Complete Procedure Coding Updates

Transcription

1 Complete 2013 Procedure Coding Updates 2012 AAPC 2480 South 3850 West, Suite B Salt Lake City, Utah CODE (2633), Fax

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3 Complete 2013 Procedure Coding Updates

4 Introduction Disclaimer This course was current when it was published. Every reasonable effort has been made to assure the accuracy of the information within these pages. Readers are responsible to ensure they are using the codes, and following applicable guidelines, correctly. AAPC employees, agents, and staff make no representation, warranty, or guarantee that this compilation of information is error-free, and will bear no responsibility or liability for the results or consequences of the use of this course. This guide is a general summary that explains guidelines and principles in profitable, efficient health care organizations. US Government Rights This product includes CPT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/ or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS (b)(2) (November 1995), as applicable, for U.S. Depart ment of Defense procurements and the limited rights restrictions of FAR (June 1987) and/or subject to the restricted rights provision of FAR (June 1987) and FAR (June 1987), as applicable, and any applicable agency FAR Supplements, for non-department of Defense Federal procurements. AMA Disclaimer CPT copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommendation their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not con tained herein. CPT is a registered trademark of the American Medical Association. Anatomical Illustrations are provided by OptumInsight and are copyright 2012, OptumInsight, Inc. Written by Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC and G.J. Verhovshek, MA, CPC 2012 AAPC 2480 South 3850 West, Suite B, Salt Lake City, Utah CODE (2633), Fax , ISBN All rights reserved. ii = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

5 Introduction Introduction As technology and clinical knowledge evolve, so does the practice of medicine. Health care also operates within a complex, ever-changing regulatory environment. To keep pace, the code sets we use to report medical services, procedures, devices, and drugs must be updated regularly. Each October, the American Medical Association releases a revised CPT code set for implementation the following January 1. At AAPC, our goal is to provide you with vital information to make the implementation process easier. This workbook summarizes significant CPT 2013 code changes available at press time. Additional changes released subsequently, as addenda or errata, will be posted on the AAPC website ( CPT 2013 contains revised section guidelines, parenthetical references, and appendices. This guide summarizes primarily revisions to the codes and code descriptors. Minor changes in grammar or spelling that do not affect code use may be omitted. This guide does not review in full all revisions within CPT, and is not meant as a replacement for the complete 2013 CPT codebook. Always use the most current version of CPT, and carefully follow all CPT section guidelines, parenthetical references, and other instruction when assigning codes. Checklist for Updating Your Codes Begin reviewing 2013 CPT code changes, using this guide Order 2013 code books Review all changes to guidelines, notes, and instructions in your book Highlight changes in the book s index pertinent to your specialty, and review those changes Highlight changes in the book s tabular (numeric) section pertinent to your specialty, and review those changes Create a documentation cheat sheet of 2013 updates that must be documented differently for coders to capture the information needed and distribute it to clinicians Review and update superbills, chargemasters, etc. Run utilization report of the deleted and revised codes using your practice management systems. Upload software change Train coding and billing staff on changes Check regularly for addenda or errata to the 2013 code set; if addenda are issued, communicate the contents to coding and clinical staff Review physician quality reporting system (PQRS) changes, if you are participating in PQRS, and educate providers/make adjustments in processes to accommodate the new reporting measures Communicate with payer/provider reps regarding reimbursement and coverage issues Archive last year s books within three months of the new code implementation dates CPT for 2013 Revisions Section Guidelines New section guidelines occur throughout CPT New guidelines in the codebook are printed in green ink to allow easy identification. Modifiers CPT 2013 contains no new modifiers; however, complete descriptors for 16 modifiers in Appendix B have undergone revisions to include other qualified health care professional language, to specify that these modifiers may be appended to non-physician services. All genetic testing code modifiers, previously listed in CPT Appendix I, have been deleted. Genetic testing codes , to which the modifiers were applied, have been deleted and replaced by new molecular pathology codes Evaluation and Management Services CPT 2013 revises 82 evaluation and management codes within the range to specify that these E/M services may be provided by a physician or other qualified health care professional. Language suggesting that only a physician may legitimately report such services has been removed from the code descriptors. For example, the revised descriptor for a level I, new patient visit in the outpatient setting (99201) now specifies: = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 1

6 Complete 2013 Procedure Coding Updates Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other providers qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient s and/or family s needs. Usually, the presenting problem(s) are self-limited or minor. Physicians typically spend Typically, 10 minutes are spent faceto- face with the patient and/or family. New text (underlined) clarifies that counseling and/or coordination of care may be provided with other physicians or other qualified health care professionals. Deleted text (stricken) eliminates the reference to physician time, thereby allowing, per AMA guidelines, that other, nonphysician providers may provide the service. Descriptor changes throughout the E/M chapter are consistent with this example. A summary of the affected codes includes: Outpatient visits: Observation: Inpatient care (initial and subsequent): Observation or initial hospital care: Office consultations: Inpatient consultations: Emergency department visits: Direction of emergency medical services: Nursing facility care (initial and subsequent): Annual nursing facility assessment: Domiciliary or rest home visits: Home visits: Standby services: Supervision of patient care: Telephone E/M services: Online E/M services: Critical care during interfacility transport, critically ill or critically injured patient, 24 months of age or younger: E/M section guidelines also have been modified to allow non-physician providers to report services. For example, the descriptors for critical care services ( , , and ) have not been revised, but section guidelines now stipulate, Critical care is the direct delivery by a physician(s) or other qualified health care professional of medical care for a critically ill or critically injured patient. Revisions to include other qualified health care providers were made so that the type of provider (eg, physician, nurse practitioners, physician assistants, outpatient hospital facilities) does not dictate which codes may be reported. CPT codes describe the services performed, not the provider who performs the service. Each state s scope-ofpractice laws determine the services an individual provider is qualified to perform. Providers typically considered to be other qualified health care professionals are advanced registered nurse practitioners (ARNP)s, physician assistants (PA)s, midwives, etc. CPT 2013 also adds seven new codes in three new E/M categories: Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient; Complex chronic care coordination services, and; Transitional care management services. E/M: Pediatric Critical Care Patient Transport Subsection Guidance New, time-based codes report the non face-to-face work of a control physician directing care during interfacility transport. The patient s age and medical condition (critical illness or critical injury), and the total time, must be documented. When determining time, do not include pretransport communication with the referring or accepting facility. Only the time spent directly by the transport team may be used to determine reportable time. The controlling provider cannot code for any of the procedures performed by the team performing the transport. Do not report or with or for the same patient. 2 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

7 Complete 2013 Procedure Coding Updates # 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 Code describes the first 30 minutes of care. Do not report for fewer than 15 minutes of care. # 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 twoway communication with transport team before transport, at the referring facility and during the transport, including data interpretation and report; each additional 30 minutes (list separately in addition to code for primary procedure) Report one unit of add-on code for each additional 30 minutes of supervision of transport care, beyond the initial 30 minutes as reported with E/M: Complex Chronic Care Coordination Services Subsection Guidance A new E/M category reports coordination of care for patients with chronic illnesses. Effective coordination of services among providers to manage complex conditions requires significant staff and provider time. Patients with one or more chronic illnesses expected to last at least 12 months, acute exacerbation of an illness, or functional decline qualify for the use of these codes. The coordination activities are detailed in the coding guidelines preceding Codes are reported per calendar month. At least one hour must be documented to claim the services. Documentation templates to record the date, time spent on chronic care coordination, and the care coordinated will facilitate proper documentation to support the services. Other CPT codes describe specific coordination or monitoring of care services not reported with For example, end-stage renal disease services ( ) cannot be reported during the same month as The provider must determine which service type required the most time, and report those codes. A parenthetical note following lists the services that cannot be reported during the same month as 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 Code describes the first hour of clinical staff time for performing complex chronic care coordination, when there has been no face-to-face visit with the patient. The code is reported per calendar month. The patient s medical condition must meet the requirements stated in the coding guidelines preceding Complex chronic care coordination services; 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 Code describes the first hour of clinical staff time for performing complex chronic care coordination. The patient s medical condition must meet the requirements stated in the coding guidelines preceding This service includes one face-to-face encounter not separately reported. Additional, medically necessary encounters may be reported separately Complex chronic care coordination services; 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) Add-on code reports each additional 30 minutes of complex chronic care coordination beyond the first hour, to be reported in addition to or E/M: Transitional Care Management Services Subsection Guidance A new E/M subsection reports transitional care management for patients discharged from an inpatient hospital, observation, or a skilled nursing facility. The goal of transitional care is to provide services needed to transition the = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 3

8 Complete 2013 Procedure Coding Updates patient from a facility to his or her home, domiciliary, rest home, or assisted living. Such care helps to prevent readmissions and lowers the cost of health care (outpatient care is less expensive then inpatient care). To qualify for these codes, the medical decision-making must be of moderate to high complexity. The services include one face-to-face visit and non face-to-face services (eg, arranging home health agencies for patient care). Coding guidelines preceding this subsection list the services performed for transitional care. Codes are selected based on medical decision-making associated with the patient s condition, when the communication is initiated with the patient, and when the face-to-face encounter occurs following discharge. The first face-to-face encounter is included. The codes may be reported only once per 30 calendar days 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 discharge Report for transitional care management that includes initial communication within two business days of discharge, and a face-to-face encounter with 14 calendar days of discharge. Moderate or high complexity medical decision-making is required 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 Code is reported for transitional care management that includes initial communication within two business days of discharge, and a face-to-face encounter with seven calendar days of discharge. High complexity medical decision-making is required. Because the patient s condition is more severe, the face-to-face encounter is expected to happen sooner when reporting than with Anesthesia Other Procedures p Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider physician or other qualified health care professional); other than the prone position The code is revised to allow reporting by other qualified health care professional (eg, certified registered nurse anesthetist (CRNA)). p Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider physician or other qualified health care professional); prone position The code is revised to allow reporting by other qualified health care professional (eg, certified registered nurse anesthetist (CRNA)). Surgery Integumentary System/Repair (Closure): Other Flaps and Grafts p Flap; island pedicle requiring identification and dissection of an anatomically named axial vessel Code is revised to clarify the proper use of the island pedicle flap. When performing flap procedures, small blood vessels may be included as the tissue is transposed. An anatomically named axial vessel must be identified and dissected as part of the pedicle flap procedure. See image on next page. 4 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

9 Complete 2013 Procedure Coding Updates Musculoskeletal System/Spine (Vertebral Column): Arthrodesis Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1 interspace The new code has been created to report pre-sacral interbody technique arthrodesis with posterior instrumentation. Code includes disc preparation, discectomy, posterior instrumentation, imaging guidance, and bone graft. Per CPT instructions, do not report with , 22840, 22848, 72275, 77002, 77003, 77011, and Anatomical Illustrations 2012, OptumInsight, Inc. Musculoskeletal System/General: Introduction or Removal For pre-sacral interbody technique arthrodesis without instrumentation, turn to Category III codes 0195T and 0196T p Removal of tongs or halo applied by another physician individual The term individual replaces physician in the code descriptor, to allow a qualified health care provider other than a physician to report the service. Musculoskeletal System/Spine (Vertebral Column): Vertebral Body, Embolization or Injection p Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure) Add-on code now includes conscious sedation, when performed. Anatomical Illustrations 2012, OptumInsight, Inc. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 5

10 Complete 2013 Procedure Coding Updates Musculoskeletal System/Shoulder: Repair, Revision, and/or Reconstruction Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component Code has been added to report the revision of a total shoulder arthroplasty with removal and replacement of the artificial joint. Previously, two codes were reported for this procedure: for the arthroplasty and either or for removal of the implant. The new code includes the removal of the artificial joint and replacement with a new joint. Report when the procedure involves either a humeral or glenoid component Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component Code has been added to report the revision of a total shoulder arthroplasty with removal and replacement of the artificial joint. Previously, two codes were reported for this procedure: for the arthroplasty and either or for removal of the implant. The new code includes the removal of the artificial joint and replacement with a new joint. Report when the procedure involves both a humeral and glenoid component. Musculoskeletal System/Humerus (Upper Arm) and Elbow: Repair, Revision, and/or Reconstruction Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component New code describes the revision of a total elbow arthroplasty, which involves removal of the artificial joint and replacement with a new joint. Previously, this procedure was reported using two codes: for the total elbow arthroplasty and for artificial joint removal. The new code reports both services. Report when the procedure involves either the humeral or ulnar component Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar component Code has been added to report the revision of a total elbow arthroplasty, which involves removal of the artificial joint and replacement with a new joint. Previously, this procedure was reported using two codes: for the total elbow arthroplasty and for artificial joint removal. The new code reports both services. Report when the procedure involves both a humeral and ulnar component. Musculoskeletal System/Foot and Toes: Other Procedures p 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 descriptor for has been amended to allow this service to be performed by a physician or other qualified health care professional. Musculoskeletal System/Application of Casts and Strapping: Strapping Any Age Denis-Browne splint strapping This procedure is no longer performed. Respiratory System/Trachea and Bronchi: Endoscopy Subsection Guidance New Category I codes replace deleted Category III codes 0250T 0252T to report procedures performed for the insertion and removal for bronchial valves. Bronchial valves are inserted to treat patients with emphysema or lung damage. Valves are inserted to limit airflow to the damaged part of the lung to promote healing. There are a total of five lobes in the lungs (two in the left lung, three in the right). 6 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

11 Complete 2013 Procedure Coding Updates 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 Report for insertion of bronchial valve(s) in an initial lobe. If performed in more than one lobe, report (below) for each additional lobe. Fluoroscopic guidance is included and may not be separately reported add-on code for each additional lobe. Fluoroscopic guidance is included and may not be separately reported 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), each additional lobe (list separately in addition to code for primary procedure[s]) Report (above) is reported for the insertion of bronchial valve(s) in an initial lobe. If performed in more than one lobe, report add-on code for each additional lobe. Fluoroscopic guidance is included and may not be separately reported Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with injection of contrast material for segmental bronchography (fiberscope only) Bronchography is no longer performed. Computed Tomography (CT) is the standard of care replacing bronchography. Anatomical Illustrations 2012, OptumInsight, Inc Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe Report for removal of bronchial valve(s) in an initial lobe. If performed in more than one lobe, report (below) for each additional lobe. Fluoroscopic guidance is included and may not be separately reported Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), each additional lobe (list separately in addition to code for primary procedure) Report (above) for removal of bronchial valve(s) in an initial lobe. If performed in more than one lobe, report Respiratory System/Trachea and Bronchi: Bronchial Thermoplasty Subsection Guidance Category III codes 0276T 0277T have been deleted and replaced with new codes to report bronchial thermoplasty. The procedure involves radiofrequency ablation to treat asthmatic patients by reducing the muscle associated with airway constriction Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe Report for bronchial thermoplasty performed on one lobe. The procedure includes fluoroscopic guidance Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes Report for bronchial thermoplasty performed on two or more lobes. The procedure includes fluoroscopic guidance. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 7

12 Complete 2013 Procedure Coding Updates Note that is not an add-on code: Select if the procedure is performed on one lobe or if performed on two or more lobes. Do not select and for the same surgical session. Respiratory System/Trachea and Bronchi: Introduction Transtracheal injection for bronchography Bronchography is no longer performed. Computed tomography (CT) is the standard of care replacing bronchography Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance New codes replace and to more accurately describe procedures performed to aspirate fluid from the pleural space. A needle or catheter is used to puncture the pleural space and withdraw fluid. The new codes are selected based on whether imaging guidance is performed. When imaging guidance is not performed, report Respiratory System/Lungs and Pleura: Removal Pneumocentesis, puncture of lung for aspiration This procedure is no longer performed. See instead Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent Code has been deleted and replaced with new codes and Thoracentesis with insertion of tube, includes water seal (eg, for pneumothorax), when performed (separate procedure) Code has been deleted and replaced with new codes and Respiratory System/Lungs and Pleura: Introduction and Removal p Tube thoracostomy, includes water seal connection to drainage system (eg, for abscess, hemothorax, empyema water seal), when performed, open (separate procedure) The description for was revised to clarify proper use. This is an open procedure. The conditions ( abscess, hemothorax, etc.) were removed to describe the procedure performed rather than the conditions treated. Anatomical Illustrations 2012, OptumInsight, Inc Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance New codes replace and to more accurately describe procedures performed to aspirate fluid from the pleural space. A needle or catheter is used to puncture the pleural space and withdraw fluid. The new codes are selected based on whether imaging guidance is performed. 8 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

13 Complete 2013 Procedure Coding Updates When imaging guidance is performed, report CPT includes a parenthetical note instructing you not to report imaging guidance separately Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance New codes have been created to report the percutaneous drainage of pleural fluid. Unlike thoracocentesis, a tube or catheter is left in place to allow for drainage. Code selection is based on whether imaging guidance is used. If imaging guidance is not used, report Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance New codes have been created to report the percutaneous drainage of pleural fluid. Unlike thoracocentesis, a tube or catheter is left in place to allow for drainage. Code selection is based on whether imaging guidance is used. When imaging guidance is used, report Do not report imaging guidance separately. Respiratory System/Lungs and Pleura: Stereotactic Radiation Therapy Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment Stereotactic radiation therapy is a new subsection in CPT that includes new guidelines for proper use. Thoracic target delineation is performed to identify tumor borders, tumor volume, and tumor relationship to adjacent anatomic structures. Delineation of the tumor allows the radiation oncologist to properly plan and deliver radiation treatments. Code is not reported with the radiation treatment codes ( ). According to the coding guidelines, may be reported only once per course of treatment, not per session. Cardiovascular System/Heart and Pericardium: Pacemaker or Pacing Cardioverter-Defibrillator p Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter- defibrillator or pacemaker pulse generator (including eg, for upgrade to dual chamber system and pocket revision) (List separately in addition to code for primary procedure) The code descriptor was revised to remove pocket revision as a requirement, and parenthetical notes have been added to instruct when it is appropriate to report with other procedures. When reporting with or 33323, claim only when pocket relocation is performed. The table for pacemaker and cardioverter-defibrillator services also has been revised to indentify the proper codes for the conversion of an existing bi-ventricular system and removal and replacement of the pulse generator. When the procedure is performed for a pacemaker, report with (dual lead system) or (multiple lead system). When the procedure is performed for a cardioverterdefibrillator, report with (dual lead system) or (multiple lead system). Cardiovascular System/Heart and Pericardium: Heart (Including Valves) and Great Vessels Subsection Guidance Category III codes 0256T, 0258T, and 0259T have been deleted and replaced with Category I codes to report transcatheter aortic valve replacement. TAVR is a non-invasive procedure to replace the aortic valve for patients with aortic stenosis (narrowing of the aortic valve). New subsection guidelines provide instruction for proper use of the new codes, and identify the services included: Gaining access, deployment, and repositioning of the valve, temporary pacemaker insertion for rapid pacing, closure of arteriotomy, angiography, and radiologic supervision and interpretation. A team of providers is required for this procedure (eg, cardiologist, interventional radiologists). When two surgeons work together to perform these procedures, append modifier 62. Diagnostic coronary angiography may be reported separately when a prior coronary angiography was not per- = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 9

