CPT CHANGES 2015 - Physician Strategy Group€¦ · · 2016-10-17CPT CHANGES 2015: What’s New, Revised, ... (TAP) block (abdominal plane block, rectus sheath ... (abdominal plane

© 2014 American Medical Association. All rights reserved.

Cristina Bentin, CCS-P, CPC-H, CMA

AHIMA Approved ICD-10-CM Trainer

Coding Compliance Management, LLC

[email protected] * 225.752.8390

CPT CHANGES 2015: What’s New, Revised, and Deleted

Current Procedural Terminology (CPT) is copyright 2014

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.

CPT® is a trademark of the American Medical Association.

mailto:[email protected]


Learning Objectives:

• 2015 CMS Final Rule Resources (CMS-1613-FC)

• AMA CPT Changes (NOT ALL INCLUSIVE)

– Integumentary – Errata

– Musculoskeletal

– Urinary, Nervous, Eye

– Cardiovascular

– Digestive

– Radiology


CMS – ASC Resource Link

http://www.cms.gov/Center/Provider-Type/Ambulatory-Surgical-Centers-ASC-Center.html © 2014 American Medical Association. All rights reserved.

http://www.cms.gov/Center/Provider-Type/Ambulatory-Surgical-Centers-ASC-Center.html












AMBULATORY SURGERY CENTER ASSOCIATION

http://www.ascassociation.org/educationevents/2015coding

• http://www.ascassociation.org/Home/


ASCA Member Resource Page/Links

http://www.ascassociation.org/federalregulations/medicarepayments © 2014 American Medical Association. All rights reserved.



http://www.ascassociation.org/Home/

http://www.ascassociation.org/federalregulations/medicarepayments

http://www.ascassociation.org/federalregulations/medicarepayments


ASCA 2015 Rate Calculator


ASCA List of 2015 Device Intensive Procedures

2015 Final Rate Calculator.xlsx

2015 Device Intensive Procedures.pdf


AMA CPT 2015 Changes

A COMPLETE LISTING OF ALL ADDITIONS, REVISIONS, DELETIONS CAN BE FOUND IN APPENDIX B OF THE AMA’S 2015 PROFESSIONAL EDITION CPT MANUAL.


AMA 11-07-2014 ERRATA Integumentary – Breast - Excision

cpt-corrections-errata-2015 nov 11 2014.pdf


2015 Musculoskeletal System


Spine Codes Added to CMS 2015 List of ASC Approved Procedures

22551 Neck spine fuse & removal below

C2 $7842.24

22554 Neck spine fusion $7842.24

22612 Lumbar spine fusion $7842.24

22614 Spine fusion extra segment N1

63020 Neck spine disk surgery $2254.50

63030 Low back disk surgery $2254.50

63042 Laminotomy single lumbar $2254.50

63044 Laminotomy add’l level L N1

63045 Laminectomy……, cervical $2254.50

63047 Laminectomy……, lumbar $2254.50

63056 Decompress spinal cord, lumbar $2254.50



CPT CODE CPT DESCRIPTOR

20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance ($22.20)




20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting ($37.95)



20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow, or ankle, olecranon bursa); without ultrasound guidance ($23.63)




20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow, or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting ($41.17)



20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance ($28.64)




20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting ($47.97)

CMS Reimbursement

CPT

2014 Rate

2015 Rate

20600 $16.24 $22.20 20604 NA $37.95 20605 $17.03 $23.63 20606 NA $41.17 20610 $20.96 $28.64 20611 NA $47.97

VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS.




20982 Ablation; therapy for reduction or eradication of 1 or more bone tumor(s) tumors (eg,osteoid osteoma, metastasis) radiofrequency including adjacent soft tissue when involved by tumor extension, percutaneous, including computed tomographic guidance (imaging guidance when performed; radiofrequency ($2062.56)



20983 Ablation; therapy for reduction or eradication of 1 or more bone tumors (eg,metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including (imaging guidance when performed; cryoablation ($2062.56)


CMS Reimbursement

CPT

2014 Rate

2015 Rate

20982 $2089.06 $2062.56 20983 NA $2062.56



CPT CODE DELETION

CPT DESCRIPTOR

22520 22520 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic (deleted in 2015)

22521 22521…...lumbar (deleted in 2015)

22522 22522…….each additional thoracic or lumbar vertebral body (deleted in 2015)


