2016 CPT Changes

Tamara Carey, CPC, CPMA

Evaluation & Management

• Prolonged Services codes and guidelines – Revised and updated for consistency– “This service is reported in addition to the primary

procedure (i.e., the designated E/M services at any level or psychotherapy, code 90837…”

• 99354 Prolonged evaluation and management or psychotherapy services…

Evaluation & Management

• Prolonged Clinical Staff Services– New title and subsection guidelines

• 2 new codes; 99415 and 99416– 99415 – first hour– +99416 – each additional 30 minutes (must surpass 15 min.)

• Prolonged service of less than 45 minutes in duration is not reported separately– Less than that is included in the E/M

Evaluation & Management

• E/M typical time is used to define when prolonged services time begins;– Example – prolonged clinical staff services would begin after 25

minutes , and 99415 is not reported until at least 70 minutes (25 + 45) total face-to-face clinical staff time has been performed.

• Reported once per date of service, even if time spent is not contiguous– Add face-to-face time together

• Codes 99415, 99416 may be reported for no more than two simultaneous patients.

Evaluation & Management

• Preventive Medicine – revisions to guidelines– Clarify the Behavior Change Intervention codes

(99406 – 99409) are appropriately reported separately in addition to the Preventive Medicine codes (99381 – 99397)• Aligns them with the original intent of the Behavior

Change Intervention code edits from 2008 which was to allow separate reporting of an E/M service, which includes Preventive Medicine codes

– Time spent providing the E/M service must be distinct (25 modifier), and time spent providing the E/M may not be used as a basis for the code selection.

Surgery

• New codes – 10035, +10036• Used to report initial and additional lesion

placement of soft tissue localization device(s)– Axilla and/or groin tissue– Marking lesions prior to therapy

• Only reported once per target, regardless of how many markers are used to mark the target

• Imaging guidance is bundled and not separately reportable

Surgery

• Three new codes – 31652, 31653, 31654 have been established in the Trachea and Bronchi subsection

• To identify endobronchial ultrasound (EBUS) guided procedures– 31652 = one or two mediastinal and/or hilar node

stations or structures– 31653 = 3 or more mediastinal and/or hilar node

stations or structures • Reported once regardless of the number of aspiration or

biopsy procedures are needed to accomplish the service

– 31654 = peripheral lesions

Surgery

• Pacemaker or Implantable Defibrillator– Guidelines were revised to include information on new

Category III codes for leadless cardiac pacemaker systems

• 0387T – 0391T– Include a pulse generator with built-in battery and

electrode for implantation in a cardiac chamber via a transcatheter approach

Surgery

• Pulmonary Valve– 0262T => 33477 a catheter based technique for the

implantation of a prosthetic valve using a percutaneous approach

• Reported once per session• Included in 33477;

– Access, placing the access sheath, advancing the device delivery system, repositioning, deploying

– Angiography, radiological S&I, interpretation to guide and report

– Cardiac catheterization– Balloon angioplasty, stent placement within the

pulmonary conduit

Surgery

• Extracorporeal Membrane Oxygenation (ECMO) or Extracorporeal Life Support Services (ECLS)

• Code series 33946 – 33989• Procedure chart has been added to illustrate

and provide instructions for appropriate code assignment

Surgery

• Arterial Mechanical Thrombectomy• CPT codes 37184, 37185, 37186

– All have been revised to include the term “non-intracranial”

• CPT code 37211– Has been revised to exclude the term “non-

intracranial”

Surgery

• Intravascular Ultrasound Services (IVUS) noncoronary vessels

• New codes +37252, +37253– Deleted codes 37250, 37251

• Radiological supervision and interpretation services are included in these codes (75945 and 75946)

• Billed in conjunction with stent or stent graft placement, angioplasty, atherectomy, embolization, thrombolysis, transcatheter biopsy

Surgery

• Intravascular Ultrasound Services (IVUS) noncoronary vessels

• What’s included;– Transducer manipulations/repositioning before, during,

and after therapeutic/diagnostic services– Intravascular vena cava filter insertion or repositioning

or removal– Intravascular foreign body retrieval

• What can be separately reported;– Diagnostic angiography– Selective and non-selective catheterizations– Therapeutic intervention

