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UCSF Clinical Enterprise Compliance Program

Medical Group Business Services

Brown Bag Education Series

University of California, San Francisco


And Now For Another Fun-Filled Year

Coding and Regulatory Updates for 2007



CECP Education SeriesWanda T. Ziemba MFA RHIT CHCC

CHCO CHC CPC

Associate Compliance Officer &

CECP Educators


The New, New, New Codes


Overview of CPT Changes New Technology

– Interventional Procedures– Laparoscopic/Endoscopic Services

Progress Towards CPT – 5 Multiple special instructions


CPT – Evaluation & Management

Clarification of services provided after an initial consultation when the consulting physician assumes care

Only one consultation per consultant per admission


Critical Care – Preambles highlighted but no changes noted


Anticoagulant Management- New Codes– 99363: Anticoagulant management for an

outpatient taking Warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed) and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements

– 99364: each subsequent 90 days of therapy (must include a minimum of 3 INR measurements


CPT – Anesthesia

Spine & Spinal Cord – – 00625: Anesthesia for procedures on the

thoracic spine and cord via an anterior or transthoracic approach; not utilizing one lung ventilation

– 00626: utilizing one lung ventilation


CPT – Integumentary

Graft Site Preparation – 4 new codes replacing 15000 and 15001.

15002:Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children

15003: each addition 100 sq cm or additional 1% of body are of infants and children


15004: as in 15002 – face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits

15005: each additional 100 sq cm or additional 1% of body area of infants and children


Lipectomy – two new

codes that replace

15831 (excision

excessive skin and

subcutaneous tissue,

including lipectomy:

abdomen (abdominoplasty.


15830: Excision, excision skin and subcutaneous tissue (includes lipectomy) abdomen, infraumbilical panniculectomy

15831: Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen, eg abdominoplasty (includes umbilical transposition and fascial plication) ( list separately in addition to code for primary procedure.


Codes are chosen based on the complexity of the service provided.

15830 is used to report less extensive procedures

15831 for extensive procedures requiring closures with umbilical transposition and fascial plication


Breast – one new code and 8 re-numbered

19105: new code for (ablation, cryosurgical of adenoma, including ultrasound guidance, each fibroadenoma

Replaces Category III code 0120T


Crosswalk for 8 Renumbered Codes

2007 Codes 2006

19300 (mastectomy for gynecomastia 16140

19301 (mastectomy, partial eg lumpectomy, tylectomy, quadrantectomy, Segmentectomy;)

19160

19302 (…with axillary lymphadenectomy) 19162

19303 (mastectomy, simple, complete) 19180

19304 (mastectomy, subcutaneous) 19182

19305 (mastectomy, radical, including pectoral muscles, axillary lymph nodes)

19200

19306 (mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes, [ Urban type operation])

19220

19307 ( mastectomy, modified radical, including axially lymph nodes with or without pectoralis minor muscle, but excluding pectoralis major)

19240


Crosswalk for 8 Renumbered Codes

2007 Codes 2006

77011 (computed tomography guidance for stereotactic localization)

76355

77031 (stereotactic localization guidance for breast biopsy or needle placement eg for wire localization or injection, radiological supervision and interpretation)

76095

77032 (mammographic guidance for needle placement, breast eg for wire localization or for injection, each lesion, radiological supervision and interpretation)

76096


CPT – Cardiovascular

Thromboendarterectomy– One revised and 5 new codes– Previously reported with CPT 35381

(thromboendartectomy with or without patch graft, femoral and/or popliteal and /or tibioperoneal)


35301: Thromboendarterectomy, including patch graft if performed

35302: Thromboendarterectomy, including patch graft if performed; superficial femoral artery

30304: Thromboendarterectomy, including patch graft if performed; popliteal artery


30305: Thromboendarterectomy, including patch graft if performed; tibial or peroneal artery, initial vessel

35306: Thromboendarterectomy, including patch graft if performed; each additional tibial or peroneal artery (list separately in addition to code for primary procedure)


