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Presented by:
Deena Ragonese, CPC, CPC-I
AHIMA Ambassador ICD-10-CM Trainer
Vice President, Senior Coding Consultant
www. CreativelyHIM.com
2 CPT Changes for 2015Objectives
Overview of the New, Revised, and Deleted CPT© codes for 2015
Review documentation requirements for the new codes Review examples of proper code use
3 Tips for being prepared
Order 2015 codebooks Review the 2015 CPT® code changes Review all changes to the guidelines, notes, and
instructions in your book, printed in . Highlight changes, make notes in your codebooks, in both
the index and tabular Check for addenda or errata Review payer policies Review PQRS changes
GREEN
4 E/M Changes Deleted codes:
99481, Total body systemic hypothermia in a critically ill neonate per day (List separately in addition to code for primary procedure)
99482, Selective head hypothermia in a critically ill neonate per day (List separately in addition to code for primary procedure)
● 99184, Initiation of in the critically ill neonate, includes appropriate patient selection by review of clinical, imaging and laboratory data, confirmation of esophageal temperature probe location, evaluation of amplitude EEG, supervision of controlled hypothermia, and assessment of patient tolerance of cooling
selective head or total body hypothermia
5 Chronic Care Management Services
● 99490, Chronic care management services, at least of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements Multiple chronic conditions expected to last at
least 12 months, or until the death of the patient, Chronic conditions place the patient at of death,
acute exacerbation/decompensation, or functional decline, Comprehensive established, implemented, revised,
or monitored.
20 minutes
(two or more)
significant risk
care plan
6 Complex Chronic Care Management Services
99487, Complex chronic care management services, with the following required elements… of clinical staff time Establishment or substantial revision of comprehensive
care plan Moderate to High MDM
60 minutes
7 Complex Chronic Care Management Services
99488, Complex chronic care coordination services, w/one face to face visit… Deleted
99489, Complex Chronic Care Management; each additional 30 minutes… Add-on code, reported with 99487 Each additional 30 minutes of clinical staff time
+
8 Advanced Care Planning
● 99497, Advanced care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and or surrogate
● 99498 ; each additional 30 minutes (List separately in addition to code for primary procedure)
+
9 Musculoskeletal: Arthrocentesis 20600, 20605, and 20610, Arthrocentesis, aspiration and/or injection;…
Without ultrasound guidance
● 20604, Arthrocentesis, aspiration and/or injection, or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting
● 20606, Arthrocentesis, aspiration and/or injection, or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting
● 20611, Arthrocentesis, aspiration and/or injection, or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting
small joint
major joint
intermediate joint
10 Ablation of Bone Tumors
20982, Ablation, bone tumor(s) (eg, osteoid osteoma, metastasis) percutaneous, including computed tomographic guidance… Include adjacent soft tissue when involved
● 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;
radiofrequency,
cryoablation
11 Open Treatment of Rib Fractures
Deleted codes 21800, Closed treatment of rib fracture, uncomplicated, each 21810, Treatment of rib fracture requiring external fixation (flail chest) Category III codes for Internal Fixation 0245T, 0246T, 0247T, and 0248T
● 21811, Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral;
● 21812 ; ● 21813 ;
1-3 ribs
4-6 ribs
7 or more ribs
12 Percutaneous Vertebroplasty 22520, 22521, and 22522 Percutaneous vertebroplasty (bone
biopsy included when performed), 1 vertebral body, unilateral or bilateral injection;… Deleted
● 22510, Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance;
● 22511 ; ● 22512 ; each additional cervicothoracic or lumbosacral
vertebral body (List separately in addition to code for primary procedure)
cervicothoracic
Lumbosacral+
13 Percutaneous Vertebral Augmentation
22523, 22524, and 22525 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);… Deleted
● 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;
● 22514 ; ● 22515 ; each additional thoracic or lumbar vertebral body (List
separately in addition to code for primary procedure)+
thoracic
Lumbar
14 Percutaneous Vertebroplasty or Augmentation
Determine the correct code Procedure a vertebroplasty or augmentation
(Kyphoplasty) Region of the spine Number of vertebral Imaging guidance is included Biopsy is include if on the same vertebral body
15 Total Disc Arthroplasty
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); cervical…
● 22858 ; cervical (List separately in addition to code for primary procedure)
● 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,
+
single interspace,
three or more levels
second level,
16 Arthrodesis of Sacroiliac Joint
27280, Arthrodesis, sacroiliac joint, including obtaining bone graft, including instrumentation, when performed…
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)… Deleted
● 27279, Arthrodesis, sacroiliac joint, (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device
open,
percutaneous or minimally invasive
17 Musculoskeletal
27370, for knee arthrography…
Deleted codes: 29020, Application of turnbuckle jacket, body; only 29025, Application of turnbuckle jacket, body;
including head 29715, Removal or bivalving; turnbuckle jacket
Injection of contrast
18 Pacemaker or Implantable Defibrillator
Category III codes, subcutaneous implantable defibrillators (0319T, 0320T, 0321T, 0322T, 0323T, 0324T, 0326T and 0327T) have been deleted and replaced with Category I codes.
