 39502 Repair paraesophageal hernia 39520 Repair of diaphragm hernia 39530 Repair of diaphragm hernia 39531 Repair of diaphragm hernia 43324 Revise esophagus & stomach 43326 Revise esophagus & stomach 43600 Biopsy of stomach 49420 Insert abdom drain, temp 61795 Brain surgery using computer 64573 Implant neuroelectrodes 75992 Atherectomy, x-ray exam 75993 Atherectomy, x-ray exam 75994 Atherectomy, x-ray exam 75995 Atherectomy, x-ray exam 75996 Atherectomy, x-ray exam 76150 X-ray exam, dry process 76350 Special x-ray contrast study 76880 Us exam, extremity 82926 Assay of gastric acid 82928 Assay of gastric acid 86903 Blood typing, antigen screen 89100 Sample intestinal contents 89105 Sample intestinal contents 89130 Sample stomach contents 89132 Sample stomach contents 89135 Sample stomach contents 89136 Sample stomach contents 89140 Sample stomach contents 89141 Sample stomach contents 89225 Starch granules, feces 89235 Water load test 90465 Immune admin 1 inj, < 8 yrs 90466 Immune admin addl inj, < 8 y 90467 Immune admin o or n, < 8 yrs 90468 Immune admin o/n, addl < 8 y 91000 Esophageal intubation 91011 Esophagus motility study 91012 Esophagus motility study 91052 Gastric analysis test 91055 Gastric intubation for smear 91105 Gastric intubation treatment 91123 Irrigate fecal impaction 92135 Ophth dx imaging post seg

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HCPCS CodeDesc 93012 Transmission of ecg 93014 Report on transmitted ecg 93230 ECG monitor/report, 24 hrs 93231 Ecg monitor/record, 24 hrs 93232 ECG monitor/report, 24 hrs 93233 ECG monitor/review, 24 hrs 93235 ECG monitor/report, 24 hrs 93236 ECG monitor/report, 24 hrs 93237 ECG monitor/review, 24 hrs 93501 Right heart catheterization 93508 Cath placement, angiography 93510 Left heart catheterization 93511 Left heart catheterization 93514 Left heart catheterization 93524 Left heart catheterization 93526 Rt & Lt heart catheters 93527 Rt & Lt heart catheters 93528 Rt & Lt heart catheters 93529 Rt, lt heart catheterization 93539 Injection, cardiac cath 93540 Injection, cardiac cath 93541 Injection for lung angiogram 93542 Injection for heart x-rays 93543 Injection for heart x-rays 93544 Injection for aortography 93545 Inject for coronary x-rays 93555 Imaging, cardiac cath 93556 Imaging, cardiac cath 96445 Chemotherapy, intracavitary C9255 Paliperidone palmitate inj C9256 Dexamethasone intravitreal C9258 Telavancin injection C9259 Pralatrexate injection C9260 Ofatumumab injection C9261 Ustekinumab injection C9263 Ecallantide injection C9264 Tocilizumab injection C9265 Romidepsin injection C9266 Collagenase clostridum histo C9267 Injection, Wilate C9268 Capsaicin patch C9269 C-1 esterase, berinert C9271 Velaglucerase alfa C9801 Smoke/tobacco asymp 3-10 C9802 Smoke/tobacco asymp >10 E0220 Hot water bottle E0230 Ice cap or collar E0238 Heat pad non-electric moist G0430 Drug screen multi class G8006 AMI pt recd aspirin at arriv G8007 AMI pt did not receiv aspiri

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HCPCS CodeDesc G8008 AMI pt ineligible for aspiri G8009 AMI pt recd Bblock at arr G8010 AMI pt did not rec bblock G8011 AMI pt inelig Bbloc at arriv G8012 Pneum pt recv antibiotic 4 h G8013 Pneum pt w/o antibiotic 4 hr G8014 Pneum pt not elig antibiotic G8015 Diabetic pt w/ HBA1c>9% G8016 Diabetic pt w/ HBA1c<or=9% G8017 DM pt inelig for HBA1c measu G8018 Care not provided for HbA1c G8019 Diabetic pt w/LDL>= 100mg/dl G8020 Diab pt w/LDL< 100mg/dl G8021 Diab pt inelig for LDL meas G8022 Care not provided for LDL G8023 DM pt w BP>=140/80 G8024 Diabetic pt wBP<140/80 G8025 Diabetic pt inelig for BP me G8026 Diabet pt w no care re BP me G8027 HF p w/LVSD on ACE-I/ARB G8028 HF pt w/LVSD not on ACE-I/AR G8029 HF pt not elig for ACE-I/ARB G8030 HF pt w/LVSD on Bblocker G8031 HF pt w/LVSD not on Bblocker G8032 HF pt not elig for Bblocker G8033 PMI-CAD pt on Bblocker G8034 PMI-CAD pt not on Bblocker G8035 PMI-CAD pt inelig Bblocker G8036 AMI-CAD pt doc on antiplatel G8037 AMI-CAD pt not docu on antip G8038 AMI-CAD inelig antiplate mea G8039 CAD pt w/LDL>100mg/dl G8040 CAD pt w/LDL<or=100mg/dl G8041 CAD pt not eligible for LDL G8051 Osteoporosis assess G8052 Osteopor pt not assess G8053 Pt inelig for osteopor meas G8054 Falls assess not docum 12 mo G8055 Falls assess w/ 12 mon G8056 Not elig for falls assessmen G8057 Hearing assess receive G8058 Pt w/o hearing assess G8059 Pt inelig for hearing assess G8060 Urinary incont pt assess G8061 Pt not assess for urinary in G8062 Pt not elig for urinary inco G8075 ESRD pt w/ dialy of URR>=65% G8076 ESRD pt w/ dialy of URR<65% G8077 ESRD pt not elig for URR/KtV G8078 ESRD pt w/Hct>or=33 G8079 ESRD pt w/Hct<33

