If you need additional information, contact our Service Management Department at or at (toll free long distance calls).

Transcription

1 CIRCULAR LETTER #M December 29, 2017 TO ALL TRIPLE-S SALUD PARTICIPANT PROVIDERS NEW CPT 2018 CODES CCI Integrated Care Center Enclosed is list of new codes, published in the Current Procedure Terminology (CPT ) for 2018, with corresponding fees. Please refer to CPT 2018 for complete description. Surgical codes marked with + are paid at 100% under the exception rule of multiple surgeries of modifier 51 or are add-on codes. It is not necessary to codify modifier 51 for the fee to apply at 100%. Those marked with $0.00 are not covered under any of our policies. Payment policies established for anesthesia in announced CPT 2018 codes prevail. The covered codes are recognized for payment to every physician according to the license and/or certification of specialty or subspecialist granted by the Puerto Rico Medical Licensing and Discipline Board. Any other specialty that offers these services should contact our Network Management Division, to make pertinent arrangements in the payment system (see circular letter # M ). These codes will be effective for services rendered starting January 1 st, These fees are not applicable to Medicare Advantage beneficiaries, commecial plan or to the beneficiaries of the Government Health Plan (PSG by Spanish acronym). If you need additional information, contact our Service Management Department at or at (toll free long distance calls). Cordially, Benjamin Santiago Torres, MD Medical Management VP If you have not registered to receive electronic Circular Letters, access our Internet site at register and join Triple-S Salud to preserve our environment.

2 Evaluation and Management $0.00 This services require a contracted clinical care team for $0.00 This services require a contracted clinical care team for $0.00 This services require a contracted clinical care team for $0.00 This services require a contracted clinical care team for $0.00 This services require a contracted clinical care team for Anesthesia N/A Added to differentiate anesthesia services for upper gastrointestinal endoscopic procedure N/A Added to differentiate anesthesia services for upper gastrointestinal endoscopic retrograde cholangiopancreatography N/A Added to differentiate anesthesia services for lower intestinal endoscopic procedures N/A Added to differentiate anesthesia services for screening colonoscopy (lower intestinal endoscopic procedures) N/A Added to differentiate anesthesia services for upper and lower gastrointestinal endoscopic procedures. Integumentary System

3 15730 $1, Flap repair code changes allow more specific location coding. The code has been added to describe Midface flap (zygomaticofacial flap) with preservation of vascular pedicle(s) $ Flap repair code changes allow more specific location coding. For example, code has been added to describe Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle [i.e., buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae], which describes the repair of more muscles than the deleted code $ The code allow you to report preparation of tumor cavity and placement of a radiation therapy applicator for intraoperative radiation therapy. The code is to be reported in addition to partial mastectomy procedures. Musculoskeletal System $27.00 You ll select bone marrow aspiration codes based on their purpose. When coding bone marrow aspiration for spine surgery, for example, you ll select the new add-on code (when performed through a separate incision) For therapeutic bone marrow aspiration, spinal only. Respiratory System $ The code allow you to report ligation of sphenopalatine artery $ The code may be reported when a nasal endoscopy with surgical ethmoidectomy with total (anterior and posterior),

4 including frontal sinus exploration, with removal of tissue from frontal sinus, when performed $ The code may be reported when a total anterior and posterior nasal endoscopy with surgical ethmoidectomy is performed. This code also includes sphenoidotomy $ The code may be reported when a total anterior and posterior nasal endoscopy with surgical etmoidectomy is performed with removal of tissue from the sphenoid sinus. This code also includes sphenoidotomy $0.00 Investigational code, is not considered for payment, refer to medical policy in our web site $0.00 Investigational code, is not considered for payment, refer to medical policy in our web site. Cardiovascular System BR The code describe the implantation of a total replacement heart system (artificial heart) with recipient cardiectomy BR The code describe the removal and replacement of total replacement heart system (artificial heart) BR The code describe the removal of a total replacement heart system (artificial heart) for heart transplantation (List Separately in addition to code for primary procedure) $1, The code describe the endografts to treat a non rupture infrarenal aorta by an aorto-aortic tube $1, The code describe the endografts to treat a rupture infrarenal aorta including temporary aortic and/or iliac balloon occlusion $1, The code describe the endografts to treat a non rupture infrarenal aorta and/or iliac artery(ies) by an aorto-uni-iliac endograft.