Revisions have also been made to all the existing cardioverter-defibrillator
Guidelines have been added for proper use of the codes Table on pg 187 (CPT© Professional Edition) is revised
19 Pacemaker or Implantable Defibrillator
● 33270, Insertion or replacement of permanent subcutaneous implantable defibrillator 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
● 33271, of subcutaneous implantable defibrillator electrode
● 33272, of subcutaneous implantable defibrillator electrode
● 33273, of previously implanted subcutaneous implantable defibrillator electrode
system,
Insertion
Removal
Repositioning
20 Pacemaker or Implantable Defibrillator
Procedure (pg 187 CPT) Code(s)
Insert subcutaneous defibrillator electrode without pulse generator
33271
Initial pulse generator insertion or replacement plus insertion of subcutaneous defibrillator electrode
33270
Removal of subcutaneous defibrillator lead only 33272
Removal and replacement of implantable defibrillator pulse generator and subcutaneous electrode
33272, 33241, 33270
Removal pulse generator with replacement pulse generator only single lead system, includes transvenous or subcutaneous defibrillator lead
33262
Removal of pulse generator only (without replacement) 33241
21
Deleted codes:
33332, Insertion of graft, aorta or great vessels; with shunt bypass
0343T, Transcatheter mitral valve repair percutaneous approach including transseptal puncture when performed; initial prosthesis
0344T, Transcatheter mitral valve repair percutaneous approach including transseptal puncture when performed; additional prosthesis (es) during same session (List separately in addition to code for primary procedure)
● 33418, Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed;
● 33419 ; during same session (List separately in addition to code for primary procedure)
● 0345T, Transcatheter mitral valve repair percutaneous approach via the
Cardiovascular
initial prosthesis
additional prosthesis(es)
coronary sinus
+
22 Extracorporeal Membrane Oxygenation (ECMO) or Extracorporeal Life Support Services (ECLS) Deleted codes:
33960, Prolonged extracorporeal circulation for cardiopulmonary insufficiency; initial day
33961, ; each subsequent day 36822, Insertion of cannula(s) for prolonged extracorporeal
circulation for cardiopulmonary insufficiency (ECMO) (separate procedure)
New category, codes and guidelines created
23 ECMO/ECLS
● 33946, Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician;
● 33947 ;
● 33948 ; each day, ● 33949 ; each day,
daily management,
initiation,
initiation,
daily management,
veno-venous
veno-venous
veno-arterial
veno-arterial
24ECMO/ECLS
● 33951, Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician;
(arterial and/or venous) cannula(e),
of age (includes fluoroscopic guidance, when performed)
● 33952 ; insertion of peripheral (arterial and/or venous) cannula(e), (includes fluoroscopic guidance, when performed)
● 33953 ; insertion of peripheral (arterial and/or venous) cannula(e),
● 33954 ; insertion of peripheral (arterial and/or venous) cannula(e),
percutaneous,
percutaneous,
open,
open,
birth through 5 years
6 years and older
birth through 5 years
6 years and older
insertion of peripheral
25ECMO/ECLS ● 33955, Extracorporeal membrane oxygenation
(ECMO)/extracorporeal life support (ECLS) provided by physician; cannula(e) by
● 33956 ; insertion of central cannula(e) by
6 years and older
● 33957 ; (arterial and/or venous) cannula(e), birth through 5 years (includes fluoroscopic guidance, when performed)
● 33958 ; reposition peripheral (arterial and/or venous) cannula(e), 6 years and older (includes fluoroscopic guidance, when performed)
sternotomy or thoracotomy,
percutaneous,
birth through 5 years
sternotomy or thoracotomy,
percutaneous,
insertion of central
reposition peripheral
26ECMO/ECLS ● 33959, Extracorporeal membrane oxygenation (ECMO)/extracorporeal life
support (ECLS) provided by physician; (arterial and/or venous) cannula(e), birth through 5 years of age (includes fluoroscopic guidance, when performed)
● 33962 ; reposition peripheral (arterial and/or venous) cannula(e), 6 years and older (includes fluoroscopic guidance, when performed)
● 33963, Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; cannula(e) by birth through 5 years of age (includes fluoroscopic guidance, when performed)
