CPT CHANGES 2015: What s New, Revised, and Deleted

Transcription

1 CPT CHANGES 2015: What s New, Revised, and Deleted Cristina Bentin, CCS-P, CPC-H, CMA AHIMA Approved ICD-10-CM Trainer Coding Compliance Management, LLC cristina@ccmpro.com * Current Procedural Terminology (CPT) is copyright 2014 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT is a trademark of the American Medical Association.

2 Learning Objectives: 2015 CMS Final Rule Resources (CMS-1613-FC) AMA CPT Changes (NOT ALL INCLUSIVE) Integumentary Errata Musculoskeletal Urinary, Nervous, Eye Cardiovascular Digestive Radiology CMS ASC Resource Link Type/Ambulatory-Surgical-Centers-ASC-Center.html

3 AMBULATORY SURGERY CENTER ASSOCIATION ASCA Member Resource Page/Links

4 ASCA 2015 Rate Calculator ASCA List of 2015 Device Intensive Procedures

5 AMA CPT 2015 Changes A COMPLETE LISTING OF ALL ADDITIONS, REVISIONS, DELETIONS CAN BE FOUND IN APPENDIX B OF THE AMA S 2015 PROFESSIONAL EDITION CPT MANUAL. AMA ERRATA Integumentary Breast - Excision

6 2015 Musculoskeletal System Spine Codes Added to CMS 2015 List of ASC Approved Procedures Neck spine fuse & removal below C2 $ Neck spine fusion $ Lumbar spine fusion $ Spine fusion extra segment N Neck spine disk surgery $ Low back disk surgery $ Laminotomy single lumbar $ Laminotomy add l level L N Laminectomy, cervical $ Laminectomy, lumbar $ Decompress spinal cord, lumbar $

7 2015 Musculoskeletal System Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance ($22.20)

8 2015 Musculoskeletal System Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting ($37.95) 2015 Musculoskeletal System Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow, or ankle, olecranon bursa); without ultrasound guidance ($23.63)

9 2015 Musculoskeletal System Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow, or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting ($41.17) 2015 Musculoskeletal System Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance ($28.64)

10 2015 Musculoskeletal System Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting ($47.97) CMS Reimbursement CPT 2014 Rate 2015 Rate $16.24 $ NA $ $17.03 $ NA $ $20.96 $ NA $47.97 VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS.

11 2015 Musculoskeletal System Ablation; therapy for reduction or eradication of 1 or more bone tumor(s) tumors (eg,osteoid osteoma, metastasis) radiofrequency including adjacent soft tissue when involved by tumor extension, percutaneous, including computed tomographic guidance (imaging guidance when performed; radiofrequency ($ ) 2015 Musculoskeletal System Ablation; therapy for reduction or eradication of 1 or more bone tumors (eg,metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including (imaging guidance when performed; cryoablation ($ )

12 CMS Reimbursement CPT 2014 Rate 2015 Rate $ $ NA $ VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS Musculoskeletal System DELETION Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic (deleted in 2015) lumbar (deleted in 2015) each additional thoracic or lumbar vertebral body (deleted in 2015)

13 2015 Musculoskeletal System DELETION Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic (deleted in 2015) lumbar (deleted in 2015) each additional thoracic or lumbar vertebral body (deleted in 2015) 2015 Musculoskeletal System Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic ($ ) lumbosacral ($ ) each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure) (N1)

14 2015 Musculoskeletal System Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance, thoracic ($ ) lumbar ($ ) each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) (N1) 2015 Musculoskeletal System Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), single interspace, cervical (Not on CMS list of approved ASC procedures)

15 2015 Musculoskeletal System Instructional parenthetical notes under CPT 22856: (Do not report in conjunction with 22554, 22845, 22851, 63075, 0375T, when performed at the same level) (For additional interspace cervical total disc arthroplasty, see 22858, 0375T) 2015 Musculoskeletal System # second level, cervical (List separately in addition to code for primary procedure) (not on CMS list) (Use in conjunction with 22856) (Do NOT report in conjunction with 0375T, when performed at the same level)