2015 Musculoskeletal System CPT CODE DELETION

CPT DESCRIPTOR

22523 22523 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic (deleted in 2015)

22524 22524…...lumbar (deleted in 2015)

22525 22525…….each additional thoracic or lumbar vertebral body (deleted in 2015)



22510 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic ($1426.27)

22511 …….lumbosacral ($1426.27)

+ 22512 …….each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure) (N1)




22513 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance, thoracic ($3465.63)

22514 …….lumbar ($3465.63)

+ 22515 …….each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) (N1)



22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), single interspace, cervical (Not on CMS list of approved ASC procedures)



Instructional parenthetical notes under CPT 22856:

• (Do not report 22856 in conjunction with 22554, 22845, 22851, 63075, 0375T, when performed at the same level)

• (For additional interspace cervical total disc arthroplasty, see 22858, 0375T)



# + 22858 …….second level, cervical (List separately in addition to code for primary procedure) (not on CMS list)

• (Use 22858 in conjunction with 22856)

• (Do NOT report 22858 in conjunction with 0375T, when performed at the same level)


2015 Musculoskeletal CAT III Addition

CAT III CODE CATEGORY III DESCRIPTOR

0375T Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), cervical, three or more levels (Not on CMS list of approved ASC procedures)

(Do not report 0375T in conjunction with 22851, 22856, 22858 when performed at the same level)

2015 Musculoskeletal CAT III Deletion

CAT III CODE DELETION

CAT III DESCRIPTOR

0092T Total disc arthroplasty (artificial disc), anterior approach,

including discectomy with end plate preparation (includes

osteophytectomy for nerve root or spinal cord decompression

and microdissection), each additional interspace, cervical


CMS Reimbursement

CPT

2014 Rate

2015 Rate

22510 NA $1426.27 22511 NA $1426.27

+22512 NA (N1) 22513 NA $3465.63 22514 NA $3465.63

+22515 NA (N1) 22856 NA NA

+22858 NA NA VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS.

Musculoskeletal Category III Revisions


0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy , when performed ($1426.27)

0201T Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy , when performed ($1426.27)




27279 Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device ($7842.24)

(For bilateral procedure, report 27279 with modifier 50)

Musculoskeletal CAT III Deletion


CAT III DESCRIPTOR

0334T Sacroiliac joint stabilization for arthrodesis, percutaneous or minimally invasive (indirect visualization), includes obtaining and applying autograft or allograft (structural or morselized), when performed, includes image guidance when performed (eg, CT or fluoroscopic)




27280 Arthrodesis, open, sacroiliac joint, including obtaining bone graft, including instrumentation, when performed (Not on CMS list of approved ASC procedures)

(For percutaneous/minimally invasive arthrodesis of the sacroiliac joint without fracture and/or dislocation, use 27279)

CMS Reimbursement

CPT

2014 Rate

2015 Rate

0200T $1422.98 $1426.27 0201T $1422.98 $1426.27 27279 NA $7842.24 27280 NA NA 0232T 54.28 N1



2015 Urinary System

• Two New Codes (52441, 52442)

• New or revised parenthetical notes


52441 Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant (not on CMS approved ASC list)

+ 52442 …….; each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure) (not on CMS approved ASC list)

2015 Urinary System


2015 Urinary System

Instructional parenthetical notes below CPT 52442:

• (To report removal of implant(s), use 52310)

• (For insertion of a permanent urethral stent, use 52282. For insertion of a temporary prostatic urethral stent, use 53855)

CMS Reimbursements

CPT

2014 Rate

2015 Rate 52005 $1108.88 $1142.74 52007 $1108.88 $1142.74 52010 $297.76 $300.88 52204 $1108.88 $1142.74 52214 $1108.88 $1142.74 52224 $1108.88 $1142.74 52234 $1108.88 $1142.74 52235 $1108.88 $1142.74 52240 $1108.88 $1142.74 52250 $1108.88 $1142.74 52260 $665.55 $672.51


2015 Nervous System


2015 Nervous System • Addition of 4 Myleography injection codes: CPT 62302, 62303, 62304, 62305 (N1 payment indicator) • Addition of 4 Tap Block codes: CPT 64486, 64487, 64488, 64489 (N1 payment indicator) • Deletion of 2 nerve transection codes: CPT 64752 (vagus nerve, transthoracic) CPT 64761 (pudendal nerve) • Deletion of 1 anastomosis code: CPT 64870 (facial-phrenic)