● 33964 ; reposition central cannula(e) by 6 years and older (includes fluoroscopic guidance, when performed)
open,
open,
sternotomy or thoracotomy,
sternotomy or thoracotomy,
reposition of peripheral
reposition of central
27 ECMO/ECLS
● 33965, Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; (arterial and/or venous) cannula(e), birth through 5 years of age
● 33966 ; removal of peripheral (arterial and/or venous) cannula(e), 6 years and older
● 33969 ; removal of peripheral (arterial and/or venous) cannula(e), birth through 5 years of age
● 33984 ; removal of peripheral (arterial and/or venous) cannula(e), 6 years and older
percutaneous,
open,
percutaneous,
open,
removal of peripheral
28ECMO/ECLS
● 33985, Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; cannula(e) by sternotomy or thoracotomy, birth through 5 years of age
● 33986 ; removal of central cannula(e) by sternotomy or thoracotomy, 6 years and older
● 33987, Arterial exposure with creation of (eg, chimney graft) to facilitate arterial perfusion for ECMO/ECLS (List separately in addition to code for primary procedure)
● 33988, of left heart vent by thoracic incision (eg, sternotomy, thoracotomy) for ECMO/ECLS
● 33989, of left heart vent by thoracic incision (eg, sternotomy, thoracotomy) for ECMO/ECLS
+
graft conduit
Insertion
Removal
removal of central
29Transcatheter Procedures
37215, Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous, including when performed, and with distal embolic protection…
37216 ; without distal embolic protection… 37217, Transcatheter placement of an intravascular stent(s),
intrathoracic common carotid artery or innominate artery via open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation…
● 37218, Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery,
including angioplasty, when performed, and radiological supervision and interpretation.
angioplasty,radiological supervision and interpretation;
open or
open or percutaneousantegrade approach,
by retrogradetreatment,
30 Endovascular Revascularization
37236, Transcatheter placement of an intravascular stent(s) (except lower extremity cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed;
37237 ; artery (List separately in addition to code for primary procedure)
+
artery(s) for occlusive disease,
initial artery
each additional
31 Esophagoscopy
● 43180, Esophagoscopy, rigid, transoral with of
(eg, Zenker’s diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed
43194, Esophagoscopy, rigid, transoral; with removal of foreign body
43197, Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)…
43215, Esophagoscopy, flexible, transoral; with removal of foreign body
diverticulectomyhypopharynx or cervical esophagus
(s)…
(s)…
32 Esophagoscopy
43216, Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s)
43247, Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body
43250, Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s)
43350, Esophagostomy, fistulization of esophagus, external;
abdominal approach… Deleted
by hot biopsy forceps…
(s)…
by hot biopsyforceps…
33 Intestines: Endoscopy, Small intestine
44360, Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, collection of specimen(s) by brushing or washing, (separate procedure)
44363, Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of foreign body
including
(s)…
when performed
34Intestines: Endoscopy, Stomal 44380, Ileoscopy, through stoma; diagnostic, collection of
specimen(s) by brushing or washing, (separate procedure)…
● 44381, Ileoscopy, through stoma; 44383, Ileoscopy, through stoma; with transendoscopic stent placement
(includes predilation)… Deleted ● 44384, Ileoscopy, through stoma; with of endoscopic
(includes when performed) 44385, Endoscopic evaluation of small intestinal pouch (Kock pouch,
ileal reservoir [S or J]); diagnostic, collection of specimen(s) by brushing or washing, (separate procedure)…
44386, Endoscopic evaluation of small intestinal pouch (Kock pouch, ileal reservoir [S or J]); with biopsy, single or multiple…
includingwhen performed
with transendoscopic balloon dilation
placement stentpre- and post-dilation and guide wire passage,
includingwhen performed
35 Intestines: Colonoscopy, Stomal