17

HCPCS CodeDesc G8080 ESRD pt inelig for HCT/Hgb G8081 ESRD pt w/ auto AV fistula G8082 ESRD pt w other fistula G8085 ESRD PT inelig auto AV FISTU G8093 COPD pt rec smoking cessat G8094 COPD pt w/o smoke cessat int G8099 Osteopo pt given Ca+VitD sup G8100 Osteop pt inelig for Ca+VitD G8103 New dx osteo pt w/antiresorp G8104 Osteo pt inelig for antireso G8106 Bone dens meas test perf G8107 Bone dens meas test inelig G8108 Pt receiv influenza vacc G8109 Pt w/o influenza vacc G8110 Pt inelig for influenza vacc G8111 Pt receiv mammogram G8112 Pt not doc mammogram G8113 Pt ineligible mammography G8114 Care not provided for mamogr G8115 Pt receiv pneumo vacc G8116 Pt did not rec pneumo vacc G8117 Pt was inelig for pneumo vac G8129 Pt treat w/antidepres for 6m G8130 Pt not treat w/antidepres 6m G8131 Pt inelig for antidepres med G8152 Pt w/AB 1 hr prior to incisi G8153 Pt not doc for AB 1 hr prior G8154 Pt ineligi for AB therapy G8155 Pt recd thromboemb prophylax G8156 Pt did not rec thromboembo G8157 Pt ineligi for thrombolism G8159 Pt w/CABG w/o IMA G8162 Iso CABG pt w/o preop Bblock G8164 Iso CABG pt w/prolng intub G8165 Iso CABG pt w/o prolng intub G8166 Iso CABG req surg rexpo G8167 Iso CABG w/o surg explo G8170 CEA/ext bypass pt on aspirin G8171 Pt w/carot endarct/ext bypas G8172 CEA/ext bypass pt not on asp G8182 CAD pt care not prov LDL G8183 HF/atrial fib pt on warfarin G8184 HF/atrial fib pt inelig warf G8185 Osteoarth pt w/ assess pain G8186 Osteoarth pt inelig assess G8193 Antibio not doc prior surg G8196 Antibio not docum prior surg G8200 Cefazolin not docum prophy G8204 MD not doc order to d/c anti G8209 Clinician did not doc G8214 Clini not doc order VTE

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HCPCS CodeDesc G8217 Pt not received DVT proph G8219 Received DVT proph day 2 G8220 Pt not rec DVT proph day 2 G8221 Pt inelig for DVT proph G8223 Pt not doc for presc antipla G8226 Pt no prescr anticoa at D/C G8231 Pt not doc for admin t-PA G8234 Pt not doc dysphagia screen G8238 Pt not doc to rec rehab serv G8240 Inter carotid stenosis30-99% G8243 Pt not doc MRI/CT w/o lesion G8246 Pt inelig hx w new/chg mole G8248 Pt w/one alarm symp not doc G8251 Pt not doc w/Barretts, endo G8254 Pt w/no doc order for barium G8257 Pt not doc rev meds D/C G8260 Pt not doc to have dec maker G8263 Pt not doc assess urinary in G8266 Pt not doc charc urin incon G8268 Pt not doc rec care urin inc G8271 Pt no doc screen fall G8274 Clini not doc pres/abs alarm G8276 Pt not doc mole change G8279 Pt not doc rec PE G8282 Pt not doc to rec couns G8285 Pt did not rec pres osteo G8289 Pt not doc rec Ca/Vit D G8293 COPD pt w/o spir results G8296 COPD pt not doc bronch ther G8298 Pt doc optic nerve eval G8299 Pt not doc optic nerv eval G8302 Pt doc w/ target IOP G8303 Pt not doc w/ IOP G8304 Clin doc pt inelig IOP G8305 Clin not prov care POAG G8306 POAG w/ IOP rec care plan G8307 POAG w/ IOP no care plan G8308 POAG w/ IOP not doc plan G8310 Pt not doc rec antiox G8314 Pt not doc to rec mac exam G8318 Pt doc not have visual func G8322 Pt not doc pre axial leng G8326 Pt not doc rec fundus exam G8330 Pt not doc rec dilated mac G8334 Doc of macular not giv MD G8338 Clin not doc pt test osteo G8341 Pt not doc for DEXA G8345 Pt not doc have DEXA G8351 Pt not doc ECG G8354 Pt not rec aspirin prior ER G8357 Pt not doc to have ECG

