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Bellagio, Las Vegas | November 26-28, 2012

Nannette Orme, CPC, CCS-P, CPMA, CEMC

2013 CPT® Update

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Summary of Changes

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Physician or Other Qualified Health Care Professional• Individual qualified by

– Education– Training– Licensure/regulation– Facility privileging (when applicable)– Performs professional service within their scope of practice– Individually reports professional services

• Distinct from clinical staff– Works under supervision

• Physician or other qualified health care professional– May perform or assist in performance of specified professional service– Do not individually report professional services

*Copy and paste this text box to enter notations/source information. 7pt type. Aligned to bottom. No need to move or resize this box.

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2013 CPT Code Count• The CPT code set for 2013 will have 9,641 codes• Almost 150 of the CPT guidelines have changed as well as 568 codes.

– 186 New / Revised Codes – 119 deleted codes – 263 revised codes– 6 resequenced – 18 revised CPT modifiers


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2013 CPT Code Count

Section Title Revised New Deleted Resequenced Total Evaluation & Management 82 7 0 89Anesthesia 2 0 0 2Surgery 22 47 11 5 80Radiology 15 5 19 39Pathology / Laboratory 19 41 24 84Medicine 114 51 48 213Category II 6 7 1 14Category III 3 28 16 47Total 263 186 119 568


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2013 CPT Code Count

• Vaccines not in 2013 – New - 4

• Category II not in 2013– New – 40– Revised - 4

• Category III not in 2013 – New - 10

• Typographical errors – 3


Evaluation and Management

New 7Revised 82Resequenced 2Deleted 0

9

New / Revised CodesInpatient Neonatal Pediatric, Neonatal Critical Care Services99485, 99486 Resequenced See 99466 – 99486#99485 Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data interpretation and report; first 30 minutes #+ 99486 each additional 30 minutes (List separately in addition to code for primary procedure)

CodeNon‐Facility Total RVU

Facility Total RVU

Follow‐up Days

Assistant Surgeon

99485 NA 2.18 099486 NA 1.9 0

10

New / Revised Codes - continuedTransitional Care Management Services99487 Complex chronic care coordination services; first hour of clinical

staff time directed by a physician or other qualified health care professional with no face-to-face visit, per calendar month

99488 first hour of clinical staff time directed by a physician or other qualified health care professional with one face-to-face visit, per calendar month

+99489 each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)


Facility Total RVU

Follow‐up Days

Assistant Surgeon

99487 2.41 NA 099488 5.4 NA 099489 1.21 NA 0

11

New / Revised Codes - continuedTransitional Care Management Services - continued99495 Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge, Medical decision making of at least moderate complexity during the service period Face-to-face visit, within 14 calendar days of discharge99496 Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge, Medical decision making of high complexity during the service period Face-to-face visit, within 7 calendar days of discharge


Facility Total RVU

Follow‐up Days

Assistant Surgeon

99495 4.82 3.96 099496 6.79 5.81 0

12

Revised Codes• Qualified Healthcare Professional

– Revisions focused on removing provider references where not require• Explicit Code Ranges

– Revisions focused on providing the most accurate listings of codes

13

Evaluation and Management Guidelines• Guidelines were added that further specify

– Definition of New and Established Patient– Initial Observation Care– Subsequent Observation Care– Hospital Inpatient Services– Initial Hospital Care – New or Established Patient– Subsequent Hospital Care– Observation or Inpatient Care Services (Including Admission and Discharge

Services)– Hospital Discharge Services– Consultations– Office or Other Outpatient Consultations – New or Established Patient– Inpatient Consultations – New or Established Patient


14

Evaluation and Management Guidelines - continued• Guidelines were added that further specify – continued

– Other Emergency Services– Critical Care Services– Nursing Facility Services– Initial Nursing Facility Care – New or Established Patient– Subsequent Nursing Facility Care– Nursing Facility Discharge Services– Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services– Domiciliary, Rest Home (eg, Boarding Home), or Home Care Plan Oversight

Services– Home Services


Anesthesia

New 0Revised 2Deleted 0

16

Anesthesia Guidelines• Guidelines were added that further specify

– Anesthesia Services– Supplied Materials


17

Revised Codes

01991 Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different physician or other qualified health care professional); other than the prone position

01992 prone position

Code Base Units01991 301992 5


Surgery


19

Surgery Guidelines• Guidelines were changed to further specify

– Services– CPT Surgical Package Definition– Supplied Materials– Reporting More Than One Procedure/Service


Integumentary System


21

Integumentary System Guidelines• Guidelines were changed to further specify

– Excision of Benign Lesions– Skin Replacement Surgery– Other Flaps and Grafts– Mohs Micrographic Surgery


22

Revised Code

15740 Flap; island pedicle requiring identification and dissection of an anatomically named axial vessel



Facility Total RVU

Follow‐up Days

Assistant Surgeon

15740 30.38 25.49 90

Musculoskeletal System

New 5Revised 3Resequenced 6Deleted 1

24

Musculoskeletal System Guidelines• Guidelines were changed to further specify

– Definitions• Reduction of a fracture and/or dislocation• Exclusion of facial or subfacial soft tissue tumors• Radical resection of soft tissue tumors