44388, Colonoscopy through stoma; diagnostic, collection of specimen(s) by brushing or washing, (separate procedure)…
44390 ; with removal of foreign body 44391 ; with of any method 44392 ; with removal of tumor(s), polyp(s), or
other lesion(s) by hot biopsy forceps
includingwhen performed
(s)…
control
36 Intestines: Colonoscopy, Stomal Deleted codes:
44393, Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
44397, with transendoscopic stent placement (includes predilation) ● 44401, Colonoscopy through stoma; with of tumor(s),
polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed)
● 44402 ; with endoscopic (including pre- and post-dilation and guide wire passage, when performed)
● 44403 ; with endoscopic mucosal resection ● 44404 ; with directed submucosal injection(s), any substance
ablation
stent placement
37 Intestines: Colonoscopy, Stomal
● 44405 ; ● 44406 ; with limited to the
sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures
● 44407 ; 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
● 44408 ; with (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed
with transendoscopic balloon dilationendoscopic ultrasound examination,
with transendoscopic ultrasound
decompression
38 Sigmoidoscopy
45330, Sigmoidoscopy, flexible; diagnostic, collection of specimen(s) by brushing or washing, (separate procedure)
45332 ; with removal of foreign body 45333 ; with removal of tumor(s), polyp(s), or other lesion(s)
by 45334 ; with of bleeding any method 45337 ; with (for pathologic distention) (eg,
volvulus, megacolon), including placement of decompression tube, when performed
includingwhen performed
(s)…
hot biopsy forceps
control
decompression
39 Sigmoidoscopy Deleted codes
45339, Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
45345, Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation)
● 45346, Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes when performed)
45340 ; with transendoscopic balloon dilation…
● 45347 ; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)
● 45349 ; with
● 45350 ; with (eg, hemorrhoids)
pre- and post-dilation and guide wire passage,
endoscopic mucosal resection
band ligation(s)
40 Colonoscopy Deleted codes
45355, Colonoscopy, rigid or flexible, transabdominal via colotomy, single or multiple
45383, Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
45387, Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)
45378, Colonoscopy, flexible; diagnostic, collection of specimen(s) by brushing or washing, (separate procedure)…
45379, Colonoscopy, flexible; with removal of foreign body
includingwhen performed
(s)…
41 Colonoscopy 45380, Colonoscopy, flexible; with biopsy, single or multiple… 45381 ; with directed submucosal injection(s), any substance… 45382 ; with of any method… ● 45388, Colonoscopy, flexible; with of tumor(s), polyp(s), or
other lesion(s) (includes when performed)
45384, Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by
45385 ; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique…
ablationpre- and post-dilation and guide wire passage,
control
hot biopsy forceps…
42 Colonoscopy 45386, Colonoscopy, flexible; with ● 45389, Colonoscopy, flexible; with endoscopic stent placement
(includes when performed) 45391 ; with endoscopic ultrasound examination limited to the
rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures…
45392 ; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes
examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures…
transendoscopic balloon dilation…
pre- and post-dilation and guide wire passage,
endoscopicultrasound
43 Colonoscopy
● 45390, Colonoscopy, flexible; with resection
● 45393, with (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed
● 45398, with (eg, hemorrhoids)
endoscopic mucosal
decompression
band ligation(s)
44 Anoscopy 46600, Anoscopy; diagnostic, collection of specimen(s) by brushing
or washing, (separate procedure)…
Deleted codes:
0226T, Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed
0227T ; with biopsy(ies)
● 46601 ; with high-resolution magnification (HRA) (eg, colposcope, and enhancement, including
collection of specimen(s) by brushing or washing, when performed
● 46607 ; with high-resolution magnification (HRA) (eg, colposcope, operating microscope) and chemical agent enhancement, single or multiple