16 2015 Musculoskeletal CAT III Addition CAT III CODE 0375T CATEGORY III DESCRIPTOR Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), cervical, three or more levels (Not on CMS list of approved ASC procedures) (Do not report 0375T in conjunction with 22851, 22856, when performed at the same level) 2015 Musculoskeletal CAT III Deletion CAT III CODE DELETION 0092T CAT III DESCRIPTOR Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), each additional interspace, cervical

17 CMS Reimbursement CPT 2014 Rate 2015 Rate NA $ NA $ NA (N1) NA $ NA $ NA (N1) NA NA NA NA VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS. Musculoskeletal Category III Revisions CAT III CODE 0200T 0201T CATEGORY III DESCRIPTOR Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed ($ ) Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed ($ )

18 2015 Musculoskeletal System Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device ($ ) (For bilateral procedure, report with modifier 50) Musculoskeletal CAT III Deletion CAT III CODE DELETION 0334T CAT III DESCRIPTOR Sacroiliac joint stabilization for arthrodesis, percutaneous or minimally invasive (indirect visualization), includes obtaining and applying autograft or allograft (structural or morselized), when performed, includes image guidance when performed (eg, CT or fluoroscopic)

19 2015 Musculoskeletal System Arthrodesis, open, sacroiliac joint, including obtaining bone graft, including instrumentation, when performed (Not on CMS list of approved ASC procedures) (For percutaneous/minimally invasive arthrodesis of the sacroiliac joint without fracture and/or dislocation, use 27279) CMS Reimbursement CPT 2014 Rate 2015 Rate 0200T $ $ T $ $ NA $ NA NA 0232T N1 VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS.

20 2015 Urinary System Two New Codes (52441, 52442) New or revised parenthetical notes 2015 Urinary System Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant (not on CMS approved ASC list) ; each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure) (not on CMS approved ASC list)

21 2015 Urinary System Instructional parenthetical notes below CPT 52442: (To report removal of implant(s), use 52310) (For insertion of a permanent urethral stent, use For insertion of a temporary prostatic urethral stent, use 53855) CMS Reimbursements CPT 2014 Rate 2015 Rate $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $672.51

22 2015 Nervous System 2015 Nervous System Addition of 4 Myleography injection codes: CPT 62302, 62303, 62304, (N1 payment indicator) Addition of 4 Tap Block codes: CPT 64486, 64487, 64488, (N1 payment indicator) Deletion of 2 nerve transection codes: CPT (vagus nerve, transthoracic) CPT (pudendal nerve) Deletion of 1 anastomosis code: CPT (facial-phrenic)

23 2015 Nervous System Myelography via lumbar injection, including radiological supervision and interpretation; cervical (N1 payment indicator) ; thoracic(n1 payment indicator) ; lumbosacral (N1 payment indicator) ; 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical) (N1 payment indicator) 2015 Nervous System Tap Block Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)(n1 payment indicator) ; by continuous infusion(s) (includes imaging guidance, when performed) (N1 payment indicator)

24 2015 Nervous System Tap Block Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)(n1 payment indicator) ; by continuous infusions (includes imaging guidance, when performed) (N1 payment indicator) 2015 Nervous System DELETION Transection or avulsion of; vagus nerve (vagotomy), transthoracic (deleted in 2015) Transection or avulsion of: pudendal nerve (deleted in 2015 was in 2014) Anastomosis; facial-phrenic (deleted in 2015 was in 2014)

25 Nervous System Reimbursements CPT 2014 Rate 2015 Rate $ $ $ $ $ $ $ $ $ $ $ $ $ $ Nervous System Reimbursements CPT 2014 Rate 2015 Rate $ $ $ $ $ $ $ $ $ $ $ $204.32

26 CMS NCCI EDITS Eye and Ocular Adnexa

27 2015 Eye and Ocular Adnexa DELETION Fistulization of sclera for glaucoma; iridencleisis or iridotasis (deleted in 2015 was in 2014) 2015 Eye and Ocular Adnexa Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft($ ) ; with graft ($ ) (Do not report in conjunction with 67255)

28 2015 Eye and Ocular Adnexa Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft($960.64) ; with graft ($960.64) (Do not report in conjunction with 67255) 2015 Eye and Ocular Adnexa Unlisted procedure, ocular extraocular muscle

