Date post: | 12-Jul-2015 |
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Healthcare |
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2015 CPT ChangesPrepared by Advanced Billing Consultants
Copyright 2014 | Advanced Billing Consultants, Inc.
More Selective Modifiers to 59:
The –X{EPSU} modifiers
XE: Separate Encounter (patient treated twice)
XS: Separate structure (two different types of lesions)
XP: Separate Practitioner (2 different providers on same
day
XU: Unusual non-overlapping service (2 unrelated
procedures)
Copyright 2014 | Advanced Billing Consultants, Inc.
E&M Changes
99481 and 99482 replaced by 99184
Copyright 2014 | Advanced Billing Consultants, Inc.
Chronic Care Management
New code: 99490- chronic care management services, at
least 20 minutes of clinical staff time directed by a
physician or other qualified health care professional,
per calendar month, with the following required
elements:
multiple (two or more) chronic conditions expected to last
at least 12 months, or until the death of the patient,
Chronic conditions place the patient at significant risk of
death, acute exacerbation/decompensation, or functional
decline,
Comprehensive care plan established, implemented,
revised or monitored
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Complex Chronic Care
Management
Deleted: 99488
Add on: 99489 to 99487
Each additional 30 minutes of clinical staff time
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Advanced Care Planning
Face to face encounter, not requiring the patient
New codes: 99497 for first 30 mins and 99498 for each
additional 30 mins
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Anesthesia
Deleted: 00452, 00622, 00634
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Surgical Package
The definition is clarified to indicate the History and
Physical are included in the procedure
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Arthrocentesis
Revised: 20600, 20605, 20610- without ultrasound
guidance
New:
20604: small joint with ultrasound guidance
20606: intermediate joint or bursa with ultrasound
guidance
20611: major joint or bursa with ultrasound guidance
Copyright 2014 | Advanced Billing Consultants, Inc.
Ablation of Bone Tumors
Revise: 20982 include the adjacent soft tissue
New: 20983
Ablation therapy for reduction or eradication of 1 or more
bone tumors including adjacent soft tissue when involved
by tumor extension, percutaneous, including imaging
guidance when performed; cryoablation
Copyright 2014 | Advanced Billing Consultants, Inc.
Open Treatment of Rib
Fractures
Deleted: 21800, 21810, 0245T, 0246T, 0247T, 0248T
New open treatment of rib fracture(s):
21811: 1-3 ribs
21812: 4-6 ribs
21813: 7 or more ribs
Copyright 2014 | Advanced Billing Consultants, Inc.
Percutaneous Vertebroplasty
Deleted: 22520, 22521, 22522
New: Percutaneous vertebroplasty
22510: cervivothoracic
22511: lumbrosacral
22512: each additional cervivothoracic or lumbosacral
vertebral body
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Percutaneous Vertebral
Augmentation
Deleted: 22523, 22524, 22525
New: Percutaneous vertebral augmentation, 1 vertebral
body
22513: thoracic
22514: lumbar
22515: each additional thoracic or lumbar vertebral body
Copyright 2014 | Advanced Billing Consultants, Inc.
Total Disc Arthroplasty
Revised: 22856 is now the parent code for 22858
New:
22858: second level, cervical
0375T: cervical, three or more levels (not an add on to
22856)
Copyright 2014 | Advanced Billing Consultants, Inc.
Arthrodesis of Sacroiliac Joint
Revised: 27280 to indicate open procedure
New:
27279: arthrodesis, sacroiliac joint, percutaneous or
minimally invasive, with image guidance, includes
obtaining bone graft when performed, and placement of
transfixing device (mod 50 allowed)
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Musculoskeletal
Deleted: 29020, 29025, 29715
Revised: 27370 to indicate the injection is performed
for contrast
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Pacemaker or Implantable
Defibrillator
Deleted: 0322T, 0323T, 0324T, 0326T, 0327T
New:
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
33271: insertion of subcutaneous implantable defibrillator electrode
33272: removal of subcutaneous implantable defibrillator electrode
33273: repositioning of previously implanted subcutaneous implantable defibrillator electrode
Copyright 2014 | Advanced Billing Consultants, Inc.
Cardiovascular
Deleted: 33472, 36469, 36822
New:
34839: Physician planning of a patient-specific fenestrated
visceral aortic endograft requiring a minimum of 90
minutes of physician time
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ECMO or ECLS
Deleted: 33960, 33961, 36822
New codes:
33946: ECMO/ECLS provided by physician; imitation, veno-
venous
33947: initiation, veno-arterial
33948: daily management, each day, veno-venous
33949: daily management, each day, veno-arterial
Copyright 2014 | Advanced Billing Consultants, Inc.