including
operating microscope) chemical agentdiagnostic,
with biopsy,
when performed
45 Liver
● 47383, Ablation, 1 or more liver tumor(s), percutaneous,
Urinary ● 52441, Cystourethroscopy, with insertion of permanent
adjustable transprostatic implant; ● 52442 ; permanent adjustable
transprostatic implant (List separately in addition to code for primary procedure
cryoablation
single implant
each additional+
46 Myelography
62284, Injection procedure for myelography and/or computed tomography, (other than C1-C2 and posterior fossa)…
● 62302, Myelography via lumbar including radiological supervision and interpretation;
● 62303 ; ● 62304 ; ● 62305, (eg, lumbar/thoracic,
cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)
lumbar
injection,cervical
thoracic
lumbosacral
2 or more regions
47 Transversus Abdominis Plane (TAP) Block
● 64486, Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) (includes imaging guidance, when performed)
● 64487 ; by (includes imaging guidance, when performed)
● 64488, Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) (includes imaging guidance, when performed)
● 64489 ; by (includes imaging guidance, when performed)
by injection(s)
by injection(s)
continuous infusion(s)
continuous infusion(s)
unilateral;
bilateral;
48 Eye and Ocular Adnexa
● 66179, Aqueous shunt to extraocular equatorial plate reservoir, external approach;
66180 ; ● 66184, of aqueous shunt to extraocular
equatorial plate reservoir; 66185 ; 67399, unlisted procedure, muscle…
without graft
with graft…
without graft
with graft…
revision
extraocular
49 Ultrasound
76645, Ultrasound, breast(s) (unilateral or bilateral), real time with image documentation… Deleted
● 76641, Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed;
● 76642 ;
complete
limited
50 Digital Tomosynthesis
● 77061, Digital breast tomosynthesis; ● 77062 ; ● 77063, Screening digital breast tomosynthesis,
bilateral (List separately in addition to code for primary procedure)
unilateral
bilateral+
51 Bones and Joint Studies
77082, Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; vertebral fracture assessment… Deleted
● 77085, Dual-energy X-ray absorptiometry (DXA), study, 1 or more sites; axial skeleton
(eg, hips, pelvis, spine), including ● 77086, Vertebral fracture assessment via dual-energy X-
ray absorptiometry (DXA)
bonedensity
vertebral fracture assessment
52 Radiation Oncology
Deleted codes: 77305, 77310, & 77315 Teletherapy, isodose plan (whether hand
or computer calculated); simple, Intermediate, & complex 77326, 77327, & 77328 Brachytherapy isodose plan; simple
intermediate, & complex ● 77306, Teletherapy isodose plan; (1 or 2 unmodified ports
directed to a single area of interest), includes basic dosimetry calculation(s)
● 77307 ; (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)
simple
complex
53 Radiation Treatment Delivery
Deleted codes: 77403, 77404, 77406, 77408, 77409, 77411, 77413, 77414, 77416 -
Radiation treatment delivery 77418, Intensity modulated treatment delivery 77421, Stereoscopic X-ray guidance for localization of target volume
for the delivery of radiation therapy 77401, Radiation treatment delivery, and/or ortho voltage,
per day; 77402, Radiation treatment delivery > 1 MeV; 77407 ; 77412 ;
superficial
simple
intermediate
complex
54 Radiation Treatment Delivery Deleted codes:
0073T, Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or higher resolution (milled or cast) compensator convergent beam modulated fields, per treatment session
0197T, Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg, 3D positional tracking, gating, 3D surface tracking), each fraction of treatment
● 77385, Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed;
● 77386 ; ● 77387, Guidance for localization of target volume for delivery of
radiation treatment delivery, includes intrafraction tracking, when performed
simple
complex
55 Drug Testing Codes
Codes selected based on the purpose of the test Therapeutic Drug assay Chemistry
Drug Assay Presumptive drug class
Drug Class List A Drug Class List B
Definitive Drug Class Table provided starting on page 474 (CPT© Professional Edition)
56 Presumptive Drug Class Screening
Deleted codes: 80100-80104, Drug screening codes.
