2015 CPT Changes Tamara Carey, CPC, CPMA. Evaluation and Management Numerous changes were made; –Addition of “military history” to the social history.

2015 CPT Changes

Tamara Carey, CPC, CPMA

Evaluation and Management• Numerous changes were made;

– Addition of “military history” to the social history element (pg. 7)

– Revision of inpatient neonatal and pediatric critical care guidelines (pg. 42)

– Deletion of intensive care codes 99481, 99482; addition of 99184 which combines the services (guideline pg. 43)

– Section title change; “Complex Chronic Care Coordination => “Care Management Services”

– New subsection; “Chronic Care Management”, “Complex Chronic Care Management”. (pg. 45)

Evaluation and Management

• Maternity Care and Delivery Guidelines (pg. 342)– Pregnancy confirmation during a problem-oriented or

preventive visit is not considered a part of antepartum care.

– Report using the appropriate E/M code for that visit.– Antepartum care includes the initial prenatal history

and physical examination.

Evaluation and Management• 2014 Complex Chronic Care Coordination

Services– 99487 – no face-to-face visit, first hour– 99488 – one face-to-face visit, first hour– 99489 – each additional 30 minutes

• 2015– New section heading (Care Management Services,

pg. 45)– Two new subsections– Deletion of code 99488– Addition of code 99490

Evaluation and Management• Care Management Services

– Chronic Care Management Services• 99490 (pg. 46)• At least 20 minutes of clinical staff time is spent, directed by

a physician or QHP, per calendar month

– Complex Chronic Care Management Services• 99487, at least 60 minutes• 99489, each additional 30 minutes (pg. 47)

Evaluation and Management• CCM – Incident-to

– CMS/Medicare will allow incident to billing for CCM with “general supervision” for services provided by clinical staff

– All other incident-to regulations apply

Evaluation and Management• Advance Care Planning (pg. 49)• New section in E/M

– Guidelines– Two new codes; 99497 and 99498

• No active management of problem(s) is undertaken during the time period reported.

• An E/M may be reported separately on the same day except for;– Critical care, inpatient neonatal and pediatric critical

care, initial and continuing intensive care services.

Surgical Package Definition

• Page 62• Revised to address the inclusive E/M• Clarification as to who can perform these

services

Musculoskeletal

• Pg. 101• 3 new codes for Arthrocentesis, aspiration

and/or injection – small, intermediate, major joint or bursa with ultrasound– 20604, 20606, 20611

• Existing codes were revised – without ultrasound– 20600, 20605, 20610

Musculoskeletal

• Pg. 105• One revised and one new code for bone tumor

ablation via radiofrequency or cryoablation– 20982 (RF)– 20983 (cryo)

• Pg. 110– 3 new codes for open treatment of rib fracture(s)

• 21811, 21812, 21813• Number of ribs

Musculoskeletal• Pg. 114 – Percutaneous Vertebroplasty and

Vertebral Augmentation– Coded 22520, 22521, 22522, 22523, 22524, 22525 were

deleted– New codes 22510, 22511, 22512, 22513, 22514, 22515

• New codes includes moderate sedation.• Old codes addressed Kyphoplasty/Vertebroplasty

of the thoracic or lumbar areas– Procedures in the cervical area were reported with an

unlisted code.

Musculoskeletal

• Pg. 120• Total Disc Arthroplasty/Additional level

– Revised code 22856 (parent code), single interspace cervical

– New code 22858, second level, cervical• three or more levels code 0375T, only (pg. 677)

• Pg. 142• Arthrodesis – sacroiliac joint

– New code 27279– Revised code 27280

Cardiovascular

• Pg. 185, Pacemaker or Implantable Defibrillator section.– Many Cat III codes => Cat I codes– Guidelines distinguish between implantable defibrillators

w/transvenous leads from those w/subcutaneous leads

• Two categories of Implantable Defibrillators– Transvenous implantable pacing cardioverter-defibrillators

(ICD)• Leads are intra-cardiac placed via veins• Has pacemaker capabilities• Uses a combination of anti-tachycardia pacing, low-energy

cardioversion, or defibrillating shocks to treat ventricular tachycardia or ventricular fibrillation

Cardiovascular

• Subcutaneous Implantable defibrillator (S-ICD)– One lead – located subcutaneously– Lacks pacemaker capabilities– Only provides defibrillating shocks – cannot provide

anti-tachycardia pacing– New codes 33270 – 33273 (pg. 191)

• Transvenous revised codes 33215 – 33220, 33233 - 33225, 33240, 33230, 33231, 33241, 33262 (pg. 188)