– Head Prothesis– Application of Casts and Strapping– Removal or Repair of Cast


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Revised Codes

20665 Removal of tongs or halo applied by another individual[Replaced physician]

28890 Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia



Facility Total RVU

Follow‐up Days

Assistant Surgeon

20665 3.06 2.62 1028890 9.9 6.76 90

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New / Revised Codes+22522 Each additional thoracic or lumbar body (List separately in addition

to code for primary procedure) 22586 Arthrodesis, pre-sacral interbody technique, including disc space

preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5 – S1 interspace

23473 Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component

23474 humeral and glenoid component



Facility Total RVU

Follow‐up Days

Assistant Surgeon

22522 NA 6.58 022586 NA 45.23 023473 NA 48.22 9023474 NA 52.09 90

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New / Revised Codes24370 Revision of total elbow arthroplasty, including allograft when

performed; humeral or ulnar component24371 humeral and ulnar component

Code Non-Facility Total RVU

Facility Total RVU

Follow-Up Days

Assistant Surgeon

23470 NA 45.57 9023471 NA 52.51 90

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Resequenced Codes

21552 Code is out of numerical sequence. See 21550 – 2163221554 Code is out of numerical sequence. See 21550 – 2163223071 Code is out of numerical sequence. See 23065 - 2322023073 Code is out of numerical sequence. See 23065 – 2322024071 Code is out of numerical sequence. See 24065 - 2411527073 Code is out of numerical sequence. See 24065 - 24115


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Deleted Codes

29590 Denis Browne splint strapping


Respiratory System


31

Respiratory System Guidelines• Guidelines were changed to further specify

– Stereotactic Radiation Therapy


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31647 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), initial lobe

31648 with removal of bronchial valve(s), initial lobe+31649 with removal of bronchial valve(s), each additional lobe (List

separately in addition to code for primary procedure)+31651 with balloon occlusion, when performed, assessment of air

leak, airway sizing, and insertion of bronchial valve(s), each additional lobe (List separately in addition to code for primary procedure[s])


Facility Total RVU

Follow-Up Days

Assistant Surgeon

31647 NA 6.63 031648 NA 6.93 031649 2.18 2.18 ZZZ31651 2.31 2.31 ZZZ

33

31660 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe

31661 with bronchial thermoplasty, 2 or more lobes


Facility Total RVU

Follow-Up Days

Assistant Surgeon

31660 NA 6.65 031661 NA 7.03 0

34

New / Revised Codes - continued32551 Tube thoracostomy, includes connection to drainage system (eg,

water seal), when performed, open (separate procedure)32554 Thoracentesis, needle or catheter, aspiration of the pleural space;

without imaging guidance 32555 with imaging guidance



Facility Total RVU

Follow‐up Days

Assistant Surgeon

32551 NA 5.24 032554 26.31 2.61 032555 16.91 3.31 0

35

New / Revised Codes - continued32556 Pleural drainage, percutaneous, with insertion of indwelling catheter;

without imaging guidance32557 with imaging guidance32701 Thoracic target(s) delineation for stereotactic body radiation therapy

(SRS/SBRT), (photon or particle beam), entire course of treatment



Facility Total RVU

Follow‐up Days

Assistant Surgeon

32556 17.81 3.63 032557 32.69 4.88 032701 NA 6.55 XXX

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Deleted Codes31715 Transtracheal injection for bronchography32420 Pneumocentesis, puncture of lung for aspiration32421 Thoracentesis, puncture of pleural cavity for aspiration, initial or

subsequent32422 Thoracentesis with insertion of tube, includes water seal (eg, for

pneumothorax), when performed (separate procedure)


Cardiovascular System


38

Cardiovascular System• New guidelines and 8 new CPT codes have been added to report

bundled non-selective and selective arterial catheter placement and diagnostic imaging of the aortic arch, carotid, and vertebral arteries

• 8 angiography S&l codes have been deleted• Parenthetical instructions have been added with the addition and

deletion of the codes.• Relocation of the diagram related to carotid angiography• New guidelines• All imaging now included• Codes 75660, 75662, 7566t5, 75671, 75676, 75680, 75685 have

been deleted and are now reported for imaging• 36221 for non-selective catheter placement in the thoracic aorta• New / Revised Codes 36222-36228-for selective catheter placement

39

New / Revised Codes - continued33225 Insertion of pacing electrode, cardiac venous system, for

left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (includingeg, for upgrade to dual chamber system and pocket revision) (List separately in addition to code for primary procedure)


Facility Total RVU

Follow‐up Days

Assistant Surgeon

33225 NA 13.4 ZZZ

40

New / Revised Codes33361 Transcatheter aortic valve replacement (TAVR/TAVI) with

prosthetic valve; percutaneous femoral artery approach33362 open femoral artery approach33363 open axillary artery approach