62302 Myelography via lumbar injection, including radiological supervision and interpretation; cervical (N1 payment indicator)

62303 …….; thoracic(N1 payment indicator)

62304 …….; lumbosacral (N1 payment indicator)

62305 …….; 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical) (N1 payment indicator)

2015 Nervous System


64486 Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)(N1 payment indicator)

64487 …….; by continuous infusion(s) (includes imaging guidance, when performed) (N1 payment indicator)

2015 Nervous System Tap Block



64488 Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)(N1 payment indicator)

64489 …….; by continuous infusions (includes imaging guidance, when performed) (N1 payment indicator)

2015 Nervous System Tap Block

2015 Nervous System

CPT CODE DELETION

CPT DESCRIPTOR

64752 Transection or avulsion of; vagus nerve (vagotomy), transthoracic (deleted in 2015)

64761 Transection or avulsion of: pudendal nerve (deleted in 2015 – was paid @764.49 in 2014)

64870 Anastomosis; facial-phrenic (deleted in 2015 – was paid @1582.01 in 2014)


Nervous System Reimbursements

CPT

2014 Rate

2015 Rate 62310 $370.07 $368.37 62311 $370.07 $368.37 62318 $370.07 $368.37 62319 $370.07 $368.37 64479 $370.07 $368.37 64480 ---- ---- 64483 $370.07 $368.37 64484 ---- ---- 64490 $370.07 $368.37 64491 ---- ---- 64492 ---- ----

Nervous System Reimbursements

CPT

2014 Rate

2015 Rate 64493 $370.07 $368.37 64494 ---- ---- 64495 ---- ---- 64633 $853.53 $805.75 64634 ---- ---- 64635 $853.53 $805.75 64636 ---- ---- 64415 $195.55 $204.32 64416 $370.07 $368.37 64417 $195.55 $204.32


CMS NCCI EDITS

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html © 2014 American Medical Association. All rights reserved.

2015 Eye and Ocular Adnexa


../../Downloads/NCCI_Policy_Manual (3).zip

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html


2015 Eye and Ocular Adnexa

CPT CODE DELETION

CPT DESCRIPTOR

66165 Fistulization of sclera for glaucoma; iridencleisis or iridotasis (deleted in 2015 – was paid @ 966.16 in 2014)

2015 Eye and Ocular Adnexa CPT CODE CPT DESCRIPTOR

66179 Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft($1711.53)

66180 …….; with graft ($1711.53)

(Do not report 66180 in conjunction with 67255)



66184 Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft($960.64)

66185 …….; with graft ($960.64)

(Do not report 66185 in conjunction with 67255)


67399 Unlisted procedure, ocular extraocular muscle


2015 Misc. Category III Code Revision Eye and Ocular Adnexa


0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; initial insertion ($1711.53)

# + 0376T

…….; each additional device insertion (List separately in addition to code for primary procedure) (N1 payment indicator)

2015 Misc. Category III Code Addition Eye and Ocular Adnexa


0356T Insertion of drug-eluting implant (including punctal dilation and implant removal when performed) into lacrimal canaliculus, each (not on CMS approved ASC list)


2015 Eye/Ocular Adnexa Reimbursements Vitrectomy

CPT

2014 Rate

2015 Rate

67036 $1690.59 $1711.53 67039 $1690.59 $1711.53 67040 $1690.59 $1711.53 67041 $1690.59 $1711.53 67042 $1690.59 $1711.53 67043 $1690.59 $1711.53

2015 Eye/Ocular Adnexa Reimbursements Cataracts/Retinals

CPT

2014 Rate

2015 Rate

66982 $975.58 $960.64 66983 $975.58 $960.64 66984 $975.58 $960.64 67101 $332.49 $456.11 67105 $236.57 $243.16 67107 $1690.59 $1711.53 67108 $1690.59 $1711.53 67110 $355.28 $486.90 67112 $1690.59 $1711.53


2015 Cardiovascular System


Implantable Defibrillator Procedures

Changes in Surgery and Medicine Cardiovascular

Sections

25 Revised

6 New






33215 Repositioning of previously implanted transvenous pacemaker or pacing cardioverter implantable defibrillator (right atrial or right ventricular) electrode ($863.86)

33216 Insertion of a single transvenous electrode, permanent pacemaker or cardioverter implantable defibrillator ($5649.82)