Cardiovascular• “Battery Change” (pg. 186)

– Do not report 33233 or 33241 – Report based on the number of final existing leads

• Revision of Skin Pocket– Included in 33206 – 33249, 33262, 33263, 33264,

33270, 33271, 33272, 33273

• Relocation of Skin Pocket– Includes all work associated w/the initial pocket

(opening, I&D, and closure

• Defibrillator Threshold Testing (DFT)– Separately reported w/transvenous system, but not

subcutaneous

Cardiovascular

• Pg. 195 – Transcatheter Mitral Valve Repair• Converted Cat III codes => Cat I

– 33418 and 33419• Guidelines specify that 33419 is only reported once per

session

– Include the work, when performed, of percutaneous access, placing the access sheath, transseptal puncture, advancing the repair device delivery system into position, repositioning the device as needed, and deploying the device.

– Angiography, radiological S&I, and interpretation performed to guide TMVR are included.

Cardiovascular• Pg. 205 – Extracorporeal Membrane

Oxygenation (ECMO) or Extracorporeal Life Support Services (ECLS)– Deleted codes 33960 and 33961, identified by CMS

as potentially misvalued codes– Patient population has changed from premature

neonates to adults with severe influenza, pneumonia and respiratory distress syndrome

– Specialty societies submitted a code change proposal– CPT Editorial Panel created an entirely new family of

codes

Cardiovascular

• ECMO/ECLS Definition– This is a procedure that provides cardiac and/or

respiratory support to the heart and/or lungs– Two methods can be used;

• Veno-arterial, will support both the heart and lungs. Requires that two cannula(e) are placed – one in a large vein and one in a large artery

• Veno-venous, is used for lung support only and requires one or two cannula(e), which are placed in a vein

– CPT code series 33946 – 33989 (some resequenced codes)

Cardiovascular• ECMO Code Grouping

– Initiation– Daily Management– Cannulation (further defined by age and method)

• Insertion• Repositioning• Removal

Cardiovascular

• Pg. 212• Fenestrated Endovascular Repair (FEVAR)• New code created to report the physician

planning for a patient-specific manufactured fenestrated visceral aortic endograft

• CPT code 34839– Requires a minimum of 90 minutes of physician time– Code guidelines specify what is included in this code;

• Review of high resolution cross-sectional images (eg, CT, CTA, MRI, and the utilization of 3D software for iterative modeling of the aorta and device in multi-planar views and center line of flow analysis

Digestive

• Variety of changes throughout this chapter– Addition of “separate procedure” designation– Editorial change – “with or without collection of

specimen” => “including collection of specimen(s) when performed”

– Control of bleeding instruction– Endoscopy, ablation or stent – includes pre/post

dilation, and guide wire passage, if performed– Definition of Colonoscopy, revised

• “…examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum or small intestine proximal to an anastomsis”

Digestive

• Pg. 278 – Endoscopy, Small Intestine– Antegrade transoral small intestinal endoscopy

(enteroscopy) is defined by the most distal segment of small intestine that is examined

• Guidelines showing code assignment based on visualizing the esophagus through the jejunum or ileum

• Guidelines showing code assignment based on how far down the endoscope can be passed

• Retrograde exam of the small intestine via anus or colon stoma, use 44799

Digestive

• Colonoscopy and modifiers 52 and 53 (pg. 279)– “When performing a screening or diagnostic

endoscopy on a patient who is scheduled or prepared for a total colonoscopy, if the physician is unable to advance the colonoscope to the cecum or colon-small intestine anastomosis due to unforeseen circumstances, report 45378 with modifier 53…”

– “For therapeutic examinations that do not reach the cecum, report the appropriate therapeutic colonoscopy code with modifier 52…”

Digestive

• CPT has provided a colonoscopy decision tree to assist coders in selecting the appropriate code. (pg. 284)– Typo in bottom row, far right box.

• “Colonoscopy (45379-45398 No Modifier”)

• CMS delayed publishing wRVUs for the lower endoscopy codes– Ileoscopy, pouchoscopy, flexible sigmoidoscopy,

colonoscopy, colonoscopy through stoma

• Identification of some of the codes as potentially misvalued

Digestive

• How to report lower GI codes in 2015, if the patient has Medicare (Original, Advantage);– If the code has not changed from 2014 to 2015

• Physicians report the CPT code

– If the code has changed from 2014 to 2015• Physicians report the G code

– If the code is new for 2015• Physicians report the CPT code

Digestive

• How to report lower GI codes in 2015, if the patient has Commercial Medicaid, Exchange, etc.– Physicians should report the 2015 CPT code, unless

instructed otherwise by the payor– Facilities report the 2015 CPT code regardless if the

code as changed, and regardless of payer• G codes are not valued in the OPPS fee schedule