ECMO or ECLS Cont’dCPT Technique Age Tunneling Status
Open
Percutaneou
s Thoracotomy Sternotomy
Birth-
5 6+ Insertion
Repositio
n Removal
33951 X X X
33952 X X X
33953 X X X
33954 X X X
33955 X X X X
33956 X X X X
33957 X X X
33958 X X X
33959 X X X
33962 X X X
33963 X X X X
33964 X X X X
33965 X X X
33966 X X X
33969 X X X
33984 X X X
33985 X X X X
33986 X X X XCopyright 2014 | Advanced Billing Consultants, Inc.
ECMO or ECLS Cont’d
New add-on codes:
33987: arterial exposure with creation of graft conduit to
facilitate arterial perfusion for ECMO/ECLS
33988: Insertion of left heart vent by thoracic incision for
ECMO/ECLS
33989: Removal of left heart vent by thoracic incision for
ECMO/ECLS
Copyright 2014 | Advanced Billing Consultants, Inc.
Transcatheter Procedures
Revised: 37215, 37216, 37217
New: 37218: Transcatheter placement of intravascular
stent(s), intrathoracic common carotid artery or
innominate artery, open or percutaneous antegrade
approach, including angioplasty, when performed, and
radiological supervision and interpretation
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Endovascular
Rebascularization
Revised: 37236, 37237
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Digestive System
Deleted: 42508
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Esophagoscopy
Revised: 43194, 43197, 43215, 43216, 43247, 43250
Deleted: 43350
New: 43180: esophagoscopy, rigid, transoral with
diverticulectomy of hypopharynx or cervical esophagus,
with cricopharyngeal myotomy, includes use of
telescope or operating microscope and repair, when
performed
Copyright 2014 | Advanced Billing Consultants, Inc.
Endoscopy
CPT 2015 divided the endoscopy, small intestine and
stomal subsection into two separate sections which
results in many revisions and new codes
1. Small intestine endoscopy
2. Stomal endoscopy
Copyright 2014 | Advanced Billing Consultants, Inc.
Endoscopy, Small Intestine
Revised: 44360, 44363
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Endoscopy, Stomal
Revised: 44380, 44385, 44386, 44388, 44390, 44391,
44392
Deleted: 44383, 44393, 44397
New:
44381, 44384, 44401, 44402, 44403, 44404, 44405, 44406,
44407, 44408
Copyright 2014 | Advanced Billing Consultants, Inc.
Endoscopy
Revised: 45330, 45332, 45333, 45334, 45337, 45378,
45379, 45380, 45381, 45382, 45384, 45385, 45386,
45391, 45392, 45340
Deleted: 45355, 45383, 45387, 45339, 45345
New: 45388, 45389, 45399, 45346, 45347, 45349, 45350,
45390, 45393, 45398
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Digestive System: Colon
New: 45399
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Anus: Endoscopy
Revised: 46600
Deleted: 0226T, 0227T
New: 46601, 46607
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Liver
New: 47383: Ablation, 1 or more liver tumor(s),
percutaneous, cryoblation
Copyright 2014 | Advanced Billing Consultants, Inc.
Urinary
New: 52441: Cystourethroscopy, with insertion of
permanent adjustable transprostatic implant, single
inplant
52442: Each additional permanent adjustable
transprostatic implant
Copyright 2014 | Advanced Billing Consultants, Inc.
Maternity Care and Delivery
Introductory guidelines clarify the visit when pregnancy
is confirmed is not part of antepartum care
Copyright 2014 | Advanced Billing Consultants, Inc.
Nervous System
Revised: 61055
Deleted: 61334, 61440, 61470, 61490, 61542, 61609,
61875, 62116
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Myelography
Revised: 62284
New: 62302, 62303, 62304, 62305
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Transversus Abdominis Plane
Block
New: 64486, 64487, 64488, 64489
Deleted: 64752, 64761, 64870
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Eye and Ocular Adnexa
Deleted: 66165
Revised: 66180, 66185, 67399
New: 66179, 66184
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Auditory System
Deleted: 69400, 69401, 69405
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Radiology
Deleted: 72291, 72292, 74291, 76645, 76950
New: 76641, 76642 (breast ultrasounds), 77061, 77062,
77063
Copyright 2014 | Advanced Billing Consultants, Inc.