14 Complete 2013 Procedure Coding Updates formed or, if a prior coronary angiography was performed, the test is not adequate (eg, patient s condition has changed since the original angiography, the initial study is inadequate visualization of anatomy). The new codes are selected based on whether the approach is open or percutaneous and the vessel the surgeon uses for the approach. Cardiopulmonary bypass is reported with the appropriate add-on code ( ), depending on the type of access performed Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach Report for transcatheter aortic valve replacement using a percutaneous approach through the femoral artery Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach Report for transcatheter aortic valve replacement using an open approach through the femoral artery Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach Report for transcatheter aortic valve replacement using an open approach through the axillary artery Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach Report for transcatheter aortic valve replacement using an open approach through the iliac artery Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy) Report for transcatheter aortic valve replacement using a transaortic approach. This is an open procedure done via median sternotomy or mediastinotomy 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) Add-on codes have been created to report cardiopulmonary bypass support when performed during a transcatheter aortic valve replacement. The add-on codes are selected based on whether the cannulation is performed percutaneously, open, or centrally. Report when peripheral arterial and venous cannulation is performed percutaneously Transcatheter aortic valve replacement (TAVR/ TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg, femoral, iliac, axillary vessels) (list separately in addition to code for primary procedure) Add-on codes have been created to report cardiopulmonary bypass support when performed during a transcatheter aortic valve replacement. The add-on codes are selected based on whether the cannulation is performed percutaneously, open, or centrally. Report when peripheral arterial and venous cannulation is performed as an open procedure 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) Add-on codes have been created to report cardiopulmonary bypass support when performed during a transcatheter aortic valve replacement. The add-on codes are selected based on whether the cannulation is performed percutaneously, open, or centrally. Report when peripheral arterial and venous cannulation is performed centrally through the aorta, right atrium, or pulmonary artery. 10 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

15 Complete 2013 Procedure Coding Updates Cardiovascular System/Heart and Pericardium: Cardiac Assist Subsection Guidance Category III codes 0048T and 0050T have been deleted and replaced with new Category I codes for insertion, removal, and repositioning of percutaenous ventricle assist devices. Ventricle assist devices assist the patient s heart to pump blood. The devices are used during high-risk procedures or for critically ill patients. Ventricle assist devices can be inserted percutaneously ( ) or transthoracically (33975, 33976, 33979). Coding guidelines have been added to the categories of Heart (Including Valves) and Great Vessels, Cardiac Valves, and Coronary Bypass procedures to direct you to the correct codes when ventricular assist devices are inserted Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only Report when the percutaneous ventricular assist device (pvad) involves arterial access only Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; both arterial and venous access, with transseptal puncture Report when the percutaneous ventricular assist device (pvad) involves arterial and venous access and transseptal puncture Removal of percutaneous ventricular assist device at separate and distinct session from insertion Report when the percutaneous ventricular assist device (pvad) is removed during a separate session. Removal during the same session as the insertion is not reported separately Repositioning of percutaneous ventricular assist device with imaging guidance at separate and distinct session from insertion Report when the percutaneous ventricular assist device (pvad) is repositioned during a separate session. Repositioning during the same session as the insertion is not reported separately. Imaging guidance is required to report this code. Cardiovascular System/Heart and Pericardium: Vascular Injection Procedures p Introduction of catheter, superior or inferior vena cava Introduction of catheter, to the superior or inferior vena cava now includes conscious sedation, when performed. p Introduction of needle or intracatheter; extremity artery Introduction of a needle or intracatheter into an extremity artery now includes conscious sedation, when performed. Cardiovascular System/Arteries and Veins: Vascular Injection Procedures Subsection Guidance The AMA/Specialty Society RVS Update Committee (RUC) reviewed codes for carotid catheter procedures because the codes were reported together more than 75 percent of the time. New codes have been created to prevent duplicated services. The new codes report selective and non-selective arterial catheter placement and angiography in the aortic arch, and carotid and vertebral arteries. They include vessel access, placement of catheter(s), contrast injection(s), fluoroscopy, radiological supervision and interpretation, and closure of the arteriotomy. The codes are unilateral; therefore, modifier 50 is appropriate if the service is performed bilaterally. CPT provides specific instruction on appending modifier 59 for these services. New guidelines provide instruction for proper use of The codes are built on a hierarchy of ser- = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 11

16 Complete 2013 Procedure Coding Updates vices. When more than one procedure is performed on the ipsilateral (same side) vessel, report only the most complex procedure. For example, a selective catheterization of the left common carotid, including an angiography of the ipsilateral extracranial circulation, is performed with a selective catheterization of the right internal carotid artery. This would be reported 36224, If both procedures were performed on the left (same) side (left common carotid and left internal carotid), you would report only. Radiological supervision and interpretation is included in codes ; however, if a 3D rendering is performed, coding guidelines allow separate reporting of or Likewise, if ultrasound guidance is required to access the vessel, report 76937; and, may be reported if the angiography is not performed for the extracranial and intracranial cervicocerebral vessels (eg, upper extremities) 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 Report for non-selective thoracic aorta catheter placement. This procedure includes angiography of the cervicocerebral arch. Do not report with phy of the extracranial carotid and cervicocerebral arch, when performed Report for selective catheter placement in the common carotid or innominate artery, including angiography of ipsilateral (same side) intracranial carotid circulation, the extracranial carotid, and the cervicocerebral arch 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 Report for selective catheter placement in the internal carotid artery, including angiography of ipsilateral (same side) intracranial carotid circulation, the extracranial carotid, and the cervicocerebral arch 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 Report for selective catheter placement in the common carotid or innominate artery, including angiography of ipsilateral (same side) extracranial carotid circulation Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiogra- Anatomical Illustrations 2012, OptumInsight, Inc 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 12 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

17 Complete 2013 Procedure Coding Updates Report for selective catheter placement in the subclavian artery. The procedure includes angiography of ipsilateral (same side) vertebral circulation and of the cervicocerebral arch. descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed Report for selective catheter placement in the vertebral artery. The procedure includes angiography of ipsilateral (same side) vertebral circulation and of the cervicocerebral arch Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (list separately in addition to code for primary procedure) Report add-on code in addition to 36222, 36223, or for selective catheter placement in the external carotid artery 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) Report add-on code in addition or for selective catheter placement in each intracranial branch of the internal carotid or vertebral arteries. Do not report more than twice, per side. p Venipuncture, younger than age 3 years, necessitating physician s the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; femoral or jugular vein p Venipuncture, younger than age 3 years, necessitating physician s the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; scalp vein descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Venipuncture, younger than age 3 years, necessitating physician s the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; other vein descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Venipuncture, age 3 years or older, necessitating physician s the skill of a physician or other qualified health care professional, for diagnostic or therapeutic purposes (not to be used for routine venipuncture) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Cardiovascular System/Arteries and Veins: Transcatheter Procedures 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 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 13

18 Complete 2013 Procedure Coding Updates Code has been created to bundle radiological supervision and interpretation to percutaneous transcatheter retrieval of a foreign body. The creation of the bundled code resulted in the deletion of Report retrieval of the vena cava filter with Transcatheter therapy, infusion for thrombolysis other than coronary CPT 2013 deletes and adds new codes that bundle the surgical and radiological supervision and interpretation services. Radiology code has been revised to remove mention of thrombolysis Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter) Code has been deleted and replaced by 37197, which bundles surgical and radiological supervision and interpretation to percutaneous transcatheter retrieval of a foreign body Exchange of a previously placed intravascular catheter during thrombolytic therapy Codes and have been deleted and replaced by new codes that bundle surgical and radiological supervision and interpretation services with infusion thrombolysis. Subsection Guidance New codes bundle surgical and radiological supervision and interpretation services with infusion thrombolysis when performed in arterial and venous vessels. During the procedure, chemicals are infused to break down clots. Codes are selected for the initial treatment day. If the treatment extends over more than one date of service, you may use separate codes to report the subsequent treatment day and the cessation or last treatment day Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day Report for infusion thrombolysis of an artery other than coronary, once per day for the initial service Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day Report for infusion thrombolysis of a vein, once per day for the initial service 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; Report for infusion thrombolysis of an artery (other than coronary) or vein on a subsequent day of therapy. You would report this service only if the infusion thrombolysis was initiated on a previous date of service. Position change or exchange is included with the subsequent code. # 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; cessation of thrombolysis including removal of catheter and vessel closure by any method Report for the cessation of infusion thrombolysis of an artery (other than coronary), including removal of the catheter and closure of the vessel. Claim only if the infusion thrombolysis was initiated on a previous date of service. If the initiation and cessation are performed on the same date of service, report either or only, depending on the type of vessel. 14 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

19 Complete 2013 Procedure Coding Updates Hemic and Lymphatic Systems: Transplantation and Post-Transplantation Cellular Infusions p Bone marrow or blood-derived peripheral stem Hematopoietic progenitor cell transplantation (HPC); allogeneic transplantation per donor Codes for HPC transplantation have been revised to assist with code selection. Allogenic transplantation means the recipient is not the donor. Because the procedure can involve cells from more than one donor, the procedure is reported per donor. The procedure includes the physician monitoring physiological parameters, verification of cell processing, patient evaluation, and direct supervision of the infusion. p Bone marrow or blood-derived peripheral stem Hematopoietic progenitor cell transplantation (HPC); autologous transplantation Codes for HPC transplantation have been revised to assist with code selection. Autologous transplantation means the recipient and donor are the same person. The procedure includes the physician monitoring physiological parameters, verification of cell processing, patient evaluation, and direct supervision of the infusion. Digestive System/Esophagus: Endoscopy # Esophagoscopy, rigid or flexible; with optical endomicroscopy Code has been created to describe esophagoscopy performed with optical endomicroscopy. Optical endomicroscopy allows the provider to eliminate random sampling and perform targeted biopsies through real-time cellular observation of mucosal tissue. The procedure is performed when the provider suspects preneoplastic diseases. Code includes moderate sedation # Hematopoietic progenitor cell (HPC); HPC boost A new code has been created to report HPC boost which may occur days, months, or years from the original HPC transplantation. The boost comes from the original HPC donor from the initial transplantation. This procedure is performed to treat a relapse or posttransplant cytopenia (deficiency or lack of cellular elements in the circulating blood). p allogenic Allogenic donor lymphocyte infusions With revisions to and 38241, is no longer a child of parent code Report for lymphocyte infusions in patients who have had a previous bone marrow transplant. Anatomical Illustrations 2012, OptumInsight, Inc. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 15

20 Complete 2013 Procedure Coding Updates Upper gastrointestinal endoscopy, simple primary examination (eg, with small diameter flexible endoscope) (separate procedure) Upper gastrointestinal endoscopy with a small diameter endoscope (43234) is now rarely performed. The most common gastrointestinal endoscopy is Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with optical endomicroscopy Code has been created to report upper gastrointestinal endoscopy performed with optical endomicroscopy. Optical endomicroscopy allows the provider to eliminate random sampling and perform targeted biopsies through real-time cellular observation of mucosal tissue. The procedure is performed when the provider suspects preneoplastic diseases. Code includes moderate sedation. Digestive System/Intestines (Except Rectum): Other Procedures Preparation of fecal microbiota for instillation, including assessment of donor specimen Code has been created to report the preparation of fecal microbiota for instillation in a patient with Clostridium difficile infection. Clostridium difficile (C. difficile) is a bacterium commonly found in the intestines that can grow out of control from use of antibiotics, which kill good bacteria in the gut. The procedure includes collecting fecal material from a donor, preparing the fecal material in a slurry, and evaluating the material prior to instillation. This service includes only the preparation prior to instillation, not the work to instill the fecal microbiota. A separate code is reported for the instillation either through colonoscopy or sigmoidoscopy. A parenthetical note following instructs you to report for oro-nasogastric tube or enema. Urinary System/Bladder: Transurethral Surgery Cystourethroscopy, with injection(s) for chemodenervation of the bladder Code has been created to report injections for chemodenervation of the bladder (eg, for neurogenic incontinence). Maternity Care and Delivery: Repair p Episiotomy or vaginal repair, by other than attending physician descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation also may be reported by other (non-physician), qualified attending health care professionals. Nervous System/Spine and Spinal Cord: Reservoir/Pump Implantation p 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 physician s of a physician or other qualified health care professional) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System: Neurostimulators (Peripheral Nerve) p Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed Percutaneous implantation of neurostimulator electrode array to the sacral nerve now includes image guidance, when performed. 16 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

21 Complete 2013 Procedure Coding Updates Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System: Destruction by Neurolytic Agent, Chemodenervation p Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm) The descriptor of was revised to add unilateral to clarify proper code application. If the procedure is performed bilaterally, append modifier 50. p Chemodenervation of muscle(s); extremity(s) and/ or trunk muscle(s) (eg, for dystonia, cerebral palsy, multiple sclerosis) Code was revised to specify extremity (singular). Because the procedure includes chemodenervation of multiple muscles, it is reported once per session for extremity or trunk muscles. Do not report with modifier Paracentesis of anterior chamber of eye (separate procedure); with therapeutic release of aqueous To simplify code selection, has been deleted and (above) was revised to report removal of aqueous for either diagnostic or therapeutic purposes. #p Biopsy Incisional biopsy of eyelid skin including lid margin Code was revised to include the anatomic site of the eyelid and the depth of tissue removed. This code is sometimes used in error when the proper integumentary biopsy code should be reported. To report 67810, the biopsy must be of the lid margin. Because this is an incisional procedure, it was resequenced under the incisional subsection instead of the excisional heading, where it previously appeared. Report 11100, 11101, or for biopsy of the skin of the eyelid Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine) Code has been created to report bilateral chemodenervation of muscles innervated by facial, trigeminal, cervical spine, and accessory nerves. This procedure typically includes 31 injection sites to treat migraine headaches. The procedure must be performed bilaterally and is valued as such: Do not append modifier 50 to Do not report with 64612, 64613, or Eye and Ocular Adnexa: Anterior Segment Incision p Paracentesis of anterior chamber of eye (separate procedure); with diagnostic aspiration removal of aqueous To simplify code selection, (below) has been deleted and was revised to report removal of aqueous for either diagnostic or therapeutic purposes. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 17

22 Complete 2013 Procedure Coding Updates A portion of a lesion or suspect tissue is removed for analysis Diagnostic Radiology: Spine and Pelvis p Radiologic examination, spine, cervical; 2 3 views or less Codes for radiology examination of the cervical spine have been revised to include the number of views to accurately capture the work performed. When three or fewer views are performed, report Lesion to be biopsied p Radiologic examination, spine, cervical; 4 minimum or 5 views Codes for radiology examination of the cervical spine have been revised to include the number of views to accurately capture the work performed. When four or five views are performed, report The incision may be repaired with sutures Anatomical Illustrations 2012, OptumInsight, Inc. Radiology Diagnostic Radiology: Chest Bronchography, unilateral, radiological supervision and interpretation Bronchography is no longer performed. Computed tomography (CT) is now the standard of care replacing bronchography Bronchography, bilateral, radiological supervision and interpretation Bronchography is no longer performed. Computed tomography (CT) is now the standard of care replacing bronchography. p Radiologic examination, spine, cervical; complete, including oblique and flexion and/ 6 or extension studies more views Codes for radiology examination of the cervical spine have been revised to include the number of views to accurately capture the work performed. When six or more views are performed, report Diagnostic Radiology/Vascular: Aorta and Arteries Angiography, cervicocerebral, catheter, including vessel origin, radiological supervision and interpretation Code has been deleted. Refer to Angiography, external carotid, unilateral, selective, radiological supervision and interpretation Code has been deleted. Refer to Angiography, external carotid, bilateral, selective, radiological supervision and interpretation Code has been deleted. Refer to = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

23 Complete 2013 Procedure Coding Updates Angiography, carotid, cerebral, unilateral, radiological supervision and interpretation Code has been deleted. Refer to and Angiography, carotid, cerebral, bilateral, radiological supervision and interpretation Code has been deleted. Refer to and Angiography, carotid, cervical, unilateral, radiological supervision and interpretation Code has been deleted. Refer to Angiography, carotid, cervical, bilateral, radiological supervision and interpretation Code has been deleted. Refer to Angiography, vertebral, cervical, and/or intracranial, radiological supervision and interpretation Code has been deleted. Refer to Diagnostic Radiology, Vascular: Transcatheter Procedures p Transcatheter therapy, infusion, any method (eg, thrombolysis other than for thrombolysis, radiological supervision and interpretation New codes ( ) have been created for infusion thrombolysis. The new codes include radiological supervision and interpretation; therefore, was revised to exclude thrombolysis. p Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis New codes ( ) have been created for infusion thrombolysis. The new codes include radiological supervision and interpretation; therefore, was revised to exclude thrombolysis Exchange of a previously placed intravascular catheter during thrombolytic therapy with contrast monitoring, radiological supervision and interpretation New codes ( ) have been created for infusion thrombolysis. The new codes include radiological supervision and interpretation; therefore, has been deleted Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), radiological supervision and interpretation Code has been deleted and replaced by Diagnostic Radiology: Other Procedures p Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time, other than or (eg, cardiac fluoroscopy) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p 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) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postpro- = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 19

24 Complete 2013 Procedure Coding Updates cessing under concurrent supervision; not requiring image postprocessing on an independent workstation Code was revised to include image postprocessing under concurrent supervision. The parenthetical note was revised to list procedures not reported with p D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation Code was revised to include image postprocessing under concurrent supervision. The parenthetical note was revised to list procedures not reported with Diagnostic Ultrasound: Extremities p Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health care professional manipulation) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Ultrasound, infant hips, real time with imaging documentation; limited, static (not requiring physician or other qualified health care professional manipulation) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Breast, Mammography p Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; diagnostic mammography (list separately in addition to code for primary procedure) descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation also may be reported by other (non-physician) health care professionals. p Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure) descriptor for has been amended to allow that, per AMA guidelines, this service may be performed by a qualified health care professional other than a physician. Bone and Joint Studies p Manual application of stress performed by physician or other qualified health care professional for joint radiography, including contralateral joint if indicated descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Nuclear Medicine/Diagnostic: Endocrine System Thyroid uptake; single determination Codes have been deleted. See Thyroid uptake; multiple determinations Codes have been deleted. See Thyroid uptake; stimulation, suppression or discharge (not including initial uptake studies) Codes have been deleted. See = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

25 Complete 2013 Procedure Coding Updates Thyroid imaging, with uptake; single determination Codes have been deleted. See Thyroid imaging, with uptake; multiple determinations Codes have been deleted. See Thyroid imaging; only Codes have been deleted. See Thyroid imaging; with vascular flow Codes have been deleted. See Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed) Codes have been deleted and new codes have been created to consolidate services and more accurately describe the types of thyroid nuclear medicine scans performed. Code is performed to evaluate the function of the gland Thyroid imaging (including vascular flow, when performed); Codes have been deleted and new codes have been created to consolidate services and more accurately describe the types of thyroid nuclear medicine scans performed. Code is performed to determine the size, shape, and position of the thyroid gland Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed) Codes have been deleted and new codes have been created to consolidate services and more accurately describe the types of thyroid nuclear medicine scans performed. Use when the services identified in and are performed during the same session. p Parathyroid planar imaging (including subtraction, when performed) Revisions were made to to more accurately describe the procedure performed. New codes have been added to report Single Photon Emission Computed Tomography (SPECT) and SPECT/CT performed for parathyroid planar imaging Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT) Prior to the creation of 78071, no CPT code properly described SPECT performed during parathyroid planar imaging Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired computed tomography (CT) for anatomical localization Prior to the creation of code 78072, no CPT code properly described SPECT/CT performed during parathyroid planar imaging. Pathology and Laboratory Molecular Pathology Last year, CPT added a new subsection and 101 new codes ( ) to the Pathology and Laboratory chapter to describe molecular pathology procedures. Molecular pathology is the study and diagnosis of disease through the examination of nucleic acid (including DNA and RNA), for the purposes of: detecting and monitoring infectious agents; establishing clonality (cells descended from and genetically identical to a single common ancestor), particularly for lymphoid diseases; assessing the presence of minimal residual disease for certain malignancies following therapy; determining prognosis and/or predicting response to therapy, and; testing for inherited diseases. For 2013, CPT adds 13 new Tier 1 molecular pathology procedure codes, as well as an unlisted molecular pathology procedure code (81479), and revises the descriptors for = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 21