Facility Total RVU

Follow-Up Days

Assistant Surgeon

33361 NA 39.73 033362 NA 43.46 033363 NA 45.00 0

41

New / Revised Codes33364 Transcatheter aortic valve replacement (TAVR/TAVI) with

prosthetic valve; open iliac artery approach 33365 transaortic approach (eg, median sternotomy,

mediastinotomy)



Facility Total RVU

Follow-Up Days

Assistant Surgeon

33364 NA 47.88 0

33365 NA 52.51 0

42

New / Revised Codes - continued+33367 Transcatheter aortic valve replacement (TAVR/TAVI) with

prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (eg, femoral vessels) (List separately in addition to code for primary procedure)

+33368 cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg, femoral, iliac, axillary vessels) (List separately in addition to code for primary procedure


Facility Total RVU

Follow‐up Days

Assistant Surgeon

33367 NA 18.44 ZZZ33368 NA 22.35 ZZZ

43

New / Revised Codes - continued+33369 Transcatheter aortic valve replacement (TAVR/TAVI) with

prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (eg, aorta, right atrium, pulmonary artery) (List separately in addition to code for primary procedure)

33990 Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access

33991 both arterial and venous access, with transseptal puncture


Facility Total RVU

Follow‐up Days

Assistant Surgeon

33369 NA 29.51 ZZZ33990 NA 12.92 XXX33991 NA 18.83 XXX

44

New / Revised Codes - continued33992 Removal of percutaneous ventricular assist device at

separate and distinct session from insertion 33993 Repositioning of percutaneous ventricular assist device

with imaging guidance at separate and distinct session from insertion


Facility Total RVU

Follow-Up Days

Assistant Surgeon

33992 NA 6.15 XXX

33993 NA 5.4 XXX

45

New / Revised Codes - continued36010 Introduction of catheter, superior or inferior vena cava36140 Introduction of needle or intracatheter; extremity artery36221 Non-selective catheter placement, thoracic aorta, with

angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

Codes Non-Facility Total RVUs

Facility Total RVUs

Follow-Up Days

Assistant Surgeon

36010 15.46 3.6 XXX36140 13.63 3.06 XXX3.06 34.02 6.39 0

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New / Revised Codes - continued36222 Selective catheter placement, common carotid or

innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

36223 includes angiography of the extracranial carotid and cervicocerebral arch, when performed


Facility Total RVU

Follow‐up Days

Assistant Surgeon

36222 42.59 8.64 036223 46.42 9.34 0

47

New / Revised Codes - continued36224 Selective catheter placement, internal carotid artery, unilateral,

with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed

36225 Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

Code Non-Facility Total RVUs

Facility Total RVUs

Follow-Up Days

Assistant Surgeon

36224 50.44 10.18 0

36225 46.05 9.3 0

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New / Revised Codes - continued36226 Selective catheter placement, vertebral artery, unilateral, with

angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includesangiography of the cervicocerebral arch, when performed

+36227 Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (Listseparately in addition to code for primary procedure)


Facility Total RVUs

Follow-Up Days

Assistant Surgeon

36226 51.45 10.2 0

36227 7.42 3.22 ZZZ

49

New / Revised Codes - continued+36228 Selective catheter placement, each intracranial branch of the internal

carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery) (List separately in addition to code for primary procedure)

• Code 36228 is reported in conjunction with 36224 or 36226. This includes any additional second or third order catheter selective placement in the same primary branch of the internal carotid, vertebral, or basilar artery and includes all the work of accessing the additional vessel, placement of catheter(s), contrast injection(s), fluoroscopy, radiological supervision and interpretation. It is not reported more than twice per side regardless of the number of additional branches selectively catheterized


Facility Total RVU

Follow‐up Days

Assistant Surgeon

36228 35.41 6.57 ZZZ

50

New / Revised Codes - continued36400 Venipuncture, younger than age 3 years, necessitating

physician's skill, not to be used for routine venipuncture; femoral or jugular vein

36405 scalp vein36406 other vein36410 Venipuncture, age 3 years or older, necessitating physician's skill (separate procedure), for diagnostic or therapeutic purposes (not

to be used for routine venipuncture)Code Non-Facility

Total RVUsFacility Total RVUs

Follow-Up Days

Assistant Surgeon

36400 0.86 0.58 XXX36405 0.79 0.49 XXX36406 0.59 0.29 XXX36410 0.51 0.28 XXX

51

New / Revised Codes - continued37197 Transcatheter retrieval, percutaneous, of intravascular foreign

body (eg, fractured venous or arterial catheter), includes radiological supervision and interpretation, and imaging guidance (ultrasound or fluoroscopy), when performed

#37211 Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day

#37212 Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day


Facility Total RVU

Follow‐up Days

Assistant Surgeon

37197 49.81 9.03 037211 NA 11.96 037212 NA 10.57 0

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#37213 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed;

#37214 cessation of thrombolysis including removal of catheter and vessel closure by any method