29 2015 Misc. Category III Code Revision Eye and Ocular Adnexa CAT III CODE CATEGORY III DESCRIPTOR 0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; initial insertion ($ ) # T.; each additional device insertion (List separately in addition to code for primary procedure) (N1 payment indicator) 2015 Misc. Category III Code Addition Eye and Ocular Adnexa CAT III CODE 0356T CATEGORY III DESCRIPTOR Insertion of drug-eluting implant (including punctal dilation and implant removal when performed) into lacrimal canaliculus, each (not on CMS approved ASC list)

30 2015 Eye/Ocular Adnexa Reimbursements Vitrectomy CPT 2014 Rate 2015 Rate $ $ $ $ $ $ $ $ $ $ $ $ Eye/Ocular Adnexa Reimbursements Cataracts/Retinals CPT 2014 Rate 2015 Rate $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

31 2015 Cardiovascular System 2015 Cardiovascular System Changes in Surgery and Medicine Cardiovascular Sections Implantable Defibrillator Procedures 25 Revised 6 New

32 2015 Cardiovascular System Repositioning of previously implanted transvenous pacemaker or pacing cardioverter implantable defibrillator (right atrial or right ventricular) electrode ($863.86) Insertion of a single transvenous electrode, permanent pacemaker or cardioverter implantable defibrillator ($ ) Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverter implantable defibrillator ($ ) 2015 Cardiovascular System Repair of single transvenous electrode, permanent pacemaker or pacing cardioverter implantable defibrillator ($ ) Repair of 2 transvenous electrodes for permanent pacemaker or pacing cardioverter implantable defibrillator ($ ) Relocation of skin pocket for cardioverter implantable defibrillator ($771.43)

33 2015 Cardiovascular System Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator) ($ ) 2015 Cardiovascular System Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure) (N1)

34 2015 Cardiovascular System Insertion of pacing cardioverter implantable defibrillator pulse generator only; with existing single lead ($20,286.25) (Do not report in conjunction with 33271, 93260, 93261) 2015 Cardiovascular System # Insertion of pacing cardioverter implantable defibrillator pulse generator only; with existing dual leads ($20,286.25) # Insertion of pacing cardioverter implantable defibrillator pulse generator only; with existing multiple leads ($27,203.55) There codes follow the parent code

35 2015 Cardiovascular System Removal of pacing cardioverter implantable defibrillator pulse generator only ($ ) (Do not report in conjunction with 93260, 93261) (Do not report in conjunction with 33230, 33231, for removal and replacement of the implantable defibrillator pulse generator. Use 33262, 33263, 33264, as appropriate, when pulse generator replacement is indicated) 2015 Cardiovascular System # Removal of pacing cardioverter implantable defibrillator pulse generator with replacement of pacing cardioverter implantable defibrillator pulse generator; single lead system ($20,286.25) # ; dual lead system ($20,286.25) # ; multiple lead system ($27,203.55)

36 2015 Cardiovascular System Removal of single or dual chamber pacing cardioverter implantable defibrillator electrode(s); by thoracotomy (not on CMS list) Removal of single or dual chamber pacing cardioverter implantable defibrillator electrode(s); by transvenous extraction (not on CMS list) 2015 Cardiovascular System Insertion or replacement of permanent pacing cardioverter implantable defibrillator system, with transvenous lead(s), single or dual chamber ($27,203.55) (Do not report in conjunction with 33216, 33217) (For removal and replacement of an implantable defibrillator pulse generator and transvenous electrode(s), use in conjunction with either or and 33249) (For insertion of transvenous implantable defibrillator lead(s), without thoracotomy, use or 33217)

37 # Cardiovascular System 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 ($27,203.55) 2015 Cardiovascular System # Insertion of subcutaneous implantable defibrillator electrode ($ ) # Removal of subcutaneous implantable defibrillator electrode (not on CMS list) # Repositioning of previously implanted subcutaneous implantable defibrillator electrode ($ )

38 2015 Cardiovascular Cat III Deletions Category III codes 0319T, 0320T, 0321T, 0322T, 0323T, 0324T, 0325T, 0326T, 0327T, 0328T have been deleted in To report, see CPT 33240, 33241, 33262, 33270, 33271, 33272, 33273, 93260, 93261, CMS Reimbursement CPT 2014 Rate 2015 Rate $ $ $ $ $ $ $ $ $ $ $ $ $9, $ $9, N1 VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS.