26 Complete 2013 Procedure Coding Updates all nine Tier 2 ( ) procedures. Because molecular pathology procedures are highly specialized and infrequently reported, we will not cover these code revisions and additions individually as part of this course. Consult your 2013 CPT codebook for complete instructions and parenthetical guidelines, definitions, and descriptors for molecular pathology codes. Molecular pathology instructions have been added to the beginning of the CPT codebook. The information provides a history for the creation of the molecular pathology codes, instructions for use, and frequently asked questions to assist with proper code selection. Multianalyte Assays with Algorithmic Analysis (MAAA) A new category, including coding guidelines, has been created to report MAAA. MAAAs are algorithmic analysis using the results of assays (molecular pathology assays, fluorescent in situ hybridization assays, and nonnucleic acid-based assays) and patient information, when appropriate, to report a numeric score(s) or probability of developing specific conditions. The code descriptions include the disease type, material analyzed, number of markers, specimen type, algorithm, and report Oncology (ovarian), biochemical assays of two proteins (CA-125 and HE4), utilizing serum, with menopausal status, algorithm reported as a risk score This new MAAA procedure is used to determine risk score for ovarian cancer. Report when biochemical assays of two proteins and menopausal status are used for the algorithm Oncology (ovarian), biochemical assays of five proteins (CA-125, apoliproprotein A1, beta-2 microglobulin, transferrin, and pre-albumin), utilizing serum, algorithm reported as a risk score This new MAAA procedure is used to determine risk score for ovarian cancer. Report for biochemical assays of five proteins Endocrinology (type 2 diabetes), biochemical assays of seven analytes (glucose, HBA1C, insulin, HS-CRP, adoponectin, ferritin, interleukin 2-receptor alpha), utilizing serum or plasma, algorithm reporting a risk score This new MAAA procedure is used to determine risk score for type 2 diabetes via assays of the seven analytes listed (glucose, HBA1C, insulin, HS-CRP, adoponectin, ferritin, interleukin 2-receptor alpha) Fetal congenital abnormalities, biochemical assays of two proteins (PAPP-A, HCG [any form]), utilizing maternal serum, algorithm reported as a risk score This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of two proteins Fetal congenital abnormalities, biochemical assays of three proteins (PAPP-A, HCG [any form], DIA), utilizing maternal serum, algorithm reported as a risk score This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of three proteins Fetal congenital abnormalities, biochemical assays of three analytes (AFP, UE3, HCG [any form]), utilizing maternal serum, algorithm reported as a risk score This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of three analytes Fetal congenital abnormalities, biochemical assays of four analytes (AFP, UE3, HCG [any form], DIA) utilizing maternal serum, algorithm reported as a risk score (may include additional results from previous biochemical testing) This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of four analytes. 22 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

27 Complete 2013 Procedure Coding Updates Fetal congenital abnormalities, biochemical assays of five analytes (AFP, UE3, total HCG, hyperglycosylated HCG, DIA) utilizing maternal serum, algorithm reported as a risk score This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of five analytes Unlisted multianalyte assay with algorithmic analysis An unlisted code has been created for MAAA tests when a Category I code does not exist and there is no appropriate code in Appendix O. Appendix O lists alphanumeric codes that include four numeric digits followed by M. Report codes in Appendix O by the proprietary name and clinical lab or manufacturer. These codes are in an Appendix because Category I codes report the service work and cannot include proprietary names. Chemistry p Acetone or other ketone bodies Ketone body(s) (eg, acetone, acetoacetic acid, serum beta-hydroxybutyrate); qualitative Code was revised to reflect current clinical practice. p Acetone or other ketone bodies Ketone body(s) (eg, acetone, acetoacetic acid, serum beta-hydroxybutyrate); quantitative Code was revised to reflect current clinical practice Galectin-3 Code has been created to report measuring of galectin-3, which can be used to assess the prognosis of heart failure patients Molecular diagnostics; molecular isolation or extraction, each nucleic acid type (ie, DNA or RNA) Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; isolation or extraction of highly purified nucleic acid, each nucleic acid type (ie, DNA or RNA) Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; enzymatic digestion, each enzyme treatment Codes have been deleted. To report, refer to molecular pathology codes Molecular diagnostics; dot/slot blot production, each nucleic acid preparation Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; separation by gel electrophoresis (eg, agarose, polyacrylamide), each nucleic acid preparation Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; nucleic acid probe, each Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; nucleic acid transfer (eg, Southern, Northern), each nucleic acid preparation Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; amplification, target, each nucleic acid sequence = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 23

28 Complete 2013 Procedure Coding Updates Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; amplification, target, multiplex, first 2 nucleic acid sequences Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; amplification, target, multiplex, each additional nucleic acid sequence beyond 2 (List separately in addition to code for primary procedure) Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; reverse transcription Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; mutation scanning, by physical properties (eg, single strand conformational polymorphisms [SSCP], heteroduplex, denaturing gradient gel electrophoresis [DGGE], RNA ase A), single segment, each Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; mutation identification by sequencing, single segment, each segment Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; mutation identification by allele specific transcription, single segment, each segment Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; mutation identification by allele specific translation, single segment, each segment Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; lysis of cells prior to nucleic acid extraction (eg, stool specimens, paraffin embedded tissue), each specimen Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; amplification, signal, each nucleic acid sequence Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; separation and identification by high resolution technique (eg, capillary electrophoresis), each nucleic acid preparation Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; interpretation and report Codes have been deleted; refer to molecular pathology codes Molecular diagnostics; RNA stabilization Codes have been deleted; refer to molecular pathology codes Mutation identification by enzymatic ligation or primer extension, single segment, each segment (eg, oligonucleotide ligation assay [OLA], single base chain extension [SBCE], or allele-specific primer extension [ASPE]) Codes have been deleted; refer to molecular pathology codes = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

29 Complete 2013 Procedure Coding Updates Immunology Codes 0279T and 0280T have been deleted and replaced with Category I codes to report testing for tumor cells circulating in the blood. The test is used to determine the prognosis for cancer patients. # Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); Code has been created to report the technical component; the interpretation and report are reported using (below). When the same provider performs the test and interpretation and report, report both and # Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required Code (above) has been created to report the technical component; the interpretation and report are reported using When the same provider performs the test and interpretation and report, report both and Antibody; JC (John Cunningham) virus Code has been created to report the testing to detect the John Cunningham virus, which causes progressive multifocal leukoencephalopathy (PML), a rare but often fatal condition that destroys myelin, a protective covering of nerve cells in the brain. Immunology: Tissue Typing Subsection Guidance New codes report testing for antibodies to human leukocyte antigens (HLA). HLA typing identifies the unique HLA antigens for an individual. Tests of HLAclass I (A, B, C) and class II (DR, DQ, DP) are performed for solid organ and bone marrow transplants. = FDA Approval Pending = Add-on Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); qualitative assessment of the presence or absence of antibody(ies) to HLA class I and class II HLA antigens Report for qualitative assessment for the presence or absence of HLA class I and class II. A qualitative test tells you if a particular substance (analyte) is present in the specimen Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); qualitative assessment of the presence or absence of antibody(ies) to HLA class I or class II HLA antigens Report for qualitative assessment for the presence or absence of HLA class I or class II. A qualitative test tells you if a particular substance (analyte) is present in the specimen Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); antibody identification by qualitative panel using complete HLA phenotypes, HLA class I Report for qualitative panel using HLA class I. A qualitative test tells you if a particular substance (analyte) is present in the specimen Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); antibody identification by qualitative panel using complete HLA phenotypes, HLA class II Report for qualitative panel using HLA class II. A qualitative test tells you if a particular substance (analyte) is present in the specimen Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), HLA class I Report for qualitative panel for identification of antibody specificities for HLA class I. A qualitative test tells you if a particular substance (analyte) is present in the specimen. Complete 2013 Procedure Updates 25

30 Complete 2013 Procedure Coding Updates Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), HLA class II Report for qualitative panel for identification of antibody specificities for HLA class II Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); semi-quantitative panel (eg, titer), HLA class I Report for semi-quantitative panel for HLA class I Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); semi-quantitative panel (eg, titer), HLA class II Report for semi-quantitative panel for HLA class II. Microbiology p Infectious agent detection by nucleic acid (DNA or RNA); enterovirus, reverse transcription and amplified probe technique Codes have been revised to include reverse transcription, which more accurately reports the procedure performed. p Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, reverse transcription and amplified probe technique Codes have been revised to include reverse transcription, which more accurately reports the procedure performed. p Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, reverse transcription and quantification Codes have been revised to include reverse transcription, which more accurately reports the procedure performed. p Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, reverse transcription and amplified probe technique Codes have been revised to include reverse transcription, which more accurately reports the procedure performed. p Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, reverse transcription and quantification Codes have been revised to include reverse transcription, which more accurately reports the procedure performed. p Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, reverse transcription and amplified probe technique Codes have been revised to include reverse transcription, which more accurately reports the procedure performed. p Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, reverse transcription and quantification Codes have been revised to include reverse transcription, which more accurately reports the procedure performed Infectious agent detection by nucleic acid (DNA or RNA); 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 New codes have been created for the nucleic acid tests performed to detect respiratory viruses. The codes are selected based on the number of targets for the test. Report for three to five targets. 26 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

31 Complete 2013 Procedure Coding Updates Infectious agent detection by nucleic acid (DNA or RNA); 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, 6-11 targets New codes have been created for the nucleic acid tests performed to detect respiratory viruses. The codes are selected based on the number of targets for the test. Report for six to 11 targets Infectious agent detection by nucleic acid (DNA or RNA); 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, targets New codes have been created for the nucleic acid tests performed to detect respiratory viruses. The codes are selected based on the number of targets for the test. Report for 12 to 25 targets Infectious agent genotype analysis by nucleic acid (DNA or RNA); cytomegalovirus Code has been created to report genotype analysis by nucleic acid for cytomegalovirus, which are herpes viruses (eg, herpes simplex viruses, varicella-zoster virus, Epstein-Barr virus) p Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, reverse transcriptase and protease regions Code has become a child code indexed to new parent code of Code application is not affected by this change Infectious agent genotype analysis by nucleic acid (DNA or RNA); hepatitis B virus New code describes genotype analysis by nucleic acid for the hepatitis B virus. Surgical Pathology Optical endomicroscopic image(s), interpretation and report, real-time or referred, each endoscopic session Code describes interpretation and report of optimal endomicroscopic images obtained. The use of optical endomicroscopic imaging allows for more precise biopsies. Report this code only when performed by a provider (eg, pathologist) other than the provider performing the endoscopic procedure. Do not report with or Array-based evaluation of multiple molecular probes; 11 through 50 probes Codes have been deleted. See molecular pathology codes Array-based evaluation of multiple molecular probes; 51 through 250 probes Codes have been deleted. See molecular pathology codes Array-based evaluation of multiple molecular probes; 251 through 500 probes Codes have been deleted. See molecular pathology codes Medicine Many codes in the Medicine section of CPT 2013 have seen descriptor revisions similar to those found in E/M chapter (and less frequently, throughout the Surgery and Radiology chapters), which now specifically allow the reporting of services by other, qualified non-physician practitioners. Other significant changes include new (replacement) codes for psychotherapy; percutaneous angioplasty, atherectomy, and stent placement; nerve conduction studies, and; intraoperative monitoring. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 27

32 Complete 2013 Procedure Coding Updates Immunization Administration for Vaccines/Toxoids Influenza vaccine, inactivated, subunit, adjuvanted, for intramuscular use Code has been created to report the supply of adjuvanted seasonal trivalent influenza vaccine. The product is currently pending FDA approval. p Influenza virus vaccine, trivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use Codes have been revised to include trivalent. Trivalent means the vaccine includes three viral strains. p Influenza virus vaccine, trivalent, live, for intranasal use Codes have been revised to include trivalent. Trivalent means the vaccine includes three viral strains Lyme disease vaccine, adult dosage, for intramuscular use Code has been deleted: The indicated vaccine is no longer available. # Influenza virus vaccine, quadrivalent, live, for intranasal use Code has been created to report quadrivalent (four viral strains) influenza vaccine for intranasal use. p Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use Codes have been revised to include trivalent. Trivalent means the vaccine includes three viral strains. p Influenza virus vaccine, trivalent, split virus, when administered to children 6-35 months of age, for intramuscular use Codes have been revised to include trivalent. Trivalent means the vaccine includes three viral strains. p Influenza virus vaccine, trivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use Codes have been revised to include trivalent. Trivalent means the vaccine includes three viral strains Diphtheria, tetanus toxoids, and whole cell pertussis vaccine (DTP), for intramuscular use Code has been deleted: The vaccine was removed from the market due to safety concerns Tetanus and diphtheria toxoids (Td) adsorbed when administered to individuals 7 years or older, for intramuscular use Code has been deleted to prevent confusion for Td vaccine. All Td vaccines are preservative free (see 90714) Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use Code has been created to report two dose schedule for Hepatitis B vaccine. The vaccine is currently pending FDA approval. 28 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

33 Complete 2013 Procedure Coding Updates p Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use Code was revised to specify three does schedule, which distinguishes it from new two-dose schedule code Psychiatry The psychiatry category received a major overhaul with creation of new codes and guidelines, as well as substantial code deletions. The revised code set more accurately report the services behavioral health providers now perform. Psychiatry/Interactive Complexity Interactive complexity (list separately in addition to the code for primary procedure) This is an add-on code reported for patients whose communication factors complicate the delivery of psychiatric services (eg, the patient is verbally underdeveloped, or an emotional caregiver complicates the session with the patient). CPT includes a list of codes with which you may report Do not report with E/M services. Psychiatry/Psychiatric Diagnostic Procedures Psychiatric diagnostic evaluation New codes and (below) replace deleted codes and Psychiatric diagnostic evaluation is an assessment that includes obtaining a history, mental status, and recommendations. The service may require speaking with the family or other sources. Report 90791/90792 once per day, but not on the same day as E/M services. If the psychiatric diagnostic evaluation is performed without a medical service, report Psychiatric diagnostic evaluation with medical services New codes (above) and replace deleted codes and Psychiatric diagnostic evaluation is an assessment that includes obtaining a history, mental status, and recommendations. The service may require speaking with the family or other sources. Report 90791/90792 once per day, but not on the same day as E/M services. If the psychiatric diagnostic evaluation is performed on the same date as a medical service, report Psychiatric diagnostic interview examination Codes and have been deleted and replaced with and Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication Codes and have been deleted and replaced with and Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient Codes 90804, 90805, 90806, 90808, and have been deleted. See new codes Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services Codes 90804, 90805, 90806, 90808, and have been deleted. See new codes Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient Codes 90804, 90805, 90806, 90808, and have been deleted. See new codes = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 29

34 Complete 2013 Procedure Coding Updates Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services Codes 90804, 90805, 90806, 90808, and have been deleted. See new codes Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient Codes 90804, 90805, 90806, 90808, and have been deleted. See new codes Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services Codes 90804, 90805, 90806, 90808, and have been deleted. See new codes Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient Codes 90810, 90811, 90812, 90813, 90814, and have been deleted. See Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services Codes 90810, 90811, 90812, 90813, 90814, and have been deleted. See Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient Codes 90810, 90811, 90812, 90813, 90814, and have been deleted. See Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services Codes 90810, 90811, 90812, 90813, 90814, and have been deleted. See Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient Codes 90810, 90811, 90812, 90813, 90814, and have been deleted. See Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services Codes 90810, 90811, 90812, 90813, 90814, and have been deleted. See Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient Codes 90816, 90817, 90818, 90819, 90821, and have been deleted. See = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

35 Complete 2013 Procedure Coding Updates Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services Codes 90816, 90817, 90818, 90819, 90821, and have been deleted. See Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient Codes 90823, 90824, 90826, 90827, 90828, and have been deleted. Refer to Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient Codes 90816, 90817, 90818, 90819, 90821, and have been deleted. See Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services Codes 90816, 90817, 90818, 90819, 90821, and have been deleted. See Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient Codes 90816, 90817, 90818, 90819, 90821, and have been deleted. See Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services Codes 90816, 90817, 90818, 90819, 90821, and have been deleted. See Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services Codes 90823, 90824, 90826, 90827, 90828, and have been deleted. Refer to Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient Codes 90823, 90824, 90826, 90827, 90828, and have been deleted. Refer to Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services Codes 90823, 90824, 90826, 90827, 90828, and have been deleted. Refer to = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 31

36 Complete 2013 Procedure Coding Updates Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient Codes 90823, 90824, 90826, 90827, 90828, and have been deleted. Refer to Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services Codes 90823, 90824, 90826, 90827, 90828, and have been deleted. Refer to Psychiatry/Psychiatric Diagnostic Procedures: Psychotherapy Subsection Guidance Psychotherapy is the treatment of mental illness and behavioral disturbances, including therapeutic communication to help the patient with emotional disturbances, adjust behaviors, and encourage personal growth. New, timebased codes simplify psychotherapy services reporting. Add-on codes have been created to report psychotherapy with an appropriate E/M code if a significant and separately identifiable evaluation and management is performed. Do not include time spent performing the E/M service as part of the psychotherapy service Psychotherapy, 30 minutes with patient and/or family member Report for minutes of psychotherapy. The time must be face-to-face with the patient and/or family Psychotherapy, 30 minutes with patient and/ or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) Report when minutes of psychotherapy is provided on the same date as an E/M service. The time must be face-to-face with the patient and/or family. Do not include time spent performing the E/M service as part of the psychotherapy service. Select the appropriate E/M code based on the documentation Psychotherapy, 45 minutes with patient and/or family member Report for minutes of psychotherapy. The time must be face-to-face with the patient and/or family Psychotherapy, 45 minutes with patient and/ or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) Report when minutes of psychotherapy is provided on the same date as an E/M service. The time must be face-to-face with the patient and/or family. Do not include time spent performing the E/M service as part of the psychotherapy service. Select the appropriate E/M code based on the documentation Psychotherapy, 60 minutes with patient and/or family member Report for 53 or more minutes of psychotherapy. The time must be face-to-face with the patient and/or family Psychotherapy, 60 minutes with patient and/ or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) Report when 53 or more minutes of psychotherapy are provided on the same date as an E/M service. The time must be face-to-face with the patient and/or family. Do not 32 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

37 Complete 2013 Procedure Coding Updates include time spent performing the E/M service as part of the psychotherapy service. Select the appropriate E/M code based on the documentation. Psychiatry/Psychiatric Diagnostic Procedures: Psychotherapy for Crises New, time-based crisis codes have been established to report treatment for urgent assessment and treatment for a patient in a crisis state. The patient s condition is typically life threatening or complex Psychotherapy for crisis; first 60 minutes Report for the first 60 minutes and (below) for each additional 30 minutes. Time must be face-to-face but is not required to be continuous Psychotherapy for crisis; each additional 30 minutes (list separately in addition to code for primary service) Report (above) for the first 60 minutes and add-on for each additional 30 minutes. Time must be faceto-face but is not required to be continuous Interactive group psychotherapy Code has been deleted. Refer to with Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy Code has been deleted. A parenthetical note directs you to 90863, or the appropriate E/M level if the provider s scope of practice allows reporting E/M service. Psychiatry/Psychiatric Diagnostic Procedures: Other Services or Procedures Code has been created to report pharmacologic management when performed with psychotherapy services. If the provider s scope of practice allows for reporting E/M codes, report the appropriate E/M instead of A parenthetical note instructs you to report with 90832, 90834, or p Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); approximately minutes To be consistent with the other codes in the psychiatry category, has been revised to specify 30 minutes. p Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); approximately minutes To be consistent with the other codes in the psychiatry category, has been revised to specify 45 minutes. p Preparation of report of patient s psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other physicians individuals, agencies, or insurance carriers descriptor for has been amended to allow that this service may be provided by providers other than a physician, to report preparation of a patient s psychiatric status, history, treatment, or progress for other qualified individuals, physicians, agencies, or insurance carriers Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (list separately in addition to the code for primary procedure) = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 33