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HCPCS CodeDesc G8360 Pt not doc vital signs recor G8362 Pt not doc 02 SAT assess G8365 Pt not doc mental status G8367 Pt not doc have empiric AB G8370 Asthma pt w survey not docum G8371 Chemother not rec stg3 colon G8372 Chemother rec stg3 colon ca G8373 Chemo plan documen prior che G8374 Chemo plan not doc prior che G8375 CLL pt w/o doc flow cytometr G8376 Brst ca pt inelig tamoxifen G8377 MD doc colon ca pt inelig ch G8378 MD doc pt inelig radiation G8379 Doc radiat tx recom 12mo ov G8380 Pt w stgIC-3Brst ca not rec G8381 Pt w stgIC-3Brst ca rec tam G8382 MM pt w/o doc IV bisphophon G8383 No doc radiation rec 12mo ov G8384 Base cytogen test MDS notper G8385 Diabet pt no do Hgb A1c 12m G8386 Diabet pt nodoc LDLiprotei G8387 ESRD pt w Hct/Hgb not docume G8388 ESRD pt w URR/Ktv notdoc eli G8389 MDS pt no doc FE st prio EPO G8390 Diabetic w/o document BP 12m G8391 Pt w asthma no doc med or tx G8402 Smoke preven interven counse G8403 Smoke preven nocounsel G8407 ABI documented G8408 ABI not documented G8409 Pt inelig for ABI measure G8423 Pt screen flu vac & counsel G8424 Flu vaccine not screen G8425 Flu vaccine screen not curre G8426 Pt not approp screen & counc G8429 Incomplete doc pt on meds G8434 Cognitive impairment screen G8435 Cognitive screen not documen G8436 Pt inelig for cognitive impa G8437 Care plan develop & document G8438 Pt inelig for devlp care pln G8439 Care plan develp & not docum G8443 Prescription by E-Prescrib s G8445 Prescrip not gen at encounte G8446 Some prescrib print or call G8449 Pt not doc w/EMR due to syst G8453 Tob use cess int counsel G8454 Tob use cess int no counsel G8455 Current tobacco smoker G8456 Current smkless tobacco user G8457 Cur tobacco non-user

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HCPCS CodeDesc G8466 Pt inelig suic; MDD remis G8467 New dx init/rec episode MDD G8479 MD rx'd ACE/ARB thxpy G8480 Pt inelig ACE/ARB thxpy G8481 MD not rx'd ACE/ARB thxpy G8488 Report ESRD Measures G8507 Pt inelig pt verif meds G8518 Clin stg b/f lun/eso ca surg G8519 Pt in; clin ca stg b/f surg G8520 Clin stg b/f surg not doc J0128 Abarelix injection J0170 Adrenalin epinephrin inject J0559 PenG benzathine/procaine inj J0560 Penicillin g benzathine inj J0570 Penicillin g benzathine inj J0580 Penicillin g benzathine inj J0704 Betamethasone sod phosp/4 MG J0970 Estradiol valerate injection J1390 Estradiol valerate 20 MG inj J1470 Gamma globulin 2 CC inj J1480 Gamma globulin 3 CC inj J1490 Gamma globulin 4 CC inj J1500 Gamma globulin 5 CC inj J1510 Gamma globulin 6 CC inj J1520 Gamma globulin 7 CC inj J1530 Gamma globulin 8 CC inj J1540 Gamma globulin 9 CC inj J1550 Gamma globulin 10 CC inj J1785 Injection imiglucerase /unit J1825 Interferon beta-1a J2321 Nandrolone decanoate 100 MG J2322 Nandrolone decanoate 200 MG J9062 Cisplatin 50 MG injection J9080 Cyclophosphamide 200 MG inj J9090 Cyclophosphamide 500 MG inj J9091 Cyclophosphamide 1.0 grm inj J9092 Cyclophosphamide 2.0 grm inj J9093 Cyclophosphamide lyophilized J9094 Cyclophosphamide lyophilized J9095 Cyclophosphamide lyophilized J9096 Cyclophosphamide lyophilized J9097 Cyclophosphamide lyophilized J9110 Cytarabine hcl 500 MG inj J9140 Dacarbazine 200 MG inj J9290 Mitomycin 20 MG inj J9291 Mitomycin 40 MG inj J9350 Topotecan injection J9375 Vincristine sulfate 2 MG inj J9380 Vincristine sulfate 5 MG inj K0734 Adj skin pro w/c cus wd<22in K0735 Adj skin pro wc cus wd>=22in

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HCPCS CodeDesc K0736 Adj skin pro/pos wc cus<22in K0737 Adj skin pro/pos wc cus>=22" L3672 SO airplane w/o jnts CF L3673 SO airplane w/joint CF Q2025 Oral Fludarabine phosphate Q4109 Tissuemend skin sub

HCPCS Description Changes The following code descriptions were changed, effective 04-01-04 HCPCS Old Description New Description S3829 Comp MLH2 gene Comp MSH2 gene The following code descriptions were changed, effective 01-01-11 HCPCS Old Description New Description 0208T Automated audiometry air Audiometry air only 0209T Auto audiometry air/bone Audiometry air & bone 0210T Auto audiometry sp thresh Speech audiometry threshold 0211T Auto audiometry sp thresh Speech audiom thresh & recog 0212T Comprehen auto audiometry Compre audiometry evaluation 0213T Us facet jt inj cerv/t 1 lev Njx paravert w/us cer/thor 0214T Us facet jt inj cerv/t 2 lev Njx paravert w/us cer/thor 0215T Us facet jt inj cerv/t 3 lev Njx paravert w/us cer/thor 0216T Us facet jt inj ls 1 level Njx paravert w/us lumb/sac 0217T Us facet jt inj ls 2 level Njx paravert w/us lumb/sac 0218T Us facet jt inj ls 3 level Njx paravert w/us lumb/sac 0219T Fuse spine facet jt cerv Plmt post facet implt cerv 0220T Fuse spine facet jt thor Plmt post facet implt thor 0221T Fuse spine facet jt lumbar Plmt post facet implt lumb 0222T Fuse spine facet jt add seg Plmt post facet implt addl 0223T Acoustic/electr cardgrphy Acoustic ecg w/i&r 0224T Acstic/elec cardgrphy av/vv Acoustic ecg 1+ analysis 0225T Acstic/elec cardgrphy av+vv Acoustic ecg analy & reprog 0226T Anosc high resol dx +-coll Anoscopy hra w/spec collect 0227T Anosc high resol dx w/bx Anoscopy hra w/biopsy 0228T US tfrml edrl inj crv/t 1lvl Njx tfrml eprl w/us cer/thor 0229T US tfrml edrl inj crv/t +lvl Njx tfrml eprl w/us cer/thor 0230T US tfrml edrl inj l/s 1lvl Njx tfrml eprl w/us lumb/sac 0231T US tfrml edrl inj l/s +lvl Njx tfrml eprl w/us lumb/sac 0232T Inj plsm img guid hrvst&prep Njx platelet plasma 0233T Skn age meas spctrscpy Skin glycation spectroscopy 11010 Debride skin, fx Debride skin at fx site 11011 Debride skin/muscle, fx Debride skin musc at fx site 11012 Debride skin/muscle/bone, fx Deb skin bone at fx site 11042 Debride skin/tissue Deb subq tissue 20 sq cm/< 11043 Debride tissue/muscle Deb musc/fascia 20 sq cm/< 11044 Debride tissue/muscle/bone Deb bone 20 sq cm/< 20664 Halo brace application Application of halo