33217

Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverter implantable defibrillator ($5649.82)



33218 Repair of single transvenous electrode, permanent pacemaker or pacing cardioverter implantable defibrillator ($1286.56)

33220 Repair of 2 transvenous electrodes for permanent pacemaker or pacing cardioverter implantable defibrillator ($1286.56)

33223

Relocation of skin pocket for cardioverter implantable defibrillator ($771.43)




33224 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator) ($7851.02)



+ 33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure) (N1)




33240 Insertion of pacing cardioverter implantable defibrillator pulse generator only; with existing single lead ($20,286.25)

(Do not report 33240 in conjunction with 33271, 93260, 93261)



# 33230 Insertion of pacing cardioverter implantable defibrillator pulse generator only; with existing dual leads ($20,286.25)

# 33231 Insertion of pacing cardioverter implantable defibrillator pulse generator only; with existing multiple leads ($27,203.55)

There codes follow the parent code 33240.




33241 Removal of pacing cardioverter implantable defibrillator pulse generator only ($1286.56)

• (Do not report 33241 in conjunction with 93260, 93261)

• (Do not report 33241 in conjunction with 33230, 33231, 33240 for removal and replacement of the implantable defibrillator pulse generator. Use 33262, 33263, 33264, as appropriate, when pulse generator replacement is indicated)



# 33262 Removal of pacing cardioverter implantable defibrillator pulse generator with replacement of pacing cardioverter implantable defibrillator pulse generator; single lead system ($20,286.25)

# 33263 .......; dual lead system ($20,286.25)

# 33264

…….; multiple lead system ($27,203.55)




33243 Removal of single or dual chamber pacing cardioverter implantable defibrillator electrode(s); by thoracotomy (not on CMS list)

33244

Removal of single or dual chamber pacing cardioverter implantable defibrillator electrode(s); by transvenous extraction (not on CMS list)



33249 Insertion or replacement of permanent pacing cardioverter implantable defibrillator system, with transvenous lead(s), single or dual chamber ($27,203.55)

• (Do not report 33249 in conjunction with 33216, 33217) • (For removal and replacement of an implantable

defibrillator pulse generator and transvenous electrode(s), use 33241 in conjunction with either 33243 or 33244 and 33249)

• (For insertion of transvenous implantable defibrillator lead(s), without thoracotomy, use 33216 or 33217)




# 33270 Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed ($27,203.55)



# 33271 Insertion of subcutaneous implantable defibrillator electrode ($5649.82)

# 33272 Removal of subcutaneous implantable defibrillator electrode (not on CMS list)

# 33273 Repositioning of previously implanted subcutaneous implantable defibrillator electrode ($1286.56)


2015 Cardiovascular Cat III Deletions

• Category III codes 0319T, 0320T, 0321T, 0322T, 0323T, 0324T, 0325T, 0326T, 0327T, 0328T have been deleted in 2015.

• To report, see CPT 33240, 33241, 33262, 33270, 33271, 33272, 33273, 93260, 93261, 93644.

CMS Reimbursement

CPT

2014 Rate

2015 Rate

33215 $841.96 $863.86 33216 $2542.22 $5649.82 33217 $2542.22 $5649.82 33218 $1280.34 $1286.56 33220 $1280.34 $1286.56 33223 $757.47 $771.43 33224 $9,285.61 $7851.02

+33225 $9,285.61 N1 VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS.


CMS Reimbursement

CPT

2014 Rate

2015 Rate

33230 $22,881.67 $20,286.25 33231 $22,881.67 $27,203.55 33240 $22,881.67 $20,286.25 33241 $1280.34 $1286.56 33243 NA NA 33244 NA NA 33249 $29,599.81 $27,203.55 33262 $22,881.67 $20,286.25


CMS Reimbursement

CPT

2014 Rate

2015 Rate

33263 $22,881.67 $20,286.25 33264 $22,881.67 $27,203.55 33270 NA $27,203.55 33271 NA $5649.82 33272 NA NA 33273 NA $1286.56



2015 Digestive System Upper GI


2015 Digestive Section Rationale for Upper GI Changes

• Updated to reflect technology, devices, and techniques used in current practice.

• Standardized to allow for parallel concepts across the 3 sections.