39 CMS Reimbursement CPT 2014 Rate 2015 Rate $22, $20, $22, $27, $22, $20, $ $ NA NA NA NA $29, $27, $22, $20, VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS. CMS Reimbursement CPT 2014 Rate 2015 Rate $22, $20, $22, $27, NA $27, NA $ NA NA NA $ VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS.

40 2015 Digestive System Upper GI 2015 Digestive Section Rationale for Upper GI Changes Updated to reflect technology, devices, and techniques used in current practice. Standardized to allow for parallel concepts across the 3 sections.

41 2015 Digestive System Rigid Esophagoscopy Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker s diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed. ($ ) (For diverticulectomy of hypopharynx or esophagus (open), see 43130, 43135) 2015 Digestive System Rigid Esophagoscopy Esophagoscopy, rigid, transoral; with removal of foreign body(s) ($583.67) (Do not report in conjunction with 43191, 43197, 43198) (If fluoroscopic guidance is performed, use 76000) (For flexible transoral esophagoscopy with removal of foreign body(s), use 43215)

42 2015 Digestive System Flexible Esophagoscopy Esophagoscopy, flexible, transnasal; diagnostic, includes including collection of specimen(s) by brushing or washing when performed (separate procedure) ($408.68) (Do not report in conjunction with 31575, 43191, 43192, 43193, 43194, 43195, 43196, 43198, , , 43266, 43270, 92511) 2015 Digestive System Flexible Esophagoscopy Esophagoscopy, flexible, transoral; with removal of foreign body(s) ($583.67) Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery ($ )

43 2015 Digestive System Esophagogastroduodenoscopy (EGD) Esophagogastroduodenoscopy, flexible transoral; with removal of foreign body(s) ($408.68) Esophagogastroduodenoscopy, flexible transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery ($583.67) EGD Reimbursements CPT 2013 Rate 2014 Rate 2015 Rate $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $583.67

44 2015 Digestive System Lower GI 2015 Digestive System Lower Endoscopy 2015 Endoscopy, Small Intestine 2014 Intestines (Except Rectum) 2014 Endoscopy, Small Intestine and Stomal 2015 Endoscopy, Stomal

45 2015 Digestive System Endoscopy Small Intestines Editorial Directive Antegrade transoral small intestinal endoscopy(enteroscopy) is defined by the most distal segment of small intestine that is examined Enteroscopy - esophagus through jejunum, antegrade Enteroscopy - esophagus through the ileum, antegrade approach 2015 Digestive System Endoscopy Small Intestines Editorial Directive If an endoscope cannot be advanced at least 50 cm beyond the pylorus, see 43233, , 43266, (i.e. EGD codes) If an endoscope can be passed at least 50 cm beyond pylorus but only into the jejunum, see 44360, 44361, 44363, 44364, 44365, 44366, 44369, 44370, 44372, *Surgeon MUST document the extent he goes so the coder will know the coding series to review.*

46 2015 Digestive System Endoscopy Editorial Change including collection of specimen(s) by brushing or washing, when performed replaces with or without collection of specimen(s) 2015 Digestive System Endoscopy, Small Intestine Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($467.23) with removal of foreign body(s) ($467.23)

47 ENDOSCOPY, STOMAL ILEOSCOPY AND POUCHOSCOPY 2015 Digestive System Endoscopy, Stomal Ileoscopy and Pouchoscopy Instructional parenthetical notes: Colonoscopy through stoma is the exam of the colon, from the colostomy stoma to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis. Report colonoscopy via stoma ( ) for endoscopic exam of a patient who has undergone segmental resection of the colon (eg, hemicolectomy, sigmoid colectomy, low anterior resection) and has a colostomy) Report ileoscopy via stoma (44380, 44381, 44382, 44384) for endoscopic examination of a patient who has an ileostomy.