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HCPCS Old Description New Description 21012 Exc face les sc = 2 cm Exc face les sbq 2+ cm 21014 Exc face tum deep = 2 cm Exc face tum deep 2+ cm 21016 Resect face tum = 2 cm Resect face tum + cm 21552 Exc neck les sc = 3 cm Exc neck les sc 3+ cm 21554 Exc neck tum deep = 5 cm Exc neck tum deep 5+ cm 21558 Resect neck tum = 5 cm Resect neck tum 5+ cm 21931 Exc back les sc = 3 cm Exc back les sc 3+ cm 21933 Exc back tum deep = 5 cm Exc back tum deep 5+ cm 21936 Resect back tum = 5 cm Resect back tum 5+ cm 22901 Exc back tum deep = 5 cm Exc back tum deep 5+ cm 24071 Exc arm/elbow les sc = 3 cm Exc arm/elbow les sc 3+ cm 25073 Exc forearm tum deep = 3 cm Exc forearm tum deep 3+ cm 25078 Resect forearm/wrist tum=3cm Resect forearm/wrist tum3+cm 27364 Resect thigh/knee tum >5 cm Resect thigh/knee tum 5+ cm 27616 Resect leg/ankle tum > 5 cm Resect leg/ankle tum 5+ cm 27632 Exc leg/ankle les sc > 3 cm Exc leg/ankle les sc 3+ cm 27634 Exc leg/ankle tum deep >5 cm Exc leg/ankle tum deep 5+ cm 28041 Exc foot/toe tum deep >1.5cm Exc foot/toe tum deep 1.5cm+ 29861 Hip arthroscopy/surgery Hip arthro w/fb removal 29862 Hip arthroscopy/surgery Hip arthr0 w/debridement 29863 Hip arthroscopy/surgery Hip arthr0 w/synovectomy 3082F Kt/v lt1.2 Kt/v <1.2 3083F Kt/v ge 1.2 and <1.7 Kt/v > 1.2 <1.7 3110F Doc pres/absn hmrhg/lesion Pres/absn hmrhg/lesion docd 3112F Ct/Mri brain done gt 24 hrs Ct/mri brain done >24 hrs 3284F IOP down>=15% of pre-svc lvl Iop down >15% of pre-svc lvl 3496F Cd4+ cell count =500 cells Cd4+ cell count + 500 cells 3498F CD4+ cell percentage >=15% Cd4+ cell % >=15% (hiv) 37765 Phleb veins - extrem - to 20 Stab phleb veins xtr 10-20 4194F Pt rec>=10mg prednison qd Pt rcvng>10mg daily predniso 4255F Anesth >= 60 min as docd Anesth 60+ min as docd 4256F Anesth < 60 min as docd Anesthe <60 min as docd 43330 Repair of esophagus Esophagomyotomy abdominal 43331 Repair of esophagus Esophagomyotomy thoracic 46250 Remove ext hem groups = 2 Remove ext hem groups 2+ 46260 Remove in/ex hem groups = 2 Remove in/ex hem groups 2+ 49419 Insrt abdom cath for chemotx Insert tun ip cath w/port 49421 Insert abdom drain, perm Ins tun ip cath for dial opn 49422 Remove perm cannula/catheter Remove tunneled ip cath 5062F Doc f2fmammo fndng in 5 days Mammo result com to pt 5 day 74261 Ct colonography, w/o dye Ct colonography dx 93224 ECG monitor/report, 24 hrs Ecg monit/reprt up to 48 hrs 93225 ECG monitor/record, 24 hrs Ecg monit/reprt up to 48 hrs 93226 ECG monitor/report, 24 hrs Ecg monit/reprt up to 48 hrs 93227 ECG monitor/review, 24 hrs Ecg monit/reprt up to 48 hrs 93270 ECG recording Remote 30 day ecg rev/report 93922 Extremity study Upr/l xtremity art 2 levels 93923 Extremity study Upr/lxtr art stdy 3+ lvls 93924 Extremity study Lwr xtr vasc stdy bilat 94011 Up to 2 yrs old, spirometry Spirometry up to 2 yrs old 94012 = 2 yrs, spiromtry w/dilator Spirmtry w/brnchdil inf-2 yr