Facility Total RVUs

Follow-Up Days

Assistant Surgeon

37213 NA 7.38 0

37214 NA 4.33 0

53

Deleted Codes 37203 Transcatheter retrieval, percutaneous, of intravascular foreign

body (eg, fractured venous or arterial catheter)37209 Exchange of a previously placed intravascular catheter during

thrombolytic therapy

Hemic and Lymphatic Systems


55

New Code38240 Bone marrow or blood-derived peripheral

stemHematopoietic progenitor cell transplantation(HPC); allogeneic transplantation per donor

38242 autologous transplantation#38243 HPC boost from the original allogeneic HPC

(hematopoietic progenitor cells) donor38242 Allogeneic lymphocyte infusions


Facility Total RVUs

Follow-Up Days

Assistant Surgeon

38240 NA 4.86 XXX

38242 NA 4.83 XXX

38243 NA 3.41 0

38242 NA 3.38 0

Mediastinum and Diaphragm


Digestive System


58

New / Revised Codes43206 Esophagoscopy, rigid or flexible; with optical

endomicroscopy 43252 Upper gastrointestinal endoscopy including esophagus,

stomach, and either the duodenum and/or jejunum as appropriate; with optical endomicroscopyThese are reported for in vivo 1microscopic imaging to facilitate real-time cellular observation of mucosal tissue during an endoscopy procedure

Can not be reported in addition to 88375 for optical endoscopy


Facility Total RVU

Follow‐up Days

Assistant Surgeon

43206 0 0 YYY43252 0 0 YYY

59

New / Revised Codes - continued44705 Preparation of fecal microbiota for instillation, including

assessment of donor specimen

For Medicare see Gxxxx


Facility Total RVUs

Follow-up Days

Assistant Surgeon

44705 0 0 XXX

60

Deleted Code43234 Upper gastrointestinal endoscopy, simple primary examination

(eg, with small diameter flexible endoscope) (separate procedure)

Urinary System


62

New Code52287 Cystourethroscopy, with injection(s) for chemodenervation

of the bladder


Facility Total RVU

Follow‐up Days

Assistant Surgeon

52287 9.16 4.9 0

Male Genital System


Female Genital System


65

Revised Code59300 Episiotomy or vaginal repair, by other than attending

[deleted physician]


Facility Total RVU

Follow‐up Days

Assistant Surgeon

59300 5.85 4.48 0

Nervous System


67

New / Revised Codes62370 Electronic analysis of programmable, implanted pump for

intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill (requiring skill of a physician or other qualified health care professional)

64561 Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed


Facility Total RVU

Follow‐up Days

Assistant Surgeon

62370 3.94 1.37 XXX64561 24.07 11.68 XXX

68

New / Revised Codes - continued64612 Chemodenervation of muscle(s); muscle(s) innervated by

facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)

64614 extremity(s) and/or trunk muscle(s) (eg, for dystonia, cerebral palsy, multiple sclerosis)

64615 Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)


Facility Total RVU

Follow‐up Days

Assistant Surgeon

64612 4.08 3.65 1064614 5.15 4.7 1064615 5.52 4.9 10

Eye and Ocular Adnexa


70

Revised Codes65800 Paracentesis of anterior chamber of eye (separate

procedure); with removal of aqueous#67810 Incisional biopsy of eyelid skin including lid margin


Facility Total RVU

Follow‐up Days

Assistant Surgeon

65800 3.6 2.77 067810 5.24 2.13 0

71

Deleted Code65805 Paracentesis of anterior chamber of eye (separate procedure);

with therapeutic release of aqueous

Auditory System


Radiology


74

New / Revised Codes 72040 Radiologic examination, spine, cervical; 3 views or less72050 4 or 5 views72052 6 or more viewsChanges are to reflect the work associated by number of views

75896 Transcatheter therapy, infusion other than for thrombolysis, radiological supervision and interpretation

75898 Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis


Facility Total RVU

Follow‐up Days

Assistant Surgeon

72040 1.31 1.31 XXX72050 1.66 1.66 XXX72052 2.13 2.13 XXX75896 ‐ 26 1.91 1.91 XXX75898 ‐ 26 2.44 2.44 XXX

75

New / Revised Codes - continued76000 Fluoroscopy (separate procedure), up to 1 hour physician or other qualified

health care professional time, other than 71023 or 71034 (eg, cardiac fluoroscopy)

76001 Fluoroscopy, physician or other qualified health care professional time more than 1 hour, assisting a nonradiologic physician or other qualified health care professional (eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)


Facility Total RVU

Follow‐up Days

Assistant Surgeon

76000 1.56 1.56 XXX76001 ‐ 26 1.03 1.03 XXX

76

New / Revised Codes - continued76376 3D rendering with interpretation and reporting of computed

tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation

76377 requiring image postprocessing on an independent workstation


Facility Total RVUs

Follow-Up Days

Assistant Surgeon

76376 1.78 1.78 XXX76377 2.44 2.44 XXX

77

New / Revised Codes - continued76885 Ultrasound, infant hips, real time with imaging documentation;

dynamic (requiring physician or other qualified health care professional manipulation)