48 2015 Digestive System Endoscopy, Stomal Ileoscopy and Pouchoscopy Ileoscopy, through stoma; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($467.23) # with transendoscopic balloon dilation ($467.23) with placement of endoscopic stent (includes pre-and post-dilation and guide wire passage, when performed) ($467.23) 2015 Digestive System Endoscopy, Stomal Ileoscopy and Pouchoscopy Endoscopic evaluation of small intestinal pouch (abdominal eg, Kock pouch, ileal reservoir [S or pelvic J]pouch; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($432.94) with biopsy, single or multiple ($432.94)

49 2015 Digestive System Endoscopy, Stomal Colonoscopy Through Stoma Colonoscopy through stoma; diagnostic, with or without (including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($432.94) with removal of foreign body(s) ($432.94) with control of bleeding, (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) any method ($432.94) with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery ($432.94) 2015 Digestive System Endoscopy, Stomal Colonoscopy Through Stoma Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) ($432.94) ; with endoscopic stent placement (including pre- and post-dilation and guide wire passage, when performed) ($432.94) ; with endoscopic mucosal resection ($432.94)

50 2015 Digestive System Endoscopy, Stomal Colonoscopy Through Stoma ; with directed submucosal injection(s), any substance ($432.94) ; with transendoscopic balloon dilation ($432.94) ; with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures ($432.94) 2015 Digestive System Endoscopy, Stomal Colonoscopy Through Stoma ; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures ($432.94) ; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ($432.94) (Do not report more than once per session)

51 2015 Digestive System Other Procedures Unlisted procedure, small intestine (For unlisted laparoscopic procedure, intestine except rectum, use 44238) (For unlisted procedure, colon, use 45399) DELETION 2015 Digestive System Colonoscopy Through Stoma ;with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (deleted in 2015) Use in ;with transendoscopic stent placement (includes predilation) (deleted in 2015) Use in 2015

52 2015 Digestive System Colon and Rectum - Endoscopy Instructional parenthetical notes: Colonoscopy via stoma ( ) Proctosigmoidoscopy ( ) Flexible sigmoidoscopy ( ) Anoscopy (46600, 46604, 46606, 46608, 46610, 46611, 46612, 46614, 46615) Ileoscopy via stoma (44380, 44381, 44382, 44384) * When bleeding occurs as a result of an endoscopic procedure, control of bleeding is not reported separately during the same operative session Digestive System Colon and Rectum - Endoscopy Instructional parenthetical notes: Report pouch endoscopy codes 44285, for endoscopic examination of a patient who has undergone resection of colon with ileo-anal anastomosis (eg, J- pouch). Report flexible sigmoidoscopy ( ) for endoscopic examination during which the endoscope is not advanced beyond the splenic flexure (keep reading all parentheticals and editorial directives).. * NOTE: Do your carriers and MAC agree? Verify with MAC LCDs, Transmittals, and Carrier directives.*

53 AMA Errata Revise the colonoscopy decision tree illustrated on page 284 of the 2015 CPT Prof book to indicate that when performing a therapeutic procedure to the cecum, report colonoscopy codes with No Modifier. DO YOUR SPECIFIC CARRIERS AND/OR MAC AGREE? SOME CARRIER AND MAC DIRECTIVES STATE WHEN SCHEDULED AS COLONOSCOPY CODE AS COLONOSCOPY WITH APPLICATION OF APPROPRIATE MODIFIER. VERIFY! VERIFY! Does NOT Reach Splenic Flexure Flexible Sigmoidoscopy (45330) AMA CPT Decision Tree 2015 Decision to Undergo Colonoscopy Diagnostic Beyond Splenic Flexure But Not to Cecum Colonoscopy (45378; Modifier 53) To Cecum Colonoscopy (45378; No Modifier AMA STATES DIAGNOSTIC OR SCREENING IN CPT MANUAL. DO YOUR SPECIFIC CARRIERS AND/OR MAC AGREE? VERIFY DEFINITIONS, TERMS, REPORTING WITH CARRIER DIRECTIVES. DON T GET CONFUSED WITH DIAGNOSTIC, SCREENING, THERAPEUTIC TERMS IN CPT WITH INDIVIDUAL CARRIER DIAGNOSIS CODE SELECTION, SEQUENCING DETERMINATION. This chart reflects AMA CPT decision tree 2015 AMA CPT Professional Edition pg 284. It is not the interpretation of all carriers/macs. Facilities must verify carrier directives and local coverage determinations (LCDs) prior to CPT code selection and reporting. Commercial carrier directives will often differ from individual MAC/CMS LCD policies.