23

HCPCS Old Description New Description 94013 = 2 yrs, lung volumes Meas lung vol thru 2 yrs 97597 Active wound care/20 cm or < Rmvl devital tis 20 cm/< 97598 Active wound care > 20 cm Rmvl devital tis addl 20 cm< D0486 Accession of brush biopsy Access of transep cytol samp D2940 Dental sedative filling Protective restoration D7960 Frenulectomy/frenulotomy Frenulectomy/frenectomy D9420 Hospital call Hospital/ASC call G0429 Dermal filler inject for LDS Dermal filler injection(s) G0431 Drug screen single class Drug screen multip class G0435 Rapid immunoassay HIV-1,2 Oral HIV-1/HIV-2 screen G8427 Doc meds verified w/pt or re Doc cur meds by prove G8428 Meds document w/o verifica Cur meds not document G8447 Pt vis doc use CCHIT cer EHR Pt vis doc use EHR cer ATCB G8448 Pt vis doc w/non-CCHIT EHR Pt vis doc w/PQRI qual EHR J0598 C1 esterase inhibitor inj C-1 esterase, Cinryze K0899 Pow mobil dev no dme pdac Pow mobil dev no dmepdac Q4101 Apligraf skin sub Apligraf Q4102 Oasis wound matrix skin sub Oasis wound matrix Q4103 Oasis burn matrix skin sub Oasis burn matrix Q4104 Integra BMWD skin sub Integra BMWD Q4105 Integra DRT skin sub Integra DRT Q4106 Dermagraft skin sub Dermagraft Q4107 Graftjacket skin sub Graftjacket Q4108 Integra matrix skin sub Integra matrix Q4110 Primatrix skin sub Primatrix Q4111 Gammagraft skin sub Gammagraft Q4112 Cymetra allograft Cymetra injectable Q4113 Graftjacket express allograf Graftjacket xpress Q4115 Alloskin skin sub Alloskin Q4116 Alloderm skin sub Alloderm

HCPCS Changes- APC, Status Indicator and/or Edit Assignments

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The following code(s) had an APC and/or SI and/or edit change, effective 01-01-10 **A blank in the field indicates no change. HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 43775 Lap sleeve gastrectomy C E N/A 28 The following code(s) had an APC and/or SI and/or edit change, effective 01-01-11 **A blank in the field indicates no change. HCPCS CodeDesc Old New APC Old SI New SI Old Edit New Edit

APC 0001F Heart failure composite M E 72 28 0005F Osteoarthritis composite M E 72 28 0012F Cap bacterial assess M E 72 28 0014F Comp preop assess cat surg M E 72 28 0015F Melan follow-up complete M E 72 28 0183T Wound ultrasound 00013 00015 0191T Insert ant segment drain int 00234 00673 0500F Initial prenatal care visit M E 72 28 0501F Prenatal flow sheet M E 72 28 0502F Subsequent prenatal care M E 72 28 0503F Postpartum care visit M E 72 28 0516F Anemia plan of care docd M E 72 28 0519F Pland chemo docd b/4 txmnt M E 72 28 0525F Initial visit for episode M E 72 28 1000F Tobacco use assessed M E 72 28 1003F Level of activity assess M E 72 28 1004F Clin symp vol ovrld assess M E 72 28 1008F Gi/renal risk assess M E 72 28 1015F Copd symptoms assess M E 72 28 1018F Assess dyspnea not present M E 72 28 1019F Assess dyspnea present M E 72 28 1022F Pneumo imm status assess M E 72 28 1026F Co-morbid condition assess M E 72 28 1030F Influenza imm status assess M E 72 28 1034F Current tobacco smoker M E 72 28 1035F Smokeless tobacco user M E 72 28 1050F History of mole changes M E 72 28 1055F Visual funct status assess M E 72 28 1060F Doc perm/cont/parox atr fib M E 72 28 1061F Doc lack perm+cont+parox fib M E 72 28 1065F Ischm stroke symp lt3 hrsb/4 M E 72 28 1066F Ischm stroke symp ge3 hrsb/4 M E 72 28 1070F Alarm symp assessed-absent M E 72 28 1071F Alarm symp assessed-1+ prsnt M E 72 28 11000 Debride infected skin 00015 00016 1118F GERD symps assessed 12 month M E 72 28 1134F Epsd bk pain for =< 6 wks M E 72 28