● 80300, Drug screen, any number of drug classes from Drug Class any number of devices or procedures, (eg,
immunoassay) capable of being read by direct observation, including instrumented-assisted when performed (eg, dipsticks, cups, cards, cartridges),
● 80301 ; single drug class method, by test systems (eg, discrete multichannel chemistry analyzers utilizing immunoassay or enzyme assay),
List A; non-TLC optical
instrumented
per date of service
per date of service
57 Presumptive Drug Class Screening
● 80302, Drug screen, presumptive, single drug class from Drug Class by immunoassay (eg, ELISA) or chromatography without mass spectrometry (eg, GC, HPLC),
● 80303, Drug screen, any number of drug classes, presumptive, single or multiple drug class method; thin layer chromatography procedure(s) (eg, acid, neutral, alkaloid plate),
● 80304 ; presumptive procedure (eg, TOF, MALDI, LDTD, DESI, DART),
List B; non-TLC
each procedure
(TLC) per date of service
not otherwise specifiedeach
procedure
58 Definitive Drug Testing
Use the definitive drug classes listing to assist with coding Select based on the type of drug and for some codes the
number of drugs Example: ● 80330, Analgesics, non-opioid;
Table: The drugs included in this category are acetaminophen, diclofenac, ibuprofen, ketoprofen, naproxen, oxaprozin, and salicylate
3-5
59 Microbiology
● 87505, Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes,
● 87506 ; ● 87507 ;
3-5 targets
6-11 targets
12-25 targets
60 Microbiology
● 87623, Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), types (eg, 6, 11, 42, 43, 44)
● 87624 ; types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)
● 87625 ; includes type 45, if performed
low-risk
high-risk
types 16 and 18 only,
61 Vaccines ● 90630, Influenza virus vaccine, quadrivalent split virus,
preservative free, for intradermal use ● 90651, Human Papillomavirus vaccine 6, 11, 16, 18, 31, 33, 45,
52, 58, nonavalent (HPV), 3 dose schedule, for intramuscular use 90654, Influenza virus vaccine, trivalent split virus, preservative-
free, for intradermal use… 90721, Diphtheria, tetanus toxoids, and acellular pertussis vaccine and
Hemophilus influenza B vaccine for intramuscular use… 90723, Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis
B, and inactivated poliovirus vaccine for intramuscular use…
90734, Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, for intramuscular use…
(IIV4),
types
(IIV3),
(DTap/Hib),
(DTap-HepB-IPV),
quadrivalent,
62Implantable and Wearable Cardiac Device Evaluations
● 93260, device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead defibrillator system
● 93261 device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator system
Revised implantable defibrillator codes (93282, 93283, 93284, 93287, 93289, 93295, and 93296)
Programming
Interrogation
63 Echocardiography
● 93355, Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (eg,TAVR, transcatheter pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal defect closure) (peri-and intra-procedural), real-time image acquisition and documentation, guidance with quantitative measurements, probe manipulation, interpretation, and report, including diagnostic transesophageal echocardiography and, when performed, administration of ultrasound contrast, Doppler, color flow, and 3D
64 Noninvasive Physiologic Studies and Procedures
0239T, Bioimpedance spectroscopy (BIS), measuring 100 frequencies or greater, direct measurement of extracellular fluid differences between the limbs… Deleted
● 93702, extracellular fluid analysis for lymphedema assessment(s)
● 0358T, composition assessment, supine position, with interpretation and report
Bioimpedance spectroscopy (BIS),
Bioelectrical impedance analysis whole body
65 Cerebrovascular Arterial Studies
● 93895, Quantitative carotid intima media thickness and carotid atheroma evaluation, bilateral
66 Central Nervous System Assessments and Tests
96110, Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument…
● 96127, (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument
Brief emotional/behavioral assessment
67 Active Wound Care Management
97605, Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area or equal to 50 square centimeters…
97606, Negative pressure wound therapy (eg, vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area 50 square centimeters…
● 97607, Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area or equal to 50 square centimeters
● 97608 ; total wound(s) surface area 50 square centimeters
(DME),
non-durable
less than
less than
greater than
greater than
68 Category III
0200T, Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes when performed…
0201T, Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes when performed…
imaging guidance and bone biopsy,
imaging guidance and bone biopsy,
69 Category III
0253T, Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the suprachoroidal space…
70 Category III
● 0340T, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance
● 0341T, pupillometry with interpretation and report, unilateral or bilateral
● 0342T, apheresis with selective HDL delipidation and plasma reinfusion