54 DO YOUR SPECIFIC CARRIERS AND/OR MAC AGREE? SOME CARRIER AND MAC DIRECTIVES STATE WHEN SCHEDULED AS COLONOSCOPY CODE AS COLONOSCOPY WITH APPLICATION OF APPROPRIATE MODIFIER. VERIFY! AMA CPT Decision Tree 2015 Decision to Undergo Colonoscopy Therapeutic 2015 AMA ERRATA NO MODIFIER- FACILITIES NEED TO MAKE CHANGE IN BOOK! Does NOT Reach Splenic Flexure Beyond Splenic Flexure But Not to Cecum To Cecum Flexible Sigmoidoscopy ( )) Colonoscopy ( Modifier 52) Colonoscopy ( _ No Modifier This chart reflects AMA CPT decision tree 2015 AMA CPT Professional Edition pg 284. It is not the interpretation of all carriers/macs. Facilities must verify carrier directives and local coverage determinations (LCDs) prior to CPT code selection and reporting. Commercial carrier directives will often differ from individual MAC/CMS LCD policies Digestive System Colon and Rectum Endoscopy Sigmoidoscopy Sigmoidoscopy, flexible; diagnostic, with or without (including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($99.89) with removal of foreign body(s) ($453.53) with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery ($270.60) with control of bleeding, (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) any method ($453.53)

55 2015 Digestive System Colon and Rectum Endoscopy Sigmoidoscopy Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of volvulus decompression tube, any method when performed ($453.53) with dilation by transendoscopic balloon, 1 or more strictures, dilation ($453.53) (For transendoscopic balloon dilation of multiple strictures during the same session, use with modifier 59 for each additional stricture dilated) DELETION 2015 Digestive System Colon and Rectum Endoscopy Sigmoidoscopy ;with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (deleted in 2015) Use in ;with transendoscopic stent placement (includes predilation) (deleted in 2015) Use in 2015

56 2015 Digestive System Colon and Rectum Endoscopy Sigmoidoscopy # Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) ($453.53) ; with placement of endoscopic stent (including pre- and post-dilation and guide wire passage, when performed) ($453.53) ; with endoscopic mucosal resection ($453.53) 2015 Digestive System Colon and Rectum Endoscopy Sigmoidoscopy ; with band ligation(s) (eg, hemorrhoids) ($453.53) (Do not report more than once per session) (To report control of active bleeding with band ligation(s), use 45334)

57 2015 Digestive System Colon and Rectum Endoscopy Colonoscopy DELETION Colonoscopy, rigid or flexible, transabdominal via colotomy, single or multiple (deleted in 2015) Use in Digestive System Colon and Rectum Endoscopy Colonoscopy Colonoscopy, flexible proximal to splenic flexure; diagnostic, with or without (including collection of specimen(s) by brushing or washing, with or without colon decompression when performed (separate procedure) ($432.94) with removal of foreign body(s) ($432.94) with biopsy, single or multiple ($432.94) with directed submucosal injection(s), any substance ($432.94)

58 2015 Digestive System Colon and Rectum Endoscopy Colonoscopy ; with control of bleeding, (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) any method ($432.94) with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery ($432.94) with removal of tumor(s), polyp(s), or other lesion(s) by snare technique ($432.94) with dilation by transendoscopic balloon, 1 or more strictures dilation ($432.94) DELETION 2015 Digestive System Colon and Rectum Endoscopy Colonoscopy ;with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (deleted in 2015) Use in ;with transendoscopic stent placement (includes predilation) (deleted in 2015) Use in 2015

59 2015 Digestive System Colon and Rectum Endoscopy Colonoscopy # Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) ($432.94) ; with endoscopic stent placement (including pre- and post-dilation and guide wire passage, when performed) ($432.94) # ; with endoscopic mucosal resection ($432.94) 2015 Digestive System Colon and Rectum Endoscopy Colonoscopy ; with endoscopic ultrasound examination, limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures ($432.94) ; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures ($432.94)