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HCPCS CodeDesc Old APC

New APC Old SI New SI Old Edit New Edit

1135F Epsd bk pain for > 6 wks M E 72 28 1136F Epsd bk pain for <= 12 wks M E 72 28 1137F Epsd bk pain for > 12 wks M E 72 28 11640 Exc face-mm malig+marg 0.5 < 00020 00019 11641 Exc face-mm malig+marg 0.6-1 00020 00019 11642 Exc face-mm malig+marg 1.1-2 00020 00019 12051 Intmd wnd repair face/mm 00133 00134 1220F Pt screened for depression M E 72 28 19295 Place breast clip percut 00000 00340 N Q1 20005 I&d abscess subfascial 00049 00020 2001F Weight record M E 72 28 2002F Clin sign vol ovrld assess M E 72 28 2004F Initial exam involved joints M E 72 28 2018F Hydration status assess M E 72 28 2020F Dilated fundus eval done M E 72 28 2029F Complete phys skin exam done M E 72 28 2030F H2o stat docd normal M E 72 28 2031F H2o stat docd dehydrated M E 72 28 2044F Doc mntl tst b/4 bk trxmnt M E 72 28 21193 Reconst lwr jaw w/o graft 00000 00256 C T 21395 Treat eye socket fracture 00000 00256 C T 23490 Reinforce clavicle 00051 00052 23802 Fusion of shoulder joint 00051 00052 24346 Reconstruct elbow med ligmnt 00051 00052 24400 Revision of humerus 00051 00052 24577 Treat humerus fracture 00138 00129 24802 Fusion/graft of elbow joint 00051 00052 25365 Revise radius & ulna 00051 00052 25391 Lengthen radius or ulna 00051 00052 25400 Repair radius or ulna 00051 00052 25425 Repair/graft radius or ulna 00051 00052 25635 Treat wrist bone fracture 00138 00129 25805 Fusion/graft of wrist joint 00051 00052 25909 Amputation follow-up surgery 00000 00049 C T 26040 Release palm contracture 00054 00053 26675 Treat hand dislocation 00138 00129 27409 Repair of knee ligaments 00051 00052 27427 Reconstruction knee 00051 00052 27810 Treatment of ankle fracture 00138 00129 27840 Treat ankle dislocation 00138 00129 28570 Treat foot dislocation 00138 00129 3006F Cxr doc rev M E 72 28 3011F Lipid panel doc rev M E 72 28 3035F O2 saturation<=88% /pao<=55 M E 72 28 3037F O2 saturation> 88% /pao>55 M E 72 28 3038F Pulm fx w/in 12 mon b/4 surg E M 28 72 3040F Fev<40% predicted value M E 72 28 3042F Fev>=40% predicted value M E 72 28 3073F Pre-surg eye measures docd M E 72 28 3088F Mdd mild M E 72 28

26

HCPCS CodeDesc Old New APC Old SI New SI Old Edit New Edit APC

3089F Mdd moderate M E 72 28 3090F Mdd severe w/o psych M E 72 28 3091F Mdd severe w/psych M E 72 28 3093F Doc new diag 1st/addl mdd M E 72 28 3130F Upper gi endoscopy performed M E 72 28 3132F Doc ref upper gi endoscopy M E 72 28 3140F Upper gi endo shows barrtts M E 72 28 3141F Upper gi endo not barrtts M E 72 28 3142F Barium swallow test ordered M E 72 28 3150F Forceps esoph biopsy done M E 72 28 3200F Barium swallow test not req M E 72 28 3230F Note hring tst w/in 6 mon M E 72 28 3268F Psa/t/glsc docd b/4 txmnt M E 72 28 3290F Pt=D(Rh)- and unsensitized M E 72 28 3291F Pt=d(rh)+ or sensitized M E 72 28 3292F Hiv tstng asked/docd/revwd M E 72 28 3317F Path rpt malig cancer docd M E 72 28 3318F Path rpt malig cancer docd M E 72 28 3321F AJCC cncr 0/IA melan docd E M 28 72 3322F Melanoma>ajcc stage 0 or ia E M 28 72 3325F Preop asses 4 cataract surg M E 72 28 3328F Prfrmnc docd 2 wks b/4 surg E M 28 72 3330F Imaging study ordered (bkp) M E 72 28 3331F Bk imaging tst not ordered M E 72 28 36600 Withdrawal of arterial blood Q1 Q3 4004F Pt tobacco screen rcvd tlk E M 28 72 4014F Written discharge instr prvd M E 72 28 4016F Anti-inflm/anlgsc agent rx M E 72 28 4017F Gi prophylaxis for nsaid rx M E 72 28 4018F Therapy exercise joint rx M E 72 28 4019F Doc recpt counsl vit d/calc+ M E 72 28 4030F Oxygen therapy rx M E 72 28 4033F Pulmonary rehab rec M E 72 28 4035F Influenza imm rec M E 72 28 4052F Hemodialysis via AV fistula M E 72 28 4053F Hemodialysis via AV graft M E 72 28 4054F Hemodialysis via catheter M E 72 28 4055F Pt rcvng periton dialysis M E 72 28 4056F Approp oral rehyd recommd M E 72 28 4058F Ped gastro ed given caregvr M E 72 28 4060F Psych svcs provided M E 72 28 4062F Pt referral psych docd M E 72 28 4064F Antidepressant rx M E 72 28 4065F Antipsychotic rx M E 72 28 4066F ECT provided M E 72 28 4067F Pt referral for ect docd M E 72 28 4077F Doc t-pa admin considered M E 72 28 4133F Antihist/decong rx/recom M E 72 28 4134F No antihist/decong rx/recom M E 72 28 4135F Systemic corticosteroids rx M E 72 28

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HCPCS CodeDesc Old New APC Old SI New SI Old Edit New Edit APC

