Current Procedural Coding Expert
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1 Current Procedural Coding Expert 2015
2 Contents Professional OPPS
3 Current Procedural Coding Expert ENDOCRINE SYSTEM Anatomical Illustrations Hyoid bone Parathyroid s (behind thyroid) Glands Isthmus Pyramid lobe Pineal Hypothalamus Pituitary Glands The pituitary and its controller, the hypothalamus, control body growth and stimulate and regulate other s Anterior and posterior pituitary s (hypophysis) Anatomical Illustrations Thyrohyoid membrane Thyrohyoid Cricoid Larynx Thyroglossal duct Trachea Epiglottis Proximal esophagus Hyoid bone Sternum Inferior pharyngeal muscle Placenta Epiglottis Hyoid bone Cricoid Epiglottis Constrictor muscle of pharynx Superior and inferior s Esophagus Superior view Posterior view Pyramid lobe Isthmus Horn of hyoid Right lobe of thyroid Parathyroid s Urethra Pubic symphysis Placenta Bladder Fetus Uterus Vagina Rectum Amniotic sac The placenta is considered part of the endocrine system, secreting chorionic gonadotropin, estrogen, progesterone, and somatomammotropin
4 Current Procedural Coding Expert Musculoskeletal System [28039, 28041] Excision Soft Tissue Tumors Foot/Toe 1 Any necessary elevation of tissue planes or dissection Measurement of tumor and necessary margin at greatest diameter prior to excision Resection without removal of significant normal tissue Simple and intermediate repairs Types of Excision: Fascial or subfascial soft tissue tumors: simple and marginal resection of most often benign and intramuscular tumors found either in or below the deep fascia, not involving bone Radical resection soft tissue tumor: wide resection of tumor, mostly malignant or aggressive benign, involving large margins of normal tissue and may involve tissue removal from one or more layers Subcutaneous: simple and marginal resection of most often benign tumors found in the subcutaneous tissue above the deep fascia 2 Complex repair Radical resection of cutaneous tumors (e.g., melanoma) ( ) Significant exploration of vessels, neuroplasty, or reconstruction Resequenced code, See code following # # Resequenced code, See code following Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm stc Global Days cm or greater stdc Global Days 090 Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); less than 1.5 cm stec Global Days cm or greater utec Global Days 090 Radical resection of tumor (eg, malignant neoplasm), soft tissue of foot or toe; less than 3 cm utc Global Days cm or greater itdc Global Days 090 Musculoskeletal System Resection Procedures Foot/Toes Arthrotomy with biopsy; intertarsal or tarsometatarsal joint Global Days 090 metatarsophalangeal joint Global Days 090 interphalangeal joint Global Days 090 Neurectomy, intrinsic musculature of foot Global Days 090 Fasciectomy, plantar fascia; partial (separate procedure) 2 Plantar fasciotomy (28008, 28250) Global Days 090 AMA: 2009, Jan, 11-31; 2008, Mar, gtc8 gtc8 gtec8 gte gtc8 l New Code s Revised Code x Maternity y Age Unlisted Not Covered # Resequenced m Reinstated 8 CCI + Add-on * Mod 51 Exempt L Mod 63 Exempt K Mod Sedation t PQRS 2014 Optum Opm (Blue Ink) CPT 2013 American Medical Association. All Rights Reserved. (Black Ink) Optum Medicare (Red Ink) 191
5 Appendix C Crosswalk of Deleted Codes Current Procedural Coding Expert Appendix C Crosswalk of Deleted Codes APPENDIX C CROSSWALK OF DELETED CODES The deleted code crosswalk is meant to be used as a reference tool to find active codes that could be used in place of the deleted code. This will not always be an exact match. Please review the code descriptions and guidelines before selecting a code. The AMA has revised the cardiac catheterization codes and guidelines for Because of the many changes made to the guidelines and the new codes added to this section, there is not a code crosswalk for the cardiac catheterization codes. Code Cross reference To report, see ~ , To report, see ~ , To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~0234T-0235T To report, see ~0236T To report, see ~0238T To report, see ~37225, To report, see ~0237T To report, see ~37229, 37231, 37233, To report, see ~0234T-0235T To report, see ~0236T To report, see ~0238T To report, see ~37225, To report, see ~0237T To report, see ~37229, 37231, 37233, To report, see ~ , 43335, To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ , To report, see ~ , , To report, see ~ To report, see ~ To report, see ~0238T, 37225, 37227, 37229, To report, see ~0238T, 37233, To report, see ~0234T Code Cross reference To report, see ~0235T To report, see ~0235T To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ To report, see ~ T To report, see ~ T To report, see ~ T To report, see ~ T To report, see ~ T To report, see ~ T To report, see ~ T To report, see ~ T To report, see ~ T To report, see ~ T To report, see ~ T To report, see ~ T To report, see ~ T To report, see ~95801
6 Current Procedural Coding Expert APPENDIX M INPATIENT ONLY PROCEDURES Inpatient Only Procedures This appendix identifies services with the status indicator C. Medicare will not pay an OPPS hospital or ASC when they are performed on a Medicare patient as an outpatient. Physicians should refer to this list when scheduling Medicare patients for surgical procedures. CMS updates this list quarterly Anesth pharyngeal surgery Anesth facial bone surgery Anesth cran surg hemotoma Anesth skull drainage Anesth skull repair/fract Anesth surgery of shoulder Anesth surgery of rib Anesth chest drainage Anesth chest surgery Anesth remvl pleura Anesth lung chest wall surg Anesth heart surg w/o pump Anesth heart surg < 1 yr Anesth hrt surg w/pmp age Anesth cabg w/pump Anesth heart/lung transplnt Anesth sitting procedure Anesth removal of nerves Anesth removal of nerves Anesth spine cord surgery Anesth hemorr/excise liver Anesth pancreas removal Anesth for liver transplant Anesth fat layer removal Anesth pelvis surgery Anesth hysterectomy Anesth pelvic organ surg Anesth removal of bladder Anesth removal of prostate Anesth removal of adrenal Anesth kidney transplant Anesth major vein ligation Anesth perineal surgery Anesth removal of prostate Anesth amputation of penis Anesth penis nodes removal Anesth penis nodes removal Anesth vaginal hysterectomy Anesth amputation at pelvis Anesth pelvic tumor surgery Anesth hip disarticulation Anesth hip arthroplasty Anesth amputation of femur Anesth radical femur surg Anesth femoral artery surg Appendix M Inpatient Only Procedures Anesth femoral embolectomy Anesth knee arthroplasty Anesth amputation at knee Anesth knee artery surg Anesth knee artery repair Anesth ankle replacement Anesth lwr leg embolectomy Anesth shoulder joint amput Anesth forequarter amput Anesth shoulder replacement Anesth shoulder vessel surg Anesth shoulder vessel surg Anesth arm-leg vessel surg Anesth radical humerus surg Support for organ donor Debride genitalia & perineum Debride abdom wall Debride genit/per/abdom wall Remove mesh from abd wall Free myo/skin flap microvasc Free skin flap microvasc Free fascial flap microvasc Escharotomy addl incision Revision of chest wall Extensive chest wall surgery Mast radical Mast rad urban type Breast reconstr w/lat flap Breast reconstruction Breast reconstruction Breast reconstruction Breast reconstruction Application of head brace Application of halo Replantation arm complete Replant forearm complete Replantation hand complete Replantation digit complete Replantation thumb complete Replantation thumb complete Replantation foot complete Sp bone agrft local add-on Sp bone agrft morsel add-on Sp bone agrft struct add-on Fibula bone graft microvasc Iliac bone graft microvasc Mt bone graft microvasc Other bone graft microvasc Bone/skin graft microvasc Bone/skin graft iliac crest Extensive jaw surgery Reconstruct midface lefort Reconstruct midface lefort Reconstruct midface lefort Appendix M Inpatient Only Procedures
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Contents Optum CPT only 2011 American Medical Association. All Rights Reserved. Contents
Contents Introduction....................................... i Anatomical Illustrations..............................v Interventional Radiology Illustrations................ xxviii Index.......................................
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