38 Complete 2013 Procedure Coding Updates Hemodialysis p Hemodialysis procedure with single evaluation by a physician evaluation or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Miscellaneous Dialysis Procedures p Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies), with single evaluation by a physician evaluation or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies) requiring repeated evaluation by a physician evaluation or other qualified health care professional, with or without substantial revision of dialysis prescription descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. End-Stage Renal Disease Services p End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician visits or other qualified health care professional per month descriptors for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-toface visits by a physician visits or other qualified health care professional per month descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-toface visits by a physician visits or other qualified health care professional per month descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician visits or other qualified health care professional per month descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p end-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician visits or other qualified health care professional per month descriptor for has been amended to allow that this 34 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

39 Complete 2013 Procedure Coding Updates service may be performed by a physician or other qualified health care professional. p End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visits by a physician visits or other qualified health care professional per month descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p End-stage renal disease (ESRD) related services monthly, for patients years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician visits or other qualified health care professional per month descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p End-stage renal disease (ESRD) related services monthly, for patients years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician visits or other qualified health care professional per month descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p End-stage renal disease (ESRD) related services monthly, for patients years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visits by a physician visits or other qualified health care professional per month descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician visits or other qualified health care professional per month descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 2-3 faceto-face visits by a physician visits or other qualified health care professional per month descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 1 faceto-face visits by a physician visits or other qualified health care professional per month descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Gastroenterology p Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with physician interpretation and report descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 35

40 Complete 2013 Procedure Coding Updates recommendation may be reported by other (non-physician), qualified attending health care professionals. p Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus with physician interpretation and report descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report Code replaces Category III code 0242T. The procedure involves pressure measurements from the stomach to the colon. Special Ophthalmological Services: Other p Special anterior Anterior segment photography imaging with interpretation and report; with specular endothelial microscopy and endothelial cell count analysis Because films have been replaced by digital images, the code descriptor has been revised to more accurately report the work done. p Special anterior Anterior segment photography imaging with interpretation and report; with fluorescein angiography Because films have been replaced by digital images, the code descriptor has been revised to more accurately report the work done. Special Otorhinolaryngologic Services: Evaluative and Therapeutic Services p Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording; physician interpretation and report only descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. p Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording; physician interpretation and report only descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. p Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording; physician interpretation and report only descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. Cardiovascular: Coronary Therapeutic Services and Procedures Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel Codes 92980, 92981, 92982, and have been deleted. See Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel (List separately in addition to code for primary procedure) Codes 92980, 92981, 92982, and have been deleted. See = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

41 Complete 2013 Procedure Coding Updates Percutaneous transluminal coronary balloon angioplasty; single vessel Codes 92980, 92981, 92982, and have been deleted. See Percutaneous transluminal coronary balloon angioplasty; each additional vessel (List separately in addition to code for primary procedure) Codes 92980, 92981, 92982, and have been deleted. See Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel Codes 92995, have been deleted. See new codes 92924, 92925, and Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; each additional vessel (List separately in addition to code for primary procedure) Codes 92995, have been deleted. See new codes 92924, 92925, and Cardiovascular/Therapeutic Services and Procedures: Coronary Subsection Guidance A new subsection has been added to CPT for coronary therapeutic services and procedures, which includes guidelines to define services and provide instruction for code use. Combination codes are used when the same vessel requires angioplasty, stent, and atherectomy. You should report only the most extensive procedure performed in each vessel. During PCI, multiple procedures may be performed in multiple vessels. You may report codes for the major coronary arteries, as well as well as for branches of the coronary arteries. The coronary arteries are left main, left anterior descending, left circumflex, right main, and ramus intermedius. All segments (proximal, mid, distal) are included in the major coronary artery procedure, unless one of the segments requires access through a bypass graft, in which case the bypass graft may be reported separately. For coding purposes, the recognized branches of the major coronary arteries are the diagonals of the left anterior descending, marginals of left circumflex, and posterior descending posterolaterals of the right. You may code no more than two branches for a major coronary artery. Base codes (92920, 92924, 92928, 92933, 92937, 92941, and 92943) are reported for the most extensive procedure in a major coronary artery. If PCI is performed during the same session in additional major coronary arteries or bypass graft, report the appropriate base code. If PCI is performed in additional coronary branches, report the applicable add-on code (92921, 92925, 92929, 92934, 92938, or 92944). PCI includes access, selective catheterization, radiologic supervision and interpretation, closure of arteriotomy, and imaging to document completion of the procedure. Diagnostic coronary angiography is usually included, but may be separately reported under the circumstances explained in the guidelines preceding the PCI codes. To properly code percutaneous coronary interventions (PCI), you must know the type of procedure(s) performed (angioplasty, stent, and/or atherectomy). During angioplasty, a balloon-tipped catheter is inserted and inflated to open an occluded vessel. Stent(s) may be required to prop open the vessel. During atherectomy, a catheter with a sharp blade is used to cut away the occlusion. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 37

42 Complete 2013 Procedure Coding Updates # Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch Report for atherectomy in a major coronary artery or branch. Angioplasty performed in the same vessel is included. # Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) Report for each additional branch of a major coronary artery. A parenthetical note lists which primary codes may be reported with. Angioplasty performed in the same vessel is included. Anatomical Illustrations 2012, OptumInsight, Inc. # Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch Report when one or more stents are placed in a major coronary artery. The procedure is coded per major coronary artery not per stent placed. Angioplasty performed in the same vessel is included. # Percutaneous transluminal coronary angioplasty; single major coronary artery or branch Report angioplasty when no other invention (stent or atherectomy) is performed in the major coronary artery. Claim one unit of for each major coronary vessel. # Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) Report for each additional branch of a major artery. A parenthetical note describes which primary codes may be reported with. Claim when angioplasty is the only intervention performed in the vessel. # Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) Report when one or more stents are placed in an additional branch of a major coronary artery. The procedure is coded per major coronary artery branch not per stent placed. Angioplasty performed in the same vessel is included. 38 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

43 Complete 2013 Procedure Coding Updates # Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch Report combination code for angioplasty, stent(s), and atherectomy performed in the same major coronary artery or branch. # Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) Report combination code for angioplasty, stent(s), and atherectomy performed in each additional branch of a major coronary artery. # 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 New codes have been created to report any intervention (angioplasty, stent, and/or atherectomy) performed through a coronary bypass graft. When multiple interventions are performed on native vessels in addition to bypass grafts, select a base code for the intervention for the native vessels, as well as the bypass graft. # 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; each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure) Report add-on code for any intervention (angioplasty, stent, atherectomy) performed in each additional branch subtended by the bypass graft. # 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 Report for any combination of services (angiography, stent, atherectomy) for a patient having an acute myocardial infarction causing an acute, subtotal occlusion. Mechanical thrombectomy (92973) may be reported separately, if performed. # 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 Report for any combination of services (angiography, stent, atherectomy) for a patient with chronic total occlusion. CPT defines chronic occlusion as no antegrade flow through the true lumen, accompanied by suggestive angiographic and clinical criteria. The clinical criterion is included in the coding guidelines preceding the PCI codes. # 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; each additional coronary artery, coronary artery branch, or bypass graft (list separately in addition to code for primary procedure) Report for each additional coronary artery, branch, or bypass graft for any combination of services (angiography, stent, atherectomy) for a patient with chronic total occlusion. CPT defines chronic occlusion as no antegrade flow through the true lumen, accompanied by suggestive angiographic and clinical criteria. The clinical criterion is included in the coding guidelines preceding the PCI codes. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 39

44 Complete 2013 Procedure Coding Updates # Percutaneous transluminal coronary thrombectomy mechanical (list separately in addition to code for primary procedure) was revised to add mechanical to promote proper coding. This code is not reported for chemical thrombectomy. Cardiography p Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. p Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. Cardiovascular Monitoring Services p External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, physician review and interpretation by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; physician review and interpretation by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; physician review and interpretation by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and physician prescribed transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. 40 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

45 Complete 2013 Procedure Coding Updates p External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, physician review and interpretation by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; physician review and interpretation by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Implantable and Wearable Cardiac Device Evaluations p Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values physician analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report by a physician or other qualified health care professional; single lead implantable cardioverter-defibrillator system descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report by a physician or other qualified health care professional; dual lead implantable cardioverter-defibrillator system descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 41

46 Complete 2013 Procedure Coding Updates p Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report by a physician or other qualified health care professional; multiple lead implantable cardioverter-defibrillator system descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report by a physician or other qualified health care professional; implantable loop recorder system descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with physician analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with physician analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable cardioverterdefibrillator system descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Interrogation device evaluation (in person) with physician analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Interrogation device evaluation (in person) with physician analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead implantable cardioverter-defibrillator system, including analysis of heart rhythm derived data elements descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Interrogation device evaluation (in person) with physician analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Interrogation device evaluation (in person) with physician analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable loop recorder system, including heart rhythm derived data analysis descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. 42 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

47 Complete 2013 Procedure Coding Updates p Interrogation device evaluation (in person) with physician analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; wearable defibrillator system descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with physician analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim physician analysis, review and report(s) by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable cardioverterdefibrillator system with interim physician analysis, review and report(s) by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, physician analysis, review and report(s) by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Interrogation device evaluation(s), (remote) up to 30 days; implantable loop recorder system, including analysis of recorded heart rhythm data, physician analysis, review and report(s) by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Echocardiography p Echocardiography, transthoracic, real-time with image documentation (2d), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with supervision by a physician supervision or other qualified health care professional descriptor for has been amended to allow that the supervision service may be performed by a physician or other qualified health care professional. Intracardiac Electrophysiological Procedure/Studies Subsection Guidance To combine comprehensive electrophysiologic evaluation with intracardiac catheter ablation of arrhythmogenic focus services, codes and have been deleted and replaced by new codes = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 43

48 Complete 2013 Procedure Coding Updates Intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination Codes and have been deleted. See new codes Intracardiac catheter ablation of arrhythmogenic focus; for treatment of ventricular tachycardia Codes and have been deleted. See new codes 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 Report when comprehensive electrophysiologic evaluation is performed in addition to ablation of supraventricular tachycardia. Ablation is the destruction of tissue in the heart to correct arrhythmia. Supraventricular tachycardia (SVT) is rapid heart rhythm originating above the ventricular tissue 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 ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3d mapping, when performed, and left ventricular pacing and recording, when performed Report when comprehensive electrophysiologic evaluation is performed in addition to ablation of ventricular tachycardia or focus of ventricular ectopy. Ablation is the destruction of tissue in the heart to correct arrhythmia. Ventricular tachycardia is rapid heartbeat that starts in the ventricles 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 or induced arrhythmia (list separately in addition to code for primary procedure) Report with 93653, 93654, or when an additional mechanism of arrhythmia requires ablation in addition to the primary site 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 Report when comprehensive electrophysiologic evaluation is performed in addition to ablation of atrial fibrillation. Atrial fibrillation is an abnormal heart rhythm where the upper chambers of the heart (atria) beat irregularly and rapidly 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) Report with if ablation of the left or right atrium is required for atrial fibrillation remaining after pulmonary vein isolation. Noninvasive Physiologic Studies and Procedures p Initial set-up and programming by a physician or other qualified health care professional of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. 44 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

49 Complete 2013 Procedure Coding Updates p Interrogation of ventricular assist device (VAD), in person, with physician or other qualified health care professional analysis of device parameters (eg, drivelines, alarms, power surges), review of device function (eg, flow and volume status, septum status, recovery), with programming, if performed, and report descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; physician review with interpretation and report descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. Cardiovascular: Other Procedures p Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Physician or other qualified health care professional services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Pulmonary: Diagnostic Testing and Therapies p Patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and physician review and interpretation by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Patient-initiated spirometric recording per 30-day period of time; physician review and interpretation by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p High altitude simulation test (HAST), with physician interpretation and report by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p High altitude simulation test (hast), with physician interpretation and report by a physician or other qualified health care professional; with supplemental oxygen titration descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 45

50 Complete 2013 Procedure Coding Updates p Intrapulmonary surfactant administration by a physician or other qualified health care professional through endotracheal tube descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Code is Modifier 51 exempt. p Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; includes monitor attachment, download of data, physician review, interpretation, and preparation of a report by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; physician review, interpretation, and preparation of a report by a physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Allergy and Clinical Immunology: Allergy Testing p Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals Percutaneous tests (scratch, puncture, prick) sequential and incremental, with drugs, biologicals or venoms, immediate type reaction, including test interpretation and report by a physician, specify number of tests Codes and have been deleted and replaced by and Intracutaneous (intradermal) tests, sequential and incremental, with drugs, biologicals, or venoms, immediate type reaction, including test interpretation and report by a physician, specify number of tests Codes and have been deleted and replaced by and 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 Codes and have been deleted. New codes describe percutaneous and/or intracutaneous allergy testing. The codes are selected based on whether the testing is with venoms or drugs and biological. Report for allergy testing with venoms Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests Codes and have been deleted. New codes describe percutaneous and/or intracutaneous allergy testing. The codes are selected based on whether the testing is with venoms or drugs and biological. Report when performing allergy testing with drugs or biologicals. 46 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

51 Complete 2013 Procedure Coding Updates p Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. p Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report by a physician, specify number of tests descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. Allergy and Clinical Immunology: Ingesting Challenge Testing Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance such as metabisulfite) Code has been deleted and replaced with timebased codes and Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); initial 120 minutes of testing Report for the first 120 minutes of testing to confirm an allergy by ingestion challenge test. Time-based codes and replace deleted code Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); each additional 60 minutes of testing (list separately in addition to code for primary procedure) Report add-on code for each additional 60 minutes, beyond the initial 120 minutes of testing (95076), to confirm an allergy by ingestion challenge test. Time-based codes and replace deleted code Allergy and Clinical Immunology: Allergen Immunotherapy p Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; single injection descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. p Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 2 or more injections descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. p Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; single stinging insect venom descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. p Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 2 stinging insect venoms = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 47

52 Complete 2013 Procedure Coding Updates descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. p Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 3 stinging insect venoms descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. p Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 4 stinging insect venoms descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. p Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 5 stinging insect venoms descriptor for has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. Neurology and Neuromuscular Procedures: Sleep Medicine Testing p Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist New polysomnography codes specify patient age, as well as type of study performed: has been revised to indicate the code may be reported for any age. p Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist New polysomnography codes specify patient age, as well as type of study performed: has been revised to indicate the code can be reported for patients six years of age, or older. p Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist New polysomnography codes specify patient age, as well as type of study performed: was revised to indicate the code may be reported for patients six years old, or older. This code differs from in that it includes initiation of continuous positive airway pressure (CPAP) therapy or bilevel ventilation. CPAP is performed by a machine that uses mild air pressure to keep the airways open. If obstructive sleep apnea is identified during a polysomnography, CPAP titration is performed to determine the pressure needed to resolve the sleep apnea, and to determine the appropriate settings if the patient needs a positive airway pressure device for treatment. 48 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

53 Complete 2013 Procedure Coding Updates # Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist Code describes polysomnography in patients younger than 6 years of age. The study includes sleep staging and four or more additional sleep parameters. The additional parameters are defined in the coding guidelines preceding the polysomnography codes. If fewer than seven hours of reporting are performed, append modifier 52. # Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist Code describes polysomnography in patients younger than 6 years of age. The study includes sleep staging and four or more additional sleep parameters. The additional parameters are defined in the coding guidelines preceding the polysomnography codes. This study also includes the initiation of continuous positive airway pressure (CPAP) or bi-level ventilation. CPAP is performed by a machine that uses mild air pressure to keep the airways open. If obstructive sleep apnea is identified during a polysomnography, CPAP titration is performed to determine the pressure needed to resolve the sleep apnea, and to determine the appropriate settings if the patient needs a positive airway pressure device for treatment. If fewer than seven hours of reporting are performed, append modifier 52. Neurology and Neuromuscular Procedures: Routine Electroencephalography p Insertion by physician or other qualified health care professional of sphenoidal electrodes for electroencephalographic (EEG) recording descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Neurology and Neuromuscular Procedures: Nerve Conduction Tests Subsection Guidance New coding guidelines define services performed for motor and nerve conduction studies. Motor nerve conduction studies require electrodes to be placed over the motor points of the muscle being tested. Nerve conduction studies require electrodes to be placed over the specific nerve to be tested. Codes are selected based on the number of studies performed. A study is defined as sensory conduction test, a motor conduction test with or without an F-wave test, or an H-reflex test. Nerve conduction studies are reported only once when the test includes multiple sites on the same nerve. To assist with coding, Appendix J includes a list of nerves and a table indicating the reasonable maximum number of studies performed for common diagnosis. When electromyography is performed with nerve conduction studies, use Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study Codes have been deleted. See new codes Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study Codes have been deleted. See new codes = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 49

54 Complete 2013 Procedure Coding Updates Nerve conduction, amplitude and latency/velocity study, each nerve; sensory Codes have been deleted. See new codes Nerve conduction studies; 1-2 studies Report nerve conduction studies based on the number of studies performed: Claim for one or two studies Nerve conduction studies; 3-4 studies Report nerve conduction studies based on the number of studies performed: Claim for three to four studies Nerve conduction studies; 5-6 studies Report nerve conduction studies based on the number of studies performed: Claim for five to six studies Nerve conduction studies; 7-8 studies Report nerve conduction studies based on the number of studies performed: Claim for seven to eight studies Nerve conduction studies; 9-10 studies Report nerve conduction studies based on the number of studies performed: Claim for nine to 10 studies Nerve conduction studies; studies Report nerve conduction studies based on the number of studies performed: Claim for 11 to 12 studies Nerve conduction studies; 13 or more studies Report nerve conduction studies based on the number of studies performed: Claim for 13 or more studies. Neurology and Neuromuscular Procedures: Autonomic Function Tests Intraoperative neurophysiology testing, per hour (List separately in addition to code for primary procedure) Code has been deleted. For intraoperative neurophysiology monitoring, see new add-on codes and Subsection Guidance Continuous intraoperative neurophysiology monitoring can be performed either in or outside of the operating room. These add-on codes are reported for monitoring time, in addition to the codes for the baseline studies (a parenthetical note lists the appropriate baseline study codes). Intraoperative monitoring performed by the surgeon or anesthesiologist is not reported separately. # Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (list separately in addition to code for primary procedure) Report for intraoperative neurophysiology monitoring, for each 15 minutes of monitoring time performed in the operating room. Do not count the time performing baseline tests in the time for monitoring. No other cases can be monitored when reporting # Continuous intraoperative neurophysiology monitoring, 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) Report for intraoperative neurophysiology monitoring, per hour, for monitoring outside of the operating room, or when monitoring more than one case in the operating room. Do not count the time performing baseline tests in the time for monitoring. Do not report if monitoring lasts 30 minutes or less. 50 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