4136F Syst corticosteroids not rx M E 72 28 4155F Hep A vac series prev recvd M E 72 28 4157F Hep B vac series prev recvd M E 72 28 4163F Pt couns 4 txmnt opt prost M E 72 28 4167F Hd bed tilted 1st day vent M E 72 28 4168F Pt care icu&vent w/in 24hrs M E 72 28 4169F No pt care ICU/vent in 24hrs M E 72 28 4174F Couns potent glauc impct M E 72 28 4176F Talk re uv light pt/crgvr M E 72 28 4178F Antid glbln rcvd w/in 26wks M E 72 28 4181F Conformal radn thxpy rcvd M E 72 28 4182F No conformal radn thxpy M E 72 28 4185F Continuous ppi or h2ra rcvd M E 72 28 4186F No cont ppi or h2ra rcvd M E 72 28 4188F Approp ACE/ARB tstng done M E 72 28 4189F Approp digoxin tstng done M E 72 28 4190F Approp diuretic tstng done M E 72 28 4191F Approp anticonvuls tstng M E 72 28 4210F ACE/ARB thxpy for >= 6 mons M E 72 28 4220F Digoxin thxpy for >= 6 mons M E 72 28 4221F Diuretic thxpy for >= 6 mons M E 72 28 4230F Anticonv thxpy for >= 6 mons M E 72 28 4240F Instr xrcz 4bk pn >12 weeks M E 72 28 4242F Sprvsd xrcz bk pn >12 weeks M E 72 28 42800 Biopsy of throat 00253 00252 43216 Esophagus endoscopy/lesion 00141 00422 43242 Uppr gi endoscopy w/us fn bx 00141 00422 43510 Surgical opening of stomach 00141 00422 43752 Nasal/orogastric w/stent X Q3 43870 Repair stomach opening 00141 00422 49465 Fluoro exam of g/colon tube 00276 00277 5005F Pt counsld on exam for moles M E 72 28 5060F Fndngs mammo 2pt w/in 3 days M E 72 28 5062F Mammo result com to pt 5 day M E 72 28 51736 Urine flow measurement 00126 00340 T X 54235 Penile injection 00164 00156 6005F Care level rationale doc M E 72 28 6040F Appro rad ds dvcs techs docd M E 72 28 62273 Inject epidural patch 00206 00207 62319 Inject spine w/cath l/s (cd) 00207 00203 65286 Repair of eye wound 00232 00255 65800 Drainage of eye 00233 00255 65820 Relieve inner eye pressure 00232 00234 65900 Remove eye lesion 00233 00232 66030 Injection treatment of eye 00232 00233 66505 Incision of iris 00232 00255 66625 Removal of iris 00233 00255 66820 Incision secondary cataract 00232 00255 66830 Removal of lens lesion 00232 00255 67025 Replace eye fluid 00237 00672

28

HCPCS CodeDesc Old New APC Old SI New SI Old Edit New Edit APC

67121 Remove eye implant material 00237 00672 68100 Biopsy of eyelid lining 00232 00255 69801 Incise inner ear 00254 00253 7020F Mammo assess cat in dbase M E 72 28 70355 Panoramic x-ray of jaws 00260 00262 71010 Chest x-ray X Q3 71015 Chest x-ray X Q3 71020 Chest x-ray X Q3 72120 X-ray exam of lower spine 00261 00260 73520 X-ray exam of hips 00261 00260 77338 Design mlc device for imrt 00303 00310 77406 Radiation treatment delivery 00301 00300 78807 Nuclear localization/abscess 00406 00414 88172 Cytp dx eval fna 1st ea site 00343 00433 88319 Enzyme histochemistry 00344 00343 88367 Insitu hybridization auto 00344 00343 89257 Sperm identification 00344 00343 89259 Cryopreservation sperm 00344 00343 89260 Sperm isolation simple 00344 00343 89261 Sperm isolation complex 00344 00343 90658 Flu vaccine 3 yrs & > im L E N/A 28 90665 Lyme disease vaccine im 01216 00000 K N 90725 Cholera vaccine injectable 01271 00000 K E N/A 9 90862 Medication management 00606 00605 91037 Esoph imped function test 00361 00360 92012 Eye exam established pat 00604 00605 92953 Temporary external pacing S Q3 93282 Icd device prog eval 1 sngl 00689 00690 93283 Icd device progr eval dual 00689 00690 93284 Icd device progr eval mult 00689 00690 93289 Icd device interrogate 00689 00690 93290 Icm device eval 00690 00035 S X 93292 Wcd device interrogate 00689 00690 93293 Pm phone r-strip device eval 00689 00690 93296 Pm/icd remote tech serv 00689 00690 93299 Icm/ilr remote tech serv 00689 00691 93307 Tte w/o doppler complete 00697 00269 93745 Set-up cardiovert-defibrill 00689 00690 94002 Vent mgmt inpat init day S Q3 94003 Vent mgmt inpat subq day S Q3 94250 Expired gas collection 00368 00367 94660 Pos airway pressure cpap S Q3 94662 Neg press ventilation cnp S Q3 94680 Exhaled air analysis o2 00369 00368 94762 Measure blood oxygen level Q1 Q3 94770 Exhaled carbon dioxide test 00367 00368 95875 Limb exercise test 00215 00218 95922 Autonomic nerv function test 00215 00218 95992 Canalith repositioning proc E A 9 N/A 96003 Dynamic fine wire emg 00215 00218