Revisions to bypass graft codes– 35501: Bypass graft with vein; common

carotid - ipsilateral internal carotid artery– 35506: carotid – subclavian or subclavian –

carotid– 35509: carotid – contralateral carotid– 35601: Bypass graft with other than vein;

common carotid – ipsilateral internal carotid


CPT – Gastrointestinal

Four new codes Two for implantation or replacement Two for revision or removal Differentiated by approach –

laparoscopic or open


43647: Laparoscopy, surgical; implantation or replacement of gastric neurostimulator electrodes, antrum

43648: revision or removal or gastric neurostimulator electrodes, antrum

43881: Implantation or replacement of gastric neurostimulator electrodes, antrum, open

43882: revision or removal or gastric neurostimulator electrodes, antrum, open


Revision of existing codes to indicate placement or revision of gastric neurostimulators in non-abdominal areas

64590: Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling

64595: Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver


43647-43648, 43881-43882 replaced Category III codes 0155T-0158T

Did not appear in the CPT 2006 because there were implement on July 1, 2006


Laparoscopic Intraperitoneal Catheter Procedures– 49324: Laparoscopy, surgical; with insertion of

intraperitoneal cannula or catheter, permanent– 49325:…with revision of previously placed

intraperitoneal cannula or catheter, with removal of intraluminal obstructive material if performed

– 49326: …with omentopexy tacking procedure (lust separately in addition to primary procedure

– 49435: Insertion of subcutaneous extension to intraperitoneal cannula or catheter with remote chest exit site (list separately in addition to code for primary procedure

– 49436: Delayed creation of exit site from embedded subcutaneous segment of intraperitoneal cannula or catheter


Replace the unlisted 49329 (unlisted laparoscopy procedure, abdomen, peritoneum and omentum

Note that 49362, 49435 and 49436 are add-on services


Six renumbered digestive procedures

Slightly revised descriptions


2007 Code 2006 Code

Changes

44157 (colostomy, total, abdominal, with proctectomy, with ileoanal anastomosis, includes loop ileostomy and rectal mucosectomy, when performed

44152 When performed added; codes now says with proctectomy, whereas code 44152 said without

44158 (…ileoanal anastomosis, partial [eg lumpectomy, tylectomy, quadrantectomy, Segmentectomy]

44153 44158 says with proctectomy whereas 44153 says without

47719 (anastomosis, choledochal cyst without excision

47716 No changes

48105 (resection or debridement of pancreas or peripancreatic tissue for acute necrotizing pancreatitis

48005 No changes

48648 (pancreatic jejunostomy, side-t-side anastomosis [Puestow-type operation]

48180 No changes

49402 (removal of peritoneal foreign body from peritoneal cavity)

49085 No changes


CPT – Male Genitourinary

One new code added 55876: placement of interstitial

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

Radiological S&I – 76942, 77002, 77012, 77021


CPT – Female Genitourinary 56442 – Hymenotomy simple incision 58541 – laparoscopy, surgical, supracervical

hysterectomy, for uterus 250 g or less 58542 - …with removal or tube(s) and/or

ovary(s) 58543 – laparoscopy, surgical, supracervical

hysterectomy for uterus greater than 250 g 58544 - …with removal or tube(s) and/or

ovary(s)


58548 – Laparoscopy, surgical with radial hysterectomy with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling with removal of tube(s) and ovary(s) if performed

58957 – Resection, tumor debulking of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal retroperitoneal tumors) with omentectomy if performed

58958 - …with pelvic lymphadenectomy and limited para-aortic lymphadenectomy


CPT – Nervous System

64910 – Nerve repair with synthetic conduit or vein allograft (eg nerve tube) each nerve