2015 Digestive System Rigid Esophagoscopy


43180 Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker’s diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed. ($1066.74)

(For diverticulectomy of hypopharynx or esophagus (open), see 43130, 43135)

2015 Digestive System Rigid Esophagoscopy


43194 Esophagoscopy, rigid, transoral; with removal of foreign body(s) ($583.67)

• (Do not report 43194 in conjunction with 43191, 43197, 43198)

• (If fluoroscopic guidance is performed, use 76000) • (For flexible transoral esophagoscopy with removal

of foreign body(s), use 43215)


2015 Digestive System Flexible Esophagoscopy


43197 Esophagoscopy, flexible, transnasal; diagnostic, includes including collection of specimen(s) by brushing or washing when performed (separate procedure) ($408.68)

(Do not report 43197 in conjunction with 31575, 43191, 43192, 43193, 43194, 43195, 43196, 43198, 43200-43232, 43235-43259, 43266, 43270, 92511)

2015 Digestive System Flexible Esophagoscopy


43215 Esophagoscopy, flexible, transoral; with removal of foreign body(s) ($583.67)

43216 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery ($1049.73)


2015 Digestive System Esophagogastroduodenoscopy (EGD)


43247 Esophagogastroduodenoscopy, flexible transoral; with removal of foreign body(s) ($408.68)

43250 Esophagogastroduodenoscopy, flexible transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery ($583.67)

EGD Reimbursements

CPT

2013 Rate

2014 Rate

2015 Rate

43235 $349.83 $370.38 $408.68 43236 $349.83 $370.38 $408.68 43237 $520.05 $559.63 $583.67 43238 $520.05 $559.63 $583.67 43239 $349.83 $370.38 $408.68 43240 $520.05 $559.63 $1049.73 43241 $349.83 $370.38 $408.68 43242 $520.05 $559.63 $583.67 43243 $349.83 $370.38 $408.68 43244 $520.05 $559.63 $583.67


2015 Digestive System Lower GI


2015 Digestive System Lower Endoscopy

2014 Intestines (Except

Rectum)

2014 Endoscopy,

Small Intestine and Stomal

2015 Endoscopy, Small

Intestine

2015 Endoscopy,

Stomal


2015 Digestive System Endoscopy – Small Intestines

Editorial Directive

• Antegrade transoral small intestinal endoscopy(enteroscopy) is defined by the most distal segment of small intestine that is examined.

• 44360-44373 – Enteroscopy - esophagus through jejunum, antegrade

• 44376-44379 – Enteroscopy - esophagus through the ileum, antegrade approach

2015 Digestive System Endoscopy – Small Intestines

Editorial Directive

• If an endoscope cannot be advanced at least 50 cm beyond the pylorus, see 43233, 43235-43259, 43266, 43270 (i.e. EGD codes)

• If an endoscope can be passed at least 50 cm beyond pylorus but only into the jejunum, see 44360, 44361, 44363, 44364, 44365, 44366, 44369, 44370, 44372, 44373.

*Surgeon MUST document the extent he goes so the coder will know the coding series to review.*


2015 Digestive System Endoscopy – Editorial Change

“including collection of specimen(s) by brushing

or washing, when performed” replaces “with or without collection of specimen(s)”

2015 Digestive System Endoscopy, Small Intestine


44360 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($467.23)

44363

……..with removal of foreign body(s) ($467.23)


ENDOSCOPY, STOMAL ILEOSCOPY AND POUCHOSCOPY

2015 Digestive System Endoscopy, Stomal

Ileoscopy and Pouchoscopy

Instructional parenthetical notes: • Colonoscopy through stoma is the exam of the colon, from the

colostomy stoma to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis.

• Report colonoscopy via stoma (44388-44408) for endoscopic

exam of a patient who has undergone segmental resection of the colon (eg, hemicolectomy, sigmoid colectomy, low anterior resection) and has a colostomy)

• Report ileoscopy via stoma (44380, 44381, 44382, 44384) for

endoscopic examination of a patient who has an ileostomy.