76886 limited, static (not requiring physician or other qualified health care professional manipulation)


Facility Total RVUs

Follow-Up Days

Assistant Surgeon

76885 4.51 4.51 XXX76886 3.15 3.18 XXX

78

New / Revised Codes - continued77051 Computer-aided detection (computer algorithm analysis of digital

image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; diagnostic mammography (List separately in addition to code for primary procedure)

77052 screening mammography (List separately in addition to code for primary procedure)

77071 Manual application of stress performed by physician or other qualified health care professional for joint radiography, including contralateral joint if indicated


Facility Total RVUs

Follow-Up Days

Assistant Surgeon

77051 0.31 0.31 ZZZ77052 0.31 0.31 ZZZ77071 1.54 1.54 XXX

79

New / Revised Codes78012 Thyroid uptake, single or multiple quantitative

measurement(s) (including stimulation, suppression, or discharge, when performed)

78013 Thyroid imaging (including vascular flow, when performed);78014 with single or multiple uptake(s) quantitative

measurement(s) (including stimulation, suppression, or discharge, when performed)


Facility Total RVU

Follow‐up Days

Assistant Surgeon

78012 2.45 2.45 XXX78013 6.19 6.19 XXX78014 7.17 7.17 XXX

80

New / Revised Codes - continued78070 Parathyroid planar imaging (including subtraction, when

performed);78071 with tomographic (SPECT)78072 with tomographic (SPECT), and concurrently acquired

computed tomography (CT) for anatomical localization


Facility Total RVU

Follow‐up Days

Assistant Surgeon

78070 9.09 9.09 XXX78071 10.68 10.68 XXX78072 ‐ 26 2.3 2.3 XXX

81

71040710607565075660756627566575671756767568075685

759007596178000780017800378006780077801078011

Deleted Codes

Pathology / Laboratory


83

Evocative Suppression• Evocative/Suppression Testing Guidelines changes• Editorial revisions to reflect entire family of therapeutic infusion codes• Reference to Prolonged services codes deleted (not appropriate due to

time interval identified for typical therapeutic infusion)• Deletion of 99070 for separate identification of supplies

84

Molecular Pathology – Tier 1• Tier 1 Codes-Gene specific and Genomic Procedures• 13 new analytes• Now contains 105 codes

85

Molecular Pathology – Tier 2• Tier 2 Codes-Medically useful procedures generally performed in lower

volumes than Tier 1 (incidence of disease tested is rare)• Arranged by level of technical resources and interpretative work by

physician/qualified health care professional• 156 new analytes

– 81400- 9 analytes– 81402- 2 analytes*– 81403- 12 analytes*– 81404- 22 analytes– 81405-41 analytes– 81406- 50 analytes– 81407- 14 analytes– 81408- 6 analytes

86

Multianalyte Assays with Algorithmic Analyses (MAAA)• Multianalyte Assays with Algorithmic Analyses (MAAA)

– Issue was generated from the Molecular Pathology Workgroup who could not determine a mechanism within the Tier 1 & Tier 2 code set hierarchy to codify these tests.

– 81500/3 - Ovarian cancer risk score– 81506- Diabetes risk score (glucose, HbA1c, insulin, hs-CRP, adoponectin,

ferritin, interleukin 2-receptor alpha)– 81508, 81509, 81510, 81511, 81512

• AII maternal serum screening for risk of fetal congenital abnormalities.

– Appendix 0-listing of Category I and Administrative MAAA/IVOMlA codes– Extensive guidelines in Appendix instruct appropriate reporting of codes– Administrative 'M' codes are sole-sourced– Look for publication of the molecular pathology codes on the CPT web site

87

In Vitro Diagnostic Multivariant Index Assays (IVDMIA)• In Vitro Diagnostic Multivariant Index Assays

– Also referred to as IVDMIA 's (FDA) – Common thread between all of these tests- multiple data points (eg, lab

results) combined in an algorithm to provide a 1result (eg, prognostic index, recurrence score, probably score)

– Typically these are sole-source tests.

88

Chemistry• Guidelines revised to account for the use of algorithms in the MAAA

codes and to differentiate those algorithmic results from results that are typically inherent and not separately reported

89

Immunology• Conversion of Category Ill 0279T -0280T to Category I

– 86152 Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood)

• ...(For physician interpretation and report, use 86153. For cell enumeration with interpretation and report, use 86152 and 86153)

– 87470 Infectious agent detection by nucleic acid (DNA or RNA);– 87631 respiratory virus (eg, adenovirus, influenza virus, coronavirus,

metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), multiplex reverse transcription and amplified probe technique, multiple types or subtypes, 3-5 targets

– 87632 respiratory virus (eg,adenovirus...), multiplex reverse transcription and amplified probe technique, multiple types or subtypes, 6-11 targets

Medicine


91

Explicit Code Ranges• Immunization Administration• Hemodialysis• Acupuncture• Osteopathic Manipulative Treatment• Chiropractic Manipulative Treatment

92

Psychotherapy• 25 codes deleted

– Setting specific codes removed• New subsections• New Guidelines• Interactive Complexity• Definition

– Treatment of mental illness and behavioral disturbances in which the physician or other qualified health care professional, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.