Ablation,
Quantitative
Therapeutic
71 Category III
● 0347T, of interstitial device(s) in bone for radiostereometric analysis (RSA)
● 0348T, Radiologic examination, radiostereometric analysis (RSA); (includes cervical, thoracic and lumbosacral, when performed)
● 0349T ; (includes shoulder, elbow, and wrist, when performed)
● 0350T ; (includes hip, proximal femur, knee, and ankle, when performed)
Placement
spine,
upper extremity(ies),
lower extremity(ies),
72 Category III
● 0351T, Optical coherence tomography of breast or axillary lymph node, each specimen; real-time intraoperative
● 0352T ; real-time or referred
● 0353T, Optical coherence tomography of breast, real-time intraoperative
● 0354T ; real-time or referred
excised tissue,
surgical cavity;
interpretation and report,
interpretation and report,
73 Category III
● 0355T, Gastrointestinal tract imaging, intraluminal (eg, colon, with interpretation and report
● 0356T, Insertion of implant (including punctal dilation and implant removal when performed) into lacrimal canaliculus, each
capsule endoscopy),
drug-eluting
74 Adaptive Behavior Assessment
● 0359T, by the physician or other qualified health care professional, face-to-face with patient and caregiver(s), includes administration of standardized and non-standardized tests, detailed behavioral history, patient observation and caregiver interview, interpretation of test results, discussion of findings and recommendations with the primary guardian(s)/caregiver(s), and preparation of report
● 0360T, assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; of technician time, face-to-face with the patient
● 0361T ; of technician time, face-to-face with the patient (List separately in addition to code for primary service)
Behavior identification assessment,
Observational behavioral follow-up
first 30 minutes
Each additional 30 minutes+
75 Adaptive Behavior Assessment
● 0362T, Exposure behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by physician or other qualified health care professional with the assistance of one or more technicians; of technician(s) time, face-to-face with the patient
● 0363T ; of technician(s) time, face-to-face with the patient (List separately in addition to code for primary procedure)
first 30 minutes
each additional 30 minutes+
76 Adaptive Behavior Assessment
● 0364T, Adaptive behavior treatment by protocol, administered by technician, face-to-face with first 30 minutes of technician time
● 0365T ; each additional 30 minutes of technician time (List separately in addition to code for primary procedure)
● 0366T, Group adaptive behavior treatment by protocol, administered by technician, face-to-face with patients; first 30 minutes of technician time
● 0367T ; each additional 30 minutes of technician time (List separately in addition to code for primary procedure)
+
+
one patient;
two or more
77 Adaptive Behavior Assessment
● 0368T, Adaptive behavior treatment with administered by physician or other qualified health care professional with one patient; first 30 minutes of patient face-to-face time
● 0369T ; each additional 30 minutes of patient face-to-face time (List separately in addition to code for primary procedure)
● 0370T, administered by physician or other qualified health care professional
● 0371T, adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present)
● 0372T, Adaptive behavior treatment administered by physician or other qualified health care professional face-to-face with multiple patients
+
protocol modification
Family adaptive behavior treatment guidance, (without the patient present)
Multiple-family group
social skills group,
78 Exposure Adaptive Behavior Treatment
● 0373T, Exposure adaptive behavior treatment with protocol modification requiring two or more technicians for severe maladaptive behavior(s); of technicians' time, face-to-face with patient
● 0374T ; of technicians' time face-to-face with patient (List separately in addition to code for primary procedure)
+
first 60 minutes
each additional 30 minutes
79 Category III
● 0377T, Anoscopy with directed of bulking agent for fecal incontinence
● 0378T, with concurrent real time data analysis and accessible data storage with patient initiated data transmitted to a remote surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional
● 0379T ; technical support and patient instructions, surveillance, analysis, and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional
● 0380T, of time series retinal images for the monitoring of disease progression, unilateral or bilateral, with interpretation and report
submucosal injection
Visual field assessment,
Computer-aided animation and analysis
80 X Modifiers
CMS has established new modifiers XE Separate encounter XP Separate practitioner XS Separate structure XU Unusual non-overlapping service
81 References: AMA
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page
CMS X Modifier
http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1422OTN.pdf
Category II
http://www.ama-assn.org/ama/pub/physician-resurces/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/category-ii-codes.page
AAPC
AAPC.com