60 2015 Digestive System Colon and Rectum Endoscopy Colonoscopy ; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ($432.94) # ; with band ligation(s) (eg, hemorrhoids) ($432.94) # Unlisted procedure, colon (not on CMS approved ASC list) Colonoscopy Reimbursements CPT 2014 Rate 2015 Rate $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $432.94

61 CMS G Codes for 2015 Final Rule (CMS-1612-FC) CMS delayed publishing updated wrvu for the lower endoscopy codes (ileoscopy, pouchoscopy, flex sigmoidoscopy, colonoscopy through stoma, colonoscopy) surveyed for this cycle. For 2015, CMS established G codes to mirror those 2014 CPT codes that were deleted in For 2015, CMS maintained the wrvu of these 2014 code values, pending a decision on how to address removing moderate sedation from the endoscopy codes Result: Stay tuned rrrrrrrr CMS G Codes for 2015 Physician Reporting-Medicare Patients DELETED 2014 CPT NEW OR REVISED 2015 CPT NEW 2015 HCPCS G G G G G G G G T G T G6027

62 CMS G Codes 2015 Facility Reporting Medicare Patients ASC facilities report 2015 CPT codes: No. Regardless of whether the code is new or has not changed No. Regardless of payor ASC Facilities do not report G codes G6018- G6027. Not valued Misc. Category III Code Addition Digestive CAT III CODE 0355T CATEGORY III DESCRIPTOR Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report (not on CMS approved ASC list)

63 2015 Digestive System Anus Endoscopy Anoscopy DESCRIPTOR Anoscopy; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure) (N1) ; diagnostic, with high-resolution magnification (HRA) (eg, colposcope, operating microscope) and chemical agent enhancement, including collection of specimen(s) by brushing or washing, when performed (N1) 2015 Digestive System Anus Endoscopy Anoscopy DESCRIPTOR ; with high-resolution magnification (HRA) (eg, colposcope, operating microscope) and chemical agent enhancement, with biopsy, single or multiple ($453.53)

64 2015 Digestive System Anus Endoscopy CAT III Deletions CAT III CODE DELETION 0226T 0227T Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed (originally in 2014 but deleted in 2015) Use in 2015 (N1).;with biopsy(ies) Use in 2015 ($453.53) 2015 Misc. Category III Code Addition Anoscopy CAT III CODE 0377T CATEGORY III DESCRIPTOR Anoscopy with directed submucosal injection of bulking agent for fecal incontinence ($ ) (Do not report 0377T in conjunction with 46600)

65 2015 Digestive System Liver Other Procedures Ablation DESCRIPTOR Ablation, 1 or more liver tumor(s), percutaneous, cryoablation ($ ) (For imaging guidance and monitoring, see 76940, 77013, 77022) report per carrier Radiology Key Points (Information below does not encompass all changes) 15 additions; 23 deletions; 4 revisions in 2015 Addition of 2 Breast ultrasound codes: CPT (CMS N1 payment indicator) Addition of 2 Teletherapy isodose codes: CPT (approx CMS reimbursement) Addition of 3 Brachytherapy isodose codes: CPT (approx CMS reimbursement) Addition of 2 modulated radiation treatment delivery codes: CPT (simple) (complex) (approx CMS reimbursement)

66 Continued 2015 Radiology Key Points (Information below does not encompass all changes) Revision - 4 radiation treatment delivery codes: CPT (approx CMS reimbursement) Deletion - 2 Radiological S & I percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty) codes: CPT are deleted in To report, see 22510, 22511, 22512, 22513, 22514, 22515, 0200T, 0201T) 2015 Misc. Category III Code Addition Respiratory CAT III CODE 0340T CATEGORY III DESCRIPTOR Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance ($ )

67 AMERICAN MEDICAL ASSOCIATION

68 ASCA Online Continuing Education Go to Enter the five digit code given at the end of the webinar Complete the evaluation of the webinar Print the continuing education certificate QUESTIONS? Please Contact: Cristina Bentin CCS-P, CPC-H, CMA AHIMA Approved ICD-10-CM Trainer Coding Compliance Management, LLC *