93

New / Revised Codes90653 Influenza vaccine, inactivated, subunit, adjuvanted, for

intramuscular use90672 Influenza virus vaccine, quadrivalent, live, for intranasal use90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for

intramuscular use


Facility Total RVU

Follow‐up Days

Assistant Surgeon

90653 0 0 XXX90672 0 0 XXX90639 0 0 XXX

94

New / Revised Codes - continued90785 Interactive complexity (List separately in addition to the code for

primary procedure)90791 Psychiatric diagnostic evaluation


Facility Total RVU

Follow‐up Days

Assistant Surgeon

90785 0.14 0.14 XXX90791 4.43 3.44 XXX

95

New / Revised Codes - continued90792 Psychiatric diagnostic evaluation with medical services•Not reported with Evaluation and Management codes•Psychotherapy Codes 90832-90838•Time based

– 30 minutes (16-37 minutes)– 45 minutes (38-52)

•60 minutes (53 or more)•Report psychotherapy add-on codes for evaluation and management with codes 99201- 99255,99304-99337,993411-99350


Facility Total RVU

Follow‐up Days

Assistant Surgeon

90792 3.65 3.55 xxx

96

New / Revised Codes - continued90838 •For management of maladaptive communication •When emotions or behavior that interferes with the caregiver's ability to assist in plan •For use of play equipment, other physical devices90839 – 90840 Psychotherapy for Crisis -Time Based Codes90863 Pharmacologic management, including prescription and review

of medication, when performed with psychotherapy services•For prescribing professionals who can not use E/M codes


Facility Total RVU

Follow‐up Days

Assistant Surgeon

90838 3.19 3.19 XXX90839 ‐ 40 0 0 XXX90863 0 0 XXX

97

Definition• Treatment of mental illness and behavioral disturbances in which the

physician or other qualified health care professional, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.

98

New / Revised Codes - continued91112 Gastrointestinal transit and pressure measurement, stomach through

colon, wireless capsule, with interpretation and report


Facility Total RVU

Follow‐up Days

Assistant Surgeon

91112 34.93 34.93 XXX

99

New / Revised Codes - continued92920 Percutaneous transluminal coronary angioplasty; single major coronary

artery or branch92921 each additional branch of a major coronary artery (List

separately in addition to code for primary procedure)92924 Percutaneous transluminal coronary atherectomy, with coronary

angioplasty when performed; single major coronary artery or branch92925 each additional branch of a major coronary artery (List

separately in addition to code for primary procedure)


Facility Total RVU

Follow‐up Days

Assistant Surgeon

92920 15.98 15.98 092921 0 0 ZZZ92924 18.99 18.99 092925 0 0 ZZZ

100

New / Revised Codes - continued92928 Percutaneous transcatheter placement of intracoronary stent(s),

with coronary angioplasty when performed; single major coronary artery or branch

92929 each additional branch of a major coronary artery (List separately in addition to code for primary procedure)

92933 Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch

92934 each additional branch of a major coronary artery (List separately in addition to code for primary procedure)


Facility Total RVU

Follow‐up Days

Assistant Surgeon

92928 17.74 17.74 092929 0 0 ZZZ29233 19.85 19.85 092934 0 0 ZZZ

101

New / Revised Codes - continued92937 Percutaneous transluminal revascularization of or through coronary artery

bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection

when performed; single vessel 92938 each additional branch subtended by the bypass graft

(List separately in addition to code for primary procedure)92941 Percutaneous transluminal revascularization of acute total/subtotal occlusion

during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel


Facility Total RVU

Follow‐up Days

Assistant Surgeon

92937 17.73 17.73 092938 0 0 ZZZ92941 19.89 19.89 0

102

New / Revised Codes - continued92943 Percutaneous transluminal revascularization of chronic total

occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel

92944 each additional coronary artery, coronary artery branch, or bypass graft (List separately in addition to code for primary procedure)


Facility Total RVU

Follow‐up Days

Assistant Surgeon

92943 19.89 19.89 092944 0 0 ZZZ

103

New / Revised Codes - continued93653 Comprehensive electrophysiologic evaluation including insertion and

repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording, His recording with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry

93654 with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular

connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry


Facility Total RVU

Follow‐up Days

Assistant Surgeon

93653 0 24.16 093654 0 32.24 0

104

New / Revised Codes - continued93655 Intracardiac catheter ablation of a discrete mechanism of

arrhythmia which is distinct from the primary ablated mechanism,including repeat diagnostic maneuvers, to treat a spontaneous orinduced arrhythmia (List separately in addition to code for primary procedure)

93656 Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with atrial recording and pacing, when possible, right ventricular pacing and recording, His bundle recording with intracardiac catheter ablation of arrhythmogenic focus, with treatment of atrial fibrillation by ablation by pulmonary vein isolation