44380 Ileoscopy, through stoma; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($467.23)

# 44381 …….with transendoscopic balloon dilation ($467.23)

44384 …….with placement of endoscopic stent (includes pre-and post-dilation and guide wire passage, when performed) ($467.23)




44385 Endoscopic evaluation of small intestinal pouch (abdominal eg, Kock pouch, ileal reservoir [S or pelvic J]pouch; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($432.94)

44386 …….with biopsy, single or multiple ($432.94)



Colonoscopy Through Stoma

CPT CODE CPT DESCRIPTOR 44388 Colonoscopy through stoma; diagnostic, with or

without (including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($432.94)

44390 …….with removal of foreign body(s) ($432.94)

44391

…….with control of bleeding , (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) any method ($432.94)

44392 …….with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery ($432.94)


44401 Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) ($432.94)

44402 …….; with endoscopic stent placement (including pre- and post-dilation and guide wire passage, when performed) ($432.94)

44403 …….; with endoscopic mucosal resection ($432.94)





44404 …….; with directed submucosal injection(s), any substance ($432.94)

44405 …….; with transendoscopic balloon dilation ($432.94)

44406 …….; with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures ($432.94)




44407 …….; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures ($432.94)

44408 …….; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ($432.94)



(Do not report 44408 more than once per session)


2015 Digestive System Other Procedures

• (For unlisted laparoscopic procedure, intestine except rectum, use 44238)

• (For unlisted procedure, colon, use 45399)


44799 Unlisted procedure, small intestine

2015 Digestive System Colonoscopy Through Stoma

CPT CODE DELETION

CPT DESCRIPTOR

44393 .......;with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (deleted in 2015) Use 44401 in 2015

44397 …….;with transendoscopic stent placement (includes predilation) (deleted in 2015) Use 44402 in 2015


2015 Digestive System Colon and Rectum - Endoscopy

Instructional parenthetical notes:

• Colonoscopy via stoma (44388-44408)

• Proctosigmoidoscopy (45300-45327)

• Flexible sigmoidoscopy (45330-45347)

• Anoscopy (46600, 46604, 46606, 46608, 46610, 46611, 46612, 46614, 46615)

• Ileoscopy via stoma (44380, 44381, 44382, 44384)

* When bleeding occurs as a result of an endoscopic procedure, control of bleeding is not reported separately during the same operative session.

2015 Digestive System Colon and Rectum - Endoscopy

Instructional parenthetical notes: • Report pouch endoscopy codes 44285, 44386 for

endoscopic examination of a patient who has undergone resection of colon with ileo-anal anastomosis (eg, J-pouch).

• Report flexible sigmoidoscopy (45330-45347) for

endoscopic examination during which the endoscope is not advanced beyond the splenic flexure……(keep reading all parentheticals and editorial directives)…..

* NOTE: Do your carriers and MAC agree? Verify with MAC LCDs, Transmittals, and Carrier directives.*


Revise the colonoscopy decision tree illustrated on page 284 of the 2015 CPT Prof book to indicate that when performing a therapeutic procedure to the cecum, report colonoscopy codes 45379-45398 with “No Modifier”.

AMA 11-07-2014 Errata

Decision to Undergo

Colonoscopy

Diagnostic

Does NOT Reach Splenic

Flexure

Flexible Sigmoidoscopy

(45330)

Beyond Splenic Flexure But Not

to Cecum

Colonoscopy (45378;

Modifier 53)

To Cecum

Colonoscopy (45378;

No Modifier

This chart reflects AMA CPT decision tree 2015 AMA CPT Professional Edition pg 284. It is not the interpretation of all carriers/MACs. Facilities must verify carrier directives and local coverage determinations (LCDs) prior to CPT code selection and reporting. Commercial carrier directives will often differ from individual MAC/CMS LCD policies.

AMA CPT Decision Tree 2015

DO YOUR SPECIFIC CARRIERS AND/OR MAC AGREE? SOME CARRIER AND MAC DIRECTIVES

STATE WHEN SCHEDULED AS COLONOSCOPY CODE AS

COLONOSCOPY WITH APPLICATION OF

APPROPRIATE MODIFIER. VERIFY! VERIFY!

AMA STATES “DIAGNOSTIC” OR

“SCREENING” IN CPT MANUAL. DO YOUR SPECIFIC CARRIERS

AND/OR MAC AGREE? VERIFY DEFINITIONS,

TERMS, REPORTING WITH CARRIER

DIRECTIVES. DON’T GET CONFUSED WITH

DIAGNOSTIC, SCREENING,

THERAPEUTIC TERMS

AMA STATES “DIAGNOSTIC” OR

“SCREENING” IN CPT MANUAL. DO YOUR SPECIFIC CARRIERS

AND/OR MAC AGREE? VERIFY DEFINITIONS,

TERMS, REPORTING WITH CARRIER

DIRECTIVES. DON’T GET CONFUSED WITH

DIAGNOSTIC, SCREENING,

THERAPEUTIC TERMS IN CPT WITH INDIVIDUAL CARRIER DIAGNOSIS

CODE SELECTION, SEQUENCING

DETERMINATION.