55 Complete 2013 Procedure Coding Updates # Testing of autonomic nervous system function; combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt Code describes combined parasympathetic and sympathetic adrenergic function tests. The tests are performed to determine the presence and site of autonomic dysfunction, and the autonomic subsystems that may be disordered. Report if the service described by and are performed during the same session. # 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 Report if a tilt table is not used during autonomic function tests: require the use of a tilt table H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle Codes 95934, have been deleted. Refer to H-reflex, amplitude and latency study; record muscle other than gastrocnemius/soleus muscle Codes 95934, have been deleted. Refer to Neurology and Neuromuscular Procedures: Special EEG Tests p Pharmacological or physical activation requiring physician or other qualified health care professional attendance during EEG recording of activation phase (eg, thiopental activation test) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of attendance by a physician attendance or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; each additional hour of attendance by a physician attendance or other qualified health care professional (list separately in addition to code for primary procedure) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Neurology and Neuromuscular Procedures: Other p Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; requiring skill of a physician s skill or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Neurology and Neuromuscular Procedures: Motion Analysis p Physician review Review and interpretation by physician or other qualified health care professional of comprehensive computer-based motion analysis, dynamic plantar pressure = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 51

56 Complete 2013 Procedure Coding Updates measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, with written report descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Neurology and Neuromuscular Procedures: Functional Brain Mapping p Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional (ie, psychologist), with review of test results and report descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Physical Medicine and Rehabilitation: Therapeutic Procedures p Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes descriptor for has been amended to allow greater flexibility in who may report this service. p Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 minutes descriptor for has been amended to allow greater flexibility in who may report this service. p Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, by the provider each 15 minutes descriptor for has been amended to allow greater flexibility in who may report this service. p Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, by the provider each 15 minutes descriptor for has been amended to allow greater flexibility in who may report this service. p Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact by provider, each 15 minutes descriptor for has been amended to allow greater flexibility in who may report this service. Physical Medicine and Rehabilitation: Tests and Measurements p Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact by provider, with written report, each 15 minutes descriptor for has been amended to allow greater flexibility in who may report this service. 52 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

57 Complete 2013 Procedure Coding Updates Non-Face-to-Face Nonphysician Services: On-line Medical Evaluation p Online assessment and management service provided by a qualified nonphysician health care professional to an established patient, or guardian, or health care provider, not originating from a related assessment and management service provided within the previous 7 days, using the internet or similar electronic communications network This code was revised to remove "other qualified health care professional" because a health care provider would not provide an assessment on another health care provider. The code was revised to correct an error made in the code description. Special Services, Procedures and Reports: Miscellaneous p Handling and/or conveyance of specimen for transfer from the physician s office to a laboratory descriptor for has been amended to allow greater flexibility in who may report this service. p Handling and/or conveyance of specimen for transfer from the patient in other than a physician s an office to a laboratory (distance may be indicated) descriptor for has been amended to allow greater flexibility in who may report this service. p Handling, conveyance, and/or any other service in connection with the implementation of an order involving devices (eg, designing, fitting, packaging, handling, delivery or mailing) when devices such as orthotics, protectives, prosthetics are fabricated by an outside laboratory or shop but which items have been designed, and are to be fitted and adjusted by the attending physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Educational supplies, such as books, tapes, and pamphlets, provided by the physician for the patient s education at cost to physician or other qualified health care professional descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional qualified by education, training, licensure/regulation. p Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/ or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional qualified by education, training, licensure/regulation. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 53

58 Complete 2013 Procedure Coding Updates Moderate (Conscious) Sedation p Moderate sedation services (other than those services described by codes ) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; younger than 5 years of age, first 30 minutes intra-service time descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Code is modifier 51 exempt. p Moderate sedation services (other than those services described by codes ) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Code is modifier 51 exempt. p Moderate sedation services (other than those services described by codes ) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; each additional 15 minutes intra-service time (list separately in addition to code for primary service) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Moderate sedation services (other than those services described by codes ), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; younger than 5 years of age, first 30 minutes intra-service time descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Moderate sedation services (other than those services described by codes ), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; age 5 years or older, first 30 minutes intra-service time descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. p Moderate sedation services (other than those services described by codes ), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intra-service time (list separately in addition to code for primary service) descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Medicine: Other Services and Procedures p Ocular photoscreening with interpretation and report Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral Code has been revised to more accurately describe the procedure performed. Photoscreening and automated refraction instruments are used when performing this screening test. 54 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

59 Complete 2013 Procedure Coding Updates p Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session descriptor for has been amended to allow that this service may be performed by a physician or other qualified health care professional. Category II Codes Category II codes are supplemental tracking codes to report performance measures, which are specific services and test results that have been shown through evidencebased medicine to support and contribute to quality patient care. Reporting of Category II codes is optional, at this time. Category II codes have no relative value associated with them because they describe clinical components included in E/M or other clinical services. Category II codes should not be used in place of Category I or Category III codes. For 2013, CPT has added seven new Category II codes, revised six codes, and deleted one code. For additional information on these codes, consult your CPT codebook or the AMA website at: physician-resources/solutions-managing-your-practice/ coding-billing-insurance/cpt/about-cpt/category-iicodes.page?. Category III Codes Category III codes describe emerging technologies and, unlike Category I unlisted procedure codes, allow for tracking and collection of specific data. If a Category III code is available, it must be reported instead of a Category I unlisted procedure code. Category III codes have a fiveyear life span: Per CPT guidelines, if a Category III code is not replaced by a Category I code (or otherwise revised) within five years, the Category III code will sunset (i.e., be archived), unless it is demonstrated that a temporary code is still needed. Category III Code 0030T Antiprothrombin (phospholipid cofactor) antibody, each Ig class Code 0030T has been deleted. Use for antiprothrombin antibody. 0048T Implantation of a ventricular assist device, extracorporeal, percutaneous transseptal access, single or dual cannulation Code has been deleted. Refer to new code T Removal of a ventricular assist device, extracorporeal, percutaneous transseptal access, single or dual cannulation Code 0050T has been deleted. Refer to new codes T Monitoring of intraocular pressure during vitrectomy surgery (List separately in addition to code for primary procedure) Code 0173T has been deleted. p 0195T Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, including without instrumentation, imaging (when performed) with image guidance, and discectomy to prepare interspace, lumbar includes bone graft when performed; single L5-S1 interspace Code 0195T was revised to include bundled services and to indicate the procedure is performed without instrumentation, to distinguish it from p 0196T Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, including without instrumentation, imaging (when performed) with image guidance, and discectomy to prepare interspace, lumbar includes bone graft when performed; each additional L4-L5 interspace (list separately in addition to code for primary procedure) Code 0196T was revised to include bundled services and to indicate the procedure is performed without instrumentation, to distinguish it from = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 55

60 Complete 2013 Procedure Coding Updates p 0206T Algorithmic 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 electrocardiographic-derived data multiple nonlinear mathematical transformations, with computer probability assessment, including report coronary artery obstruction severity assessment Code 0206T has been revised to more accurately describe the procedure. This code is used to identify coronary artery obstruction, and is not intended for cardiac ischemia. 0242T Gastrointestinal tract transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report Code 0242T has been deleted. Refer to new code T Airway sizing and insertion of bronchial valve(s), each lobe (List separately in addition to code for primary procedure) Code 0250T has been deleted. Refer to new codes T Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe Code 0251T has been deleted. Refer to new codes T Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), each additional lobe (List separately in addition to code for primary procedure) Code 0252T has been deleted. Refer to new codes T Implantation of catheter-delivered prosthetic aortic heart valve; endovascular approach Code 0256T has been deleted. Refer to new codes T Implantation of catheter-delivered prosthetic aortic heart valve; open thoracic approach (eg, transapical, transventricular) Code 0257T has been deleted. Refer to new codes and 0318T. 0258T Transthoracic cardiac exposure (eg, sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; without cardiopulmonary bypass Code 0258T has been deleted. Refer to new codes and T Transthoracic cardiac exposure (eg, sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; with cardiopulmonary bypass Code 0259T has been deleted. Refer to new codes T Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe Codes 0276T and 0277T have been deleted. Refer to new codes and T Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes Codes 0276T and 0277T have been deleted. Refer to new codes and T Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood) Codes 0279T and 0280T have been deleted. Refer to new codes and = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

61 Complete 2013 Procedure Coding Updates 0280T Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); interpretation and report Codes 0279T and 0280T have been deleted. Refer to new codes and T 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) Intravascular optical coherence tomography provides microstructural information on atherosclerotic plaques. Report 0291T in addition to cardiac catheterization (92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975, , 93563, 93564) for the initial vessel. 0292T Intravascular optical coherence tomography (coronary native vessel or graft) during diagnostic evaluation and/or therapeutic intervention, including imaging supervision, interpretation, and report; each additional vessel (list separately in addition to primary procedure) Intravascular optical coherence tomography provides microstructural information on atherosclerotic plaques. Report 0292 for each additional vessel, as an add-on with 0291T and primary cardiac catheterization (92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975, , 93563, 93564). 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 Code 0293T describes insertion of a device to monitor left atrial pressure, to identify pressure changes in patients with heart failure. Do not report 0293T with or T Insertion of left atrial hemodynamic monitor; pressure sensor lead at time of insertion of pacing cardioverterdefibrillator pulse generator including radiological supervision and interpretation and associated injection procedures, when performed (list separately in addition to code for primary procedure) Report 0294T for insertion of a device to monitor left atrial pressure, when performed during insertion of a pacing cardioverter-defibrillator. The device is used to identify pressure changes in patients with heart failure. Claim 0294T in addition to 33230, 33231, 33240, , or Do not report with or T 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 New codes describe external electrocardiographic recording for more than 48 hours, up to 21 days. Current codes ( ) report similar recording when performed up to 48 hours. Combination code 0295T describes all the components (recording, scanning analysis with report, review and interpretation). Codes 0296T 0298T report the component services separately, in case the services are performed by different providers. 0296T External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; recording (includes connection and initial recording) New codes describe external electrocardiographic recording for more than 48 hours, up to 21 days. Current codes ( ) report similar recording when performed up to 48 hours. Report 0296T for recording only. If the same provider performs recording, scanning analysis with report, review and interpretation, report 0295T. 0297T External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; scanning analysis with report New codes describe external electrocardiographic recording for more than 48 hours, up to 21 days. Current codes = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 57

62 Complete 2013 Procedure Coding Updates ( ) report similar recording when performed up to 48 hours. Report 0297T for scanning analysis with report only. If the same provider performs recording, scanning analysis with report, review and interpretation, report 0295T. 0298T External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; review and interpretation New codes describe external electrocardiographic recording for more than 48 hours, up to 21 days. Current codes ( ) report similar recording when performed up to 48 hours. Report 0298T for review and interpretation only. If the same provider performs recording, scanning analysis with report, review and interpretation, report 0295T. 0299T Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound Extracorporeal shock wave treatment (ESWT) has been shown in the clinical setting to promote the healing of burns and other difficult-to-heal wounds. Codes for ESWT for wound healing are reported per wound. Claim 0299T for the initial wound. Code 0301T describes focused microwave thermotherapy of the breast. Microwave applicators are placed on either side of the compressed breast. A probe is placed within the breast to monitor the interstitial temperature. The technique is based on the preferential microwave heating that occurs in high-water content breast carcinoma, compared to the surrounding lower water content healthy breast tissues. The procedure includes imaging guidance. Do not report 0301T with 76645, 76942, 76998, or T 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) An intracardiac ischemic monitoring device system includes a generator, adaptor, and transvenous lead. The system detects and warns patients during a major ischemic coronary event (eg, coronary plaque rupture). New codes report insertion of the system, insertion of individual components when the entire system is not inserted, removal of the system, programming, and interrogation. Report 0302T when the entire system is inserted or replaced. The procedure includes interrogation and programming. 0300T Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; each additional wound (list separately in addition to code for primary procedure) Codes for ESWT for wound healing are reported for each wound. Report +0300T for each additional wound, in addition to 0299T for the initial wound. 0301T 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 0303T 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; electrode only An intracardiac ischemic monitoring device system includes a generator, adaptor, and transvenous lead. The system detects and warns patients during a major ischemic coronary event (eg, coronary plaque rupture). New codes report insertion of the system, insertion of individual components when the entire system is not inserted, removal of the system, programming, and interrogation. Report 0303T when the electrode is inserted or replaced. The procedure includes interrogation and programming. 58 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

63 Complete 2013 Procedure Coding Updates 0304T 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; device only An intracardiac ischemic monitoring device system includes a generator, adaptor, and transvenous lead. The system detects and warns patients during a major ischemic coronary event (eg, coronary plaque rupture). New codes report insertion of the system, insertion of individual components when the entire system is not inserted, removal of the system, programming, and interrogation. Report 0304T when the device is inserted or replaced. The procedure includes interrogation and programming. 0305T Programming device evaluation (in person) of intracardiac ischemia monitoring system with iterative adjustment of programmed values, with analysis, review, and report An intracardiac ischemic monitoring device system includes a generator, adaptor, and transvenous lead. The system detects and warns patients during a major ischemic coronary event (eg, coronary plaque rupture). New codes report insertion of the system, insertion of individual components when the entire system is not inserted, removal of the system, programming, and interrogation. Report 0305T for programming and adjustments of the system, including analysis, review, and report. The service must be performed in person. 0306T Interrogation device evaluation (in person) of intracardiac ischemia monitoring system with analysis, review, and report An intracardiac ischemic monitoring device system includes a generator, adaptor, and transvenous lead. The system detects and warns patients during a major ischemic coronary event (eg, coronary plaque rupture). New codes report insertion of the system, insertion of individual components when the entire system is not inserted, removal of the system, programming, and interrogation. Report 0306T for interrogation of the system, including analysis, review, and report. The service must be performed in person. 0307T Removal of intracardiac ischemia monitoring device An intracardiac ischemic monitoring device system includes a generator, adaptor, and transvenous lead. The system detects and warns patients during a major ischemic coronary event (eg, coronary plaque rupture). New codes report insertion of the system, insertion of individual components when the entire system is not inserted, removal of the system, programming, and interrogation. Report 0307T when the device is removed without replacement. 0308T Insertion of ocular telescope prosthesis including removal of crystalline lens Code 0308T describes insertion and implantation of a telescope into the lens capsule. The procedure is performed on patients with central vision loss caused by end-stage, age-related macular degeneration. Code 0308T is modifier 51 exempt. 0309T 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) The new code has been created to report pre-sacral interbody technique arthrodesis with posterior instrumentation. Code 0309T includes the disc preparation, discectomy, posterior instrumentation, imaging guidance, and bone graft. Report 0309T when the procedure is performed at the L4-L5 interspace. This code is used with Do not report with , 22840, 22848, 72275, 77002, 77003, 77011, or T Motor function mapping using non-invasive navigated transcranial magnetic stimulation (ntms) for therapeutic treatment planning, upper and lower extremity Report 0310T for motor function mapping accomplished by combining transcranial magnetic stimulation (TMS) and electromyography (EMG) with guidance, with magnetic resonance. The test is performed to identify functional motor cortex prior to brain surgery. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 59

64 Complete 2013 Procedure Coding Updates 0311T Non-invasive calculation and analysis of central arterial pressure waveforms with interpretation and report Code 0311T describes central arterial pressure waveforms to evaluate patients with difficult-to-treat hypertension (eg not responding to medication). 0312T 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 programming Vagal blocking employs a device to block hunger and satiety signals from the vagus nerve. The procedure is performed laparoscopically and does not alter the anatomy of the stomach. A total of six Category III codes were created to report the insertion of the system, revision or replacement of the components of the system, removal of components, and analysis and reprogramming. Report 0312T for laparoscopic implantation of the neurostimulator electrode array, pulse generator, and programming. 0313T Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagal blocking employs a device to block hunger and satiety signals from the vagus nerve. The procedure is performed laparoscopically and does not alter the anatomy of the stomach. A total of six Category III codes were created to report the insertion of the system, revision or replacement of the components of the system, removal of components, and analysis and reprogramming. Report 0313T for laparoscopic revision or replacement of the electrode array, and connection to the existing pulse generator. 0314T Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagal blocking employs a device to block hunger and satiety signals from the vagus nerve. The procedure is performed laparoscopically and does not alter the anatomy of the stomach. A total of six Category III codes were created to report the insertion of the system, revision or replacement of the components of the system, removal of components, and analysis and reprogramming. Report 0314T for laparoscopic removal of the electrode array and pulse generator only. 0315T Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagal blocking employs a device to block hunger and satiety signals from the vagus nerve. The procedure is performed laparoscopically and does not alter the anatomy of the stomach. A total of six Category III codes were created to report the insertion of the system, revision or replacement of the components of the system, removal of components, and analysis and reprogramming. Report 0315T for removal of the pulse generator only. 0316T Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagal blocking employs a device to block hunger and satiety signals from the vagus nerve. The procedure is performed laparoscopically and does not alter the anatomy of the stomach. A total of six Category III codes were created to report the insertion of the system, revision or replacement of the components of the system, removal of components, and analysis and reprogramming. Report 0316T for replacement of the pulse generator only. 60 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

65 Complete 2013 Procedure Coding Updates 0317T Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Vagal blocking employs a device to block hunger and satiety signals from the vagus nerve. The procedure is performed laparoscopically and does not alter the anatomy of the stomach. A total of six Category III codes were created to report the insertion of the system, revision or replacement of the components of the system, removal of components, and analysis and reprogramming. Report 0317T for electronic analysis and reprogramming of the pulse generator. 0318T Implantation of catheter-delivered prosthetic aortic heart valve, open thoracic approach, (eg, transapical, other than transaortic) Procedures for the implantation of a prosthetic aortic heart valve are reported based on approach. Report 0318T when the procedure is performed using an open thoracic approach. A parenthetical note directs you to for other approaches. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 61

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67 Complete 2013 Procedure Practical Coding Updates Activity Practical Activity During this portion of the workshop, you will be coding five cases. These cases were selected to test new codes or coding concepts for You will be given time to code the cases on your own. After you complete the cases, your presenter will review the answers and rationales with you. For each case, select the appropriate CPT codes, and modifiers if applicable. Case 1 DATE OF PROCEDURE: January 31, 2013 PROCEDURE PERFORMED: 1. Cervical cerebral arch angiography 2. Selective catheter placement, bilateral common carotid artery 3. Selective innominate and bilateral carotid, cervical, and intracervical angiography BRIEF HISTORY OF PRESENT ILLNESS: This is a 67-year-old Caucasian female who presented with abnormal Doppler study with outpatient carotid bruit. She underwent cardiac vascular consultation, and elected to proceed with carotid angiography to accurately assess disease severity and plan for management. Carotid velocities were 317/132 cm per second with a ratio of Left internal carotid velocities were 166/67 cm per second with a ratio of Bilateral vertebral artery flow direction with antegrade and normal. Informed consent was obtained. The risk/benefit ratio of the procedure was explained. On arrival to the lab, the patient was in pain-free, hemodynamically stable condition. A 5-French sheath was placed in right common femoral artery over a J-wire. A pigtail catheter was advanced and was parked in the ascending aorta and 25 ml of contrast was injected at 20 ml per second and a cerebral arch angiography was performed. Subsequently, a Bernstein-2 catheter was advanced and sequentially placed with the help of a Glidewire in the innominate, right common, and left common carotid artery, selective innominate, bilateral cervical carotid, and intracerebral carotid angiography was performed using diluted Visipaque dye injection. Complications were none immediate. FINDINGS: This is a type 2 (B) arch with a slight downward displacement of innominate artery and left common carotid artery. Innominate artery is widely patent and bifurcates normally into the subclavian and common carotid artery. Subclavian artery has mild, non-obstructive plaque and gives rise to dominant vertebral and internal mammary artery, which are unremarkable. The right common carotid artery is free of significant disease. The right internal carotid artery at its origin has complex hazy 90 percent grade stenosis. There is a faint contrast line, and it appears there is significant calcification on the back wall of this vessel. The remainder of the cervical internal carotid artery is unremarkable. Right external carotid artery has mild non-obstructed plaque at its origin. Intracerebral right angiography reveals unremarkable intracerebral internal carotid artery sub-segments and normal cerebral artery and middle cerebral artery. No intracerebral aneurysms are identified. Capillary phases and venous phases are unremarkable. The left common carotid artery has non-obstructing plaque at its origin. The left carotid bulb has out-pouching and a small contained ulcerated area. The left internal carotid artery at its origin has 60 percent smooth excentric stenosis. The remainder of the left cervical and intracerebral internal carotid artery are unremarkable. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 63