Digestive2014 CPT Code

2015 G Code

Descriptor

44383 G6018 Ileoscopy, thru stoma; with transendoscopic stent placement (includes predilation)

44393 G6019 Colonoscopy thru stoma; w/ablation of tumor(s)…..not amenable to removal by hot biopsy forceps, bipolar cautery or snare

44397 G6020 Colonoscopy thru stoma; w/transendoscopic stent placement (includes predilation)

44799 G6021 Unlisted procedure, intestine

45339 G6022 Sigmoidoscopy, flexible; w/ablation of tumor(s)...not amenable to removal by hot biopsy forceps, bipolar cautery or snare

45345 G6023 Sigmoidoscopy, flexible; w/transendoscopic stent placement

45383 G6024 Colonoscopy, flexible, proximal to splenic flexure; w/ablation of tumor(s)…not amenable to removal by hot biopsy forceps, bipolar cautery or snare

45387 G6025 Colonoscopy, flexible, proximal to splenic flexure; w/transendoscopic stent placement (includes predilation)

Digestive

• Cologard test– CMS established HCPCS code G0464 for the

Cologard test• Colorectal cancer screening; stool-based DNA and fecal

occult hemoglobin (e.g., KRAS, NDRG4 and BMP3)

Nervous

• Pg. 363• Myelography – 4 new codes

– 62302 - cervical– 62303 - thoracic– 62304 - lumbosacral– 62305 – 2 or more regions

• Complete procedure codes

Radiology

• Pg. 428• Chest

– New introductory guidelines– Two new codes

• 76641, 76642

– 76641 represents a complete ultrasound exam of all four quadrants of the breast and the retroareolar region

• Includes US of the axilla if performed

– 76642 represents a focused US exam of the breast limited to the assessment of one or more, but not all

• US exam of axilla included if performed

Radiology

• Pg. 434• Digital Breast Tomosynthesis

– 77061 (unilateral), 77062 (bilateral), and +77063 (screening bilateral)

• CMS is delaying valuing 77061, 77062– CMS will recognize +77063 to be reported when

tomosynthesis is used in addition to 2-D mammogram– CMS created G2079, Diagnostic digital breast

tomosynthesis, unilateral or bilateral (List separately in addition to G0204 or G0206)

Path & Lab• Changes for 2015

– Drug Testing (pg. 467)• Major revision of entire area• Pg. 471, Presumptive Drug Class (80300 – 80304)

– Drug Class List A

– Drug Class List B

• Pg. 472, Definitive Drug Class– Table provided starting on page 474

– Select based on the type of drug, and for some, the number of drug

– Example, 80330 Analgesics, non-opioid; 3-5

Medicine

• Pg. 552– Revision to the immunization injection instructions

• Modifier 51 is not required when reporting 90476 – 90479 and 90460 – 90474

• Pg. 553– Two new codes 90651 and 90630

• 90651 has been established for a vaccine that protects against nine (nonavalent) types of HPV (6, 11, 16, 18, 31, 33, 45, 52, 58)

• 90630 was established for a quadrivalent intradermal influenza virus vaccine anticipated to receive FDA approval by the end of 2014, and available for use in the 2015/2016 flu season

Medicine

• Pg. 620– Code 96110 was revised to better distinguish it from

the new brief emotional/behavioral assessment code 96127

• 96110 describes an assessment that is focused on identification of childhood and adolescent developmental levels (eg, fine and gross motor skills, cognitive level, receptive/expressive and pragmatic language abilities, etc.)

• 96127 has been established to report the service associated with the administration of a standardized behavioral and emotional assessment instrument (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale) primarily for, but not limited to children and adolescents.

Medicine

• Pg. 637– Instruction regarding the use of selective head or total

body hypothermia code 99184.– Includes all of the service components required of this

procedure, the review of;• Imaging• Laboratory data• Confirmation of esophageal temperature probe location• Evaluation of amplitude EEG• Supervision of controlled hypothermia, and • Assessment of patient tolerance of cooling

Medicine

• Pg. 637– Code 99188 was established to report the application

of topical fluoride varnish by a physician or QHP for the prevention of dental caries

– This code is intended for use only by a physician or QHP, and only for patients that are at high risk for caries

– When performed by clinical staff, i.e. RN, LPN, etc. this service cannot be reported

– CMS will not cover this service for 2015

THANK YOU FOR YOUR TIME!

Questions????