Bone/Joint Studies
Deleted: 77082
New:
77085: DXA with vertebral fracture assessment
77086: vertebral fracture assessment only
Copyright 2014 | Advanced Billing Consultants, Inc.
Radiation Oncology
Deleted: 77305, 77310, 77315, 77326, 77327, 77328
New: 77306, 77307, 77316, 77317, 77318
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Radiation Treatment Delivery
Deleted: 77403, 77404, 77406, 77408, 77409, 77411,
77413, 77414, 77416, 77418, 77421
Revised: 77401, 77402, 77407, 77412
New: 77385, 77386, 77387
Copyright 2014 | Advanced Billing Consultants, Inc.
Drug Assay and Drug Testing
All codes deleted and replaced with new codes
Codes specify purpose of the test
See CPT book for the presumptive drug class A and B
lists and the definitive drug classes
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Molecular Pathology
New codes: 81246, 81288, 81313
Revised: 81245, 81402, 81403, 81404, 81405
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MAAA
New: 81519: oncology (breast), mRNA, gene expression
profiling by real-time RT-PCR of 21 genes, utilizing
formalin-fixed paraffin embedded tissue, algorithm
reported as recurrence score
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Chemistry
Revised: 82541, 82542, 82543, 82544, 84600
Deleted: 82980, 83008, 83055, 83071, 83634
New: 83006
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Transfusion Medicine
Revised: 86900, 86901, 86902, 86904, 86905, 86906
Copyright 2014 | Advanced Billing Consultants, Inc.
Microbiology
Deleted: 87001, 87620, 87621, 87622
Revised: 87501, 87502, 87503, 87631, 87632, 87633
New: 87505, 87506, 87507, 87623, 87624, 87625, 87806
Copyright 2014 | Advanced Billing Consultants, Inc.
Surgical Pathology
Deleted: 88343, 88349
Revised: 88342, 88360, 88361, 88365, 88367, 88368
New: 88341, 88344, 88364, 88366, 88373, 88374, 88369,
88377
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Reproductive Medicine
Procedures
New: 89337
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Vaccines
New HPV and Flu: 90651, 90630
Revised: 90654, 90721, 90723, 90734
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Gastroenterology
New: 91200
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Ophthalmology
New: 92145
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Implantable & Wearable
Cardiac Device Evaluations
New: 93260, 96261
Revised: 93282, 93283, 93284, 93287, 93289, 93295,
93296
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Echocardiography
New: 93355
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Intracardiac Electrophysiological
Procedures/Studies
New: 93644
Revised: 93642
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Noninvasive Physiologic
Studies & Procedures
New: 93702
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Cerebrovascular Arterial
Studies
New: 93895
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Neurostimulators, Analysis-
Programming
Revised: 95972
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Central Nervous System
Assessments/Tests
Revised: 96110 (with scoring and documentation
New: 96127: Brief emotional/behavior assessment, with
scoring and documentation per standardized instrument
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Active Wound Care
Managment
Revised: 97605, 97606: utilizing DME
New: 97607, 97608: utilizing disposable, non-durable
medical equipment
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Other Services and
Procedures
New: 99188
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Adaptive Behavior Assessment
Mid year 2014 changes:
New: 0659T, 0360T, 0360T, 0362T, 0363T, 0364T, 0365T,
0366T, 0367T, 0368T, 0369T, 0370T, 0371T, 0372T
Copyright 2014 | Advanced Billing Consultants, Inc.
Exposure Adaptive Behavior
Treatment
Mid year 2014 changes:
New: 0373T, 0374T
Copyright 2014 | Advanced Billing Consultants, Inc.
Value Based Payment Modifier
Groups of 10 or more eligible professionals should make
sure they are participating in PQRS to avoid 2%
reduction in Medicare payments for 2016. This is based
on 2014 performance
For more specific info:
http://www.cms.gov/Medicare/Medicare-Fee-for-
Service-
Payment/PhysicianFeedbackProgram/ValueBasedPaymen
tModifier.html
Copyright 2014 | Advanced Billing Consultants, Inc.
References
AAPC. “2015 CPT Updates” (2014). Web 12 Dec 2014.
www.aapc.com
American Medical Association. “ Changes. An Insiders
View.” (2014)
Copyright 2014 | Advanced Billing Consultants, Inc.