64911 - …with autogenous vein graft (includes harvest of vein graft) each nerve


CPT – Eye

67346 – Biopsy of extraocular muscle


CPT Radiology

Significant additions Changes in technology

– Functional MRI of brain– Obstetric Ultrasound– Guidance techniques

• Fluoroscopy• CT• MRI• Stereotactic


New mammography CPT codes Bone and joint studies Stereotactic delivery of radiation

treatment


Functional MRI– Identification and mapping of stimulation of

brain function• 70554 – MRI imaging, brain, functional MRI;

including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration

• 70555 - …requiring physician or psychologist administration of entire neurofunction testing

– Significant instructional notes for bundled services (see 96020)


Obstetric Ultrasound– 76813 – Ultrasound, pregnant uterus, real time

with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation

– 76814 - …each additional gestation (list separately in addition to code for primary procedure)


Fluoroscopic Guidance– 77001 – Central venous access device

placement, replacement or removal– 77002 – Needle placement, localization

devices– 77003– Spine or paraspinous diagnostic or

therapeutic injections procedures


CT Guidance– 77011 – Stereotactic localization– 77012 – Needle placement– 77013 – guidance for and monitoring of

parenchymal tissue ablation– 77014 – Placement of radiation therapy

fields


MRI Guidance– 77021 - Needle placement– 77022 - guidance for and monitoring of

parenchymal tissue ablation


Breast Mammography– New codes for computer-aided detection– Ductograms and galactograms– Unilateral and bilateral services for both

diagnostic and screening– MRI breast with and/or without contracts,

unilateral & bilateral


Bone and Joint Studies– 77071 – Manual application of stress

performed by physician– 77072 – Bone age studies– 77073 – Bone length studies– 77074 – Radiologic examination, osseous

survey, limited– 77075 – …complete axial & appendicular

skeleton


– 77076 – Radiologic examination, osseous survey, infant

– 77077 – Joint survey, single view, two or more joints

– 77078 =- CT bone mineral density study, 1or mo3 sites, axial

– 77079 - …axial skeleton


77080 – DEXA bone density study, 1 or mor3e sites, axial

77081 …appendicular skeleton 77082 - …vertebral fracture assessment 77083 – Radiographic absorptiometry, 1

or more sites 77084 – MRI bone marrow blood supply


Radiation Oncology– Stereotactic delivery

• 77371 – Complete course consisting of 1 session; multi source Cobalt 60 based

• 77372 - …linear accelerator based• 77373 – per fraction, to one or more lesions

entire course not to exceed 5 fractions


CPT – Pathology and Laboratory

Few new codes New bugs, new detection

– 83913 – RNA stabilization– 87305 – …Aspirgillus (Microbiology)– 87498 - …enterovirus– 87640 - …staph aureus, amplified probe– 87641 - …above, methicillin resistant– 87653 - …Streptococcus, group B, direct probe

technique


CPT – Medicine

Pulmonary – new ventilator management codes replacing 94656 and 94657– 94002 – Hospital, initial day– 94003 - …hospital subsequent day– 94004 - …nursing facility per day– 94005 – Home vent management care

plan oversight per month, 30 minutes or more


Apnea Monitoring– 94774 – pediatric home apnea event

monitoring– 94775 - …monitor attachment only– 94776 - …monitoring, download of

information, receipt of transmissions and analysis by computer only

– 94777 - …physician review, interpretation and preparation of report only


CPT Category II & III

Multiple monitoring codes for CAP (community acquired pneumonia) and COPD (with tobacco use/asthma)

Additional physical examination monitoring codes such as vital signs, mental status, hydration

Diagnostic/Screening Processes or results such as Colorectal, mammography, pulmonary function and cardiac measurements


Multiple category III for CT heart services, islet cell services, gastric stimulation electrodes, disc arthroplasty and placement of devices via stereotactic guidance.


Summary

Multiple additions reflective of new technology or new methods of approach

Significant number of special instructions which must be reviewed prior to assigning codes

Multiple deletions from the category codes and assignment of CPT

Prepare for Pay-for-Service by becoming accustomed to the Category II codes

Brush up on your ICD-9-CM

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