Facility Total RVU

Follow‐up Days

Assistant Surgeon

93655 0 12.08 ZZZ93656 0 3.25 0

105

New / Revised Codes - continued93657 Additional linear or focal intracardiac catheter ablation of the left

or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (List separately in addition to code for primary procedure)


Facility Total RVU

Follow‐up Days

Assistant Surgeon

93657 0 9.14 ZZZ

106

New / Revised Codes - continued95017 Allergy testing, any combination of percutaneous (scratch,

puncture, prick) and intracutaneous (intradermal), sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests

95018 …with drugs or biologicals…95076 Ingestion challenge test (sequential and incremental ingestion of

test items, eg, food, drug or other substance); initial 120 minutes of testing

95079 each additional 60 minutes of testing (List separately in addition to code for primary procedure)


Facility Total RVU

Follow‐up Days

Assistant Surgeon

95017 2.52 0.11 XXX95018 0.86 0.21 XXX95076 3.42 2.1 XXX95079 2.41 1.94 ZZZ

107

New / Revised Codes - continued95782 Polysomnography; younger than 6 years, sleep staging with 4 or

more additional parameters of sleep, attended by a technologist


Facility Total RVU

Follow‐up Days

Assistant Surgeon

95782 31.35 31.35 XXX

108

New / Revised Codes - continued95907 Nerve conduction studies; 1-2 studies95908 3-4 studies95909 5-6 studies95910 7-8 studies95911 9-10 studies95912 11-12 studies95913 13 or more studies


Facility Total RVU

Follow‐up Days

Assistant Surgeon

95907 2.78 2.78 XXX95908 3.43 3.43 XXX90909 4.11 4.11 XXX95910 5.41 5.41 XXX95911 6.54 6.54 XXX95912 7.67 7.67 XXX95913 8.88 8.88 XXX

109

New / Revised Codes - continued95940 Continuous intraoperative neurophysiology monitoring in the

operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to codefor primary procedure)

95941 from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure)


Facility Total RVU

Follow‐up Days

Assistant Surgeon

95940 0 0.093 XXX95941 0 0 XXX

110

New / Revised Codes - continued95942 Testing of autonomic nervous system function; combined

parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt

95943 Simultaneous, independent, quantitative measures of both parasympathetic function and sympathetic function, based on time-frequency analysis of heart rate variability concurrent with time-frequency analysis of continuous respiratory activity, with mean heart rate and blood pressure measures, during rest, paced (deep) breathing, Valsalva maneuvers, and head-up postural change


Facility Total RVU

Follow‐up Days

Assistant Surgeon

95942 0 0 XXX95943 0 0 XXX

111

Percutaneous Revascularization Services• Codes 92980-92984 Deleted

– 13 New / Revised Codes added to report contrast injections, angiography, road mapping, fluoroscopic guidance for the coronary interventions

– Vessel measurement for the coronary interventions– Post-coronary angioplasty/stentlatherectomy– angiography, as this work is captured in the percutaneous coronary

revascularization services (92920-92944).

112

Nerve Conduction Testing• 95900, 95903, 95904 Deleted• Appendix J to guide Coding for Nerve Studies Revised• Nerve Conduction Studies• New / Revised Codes 95907, 95908, 95909, 95910,

95911,95912,95913– 1-2 studies– 3-4 studies– 5-6 studies

113

Interoperative Neurophysiology• 95920 Deleted

– 95940 Continuous intraoperative neurophysiology monitoring in the operating room-face-to-face

– 95941 Continuous intraoperative neurophysiology monitoring outside the operating room-remote

– For reporting the total duration of respective time spent providing each service, even if that time is not in a single continuous block

• 95940 reported for each 15 minutes– 95941 -Report once per hour– Ongoing neurophysiologic n1onitoring, testing, and data interpretation

distinct from performance of specific type(s) of baseline neurophysiologic study(s) performed during surgical procedures.

114

Autonomic Function Testing• 95940 reported for each 15 minutes

– 95941 -Report once per hour– Ongoing neurophysiologic n1onitoring, testing, and data interpretation

distinct from performance of specific type(s) of baseline neurophysiologic study(s) performed during surgical procedures.

115

Revised Codes• These codes were revised to include the language, “or other health

care professional:”90935 90960 93293 94774 9907190945 90961 93294 94777 9907890947 90962 93295 95120 9909190951 93224 93298 95830 9914390952 93227 93351 95954 9914890953 93228 93745 9596190954 93229 93750 9596290955 93268 93797 9599190956 93272 94014 9600490957 93279 94016 9602090958 93286 94452 9900290959 93288 94610 99070

116

Revised Codes - continued• These codes were revised to remove the word, “physician,” “provider,”

or “health care provider:”

90889 9753091111 9753292613 9753392615 9753592617 9753793015 9775593790 9896995004 9900095024 9900195027