Surgery

• Guidelines– Report one IVUS code for a lesion extending across

more than 1 vessel

• Example;– IVUS for DVT extending from the popliteal vein

through the IVC, report with 37252

Surgery

• Esophagogastroduodenoscopy (EGD) subsection

• New code #43210 for partial or complete, transoral esophagogastric fundoplasty– Also referred to an incisionless fundoplication or TIF– Includes esophagoscopy– Includes duodenoscopy when performed

Surgery

• Biliary Tract– Percutaneous Biliary Procedures

• 14 new codes – 47531 – 47544– These codes are different from endoscopy because you aren’t

accessing the biliary tree via a hollow viscus

• Imaging guidance is included• Diagnostic cholangiography is inherently

included

Surgery

• Biliary Stent Placement • Term “stent” can mean two different things, often

not distinguished in a report– Catheter placed for drainage, e.g., bridging an

occlusion, that can be accessed externally• External drain• Internal/external drain• Referred to as a “drainage catheter” (47533 – 47537)

– Internally positioned device; not externally accessible• Metal expanding stent placed to hold open an

stenosis/occlusion• Internal plastic catheter that bridges an occlusion/stenosis• CPT codes 47538, 47539, 47540

Surgery

• Biliary Stent Placement • To be able to select the correct code(s) for stent

placement, you must know;– If access for each stent placed were, single or

multiple punctures, and if it is an existing or new access.

– The position of each stent– If the biliary ductal anatomy, single or multiple ducts;

contiguous or separate ducts– If a catheter drain was left in place

Surgery

• Biliary Stent Placement – Guidelines– Reported once per session for one or more

overlapping/serial stents– Reported once per session for bridging 1 ductal

segment through 1 access

• May be reported twice (modifier 59) when;– Placing side by side stents in single bile duct– Placing two or more stents into separate ducts via 1

access– Placing stents via 2 or more percutaneous access

sites

Surgery

• Laparoscopy – Transhepatic cholangiography w/w/o biopsy– First parenthetical– Codes 47560 and 47561 have been deleted– Instructed to report 47579 (NOC)

• Per CPT rationale, laparoscopic cholangiography is no longer standard practice, as more advanced imaging techniques have been developed (e.g. MRI and CT), therefore the codes were deleted.

Surgery

• Abdomen, Peritoneum, Omentum– Excision, Destruction– New CPT code 49185, Sclerotherapy of a fluid

collection• Examples provided within the code descriptor

• Parentheticals following the new code directs the coder to the appropriate codes to use to report drainage of other types of fluid collections.

• Multiple lesions in a single day, separate access, use 59 for each additional lesion treated

Surgery

• Other Introduction (Injection/Change/Removal) Procedures– New guidelines to reflect intended use of codes

included within this section– Imaging guidance is included (e.g. fluoroscopy,

ultrasound, CT or other modality)– Diagnostic procedures (50430, 50431) include;

• Contrast injections• Associated RS&I• Procedural image guidance• 50430 also includes catheter or needle access into collecting

system and/or ureter access

Surgery

Nephrostomy Tube Nephroureteral Stent Ureteral Stent

50432 (placement) 50433 (placement) 50693 (placement, existing nephrostomy)

50694 (placement, new access, w/o neph tube in

addition

50435 (exchange) 50387 (exchange) 50695 (placement, new access, w/additional

neph tube)

50389 (removal w/fluoro) 50434 (conversion of nephrostomy to

nephroureteral stent)

50382 – 50386 (removal)

Surgery50432 – Percutaneous nephrostomy (neph tube)

A single transnephric catheter placed into the renal pelvis for drainage

(drains to external bag)

50433 – Percutaneous nephroureteral catheter, new access

A single transnephric catheter that drains the kidney, but extends into the bladder. It maintains external access

through the flank, and can drain externally to bag and/or internally to

bladder

50434 – Convert neph tube to nephroureteral catheter

System access through an existing nephrostomy catheter (which is

removed) w/placement of nephroureteral stent

50432 – Exchange neph tube Existing neph tube exchanged for new tube

Surgery

• Therapeutic procedures; 50432 – 50435 includes;– Access– Placement of drain– Catheter manipulation– Guidance– RS&I– Diagnostic study