68 Complete Practical Activity 2013 Procedure Coding Updates The left middle cerebral and internal carotid arteries are unremarkable. Vertebral artery angiography was not performed due to lack of any posterior fossa symptoms. Subclavian artery was unremarkable. All the equipment was removed and access site hemostasis was achieved with manual compression. IMPRESSION: Critical right internal carotid artery and moderate-grade left internal carotid artery stenosis. CPT code(s): Case 2 CARDIOPULMONARY SERVICES/CATHETERIZATION LABORATORY REPORT DATE OF PROCEDURE: 7/10/13 PROCEDURES PERFORMED: 1. Rotational atherectomy of the mid left anterior descending utilizing a 1.5- mm bur. 2 Cutting balloon atherectomy of the mid left anterior descending, 3. Intracoronary stent placement utilizing a 3.5 x 23 Promus stent in the mid left anterior descending. 4. Percutaneous transluminal coronary angioplasty of the first diagonal branch. 5. Intravascular ultrasound-guided percutaneous coronary intervention of the left anterior descending. CLINICAL PROFILE: This is an 87-year-old man with a history of angina and complex two-vessel coronary artery disease, referred for intervention. PROCEDURAL DETAILS: Pre-procedure informed consent was obtained. The patient was brought to the cardiac catheterization laboratory and sedated with low doses of Versed and Fentanyl, as detailed in the event log. Using standard sterile percutaneous technique and local administration of 2 percent lidocaine, the right femoral artery was entered with an #8Fr. short sheath. IV Angiomax was begun. We then advanced an #8Fr. XB 3.5 guiding catheter but this would not engage the left main trunk, which arose low off a very long and dilated ascending aorta. A total of nine different guides were then attempted in a series without successfully cannulating the left main trunk. Ultimately, we switched out the short sheath for a long #8Fr. sheath, as it appeared that tortuosity in the iliacs was in part impeding our ability to manipulate guide and cannulate the vessel. After this and utilizing a #7Fr. XB-5 guide, we were successfully able to cannulate the left main trunk, although guide support was mediocre. Please see the event log for a detailed list of the guide catheters. Altogether, it took 38 minutes to cannulate the left main trunk. We then advanced a short Runthrough wire into the apex of the LAD. There was an obvious, complex, calcified lesion in the mid vessel. We attempted to pre dilate this with a cutting balloon, but this balloon would not cross the lesion. We then pre dilated the mid LAD with a 2.5 Voyager balloon. Following this, we again tried to advance the cutting balloon across the lesion but this was not successful. We therefore advanced a Rotablator GoldWire into the distal LAD and removed the Runthrough wire. The mid LAD was rotablated with a 1.5-mm burr. Following this, we successfully advanced the Cutting balloon. This was a 3.0 X 10 Cutting balloon. We then performed baseline IVUS with an Eagle Eye ultrasound catheter. A 3.5 x 23 Pronmus stent was then advanced across the lesion and deployed successfully. The first diagonal branch was subtotally occluded after stenting the LAD and was noted to be 90 percent at baseline. A Whisper ES wire was then advanced into the first diagonal branch. We then attempted to pass a 2.0 x 12 Sprinter balloon in the first diagonal branch and it would not cross. A 1.5 x 12 Maverick Fire Star balloon, crossed with difficulty and multiple balloon inflations were obtained. We then advanced a 2.0 x 12 Quantum balloon and performed additional balloon dilations with an excellent result. We then performed post procedure IVUS of the LAD and this showed adequate stent expansion. Final angiograms were then performed with all devices removed, and the patient 64 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

69 Complete 2013 Procedure Practical Coding Updates Activity returned to the holding area in stable condition. Total fluoroscopic time was 30 minutes. He was loaded with Plavix post procedure. He will be observed overnight. Sheath management will be per protocol on the floor. ANGIOGRAPHIC FINDINGS: Left Selective Coronary Angiography: Left selective coronary angiograms demonstrate a superiorly-directed left main trunk which arises low in the aortic root. The LAD shows moderate ostial disease of 50 percent or less severity. A 90 percent stenosis is present in the mid LAD. This is complex calcified lesion arising between the first and second diagonal branches. The first diagonal branch shows 90 percent baseline stenosis. Following intervention, there is zero percent residual stenosis in the LAD, and a 20 percent or less residual stenosis in the first diagonal branch. A 60 percent stenosis in the LAD beyond the stent is to be treated medically. There is TIMI grade-iii flow post procedure. FINAL SUMMARY: Successful but technically difficult interventional procedure to the mid left anterior descending, involving the combination of Rotablator, cutting balloon atherectomy, and stenting. CPT code(s): Case 3 I discussed the procedure, risks, benefits, and alternatives regarding placement of a chest tube with the patient prior to the procedure. Patient understood and consented to the procedure. SHORT HISTORY INDICATIONS FOR OPERATION: Female had a horseback riding accident yesterday and over the last day has acquired a pneumothorax, which has been enlarging. It became very large, at least a 50 percent, maybe more, pneumothorax later this morning. Because it was enlarging and getting to the point of being dangerous, I felt that a small chest tube would be indicated to expand the lungs and to decrease the chance of a complete collapse of her lung. ANESTHESIA: Of note; also 1 gram of Ancef was given preprocedure for coverage. DESCRIPTION OF PROCEDURE: The patient was placed in the right lateral decubitus position and the area was prepped and draped. Under sterile conditions a #12 French chest tube was placed in the left lateral chest wall as high as could be and the chest tube going over the rib, approximately the 3 to 4 rib that the chest tube went over. It was placed into position. I felt with my finger and felt no lung material, only the fluid that I pushed through and the chest tube was placed easily in the proper position. If was sewn in place using 2-0 silk suture. Chest tube was placed on suction and in the recovery room, a post chest tube chest x-ray was taken and it shows that the lung has expanded to near completion and the chest tube is in proper position. The patient was brought to the recovery room in stable condition. CPT code(s): Case 4 PROGRESS NOTE: Pharmacologic Management SUBJECTIVE/OBJECTIVE: The patient brought in lab results he recently had done at the hospital from his physician, showing he had CBC, kidney function test, blood sugar, liver function test, and thyroid function test that were within normal limits, and his total cholesterol was 188. His HDL was 53. His LDL was 119 and his triglycerides were 78. The patient says he is feeling well. He has good focus and is working well. The only thing he is requesting is to go back to the immediate release Ritalin because of the cost. He says he is a bit short of money, although he knows that the Ritalin IR does not work as well for him, he wants to try that again. His energy is good. His sleep is good. MENTAL STATUS EXAMINATION: Shows a gentleman who looks his stated age. He is cooperative and pleasant. Has good eye contact. His mood is euthymic. His affect is congruent. He denies auditory or visual hallucinations, suicidal or homicidal ideations. He denies delusions. He is alert and oriented x 4. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 65

70 Complete Practical Activity 2013 Procedure Coding Updates PLAN: As per patient s request, we will switch over to Ritalin Immediate Release 40 mg bid because of cost, #60. I gave him a prescription with today s date, not to be filled until September 24 and I noted that on the prescription, because the patient had his last prescription called on August 24, Prescription: Ritalin IR 40 mg bid #60, no refills, to be filled only on September 24, Follow Up: The patient is to follow up in the office in six weeks. M Smith, MD CPT code(s): Case 5 PREOPERATIVE DIAGNOSIS: 1. Right Shoulder Failed Hemiarthroplasty for Superior Proximal Humerus Fracture 2. Right Shoulder Chronic Anterior Inferior Dislocation POSTOPERATIVE DIAGNOSIS: 1. Right Shoulder Failed Hemiarthroplasty for Superior Proximal Humerus Fracture 2. Right Shoulder Chronic Anterior Inferior Dislocation NAME OF PROCEDURE: 1. Right Shoulder Arthroplasty Revision 2. Right Shoulder Anterior Capsular Shift ANESTHESIA: General PREOPERATIVE PREAMBLE: This patient is a delightful female who has a right shoulder anterior inferior dislocation with loosening of the soft tissue anteriorly. This is a chronic condition. I have counseled this patient at length regarding the natural history of this problem, as well as potential risks, complications, and benefits of surgical versus nonsurgical management. The patient and the patient s family state they understand the risks include, but are not limited to, infection, component loosening, dislocation, injury to myotendinous units, injury to neurovascular bundles, deep venous thrombosis, pulmonary embolus, anesthesia problems, and even death. She has been given no warranties, no guarantees, no promises. Full informed consent has been obtained. The patient was taken to the operating room and in the supine position successfully induced with a general anesthesia using endotracheal intubation. After adequate analgesia was obtained, the right shoulder was prepped and draped in the usual sterile fashion, standard deltopectoral interval approach was used to incise the epidermis, dermis, and subcutaneous tissue with a #10 blade. The dissection was carried down through the deltopectoral interval, then the clavipectoral interval was then entered, gaining access to the joint. The patient had a large redundant anterior joint capsule, thick and fibrotic material. The patient was also found to have a component, which had subsided some and loosened some. Therefore, it was removed, as well as a portion of the proximal cement mantle in the proximal humerus. I then debrided the intraarticular aspect of the joint, removing any obstructive fibrious tissue and obstructive debris, gaining access to the glenoid, which was found to have some minimal degenerative change but no significant arthritis. The labrum was also somewhat atrophied anteriorly but was largely intact. I removed the existing humeral component and I resized the component for a smaller diameter component, which would allow cementing into the preexisting cement mantle. I also over retroverted the components to try to prevent further anterior interior dislocation. I gained length through the soft tissue envelope, approximately 2 cm, which should also keep 66 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

71 Complete 2013 Procedure Practical Coding Updates Activity the component from moving inferiorly, therefore by retroversion and lengthening I was able to create significant stability. The final component was opened, which was 2 mm smaller in diameter than the original component, giving an adequate cement mantle. I cemented into the original cement mantle with more retroversion and more length. When the cement dried, the shoulder was reduced and found to be stable. I then performed an anterior capsulorrhaphy, capsular tightening, capsular shift by bringing up the anterior interior capsule material and taking away the redundancy anteriorly and inferiorly. This was done with multiple interrupted sutures. The wound was then copiously irrigated and closed in standard fashion. Sterile dressing was placed over the wounds. At the end of this procedure, the sponge, needle, and instrument counts were correct. This procedure was completed without event. Patient is now convalescing without event in the recovery room. CPT code(s): = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 67

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73 Complete Practical 2013 Activity Answers Procedure Coding and Rationales Updates Practical Exercise Answer Key and Rationales Case 1 CPT code(s): Rationale: Look in the CPT index for Angiography/Common Carotid/Selective Catheterization (36222, 36223). Selective catheterization of the right common carotid was followed by angiography and interpretation of the right common carotid, right external carotid, right internal carotid and the right intracerebral arteries (36223). Selective catheterization of the left common carotid was followed with angiography and interpretation of the left common carotid, the left internal carotid, and left intracerebral arteries, which again is code The left and right external carotid angiography was not performed; however, the descriptor indicates it is included when performed. Arch angiography is also included in this code. Modifier 50 is appended to indicate a bilateral procedure. The documentation notes that the right subclavian has mild non-obstructive plaque and right internal mammary is normal. The left subclavian artery was unremarkable. This is included in the arch angiography, which is bundled. Do not report , The final code selection is Case 2 CPT code(s): LD, LD, Rationale: Angioplasty, followed by atherectomy, then stent placement in the LD was performed. Report only the most intensive procedure, which is the atherectomy. New combination codes were created to report atherectomy, stent, and angioplasty performed in the same major coronary artery. See This was a single major coronary artery reported with Modifier LD is appended for the left anterior descending artery. Next report the angioplasty of the first diagonal branch of the LD. Look in the CPT index for Angioplasty/Coronary Artery/Percutaneous Transluminal This is an additional branch of the left anterior descending; therefore, add-on code LD is correct. Next, report the IVUS. Look in the CPT index for Vascular Procedures/Intravascular Ultrasound/Coronary Vessels Although IVUS was used pre- and post-procedure, it is only reported once per vessel. You might have considered adding modifier 22 Increased procedural service because it took 38 minutes to cannulate the left main trunk and the case was difficult; however, the documentation does not substantiate that the case took much longer and was more difficult than usual. Do not report moderate sedation. The bullseye next the codes indicate it is included (further, no time is listed for moderate sedation). Case 3 CPT : LT Rationale: This is the placement of a chest tube. Look in the CPT index for Insertion/Catheter/Pleural Cavity 32550, Image guidance was not performed to place the tube. The correct code is Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 69

74 Complete Practical Activity Answers 2013 Procedure Coding and Rationales Updates Case 4 CPT code(s): Rationale: The new pharmacologic management code (90863) is an add-on code that may be reported only with psychotherapy services; psychotherapy services were not provided. According to the coding guidelines, providers who are permitted should report the service with E/M codes. The provider rendering the service is an MD; therefore, you would select the appropriate E/M code using the three key components (history, exam, and medical decision making). The provider documented: Problem focused history: brief HPI, problem focused ROS Expanded problem focused exam: limited exam of 2-7 body areas and/or organ systems (1995) or a problem focused exam for 1997 Psychiatric Exam (4 elements) Straightforward MDM: One established stable diagnosis, one data point (review of labs), moderate risk (prescription drug management). Only 2 of the 3 key components are needed; however, this will not change the assignment of Case 5 CPT code(s): RT Rationale: The procedure preformed is the revision of an arthroplasty of the shoulder. From the CPT index, look up Revision/Shoulder. You are referred to Arthroplasty/Shoulder Joint, which directs you to 23470, The code is selected based on whether the procedure involves the humeral and/or glenoid component. The description of the procedure states the humeral component was removed and replaced (23473). Debris was removed from the glenoid but the component did not require revision. According to the NCCI edits an anterior capsulorrhaphy is bundled with shoulder arthroplasty; therefore, it is not reported separately. The notes for instruct not to report Removal of foreign body, shoulder; deep with = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

75 Complete 2013 Procedure Slide Coding Presentation Updates Slide Presentation 2013 CPT Coding Updates Presented by: Raemarie Jimenez, CPC, CPMA, CPC I, CANPC, CRHC Director of Education Co written by John Verhovshek, CPC 1 CPT Disclaimer CPT copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 71

76 Complete Slide Presentation 2013 Procedure Coding Updates Objective Overview of the New, Revised and Deleted CPT codes for 2013 Review documentation requirements for the new codes Hands on exercises to practice using the new and revised codes Code Changes Now What? Review 2013 CPT code changes, using this guide Order 2013 codebooks Review all changes to guidelines, notes and instructions in your book Highlight changes in the book s index pertinent to your specialty and review those changes 4 72 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

77 Complete 2013 Procedure Slide Coding Presentation Updates Code Changes Now What? Highlight changes in the tabular section pertinent to your specialty Create a documentation cheat sheet of 2013 updates that must be documented differently for coders to capture the information needed and distribute it to clinicians Review and update superbills, chargemasters, etc. Run utilization report of the deleted and revised codes. 5 Code Changes Now What? Upload software change Train coding and billing staff on changes Check for addenda or errata ( corrections errata.pdf) Review PQRS changes Communicate with payer/provider reps regarding reimbursement and coverage issues Archive last year s books 6 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 73

78 Complete Slide Presentation 2013 Procedure Coding Updates Time Defined Time defined in the Introduction Use the following criteria unless section or subsection guidelines instruct otherwise Time is met when the midpoint is passed Codes reporting an hour require a minimum of 31 minutes to report the code Do not report time performing a concurrent service Example: deduct the time spent performing billable services (eg, CPR) from critical care time 7 E/M Changes 82 E/M codes revised to include other qualified health care professionals Example: Descriptor revisions for Counseling and/or coordination of care with other physicians, other providers qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient s and/or family s needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend Typically, 10 minutes are spent face to face with the patient and/or family = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

79 Complete 2013 Procedure Slide Coding Presentation Updates E/M Changes Other Qualified Health Care Professionals CPT code description changed to describe the service, not the provider performing the service CPT codes are used by other providers not just physicians Examples: Outpatient hospitals/asc Nurse practitioners/physician Assistants Physical Therapist/Occupational Therapist 9 E/M Changes Other Qualified Health Care Professional State Scope of Practice Facility Requirements Payer Policies Medicare Claims Processing Manual 10 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 75

80 Complete Slide Presentation 2013 Procedure Coding Updates Pediatric Critical Care Transport New codes report services provided by the control physician during an interfacility transport and Based on time Patients 24 months of age or younger Must be critically ill or critically injured 11 Pediatric Critical Care Transport Services include: Two way communication with transport team Time Begins when the control physician first contacts the transport team Ends when patient care is taken over by the receiving facility = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

81 Complete 2013 Procedure Slide Coding Presentation Updates Pediatric Critical Care Transport Do not report: Services performed by the transport team Pretransport communication time with receiving facility Direct face to face transport (99466, 99467) with 99485, Complex Chronic Care Coordination Services For clinical staff time directed by a physician or other qualified health care provider Reported for coordination of services (medical and psychosocial) Time based Reported per calendar month Based on whether patient has face to face encounter during the month 14 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 77

82 Complete Slide Presentation 2013 Procedure Coding Updates Complex Chronic Care Coordination Services Clinical indications that qualify: One or more chronic illnesses expected to last at least 12 months Acute exacerbation or decompensation Functional decline Medical Decision Making must be moderate or high 15 Complex Chronic Care Coordination Services Documentation must include: Condition of the patient Total time spent performing coordination services for complex chronic care Based on clinical staff time If physician performs coordination services, the time is added to the clinical staff time to support the code = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

83 Complete 2013 Procedure Slide Coding Presentation Updates Complex Chronic Care Coordination Services Fact to face encounter (during calendar month) Yes No (first hour) (each additional 30 minutes) (first hour) (each additional 30 minutes) 17 Complex Chronic Care Coordination Services Patient Diagnosis: Multiple Sclerosis and COPD exacerbation Date Time Services Coordinated 1/10/13 20 minutes Contacted Home Health to arrange for oxygen in the patients home. Patient is scheduled to receive the oxygen this afternoon. The CMN was completed and sent to the home health agency. Discussed the arrangements and proper use of oxygen with the patient s daughter. Patient and daughter understand 1/15/13 15 minutes Patient s daughter called stating the patient is depressed due to the limitations she is experiencing due to the MS. Arranged for the patient to see psychologist and evaluation from PT to see if there can be any improvement in mobility. 18 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 79