117

Deleted Codes90665 90811 90824 9299690701 90812 90826 9501090718 90813 90827 9501590801 90814 90828 9507590802 90815 90829 9590090804 90816 90857 9590390805 90817 90862 9590490806 90818 92980 9593490807 90819 92981 9593690808 90821 9298290809 90822 9298490810 90823 92995

Category II


Category III


120

New / Revised Codes0291T Intravascular optical coherence tomography (coronary native vessel or

graft) during diagnostic evaluation and/or therapeutic intervention, including imaging supervision, interpretation, and report; initial vessel (List separately in addition to primary procedure)

0292T each additional vessel (List separately in addition to primary procedure)

0293T Insertion of left atrial hemodynamic monitor; complete system, includes implanted communication module and pressure sensor lead in left atrium including transseptal access, radiological supervision and interpretation, and associated injection procedures, when performed

0294T pressure sensor lead at time of insertion of pacing cardioverter-defibrillator pulse generator including radiological supervision and interpretation and associated injection procedures, when performed (List separately in addition to code for primary procedure)

121

New / Revised Codes - continued0295T External electrocardiographic recording for more than 48 hours

up to 21 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation

0296T recording (includes connection and initial recording)0297T scanning analysis with report0298T review and interpretation0299T Extracorporeal shock wave for integumentary wound healing,

high energy, including topical application and dressing care; initial wound

0300T each additional wound (List separately in addition to code for primary procedure)

122

New / Revised Codes - continued0301T Destruction/reduction of malignant breast tumor with externally

applied focused microwave, including interstitial placement of disposable catheter with combined temperature monitoring probe and microwave focusing sensocatheter under ultrasound thermotherapy guidance

0302T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; complete system (includes device and electrode)

0303T electrode only0304T device only0305T Programming device evaluation (in person) of intracardiac

ischemia monitoring system with iterative adjustment of programmed values, with analysis, review, and report

123

New / Revised Codes - continued0306T Interrogation device evaluation (in person) of intracardiac

ischemia monitoring system with analysis, review, and report0307T Removal of intracardiac ischemia monitoring device0308T Insertion of ocular telescope prosthesis including removal of

crystalline lens0309T Arthrodesis, pre-sacral interbody technique, including disc space

preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft, when performed, lumbar, L4-L5 interspace (List separately in addition to code for primary procedure)

0310T Motor function mapping using non-invasive navigated transcranial magnetic stimulation (nTMS) for therapeutic treatment planning, upper and lower extremity

124

New / Revised Codes - continued0311T Non-invasive calculation and analysis of central arterial pressure

waveforms with interpretation and report0312T Vagus nerve blocking therapy (morbid obesity); laparoscopic

implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming0313T laparoscopic revision or replacement of vagal trunk

neurostimulator electrode array, including connection to existing pulse generator

0314T laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator

0315T removal of pulse generator0316T replacement of pulse generator0317T neurostimulator pulse generator electronic analysis, includes

reprogramming when performed0318T Implantation of catheter-delivered prosthetic aortic heart valve, open thoracic

approach, (eg, transapical, other than transaortic)

125

Revised Codes0195T Arthrodesis, pre-sacral interbody technique, including

instrumentation, imaging (when performed), and discectomy to prepare interspace, lumbar; single interspace

0196T each additional interspace (List separately in addition to code for primary procedure)

0206T Computerized database analysis of multiple cycles of digitized cardiac electrical data from two or more ECG leads, including transmission to a remote center, application of multiple nonlinear mathematical transformations, with coronary artery obstruction severity assessment

126

0030T0048T0050T0173T0242T0250T0251T0252T0256T0257T

0258T0259T0276T0277T0279T0280T

Deleted Codes

Modifiers


128

Physician or Other Qualified Health Care Professional

• The addition of this language affects the following modifiers– 24 Unrelated Evaluation and Management Service by the Same

Physician or Other Qualified Health Care Professional During a Post Operative Period

– 25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service

– 26 Professional Component– 52 Reduced Services– 53 Discontinued Procedure– 54 Surgical Care Only– 55 Postoperative Management Only

129

Physician or Other Qualified Health Care Professional -continued

• The addition of this language affects the following modifiers (continued)– 56 Preoperative Management Only– 58 Staged or Related Procedure or Service by the Same Physician

or Other Qualified Health Care Professional During the Postoperative Period

– 63 Procedures Performed on Infants less than 4 kg – 66 Surgical Team– 76 Repeat Procedure or Service by the Same Physician or Other

Qualified Health Care Professional– 77 Repeat Procedure by Another Physician or Other Qualified

Health Care Professional

130

Physician or Other Qualified Health Care Professional -continued

• The addition of this language affects the following modifiers (continued)– 78 Unplanned Return to the Operating/Procedure Room by the

Same Physician or Other Qualified Health Care Professional Following the Initial Procedure for a Related Procedure During the Postoperative Period

– 79 Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional

– 90 Reference (Outside) Laboratory

131

Questions?

Thank You.

Contact informationNannette Orme, Clinical Technical Editor and Subject Matter ExpertOptumInsight, [email protected]

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