Surgery• New Ureter subsection; Incision and Biopsy• New CPT code +50606

– Describes endoluminal biopsy procedures using non-endoscopic imaging guidance (reported once per collecting system/ureter biopsied

– Includes; biopsy, image guidance for biopsy, RS&I for biopsy

• Biopsies can be done via any non-endoscopic access;– De Novo (new) transrenal access– Existing renal or ureteral access– Transurethral access, ileal conduit, ureterostomy

Surgery

• Endoscopy – Cystoscopy, Urethroscopy, Cystourethroscopy– “Because cutaneous urinary diversions utilizing ileum

or colon serve as functional replacements of a native bladder, endoscopy of such bowel segments, as well as performance of secondary procedures can be captured by using the cystourethroscopy codes. For example, endoscopy of an ileal loop with removal of ureteral calculus would be coded as cystourethroscopy (including ureteral catheterizations); with removal of ureteral calculus (52320).”

Surgery

• Endovascular Therapy• New CPT codes 61645, 61650, and +61651

– Used for cerebral endovascular therapeutic interventions in any intracranial artery which includes;• Selective catheterization• Diagnostic angiography• All subsequent angiography• Associated RS&I within the treated vascular territory• Fluoroscopic guidance• Neurologic and hemodynamic monitoring of the patient• Closure of the arteriotomy by manual pressure, an

arterial closure device or suture

Surgery• Paravertebral Blocks

– 3 new CPT codes, 64461, +64462, 64463 to identify paravertebral blocks using single/multiple injection(s) or continuous infusion using a catheter

– The intent is to provide a dense, ipsilateral somatic and sympathetic blockade as an analgesic alternative to a neuraxial blockade (which is performed as an epidural or via access to the spine)• Dermatomal coverage from T2 – L1

Surgery

• 64461 – initial injection• +64462 – second and any additional injection(s)

site(s)– Report only once per day

• 64463 – continuous infusion by catheter– Continuous infusion is performed through a

percutaneous indwelling catheter that is left in place during the course of the infusion

– The infusion may be either repeated intermittent boluses through the catheter or an interrupted infusion by a pump at a set infusion rate

Surgery

• New CPT code 65785 – Implantation of intrastromal corneal ring segments– Category III code 0099T

• Used to reshape and improve the functionality of the cornea– Patients with chronic/progressive keratoconus– Thinning and protrusion of the cornea– Can no longer focus on an image and cannot be corrected with

glasses or contact lens(es)– Worst case get scarring and may require corneal transplant

Surgery• Laser Trabeculoplasty – 65855

– Treatment of glaucoma

• 2016 revised to removed “1 or more treatment sessions..”– 65855 was identified by RUC as a potentially misvalued code for

more than 1.5 postoperative visits in a 10-day global– The code was changed from a 90-day to a 10-day global period

when it was last valued in 2000. However the descriptor wasn’t updated to reflect the change

– Code 65855 describes multiple laser applications to the trabecular meshwork through a contact lens to reduce intraocular pressure. Current practice is to perform only one treatment session of the laser for glaucoma and wait 10 days for the effect on the intraocular pressure

Surgery

• WE HAVE A NEW CERUMEN REMOVAL CODE!!!!

• 69209 Removal impacted cerumen using irrigation/lavage, unilateral.

Radiology

• “Written Report(s)” revised to reflect current practice– Written report = handwritten or electronic– “images” = analog, i.e. film or digital, i.e. electronic

• Editorial changes have been made throughout the Radiology section to replace the word “film” with “images”

Radiology

• 72080 revised to include # of views– New codes 72081 – 72084 = more views– COUNT THE NUMBER OF VIEWS– New codes include skull, C-spine and sacrum, when

performed– Parenthetical sends you to 72020 for a single view

thoracolumbar (single view examination of the thoracolumbar junction)• Single view that includes the entire thoracic and lumber

spine, use 72081

Radiology

• Hip, Pelvis, & Femur– New family of six bundled codes 73501-73503,

73521-73523 has been established to replace deleted codes 73500, 73510, 73520, 73530, 73540, and 73550