84 Complete Slide Presentation 2013 Procedure Coding Updates Complex Chronic Care Coordination Services Do not report with Care plan oversight (99339, 99340, ) Prolonged services without direct contact (99358, 99359) Anticoagulant management (99363, 99364) Medical conference team ( ) Education and training ( , 99071, 99078) Telephone services ( , ) 19 Complex Chronic Care Coordination Services Do not report with Online medical evaluation services ( ) Preparation of special reports (99080) Analysis of data (99090, 99091) Transitional care management (99495, 99496) Medication therapy management services ( ) ESRD services ( ) = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

85 Complete 2013 Procedure Slide Coding Presentation Updates Transitional Care Management Services Reported for transitional care for patients discharged from the hospital, SNF, rehab hospital, partial hospital or observation to home, domiciliary, rest home or assisted living Proper transitional care is important to prevent repeat admissions Reported by physician or other qualified health care provider. Can be reported by the same individual who discharged the 21 Transitional Care Management Services Documentation must include: Contact with the patient (telephone or electronic) within two business days of discharge Documentation to support MDM requires at least moderate MDM requires high MDM Face to face visit within 14 business days within 7 business days 22 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 81

86 Complete Slide Presentation 2013 Procedure Coding Updates Transitional Care Management Services MDM Face to face visit within 7 days Moderate High Face to face visit in 8 to 14 days 23 Transitional Care Management Services Documentation should include: Date of the patient s discharge Initial patient contact within 2 days (phone or ) MDM must be documented Refer to the MDM criteria using the CPT coding guidelines or 1995/1997 CMS Documentation Guidelines Documented face to face encounter Do not report a separate code for the E/M = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

87 Complete 2013 Procedure Slide Coding Presentation Updates Transitional Care Management Services Do not report with Care plan oversight (99339, 99340, ) Prolonged services without direct contact (99358, 99359) Anticoagulant management (99363, 99364) Medical conference team ( ) Education and training ( , 99071, 99078) Telephone services ( , ) 25 Transitional Care Management Services Do not report with ESRD services ( ) Online medical evaluation services ( ) Preparation of special reports (99080) Analysis of data (99090, 99091) Complex chronic care coordination ( ) Medication therapy management services ( ) 26 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 83

88 Complete Slide Presentation 2013 Procedure Coding Updates Anesthesia Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider physician or other qualified health care professional); other than the prone position Same change is made to Revision to include other qualified health care professionals 27 Integumentary Flap; island pedicle requiring identification and dissection of an anatomically named axial vessel Revision made to clarify proper code use because reason to believe code is misused Most commonly reported with skin malignancy diagnosis = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

89 Complete 2013 Procedure Slide Coding Presentation Updates Integumentary Documentation for island pedicle flap Island of skin is detached from its epidermal and dermal attachments while retaining its vascular supply (anatomically named axial vessel) Most commonly used on the lip and nose 29 Musculoskeletal Removal of tongs or halo applied by another physician individual Revision to remove physician as the only provider Percutaneous vertebroplasty Includes moderate sedation and already included moderate sedation 30 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 85

90 Complete Slide Presentation 2013 Procedure Coding Updates Musculoskeletal Arthrodesis, pre sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5 S1 interspace 31 Musculoskeletal Documentation for Unlike other spine codes, this code is specific to the interspace (L5 S1) Posterior instrumentation required Imaging guidance cannot be reported separately = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

91 Complete 2013 Procedure Slide Coding Presentation Updates Musculoskeletal Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component 33 Musculoskeletal Documentation for Revision of a previous shoulder arthroplasty Includes the removal of previous placed components Humeral or glenoid component Documentation for Revision of a previous shoulder arthroplasty Includes the removal of previous placed components Humeral and glenoid component 34 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 87

92 Complete Slide Presentation 2013 Procedure Coding Updates Musculoskeletal Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar component 35 Musculoskeletal Documentation for Revision of a previous elbow arthroplasty Includes the removal of previous placed components Humeral or ulnar component Documentation for Revision of a previous elbow arthroplasty Includes the removal of previous placed components Humeral and ulnar component = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

93 Complete 2013 Procedure Slide Coding Presentation Updates Musculoskeletal 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 Revision to remove physician as the only provider 37 Musculoskeletal Denis Browne splint strapping No longer performed 38 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 89

94 Complete Slide Presentation 2013 Procedure Coding Updates Respiratory New codes replace Category III codes 0250T 0252T for insertion/removal for bronchial valves Bronchial valves are inserted to treat patients with emphysema or lung damage Valves limit airflow to the damaged part of the lung to promote healing There are a total of five lobes in the lungs Two lobes in the left lung Three lobes in the right lung Procedures include conscious sedation 39 Respiratory 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 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

95 Complete 2013 Procedure Slide Coding Presentation Updates Respiratory Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), each additional lobe (list separately in addition to code for primary procedure) 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), each additional lobe (list separately in addition to code for primary procedure[s]) 41 Respiratory Documentation Requirements Insertion of valves How many lobes Removal of valves How many lobes 42 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 91

96 Complete Slide Presentation 2013 Procedure Coding Updates Respiratory Bronchography is no longer performed Deleted codes include: Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with injection of contrast material for segmental bronchography (fiberscope only) Transtracheal injection for bronchography Computed Tomography (CT) is the current standard of care 43 Respiratory Category III codes 0276T 0277T have been deleted and replaced with new codes ( ) for bronchial thermoplasty Uses radiofrequency ablation to treat asthmatic patients Reduces the muscle associated with airway constriction Procedures include conscious sedation = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

97 Complete 2013 Procedure Slide Coding Presentation Updates Respiratory Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes 45 Respiratory Documentation for 31660, Thermoplasty: therapeutic radiofrequency energy used to heat and reduce the tissue of smooth muscle present in the airway wall If performed on one lobe, report If performed on two or more lobes, report The codes include fluoroscopic guidance and conscious sedation 46 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 93

98 Complete Slide Presentation 2013 Procedure Coding Updates Respiratory Pneumocentesis, puncture of lung for aspiration No longer performed Directed to use Biopsy, lung or mediastinum, percutaneous needle 47 Respiratory Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent Deleted See 32554/ Thoracentesis with insertion of tube, includes water seal (eg, for pneumothorax), when performed (separate procedure) Deleted See 32554/ = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

99 Complete 2013 Procedure Slide Coding Presentation Updates Respiratory Tube thoracostomy, includes water seal connection to drainage system (eg, for abscess, hemothorax, empyema water seal), when performed, open (separate procedure) Clarify access Open procedure Conditions removed so as not to limit use to only abscess, hemothorax, empyema Includes conscious sedation 49 Respiratory Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance A needle or catheter is used to puncture the pleural space and withdraw fluid Replace 32420/32422 Select codes based on whether imaging guidance is performed 50 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 95

100 Complete Slide Presentation 2013 Procedure Coding Updates Respiratory Documentation requirements 32554, Surgical puncture and drainage of the pleural space The catheter or needle is not left in over time The puncture is performed and the fluid is aspirated Code selection based on whether imaging guidance is performed Do not report a separate code for the imaging 51 Respiratory Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

101 Complete 2013 Procedure Slide Coding Presentation Updates Respiratory Documentation requirements 32556, Reports percutaneous drainage of pleural fluid If performed as an open procedure report Tube or catheter is left in place (unlike thoracocentesis) Code selection is based on whether imaging guidance is used Do not report a separate code for the imaging 53 Respiratory Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment New subsection and guidelines Performed to identify tumor borders, volume and relationship to adjacent anatomic structures Do not report with Report only once per course of treatment 54 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 97

102 Complete Slide Presentation 2013 Procedure Coding Updates Cardiovascular Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter defibrillator or pacemaker pulse generator (including eg, for upgrade to dual chamber system and pocket revision) (List separately in addition to code for primary procedure) revised to remove pocket revision as a requirement parenthetical notes have been added to instruct when it is appropriate to report with other procedures 55 Cardiovascular Category III codes 0256T, 0258T and 0259T deleted and replaced by for TAVR non invasive procedure to replace the aortic valve for patients with aortic stenosis (narrowing of the aortic valve) Services include: Gaining access Deployment and repositioning of the valve Temporary pacemaker insertion for rapid pacing Closure of arteriotomy Angiography Radiologic supervision and interpretation = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

103 Complete 2013 Procedure Slide Coding Presentation Updates , cont Cardiovascular Two providers are required for this procedure (eg, cardiologist, interventional radiologists) When two surgeons work together to perform these procedures, append modifier 62 Diagnostic coronary angiography may be reported separately when: a prior coronary angiography was not performed if a prior coronary angiography was performed, the test is not adequate (eg, patient s condition has changed since the original angiography, the initial study is inadequate visualization of anatomy) , cont Cardiovascular Codes selection is based on whether the approach is open or percutaneous the vessel the surgeon uses for the approach Cardiopulmonary bypass may be reported with the appropriate add on code ( ), depending on the type of access performed 58 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 99

104 Complete Slide Presentation 2013 Procedure Coding Updates Cardiovascular percutaneous approach femoral artery open approach femoral artery open approach axillary artery open approach iliac artery transaortic approach Cardiovascular open procedure via median sternotomy or mediastinotomy = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

105 Complete 2013 Procedure Slide Coding Presentation Updates Cardiovascular Add ons report cardiopulmonary bypass during a TAVR Select codes based on whether the cannulation is performed percutaneously, open or centrally percutaneous peripheral arterial and venous cannulation open peripheral arterial and venous cannulation central arterial and venous cannulation 61 Cardiovascular New codes describe insertion, removal and repositioning of percutaenous ventricle assist devices (pvad) Replace category III codes 0048T and 0050T Ventricle assist devices assist the patient s heart to pump blood during high risk procedures or for critically ill patients Coding guidelines have been added to Heart (Including Valves) and Great Vessels, Cardiac Valves and Coronary Bypass subcategories 62 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 101

106 Complete Slide Presentation 2013 Procedure Coding Updates arterial access only Cardiovascular arterial and venous access and transseptal puncture Removal during a separate session Removal during the same session as insertion included repositioning during a separate session Repositioning during the same session as insertion is included 63 Cardiovascular Documentation for Include conscious sedation Type of access arterial or arterial and venous, which requires transseptal puncture Removal is coded if performed at a separate session Repositioning is coded if performed at a separate session = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

107 Complete 2013 Procedure Slide Coding Presentation Updates Cardiovascular Conscious sedation now included: Introduction of catheter, superior or inferior vena cava Introduction of needle or intracatheter; extremity artery 65 Cardiovascular New codes describe selective and non selective arterial catheter placement and angiography in the aortic arch, and carotid and vertebral arteries Included: vessel access placement of catheter(s) contrast injection(s) fluoroscopy radiological supervision and interpretation closure of the arteriotomy New guidelines provide instruction for proper use 66 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 103

108 Complete Slide Presentation 2013 Procedure Coding Updates , cont Codes are unilateral Cardiovascular Modifier 50 is for bilateral service CPT provides specific instruction on appending modifier 59 for these services Codes are built on a hierarchy of services When more than one procedure is performed on the ipsilateral (same side) vessel, report only the most complex procedure , cont Cardiovascular Radiological supervision and interpretation is included; however if a 3D rendering is performed, you may separately report or if ultrasound guidance is required to access the vessel, report may be reported if the angiography is not performed for the extracranial and intracranial cervicocerebral vessels (eg, upper extremities) Conscious sedation is included = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

109 Complete 2013 Procedure Slide Coding Presentation Updates Cardiovascular Non selective thoracic aorta catheter placement Includes angiography of the cervicocerebral arch Do not report with Selective catheter placement in common carotid or innominate artery includes angiography of ipsilateral extracranial carotid circulation Selective catheter placement in common carotid or innominate artery Includes angiography of ipsilateral (same side) intracranial carotid circulation, extracranial carotid and cervicocerebral arch 69 Cardiovascular Selective catheter placement in internal carotid artery Includes angiography of ipsilateral intracranial carotid circulation, extracranial carotid and cervicocerebral arch Selective catheter placement in the subclavian artery Includes angiography of ipsilateral vertebral circulation and cervicocerebral arch Selective catheter placement in the vertebral artery Includes angiography of ipsilateral vertebral circulation and cervicocerebral arch 70 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 105

110 Complete Slide Presentation 2013 Procedure Coding Updates Cardiovascular Report in addition to 36222, 36223, or for selective catheter placement in the external carotid artery Report in addition or for selective catheter placement in each intracranial branch of the internal carotid or vertebral arteries Do not report more than twice, per side 71 Cardiovascular Venipuncture code descriptors are revised to allow reporting by other qualified health care professional = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

111 Complete 2013 Procedure Slide Coding Presentation Updates Cardiovascular 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 Bundles radiological S&I to percutaneous transcatheter retrieval of a foreign body deleted Report retrieval of the vena cava filter with Cardiovascular New codes bundle infusion thrombolysis with radiological S&I when performed in arterial and venous vessels deleted revised deleted deleted During the procedures, chemicals are infused to break down clots 74 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 107

112 Complete Slide Presentation 2013 Procedure Coding Updates Cardiovascular , cont Codes are selected per day If the treatment extends over more than one date of service, you may use separate codes to report the subsequent treatment day and the cessation or last treatment day For infusion thrombolysis of artery other than coronary Once per day for the initial service For infusion thrombolysis of a vein Once per day for the initial service , cont Cardiovascular Infusion thrombolysis of an artery (other than coronary) or vein Subsequent day of therapy Cessation of infusion thrombolysis of an artery (other than coronary Includes removal of the catheter and closure of the vessel = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

113 Complete 2013 Procedure Slide Coding Presentation Updates Hemic and Lymphatic Systems Codes for hematopoietic progenitor cell (HPC) transplantation (38240, 38241) have been revised to assist with code selection Allogenic transplantation = the recipient is not the donor Because the procedure can involve cells from more than one donor, the procedure is reported per donor Includes the physician monitoring physiological parameters, verification of cell processing, patient evaluation and direct supervision of the infusion 77 Hemic and Lymphatic Systems Autologous transplantation = the recipient is the donor Includes the physician monitoring physiological parameters, verification of cell processing, patient evaluation and direct supervision of the infusion 78 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 109

114 Complete Slide Presentation 2013 Procedure Coding Updates Hemic and Lymphatic Systems Codes for hematopoietic progenitor cell (HPC) transplantation (38240, 38241) have been revised to assist with code selection Allogenic transplantation = the recipient is not the donor Because the procedure can involve cells from more than one donor, the procedure is reported per donor Includes the physician monitoring physiological parameters, verification of cell processing, patient evaluation and direct supervision of the infusion 77 Hemic and Lymphatic Systems Autologous transplantation = the recipient is the donor Includes the physician monitoring physiological parameters, verification of cell processing, patient evaluation and direct supervision of the infusion = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

115 Complete 2013 Procedure Slide Coding Presentation Updates Hemic and Lymphatic Systems Hematopoietic progenitor cell (HPC) boost May occur days, months or years from the original HPC transplantation Comes from the original HPC donor from the initial transplantation To treat a relapse or post transplant cytopenia (deficiency or lack of cellular elements in the circulating blood) No longer a child of For patients with previous bone marrow transplant 79 Digestive System Esophagoscopy, rigid or flexible; with optical endomicroscopy Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with optical endomicroscopy Eliminates random sampling and allows targeted biopsy through real time cellular observation of mucosal tissue Performed for suspected preneoplastic diseases Includes moderate sedation 80 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 111

116 Complete Slide Presentation 2013 Procedure Coding Updates Digestive System Upper gastrointestinal endoscopy, simple primary examination (eg, with small diameter flexible endoscope) (separate procedure) Deleted/rarely performed Most common GI endoscope is Digestive System Preparation of fecal microbiota for instillation, including assessment of donor specimen for Clostridium difficile instillation Bacterium can grow out of control from use of antibiotics Includes collecting fecal material from a donor, preparing the fecal material in a slurry and evaluating the material prior to instillation Includes only the preparation prior to instillation, not the work to instill the fecal microbiota Report instillation through colonoscopy or sigmoidoscopy separately = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

117 Complete 2013 Procedure Slide Coding Presentation Updates Urinary System Cystourethroscopy, with injection(s) for chemodenervation of the bladder For chemodenervation of the bladder eg, neurogenic incontinence 83 Maternity Care and Delivery: Repair Episiotomy or vaginal repair, by other than attending physician Revised to allow reporting by attending provider other than physician Midwife 84 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 113

118 Complete Slide Presentation 2013 Procedure Coding Updates Nervous System Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (requiring skill physician s of a physician or other qualified health care professional) No longer limited to physician reporting Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed Now includes imaging guidance 85 Nervous System Revised to add unilateral If performed bilaterally, append modifier Revised to specify extremity (singular) Report once per session for extremity and/or trunk muscles Do not report with modifier = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

119 Complete 2013 Procedure Slide Coding Presentation Updates Nervous System Describes bilateral chemodenervation of muscles innervated by facial, trigeminal, cervical spine and accessory nerves Inherently bilateral Do not append modifier 50 Do not report with 64612, or Eye and Ocular Adnexa Paracentesis of anterior chamber of eye (separate procedure); with diagnostic aspiration removal of aqueous Paracentesis of anterior chamber of eye (separate procedure); with therapeutic release of aqueous deleted now report either diagnostic or therapeutic removal of aqueous 88 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 115

120 Complete Slide Presentation 2013 Procedure Coding Updates Eye and Ocular Adnexa Biopsy Incisional biopsy of eyelid skin including lid margin Biopsy must be of the lid margin Report 11100, or for biopsy of the skin of the eyelid 89 Radiology Bronchography, unilateral, radiological supervision and interpretation Bronchography, bilateral, radiological supervision and interpretation Bronchography is no longer performed Computed tomography (CT) is now the standard of care replacing bronchography = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

121 Complete 2013 Procedure Slide Coding Presentation Updates Radiology Codes for radiology examination of the cervical spine have been revised to include the number of views Radiologic examination, spine, cervical; 3 views or less or 5 views or more views 91 Radiology Angiography codes have been deleted Replaced by combination codes that bundle surgical and radiological services See = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 117

122 Complete Slide Presentation 2013 Procedure Coding Updates Radiology Transcatheter therapy, infusion, any method (eg, thrombolysis other than for thrombolysis, radiological supervision and interpretation Angiography through existing catheter for follow up study for transcatheter therapy, embolization or infusion, other than for thrombolysis Exchange of a previously placed intravascular catheter during thrombolytic therapy with contrast monitoring, radiological supervision and interpretation New codes infusion thrombolysis codes include radiological supervision and interpretation 93 Radiology Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), radiological supervision and interpretation Replaced by = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

123 Complete 2013 Procedure Slide Coding Presentation Updates Radiology Revised to include other qualified health care professional 76000/76001 Fluoroscopy 76885/76886 Ultrasound / Computer aided mammography Joint radiography 95 Radiology D rendering with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation D rendering with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation Revised to include image postprocessing under concurrent supervision Parenthetical note lists procedures not reported with 76376/ = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 119

124 Complete Slide Presentation 2013 Procedure Coding Updates Radiology New codes replace for thyroid imaging to evaluate the function of the gland to determine the size, shape and position of the thyroid gland when the services identified in and are performed during the same session 97 Radiology Parathyroid planar imaging (including subtraction, when performed) Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT) Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired computed tomography (CT) for anatomical localization = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

125 Complete 2013 Procedure Slide Coding Presentation Updates Pathology and Laboratory Molecular Pathology 13 New Tier 1 molecular pathology procedure codes An unlisted molecular pathology procedure code added (81479) Revised the descriptors for all nine Tier 2 ( ) procedures 99 Pathology and Laboratory Multianalyte Assays with Algorithmic Analysis (MAAA) New subsection with guidelines for proper use 9 new codes ( ) Algorithmic analysis using the results of assays (molecular pathology assays, fluorescent in situ hybridization assays, and nonnucleic acid based assays) and patient information, when appropriate, to report a numeric score(s) or probability of developing specific conditions 100 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 121