Decision to Undergo

Colonoscopy

Therapeutic

Does NOT Reach Splenic

Flexure

Flexible Sigmoidoscopy

(45331-45347))

Beyond Splenic Flexure But Not

to Cecum

Colonoscopy (45379-45398 Modifier 52)

To Cecum

Colonoscopy (45379-45398_

No Modifier

This chart reflects AMA CPT decision tree 2015 AMA CPT Professional Edition pg 284. It is not the interpretation of all carriers/MACs. Facilities must verify carrier directives and local coverage determinations (LCDs) prior to CPT code selection and reporting. Commercial carrier directives will often differ from individual MAC/CMS LCD policies.

2015 AMA ERRATA – NO

MODIFIER- FACILITIES NEED TO

MAKE CHANGE IN

BOOK!

AMA CPT Decision Tree 2015

DO YOUR SPECIFIC CARRIERS AND/OR MAC AGREE? SOME CARRIER AND MAC DIRECTIVES

STATE WHEN SCHEDULED AS COLONOSCOPY CODE AS

COLONOSCOPY WITH APPLICATION OF

APPROPRIATE MODIFIER. VERIFY!

2015 Digestive System Colon and Rectum – Endoscopy

Sigmoidoscopy

CPT CODE CPT DESCRIPTOR 45330 Sigmoidoscopy, flexible; diagnostic, with or without

(including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($99.89)



45334 …….with control of bleeding , (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) any method ($453.53)



Sigmoidoscopy


45337 Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of volvulus decompression tube, any method when performed ($453.53)

45340 …….with dilation by transendoscopic balloon, 1 or more strictures , dilation ($453.53)

(For transendoscopic balloon dilation of multiple strictures during the same session, use 45340 with modifier 59 for each additional stricture dilated)


Sigmoidoscopy

CPT CODE DELETION

CPT DESCRIPTOR





# 45346 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) ($453.53)

45347 …….; with placement of endoscopic stent (including pre- and post-dilation and guide wire passage, when performed) ($453.53)

45349 …….; with endoscopic mucosal resection ($453.53)


Sigmoidoscopy


45350 …….; with band ligation(s) (eg, hemorrhoids) ($453.53)


Sigmoidoscopy

• (Do not report 45350 more than once per session) • (To report control of active bleeding with band

ligation(s), use 45334)



Colonoscopy

CPT CODE DELETION

CPT DESCRIPTOR

45355 Colonoscopy, rigid or flexible, transabdominal via colotomy, single or multiple (deleted in 2015) Use 45399 in 2015


Colonoscopy

CPT CODE CPT DESCRIPTOR 45378 Colonoscopy, flexible proximal to splenic flexure;

diagnostic, with or without (including collection of specimen(s) by brushing or washing, with or without colon decompression when performed (separate procedure) ($432.94)


45380 …….with biopsy, single or multiple ($432.94)

45381 …….with directed submucosal injection(s), any substance ($432.94)



Colonoscopy

CPT CODE CPT DESCRIPTOR 45382 …….; with control of bleeding, (eg, injection, bipolar

cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) any method ($432.94)


45385 …….with removal of tumor(s), polyp(s), or other lesion(s) by snare technique ($432.94)

45386 …….with dilation by transendoscopic balloon, 1 or more strictures dilation ($432.94)


Colonoscopy

CPT CODE DELETION

CPT DESCRIPTOR





# 45388 Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) ($432.94)

45389 …….; with endoscopic stent placement (including pre- and post-dilation and guide wire passage, when performed) ($432.94)

# 45390 …….; with endoscopic mucosal resection ($432.94)


Colonoscopy


45391 …….; with endoscopic ultrasound examination, limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures ($432.94)

45392 …….; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures ($432.94)


Colonoscopy



45393 …….; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ($432.94)

# 45398 …….; with band ligation(s) (eg, hemorrhoids) ($432.94)

# 45399 Unlisted procedure, colon (not on CMS approved ASC list)


Colonoscopy

Colonoscopy Reimbursements

CPT

2014 Rate

2015 Rate

45378 $407.05 $432.94 45379 $407.05 $432.94 45380 $407.05 $432.94 45381 $407.05 $432.94 45382 $407.05 $432.94 45384 $407.05 $432.94 45385 $407.05 $432.94 45386 $407.05 $432.94 45391 $407.05 $432.94 45392 $407.05 $432.94


CMS G Codes for 2015 Final Rule (CMS-1612-FC)

• CMS delayed publishing updated wRVU for the lower endoscopy codes (ileoscopy, pouchoscopy, flex sigmoidoscopy, colonoscopy through stoma, colonoscopy) surveyed for this cycle.