– RUC flagged codes 72170, 73500, 73520 and 73550 for restructuring as bundled• 73500 and 72170 were identified on a screen showing

that they were performed together more than 75% of the time

• Two new codes for femur x-rays; 73551 and 73552

Radiology

• Gynecological and Obstetrical subsection - Fetal MRI– Two new codes for to report fetal MRI; 74712 and

74713 (typically performed at 16 weeks gestation or later)

– Allow for accurate reporting of the fetus, placenta and the maternal pelvis (previously 72195, 72196, 72197)

– Very challenging to image a baby in the womb to look for fetal anomalies

• Reported per fetus;– 74712 is reported for a single or first fetus imaged– 74713 is reported for each additional fetus imaged

mghradrounds.org

Radiology• Clinical Brachytherapy

– Five new CPT codes added for HDR interstitial brachytherapy• 77767 Remote afterloading HDR radionuclide skin

surface brachytherapy…lesion diameter up to 2.0 cm or 1 channel

• 77768 lesion diameter over 2.0 cm….• 77770 Remote afterloading HDR radionuclide

interstitial or intracavitary brachytherapy…1 channel• 77771 2 – 12 channels• 77772 over 12 channels

Path & Lab• Tier 1 MoPath

– Represent gene-specific and genomic procedures– Now contains 119 codes– For 2016, 9 new codes were added, and 3 codes

were revised

• Tier 2 MoPath– For 2016 revisions to existing codes include; addition

of analytes, revised analyte names, and deleted analytes• 81401 revised 1 analyte, added 2 analytes; 81402

removed 1 analyte; 81403 removed 3 analytes; 81404 removed 3 analytes; 81405 revised 1 analyte; 81406 revised 1 analyte, added 1 analyte

Path & Lab

• Obstetric Panel– New code 80081 Obstetric Panel (includes HIV

testing)• Differs from existing code 80055 because it includes

HIV testing

Path & Lab

• Immunofluorescence– 88346 was revised to describe per specimen, initial

single antibody stain procedure– If additional single antibody stain procedures are

performed, report 88350 for each additional single antibody stain procedure

Path & Lab

• Hepatitis A Antibody– Code 86708 was revised and now only allows

reporting the detection of an IgG antibody to hepatitis A

– Code 86709 allows reporting of IgM antibody detection

Path & Lab

• Enzyme Immunoassay Infectious Agent Detection– Microbiology codes 87301- 87451– The revisions broadens the intent of these codes to

include immunoassays other than enzyme immunoassays

– The revised codes now allow reporting of infectious agent antigen detection by any immunoassay technique.

Medicine• Immune Globulins, Serum….

– Several codes have been added to the range of administration codes, i.e.• 96366, 96367, 96369, 96370, and 96371• Previously, 96365, 96368, 96372, 96374, 96375

• Vaccine, Toxoids– Revised codes listed have been updated to

incorporate the Advisory Committee on Immunization Practices (ACIP), US Vaccine Abbreviations

Medicine

• 90697 – new hexavalent vaccine, includes;– Diptheria, tetanus, acellular pertusis (DTaP)– Poliomyelitis (IPV)– Haemophilus influenza type b (Hib), and – Hepatitis B (HepB)

• Effective 1/1/2015, printed in 2016 code book with () = FDA approval pending

• 90620 and 90621 – two new Meningococcal recombinant vaccines

Medicine

• Code 91040 was revised to remove the provocation requirement and to specify the study as diagnostic.– Uses balloon catheter with barostat capability– Measures distensibility of esophageal lumen via

inflation and deflation of the balloon– Reported once per session

Medicine

• Exclusionary notes following 92002, 92004, 92012 and 92014– Precludes reporting of screening codes 99173, 99174

and 99177 – Located on pg. 665

• 99173 – Screening test of visual acuity, quantitative, bilateral

• 99174 – Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with remote analysis

• 99177 - with on-site analysis

Medicine

• Vestibular Function Tests– Two new CPT codes 92537 and 92538– Used to report bilateral caloric vestibular testing both

bithermal (92537) and monothermal (92538)– Code 92543 has been deleted

Medicine

• Special Dermatological Procedures– Six new codes 96931 – 96936– Created to report reflectance confocal microscopy for

cellular and subcellular imaging of the skin• Prior to 2016, 43206 and 43252

THANK YOU FOR YOUR TIME!!

Questions????