126 Complete Slide Presentation 2013 Procedure Coding Updates Pathology and Laboratory Multianalyte Assays with Algorithmic Analysis (MAAA) Example: Oncology (ovarian), biochemical assays of five proteins (CA 125, apoliproprotein A1, beta 2 microglobulin, transferrin, and pre albumin), utilizing serum, algorithm reported as a risk score 101 Pathology and Laboratory Chemistry Acetone or other ketone bodies Ketone body(s) (eg, acetone, acetoacetic acid, serum beta hydroxybutyrate); qualitative Acetone or other ketone bodies Ketone body(s) (eg, acetone, acetoacetic acid, serum betahydroxybutyrate); quantitative Changes made to reflect current clinical practice = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

127 Complete 2013 Procedure Slide Coding Presentation Updates Chemistry Pathology and Laboratory Galectin 3 Used to assess the prognosis of patient with heart failure 103 Pathology and Laboratory Chemistry have been deleted Refer to molecular pathology codes = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 123

128 Complete Slide Presentation 2013 Procedure Coding Updates Pathology and Laboratory Immunology # Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); # Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required 105 Pathology and Laboratory Immunology Antibody; JC (John Cunningham) virus = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

129 Complete 2013 Procedure Slide Coding Presentation Updates Tissue Typing Pathology and Laboratory New codes were created to report tissue typing for solid organ and bone marrow transplants 107 Microbiology Pathology and Laboratory Infectious agent detection by nucleic acid (DNA or RNA); enterovirus, reverse transcription and amplified probe technique Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, reverse transcription and amplified probe technique Hepatitis C, reverse transcription and quantification 108 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 125

130 Complete Slide Presentation 2013 Procedure Coding Updates Pathology and Laboratory Microbiology Infectious agent detection by nucleic acid (DNA or RNA); HIV 1, reverse transcription and amplified probe technique HIV 1, reverse transcription and quantification HIV 2, reverse transcription and amplified probe technique HIV 2, reverse transcription and quantification 109 Pathology and Laboratory New codes describe nucleic acid tests performed to detect respiratory viruses Codes are selected based on the number of targets for the test Parenthetical For assays that are used to type and subtype influenza viruses only, see For assays that include influenza viruses with additional respiratory viruses, see = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

131 Complete 2013 Procedure Slide Coding Presentation Updates Microbiology Pathology and Laboratory Infectious agent genotype analysis by nucleic acid (DNA or RNA); cytomegalovirus Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV 1, reverse transcriptase and protease regions Infectious agent genotype analysis by nucleic acid (DNA or RNA); hepatitis B virus 111 Pathology and Laboratory Surgical Pathology Optical endomicroscopic image(s), interpretation and report, real time or referred, each endoscopic session Used to report interpretation and report when or are performed Not reported by the surgeon, only when performed by another physician (eg, pathologist) 112 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 127

132 Complete Slide Presentation 2013 Procedure Coding Updates Pathology and Laboratory Codes have been deleted See molecular pathology codes Medicine Many codes revised to include other qualified health care professional, or to remove physician from the code description Hemodialysis (90935, 90945, 90947) End Stage Renal Disease Services ( ) Gastroenterology (91110, 91111) Evaluative and Therapeutic Services (92613, 92615, 92617) = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

133 Complete 2013 Procedure Slide Coding Presentation Updates Medicine Other qualified providers, cont Cardiography (93015, 93016) Cardiovascular Monitoring Services (93224, 93227, 93228, 93229, 93268, 93272) Implantable and Wearable Cardiac Device Evaluations ( ) Echocardiography (93351) 115 Medicine Other qualified providers, cont Noninvasive Physiologic Studies and Procedures (93745, 93750, 93790) Other Procedures (93797, 93798) Pulmonary Diagnostic Testing and Therapies (94014, 94016, 94452, 94453, 94610, 94774) Allergy Testing (95004, 95024, 95027) Allergen Immunotherapy ( ) 116 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 129

134 Complete Slide Presentation 2013 Procedure Coding Updates Medicine Other qualified providers, cont Special EEG Tests (95954, 95961, 95962) Other Procedures (95991) Motion Analysis (96004) Functional Brain Mapping (96020) Therapeutic Procedures ( ) Tests and Measurements (97755) Online Medical Evaluation (98969) 117 Medicine Other qualified providers, cont Special Services, Procedures and Reports ( , 99070, , 99078, 99091) Moderate (Conscious) Sedation ( ) Other Services and Procedures (99174, 99183) = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

135 Complete 2013 Procedure Slide Coding Presentation Updates Medicine Psychiatry: Significant changes to codes and guidelines New codes Interactive complexity Psychiatric diagnostic evaluation Psychotherapy Psychotherapy for crisis Pharmacologic management 119 Interactive Complexity Medicine Add on code (90785) used to report communication factors that complicate psychiatric services Typical factors Third parties involved with care (guardians, caregivers) Require others to be involved with the care (interpreters) Require third parties (welfare agencies, schools) 120 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 131

136 Complete Slide Presentation 2013 Procedure Coding Updates Medicine Interactive Complexity cont Must include one of the following: Manage maladaptive communication (high reactivity) Caregiver emotions or behavior interferes Disclosure of sentinel events and mandated reporting (abuse to state agency) Use of play equipment or physical devices Require others to be involved with the care (interpreters) Has not developed or lost expressive language communication skills. 121 Medicine Interactive Complexity cont Can be used with the following codes: Diagnostic psychiatric evaluation (90791, 90792) Psychotherapy (90832, 90834, 90837) Psychotherapy with E/M (90833, 90836, 90838, , , ) Group psychotherapy (90853) = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

137 Complete 2013 Procedure Slide Coding Presentation Updates Medicine Interactive Complexity, cont Do not report with: Psychotherapy for crisis (90839, 90840) E/M performed without psychotherapy 123 Medicine Psychiatric Diagnostic Evaluation (90791, 90792) 90801, deleted Biophysical assessment including history, mental status and recommendations Do not report on the same date as E/M If medical service is performed on same DOS as psychiatric diagnostic evaluation, report For interactive complexity, report with or Do not report and on the same DOS 124 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 133

138 Complete Slide Presentation 2013 Procedure Coding Updates Medicine Psychotherapy ( ) , , and deleted New codes are based on time Add on codes used when psychotherapy is performed on the same DOS as E/M Do not include time performing the E/M service as psychotherapy time For interactive psychotherapy, report with the psychotherapy code 125 Time (min) Psychotherapy Psych and E/M Psych and Interactive Psych Psych, Interactive Psych and E/M E/M, , E/M, 90833, E/M, , E/M, 90836, > E/M, E/M, 90838, = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

139 Complete 2013 Procedure Slide Coding Presentation Updates Medicine Psychotherapy in Crisis (90839, 90840) Urgent assessment of a patient with a life threatening or complex condition Reported based on time If performed 30 minutes or less, report with or Do not report with psychiatric diagnostic evaluation (90791, 90792), psychotherapy codes ( ) or other psychiatric services ( ) 127 Medicine Pharmacologic management (90863) was deleted New code is an add on code that can only be reported with psychotherapy codes Do not use time spent performing pharmacologic management to determine psychotherapy codes If the provider is permitted to bill with E/M codes (eg, psychiatrist), report the service as an E/M Do not report with an E/M code 128 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 135

140 Complete Slide Presentation 2013 Procedure Coding Updates Medicine Gastroenterology 0242T was deleted and replaced with Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report 129 Medicine Ophthalmoscopy Special anterior Anterior segment photography imaging with interpretation and report; with specular endothelial microscopy and endothelial cell count analysis Special anterior Anterior segment photography imaging with interpretation and report; with fluorescein angiography = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

141 Complete 2013 Procedure Slide Coding Presentation Updates Medicine Coronary Therapeutic Services and Procedures Codes 92980, 92981, 92982, 92984, 92995, were deleted Services in this subsection include: atherectomy, stent and angioplasty on coronary arteries Services include: access, selective catheterization, radiologic supervision and interpretation, closure of arteriotomy, and imaging to document completion of the procedure 131 Medicine Coronary Therapeutic Services and Procedures, cont Coronary arteries: left main, left anterior descending, left circumflex, right main and ramus intermedius Coronary branches: diagonals of the left anterior descending, marginals of left circumflex and posterior descending posterolaterals of the right 132 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 137

142 Complete Slide Presentation 2013 Procedure Coding Updates Medicine Documentation must include: Major coronary arteries and branches involved in the procedure(s) Procedures being performed More than one intervention can be performed on multiple vessels Patient s condition: acute myocardial infarction or chronic total occlusion There are specific codes for this Is the procedure being performed on a bypass graft? 133 PCI code selection: Medicine Report one base code for the most complex procedure for each major coronary artery involved in the case Atherectomy > stent > angioplasty Can report up to two branches Conscious sedation included = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

143 Complete 2013 Procedure Slide Coding Presentation Updates Medicine Percutaneous transluminal coronary angioplasty; single major coronary artery or branch Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) Medicine Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 139

144 Complete Slide Presentation 2013 Procedure Coding Updates Medicine Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) 137 Medicine Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

145 Complete 2013 Procedure Slide Coding Presentation Updates Medicine 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 each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure) 139 Medicine 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 140 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 141

146 Complete Slide Presentation 2013 Procedure Coding Updates Medicine 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 each additional coronary artery, coronary artery branch, or bypass graft (list separately in addition to code for primary procedure) 141 Medicine PCI example: Stent placed and angioplasty performed on LAD, stent placed in D1, angioplasty in D = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

147 Complete 2013 Procedure Slide Coding Presentation Updates Medicine Correct Codes: LD, LD, LD 143 Picture Source: Radiology Assistant Medicine Percutaneous transluminal coronary thrombectomy mechanical (list separately in addition to code for primary procedure) Code revised because this code is not used for chemical thrombectomy only mechanical 144 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 143

148 Complete Slide Presentation 2013 Procedure Coding Updates Medicine Intracardiac Electrophysiological Procedures and have been deleted New codes reported for comprehensive electrophysciologic evaluation and ablation of arrhythmia Code is selected based on the arrhythmia treated 145 Allergy Testing Medicine Codes and were deleted Report with or based on whether venom or drugs and biologicals are used in the testing = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

149 Complete 2013 Procedure Slide Coding Presentation Updates Medicine Code has been deleted and replaced with timebased codes and Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); initial 120 minutes of testing each additional 60 minutes of testing (list separately in addition to code for primary procedure) 147 Sleep Medicine Testing Medicine Codes revised to include the age of the patient reported for any age 95810, for ages 6 years and older New codes 95782, for patients younger than 6 years 148 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 145

150 Complete Slide Presentation 2013 Procedure Coding Updates Nerve Conduction Studies Medicine Codes were deleted New codes reported based on the number of studies performed Motor nerve conduction studies: electrodes placed over the motor points of the muscle being tested Nerve conduction studies: electrodes placed over the specific nerve to be tested 149 Medicine Nerve Conduction Studies, cont A study is defined as sensory conduction test, a motor conduction test with or without an F wave test, or an H reflex test Use Appendix J to assist with coding = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

151 Complete 2013 Procedure Slide Coding Presentation Updates Medicine Intraoperative Neurophysiology is deleted Codes reported based on whether the monitoring is one on one in the operating room (95940) or remote (95941) Report add ons with the baseline studies If more than one patient is monitored in the operating room, report Can not be reported by the surgeon or anesthesiologist 151 Category II Supplemental codes for tracking performance measures More information on the AMA site assn.org/ama/pub/physician resources/solutions managingyour practice/coding billing insurance/cpt/about cpt/category iicodes.page More information on the CMS site Initiatives Patient Assessment Instruments/PQRS/MeasuresCodes.html 152 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 147

152 Complete Slide Presentation 2013 Procedure Coding Updates Category III Deleted Cat. Code 0030T 0048T 0050T 0173T 0242T 0250T 0252T Replacement Code N/A Category III Codes Deleted Cat. III Code 0256T 0257T 0258T 0259T 0276T, 0277T 0279T, 0280T Replacement Code T , , = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

153 Complete 2013 Procedure Slide Coding Presentation Updates Category III Codes 0195T Arthrodesis, pre sacral interbody technique without instrumentation L5 S1 interspace +0196T L4 L5 interspace Codes revised to indicate without instrumentation Distinguish from (with instrumentation) 155 Category III Codes 0206T Algorithmic 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 electrocardiographic derived data multiple nonlinear mathematical transformations, with computer probability assessment, including report coronary artery obstruction severity assessment Revised to describe coronary artery obstruction Not intended for cardiac ischemia 156 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 149

154 Complete Slide Presentation 2013 Procedure Coding Updates Category III Codes +0291T intravascular optical coherence tomography initial vessel (list separately in addition to primary procedure) Provides micro structural information on atherosclerotic plaques Report with 92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975, , 93563, for the initial vessel Includes conscious sedation 157 Category III Codes +0292T Intravascular optical coherence tomography each additional vessel (list separately in addition to primary procedure) Add on with 0291T Report with 92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975, , 93563, for the initial vessel Includes conscious sedation = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

155 Complete 2013 Procedure Slide Coding Presentation Updates Category III Codes 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 Insertion to monitor left atrial pressure Do not report with or Includes conscious sedation 159 Category III Codes +0294T Insertion of left atrial hemodynamic monitor; pressure sensor lead at time of insertion of pacing cardioverter defibrillator pulse generator including radiological supervision and interpretation and associated injection procedures Device to monitor left atrial pressure during insertion of a pacing cardioverter defibrillator Claim with 33230, 33231, 33240, or Do not report with or Includes conscious sedation 160 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 151

156 Complete Slide Presentation 2013 Procedure Coding Updates Category III Codes New codes describe external electrocardiographic recording for more than 48 hours, up to 21 days. Current codes ( ) report similar recording when performed up to 48 hours. 0295T recording, scanning analysis with report, review and interpretation 0296T recording (includes connection and initial recording) 0297T scanning analysis with report 0298T review and interpretation Category III Codes 0299T 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) Promotes healing of burn wounds Report per wound 152 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

157 Complete 2013 Procedure Slide Coding Presentation Updates Category III Codes 0301T 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 Focused microwave thermotherapy of the breast Includes imaging guidance Includes conscious sedation Do not report with 76645, 76942, or Category III Codes Intracardiac ischemic monitoring system detects/warns patients of major ischemic coronary event eg, coronary plaque rupture Includes a generator, adaptor and transvenous lead 0302T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intraoperative interrogation and programming when performed; complete system (includes device and electrode) Includes conscious sedation Insert or remove complete system 164 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 153

158 Complete Slide Presentation 2013 Procedure Coding Updates Category III Codes Intracardiac ischemic monitoring, cont 0303T Insertion or removal and replacement electrode only Electrode only insertion/replacement Includes interrogation and programming Includes conscious sedation 0304T device only Device only insertion/replacement Includes interrogation and programming Includes conscious sedation 165 Category III Codes Intracardiac ischemic monitoring, cont 0305T Programming device evaluation (in person) of intracardiac ischemia monitoring system with iterative adjustment of programmed values, with analysis, review, and report Programming and adjustments Must be performed in person 0306T Interrogation device evaluation (in person) of intracardiac ischemia monitoring system with analysis, review, and report System interogation, including analysis, review and report Must be performed in person = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

159 Complete 2013 Procedure Slide Coding Presentation Updates Category III Codes Intracardiac ischemic monitoring, cont 0307T Removal of intracardiac ischemia monitoring device Device removal without replacement Includes conscious sedation 167 Category III Codes 0308T Insertion of ocular telescope prosthesis including removal of crystalline lens Insertion/implantation of a telescope For patients with central vision loss caused by end stage, age related macular degeneration Modifier 51 exempt Includes conscious sedation 168 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 155

160 Complete Slide Presentation 2013 Procedure Coding Updates Category III Codes +0309T 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) Pre sacral interbody technique arthrodesis with posterior instrumentation Includes disc preparation, discectomy, posterior instrumentation, imaging guidance and bone graft Performed at L4 L5 interspace 169 Category III Codes T Motor function mapping using noninvasive navigated transcranial magnetic stimulation (ntms) for therapeutic treatment planning, upper and lower extremity Motor function mapping combining transcranial magnetic stimulation (TMS) and electromyography (EMG) with guidance, with magnetic resonance Performed to identify functional motor cortex prior to brain surgery 156 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

161 Complete 2013 Procedure Slide Coding Presentation Updates Category III Codes 0311T Non invasive calculation and analysis of central arterial pressure waveforms with interpretation and report Central arterial pressure waveforms for patients with difficult to treat hypertension 171 Category III Codes Vagal blocking for weight loss 0312T = laparoscopic implantation of the neurostimulator electrode array, pulse generator and programming 0313T = laparoscopic revision or replacement of the electrode array, and connection to the existing pulse generator 0314T = laparoscopic removal of the electrode array and pulse generator only 172 = FDA Approval Pending = Add-on Complete 2013 Procedure Updates 157

162 Complete Slide Presentation 2013 Procedure Coding Updates Category III Codes Vagal blocking for weight loss, cont 0315T = removal of the pulse generator only 0316T = replacement of the pulse generator only 0317T = electronic analysis and reprogramming of the pulse generator 173 Category III Codes 0318T Implantation of catheter delivered prosthetic aortic heart valve, open thoracic approach, (eg, transapical, other than transaortic) Implantation of a prosthetic aortic heart valve Reported based on approach 0318T = open thoracic approach for other approaches = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

163 The Official American Medical Association CPT Errata

164 CORRECTIONS DOCUMENT CPT 2013 Introduction Current Procedural Terminology (CPT ), Fourth Edition, is a set of Inclusion of a descriptor and its associated five-digit code number in Add new text symbols to denote revision of the text in the Introduction to the CPT code set. Evaluation and Management (E/M) Services Guidelines Counseling Counseling is a discussion with a patient and/or family concerning one or more of the following areas: Diagnostic results, impressions, and/or recommended diagnostic studies Prognosis Risks and benefits of management (treatment) options Instructions for management (treatment) and/or follow-up Importance of compliance with chosen management (treatment) options Risk factor reduction Patient and family education (For psychotherapy, see , ) Add an instructional parenthetical note following the counseling guidelines to coincide with the new psychotherapy range of codes and Evaluation and Management Tables Initial Neonatal Intensive Care Remove reference to weight gms from the (E/M) Initial Neonatal Intensive Care table. Revised: 10/19/2012-9:49:26 AM 1 Copyright American Medical Association All Rights Reserved

165 Evaluation and Management Table Continuing Neonatal and Infant Inpatient Low Birth-Weight Intensive Care Remove reference to age 28 days of age or less from the (E/M) Continuing Neonatal and Infant Inpatient Low Birth-Weight Intensive Care table. Evaluation and Management Nursing Facility Services guidelines The following codes are used These codes should also be used Nursing facilities that provide Physicians and other qualified health care professionals have a central role in assuring that all residents receive thorough assessments and that medical plans of care are instituted or revised to enhance or maintain the residents physical and psychosocial functioning. This role includes providing input in the development of the MDS and a multi-disciplinary plan of care, as required by regulations pertaining to the care of nursing facility residents. Two major subcategories of nursing facility services For definitions of key components... Revise the Nursing Facility Services guidelines by removing reference to the terms and other qualified health care professionals as initial assessments in the nursing facility are only done by physicians. Revised: 10/19/2012-9:49:26 AM 2 Copyright American Medical Association All Rights Reserved