• For 2015, CMS established G codes to mirror those 2014 CPT codes that were deleted in 2015.

• For 2015, CMS maintained the wRVU of these 2014 code values, pending a decision on how to address removing moderate sedation from the endoscopy codes

Result: Stay tuned rrrrrrrr

CMS G Codes for 2015 Physician Reporting-Medicare Patients

DELETED 2014 CPT

NEW OR REVISED

2015 CPT

NEW

2015 HCPCS 44383 44384 G6018

44393 44401 G6019

44397 44402 G6020

44799 G6021

45339 45346 G6022

45345 45347 G6023

45383 45388 G6024

45387 45389 G6025

0226T 46601 G6026

0227T 46607 G6027


CMS G Codes 2015 Facility Reporting – Medicare Patients

ASC facilities report 2015 CPT codes:

• No. Regardless of whether the code is new or has not changed

• No. Regardless of payor

• ASC Facilities do not report G codes G6018-G6027. Not valued.

2015 Misc. Category III Code Addition Digestive


0355T Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report (not on CMS approved ASC list)


CPT CODE CPT CODE DESCRIPTOR

46600 Anoscopy; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure) (N1)

46601 …….; diagnostic, with high-resolution magnification (HRA) (eg, colposcope, operating microscope) and chemical agent enhancement, including collection of specimen(s) by brushing or washing, when performed (N1)

2015 Digestive System Anus – Endoscopy

Anoscopy


46607 …….; with high-resolution magnification (HRA) (eg, colposcope, operating microscope) and chemical agent enhancement, with biopsy, single or multiple ($453.53)

2015 Digestive System Anus – Endoscopy

Anoscopy


2015 Digestive System Anus – Endoscopy CAT III Deletions


CPT DESCRIPTOR

0226T Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed (originally reimbursed @29.52 in 2014 but deleted in 2015) Use 46601 in 2015 (N1)

0227T …….;with biopsy(ies) Use 46607 in 2015 ($453.53)

2015 Misc. Category III Code Addition Anoscopy


0377T Anoscopy with directed submucosal injection of bulking agent for fecal incontinence ($1425.69)

(Do not report 0377T in conjunction with 46600)



47383 Ablation, 1 or more liver tumor(s), percutaneous, cryoablation ($2245.03)

2015 Digestive System Liver – Other Procedures

Ablation

(For imaging guidance and monitoring, see 76940, 77013, 77022) …report per carrier.

2015 Radiology Key Points (Information below does not encompass all changes)

15 additions; 23 deletions; 4 revisions in 2015 • Addition of 2 Breast ultrasound codes: CPT 76641-76642 (CMS N1 payment indicator) • Addition of 2 Teletherapy isodose codes: CPT 77306-77307 (approx. 60.00 CMS reimbursement) • Addition of 3 Brachytherapy isodose codes: CPT 77316-77318 (approx. 60.00-175.00 CMS reimbursement) • Addition of 2 modulated radiation treatment delivery codes: CPT 77385 (simple)-77386 (complex) (approx. 275.00 CMS reimbursement)


Continued…2015 Radiology Key Points (Information below does not encompass all changes)

• Revision - 4 radiation treatment delivery codes:

CPT 77401-77412 (approx. 20-100.00 CMS reimbursement)

• Deletion - 2 Radiological S & I percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty) codes:

CPT 72291 – 72292 are deleted in 2015.

To report, see 22510, 22511, 22512, 22513, 22514, 22515, 0200T, 0201T)

2015 Misc. Category III Code Addition Respiratory


0340T Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance ($2245.03)


AMERICAN MEDICAL ASSOCIATION

http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/errata.page





















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Documents

CPT CHANGES 2015 - Physician Strategy Group€¦ · · 2016-10-17CPT CHANGES 2015: What’s New, Revised, ... (TAP) block (abdominal plane block, rectus sheath ... (abdominal plane