29

HCPCS CodeDesc Old New APC Old SI New SI Old Edit New Edit APC

96567 Photodynamic tx skin 00016 00015 A9581 Gadoxetate disodium inj 09246 00000 G N C9248 Inj, clevidipine butyrate G K C9356 TenoGlide tendon prot, cm2 09356 00000 G N C9358 SurgiMend, fetal G K C9359 Implnt,bon void filler-putty 09359 00000 G N G0402 Initial preventive exam 00607 00606 G0416 Sat biopsy prostate 1-20 spc 01505 00661 S X G0417 Sat biopsy prostate 21-40 01507 01506 J0150 Injection adenosine 6 MG 00379 00000 K N J0190 Inj biperiden lactate/5 mg N E N/A 9 J0348 Anidulafungin injection 00760 01349 J0365 Aprotonin, 10,000 kiu 01682 00000 K N J0470 Dimecaprol injection 01273 00000 K N J0515 Inj benztropine mesylate 00000 01302 N K J1267 Doripenem injection 09241 00000 G N J1324 Enfuvirtide injection 01257 00000 K N J1435 Injection estrone per 1 MG N E N/A 9 J1436 Etidronate disodium inj 01436 00000 K N J1453 Fosaprepitant injection G K J1459 Inj IVIG privigen 500 mg G K J1571 Hepagam b im injection G K J1573 Hepagam b intravenous, inj G K J1620 Gonadorelin hydroch/ 100 mcg 07005 00000 K N J1652 Fondaparinux sodium 01276 00000 K N J1817 Insulin for insulin pump use 01277 00000 K N J1953 Levetiracetam injection 09238 00000 G N J2170 Mecasermin injection 00000 01308 N K J2430 Pamidronate disodium /30 MG 00730 00000 K N J2510 Penicillin g procaine inj 00000 01346 N K J2700 Oxacillin sodium injeciton 00000 01347 N K J2785 Regadenoson injection G K J2796 Romiplostim injection G K J2805 Sincalide injection 00000 01348 N K J2940 Somatrem injection 01225 00000 K N J3030 Sumatriptan succinate / 6 MG 03030 00000 K N J3305 Inj trimetrexate glucoronate 07045 00000 K N J3310 Perphenazine injeciton 00000 01304 N K J3320 Spectinomycn di-hcl inj N E N/A 9 J3350 Urea injection 00000 01306 N K J3400 Triflupromazine hcl inj N E N/A 9 J7502 Cyclosporine oral 100 mg 01292 00000 K N J7507 Tacrolimus oral per 1 MG 00891 00000 K N J7515 Cyclosporine oral 25 mg 01294 00000 K N J7516 Cyclosporin parenteral 250mg 01204 00000 K N J7517 Mycophenolate mofetil oral 09015 00000 K N J7520 Sirolimus, oral 09020 00000 K N J8510 Oral busulfan 00000 01307 N K J9033 Bendamustine injection G K J9165 Diethylstilbestrol injection 01209 00000 K N

30

HCPCS CodeDesc Old New APC Old SI New SI Old Edit New Edit APC

J9207 Ixabepilone injection G K J9209 Mesna injection 00732 00000 K N J9213 Interferon alfa-2a inj 00834 00000 K N J9225 Vantas implant G K J9226 Supprelin LA implant G K J9265 Paclitaxel injection 00000 01309 N K L3677 SO hard plastic stabilizer E A 9 N/A Q0174 Thiethylperazine maleate10mg N E N/A 9 Q2004 Bladder calculi irrig sol 01293 00000 K N Q4114 Integra flowable wound matri G K

Hcpcs Edit Changes The following code(s) were added to the list of female procedures, effective 01-01-11 Hcpcs 53860 57156 84112 88177

HCPCS Approval and/or Termination Date Changes The following code(s) had approval and /or termination date changes HCPCS Old ApprovalDt New ApprovalDt Old TerminationDt New TerminationDt C9801 20100826 20100825 C9802 20100826 20100825

Procedure/ Device Pair Changes The following procedure/device code pair requirements were added, effective 01-01-11 Proc Device1 37220 C1725 37220 C1885 37221 C1874 37221 C1875 37221 C1876 37221 C1877 37221 C2617 37221 C2625 37222 C1725 37222 C1885 37223 C1874

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Proc Device1 37223 C1875 37223 C1876 37223 C1877 37223 C2617 37223 C2625 37224 C1725 37224 C1885 37226 C1874 37226 C1875 37226 C1876 37226 C1877 37226 C2617 37226 C2625 37227 C1874 37227 C1875 37227 C1876 37227 C1877 37227 C2617 37227 C2625 37228 C1725 37228 C1885 37230 C1874 37230 C1875 37230 C1876 37230 C1877 37230 C2617 37230 C2625 37231 C1874 37231 C1875 37231 C1876 37231 C1877 37231 C2617 37231 C2625 37232 C1725 37232 C1885 37234 C1874 37234 C1875 37234 C1876 37234 C1877 37234 C2617 37234 C2625 37235 C1874 37235 C1875 37235 C1876 37235 C1877 37235 C2617 37235 C2625 64568 C1767 64568 C1820 64568 L8685 64568 L8686

32

Proc Device1 64568 L8687 64568 L8688 The following procedure/device code pair requirements were removed, effective 01-01-11 Proc Device1 35459 C1725 35459 C1874 35459 C1876 35459 C1885 35459 C2625 35470 C1725 35470 C1874 35470 C1876 35470 C1885 35470 C2625 35473 C1725 35473 C1874 35473 C1876 35473 C1885 35473 C2625 35474 C1725 35474 C1874 35474 C1876 35474 C1885 35474 C2625 64573 C1778 64573 C1897 64573 L8680 The following procedure/device code pair requirements were added, effective 01-01-11 Proc Device2 64568 C1778 64568 C1897 64568 L8680

Device/Procedure Pair Changes The following device/procedure code pair requirements were added, effective 01-01-11 Device Proc C1767 64568 C1778 64568 C1820 64568 C1897 64568 L8680 64568 L8685 64568 L8686 64568

33

Device Proc L8687 64568 L8688 64568 The following device/procedure code pair requirements were removed, effective 01-01-11 Device Proc C1778 64573 C1897 64573 L8680 64573

MODIFIERS

Added Modifiers The following modifier(s) were added to the list of valid modifiers, effective 04-01-10 modif ACTIVATIONDATE CS 20100420 The following modifier(s) were added to the list of valid modifiers, effective 01-01-11 modif ACTIVATIONDATE 4P 0 4Q 0 4R 0 4S 0 4T 0 4U 0 AY 0 AZ 0 DA 0 GU 0 NB 0 PT 0