5 34704 $1, The code describe the endografts to treat a rupture infrarenal aorta and/or iliac arter(ies) including temporary aortic and/or iliac balloon occlusion $1, The code describe the endografts to treat a non-rupture infrarenal aorta and/or iliac artery(ies) by an aorto-bi-iliac endograft $1, The code describe the endografts to treat a rupture infrarenal aorta and/or iliac artery including temporary aortic and/or iliac balloon occlusion $ The code describe the placement of an extension prosthesis to repair a non-rupture iliac artery by an ilio-iliac tube endograft $1, The code describes the placement of an extension prosthesis to repair a rupture iliac artery by an ilio-iliac tube endograft, including temporary aortic and/or iliac balloon occlusion $ The code describes the placement of an extension prosthesis (es) distal to common iliac artery (ies) or proximal to renal artery (ies) $ The code describes an extension prosthesis(es) NOT performed at same time as EVAR $ The code describes delayed placement extension prosthesis not performed at same time as EVAR. Code is an Add-on code to $ Code has been added for transcatheter delivery of enhanced fixation device(s) to an endograft and may be reported only once per operative session $97.20 Code was created to report placement of femoralfemoral prosthetic graft during endovascular aortic aneurysm repair $ Code describes the open exposure of the femoral artery and creation of a conduit for an endovascular prosthesis or for cardiopulmonary bypass.

6 34715 $ Code are used to report the open exposure of the axillary/subclavian artery to deliver an endovascular prosthesis by infraclavicular or supraclavicular incision $ Code are used to report the exposure of the axillary/ subclavian artery to deliver an endovascular prosthesis or for establishment of cardiopulmonary bypass $ The code describe a saphenous ablation therapy by injection of non-compounded truncal vein foam sclerosant using ultrasound compression to guide dispersal of the injection in incompetent extremity truncal veins. For direct puncture sclerotherapy use $ The code describe a saphenous ablation therapy by injection of non-compounded truncal vein foam sclerosant using ultrasound compression to guide dispersal of the injection in incompetent extremity truncal veins. For direct puncture sclerotherapy use $0.00 Investigational code, is not considered for payment, refer to medical policy in our web site $0.00 Investigational code, is not considered for payment, refer to medical policy in our web site. Hemic and Lymphatic Systems $99.00 The code describe a bone marrow aspiration and a biopsy. You ll select bone marrow aspiration codes based on their purpose. For diagnostic bone marrow aspiration, report revised code 38220; when it s for a biopsy, report $ The code describe a laparoscopic total pelvic lymphadenectomy in cancer cases.

7 Digestive System BR The code have been added to identify an esophagectomy performed with a scope and based on approach. Via an open and laparoscopic approach BR The code have been added to identify esophagectomy performed with a scope and based on approach. Via a thoracoscopic and laparoscopic approach BR The code have been added to identify esophagectomy performed with a scope and based on approach. Via a thoracoscopic, laparoscopic, and open approach. Male Genital System BR Code is intended for reporting injection of biodegradable material between the prostate and rectum, which is performed to protect viable tissue not intended for treatment during radiation of prostate cancer. The procedure is commonly performed using imaging. Female Genital System $1, The code have been added to identify services that previously requiere resection by laparotomy to now be performed via laparoscopy, for cancer debulking. Nervous System $ The code have been added to identify nerve repairs with nerve allografts; first stand (cable).

8 64913 $ The code have been added to identify nerve repairs with nerve allografts; each additional stand (cable). Radiology CPT codes, has simplified the coding of chest x-rays by reducing the number of code choices from nine to just four. Codes 71010, 71015, , 71030, 71034, and 71035, which described x-rays as stereo, with apical lordotic procedure, with fluoroscopy, or special views, have been deleted for View (e.g. AP, lateral, oblique ) are not equal to images. It may take more than one image to perform a complete view $14.00 The chest x-ray code identify a single view $21.00 The chest x-ray code identify 2 views $27.00 The chest x-ray code identify 3 views $28.00 The chest x-ray code identify 4 or more views $14.00 The abdominal x-ray code identify a single view $18.90 The abdominal x-ray code identify 2 views $25.00 The abdominal x-ray code identify 3 or more views. Cardiovascular $65.00 This services require a contract for the program. The code identify Home and outpatient International Normalized Ratio (INR) Monitoring, training $65.00 This services require a contract for the program. The code identify Home and outpatient International Normalized Ratio (INR) Monitoring, anticoagulant management. Pulmonary

9 94617 $74.70 The code identify a exercise test for bronchospasm diagnostic test $27.00 The code identify a pulmonary stress testing. Endocrinology $16.20 The code identify ambulatory continuous glucose monitoring with patient provided equipment, sensor placement, hook up, calibration, training and print out of recording. Photodynamic Therapy $26.45 The code identify a nonsurgical treatment of cutaneous lesions using photodynamic therapy by external application of light to destroy premalignant lesion(s) of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) $ The code identify a debridement of premalignant hyperkeratotic lesion(s) followed by photodynamic therapy application of light to destroy premalignant lesion(s) of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s). Physical Medicine $27.00 The code identify a cognitive function intervention. Include use of compensatory strategies, an executive function, reasoning and pragmatic functioning. Report only once per day $0.00 The code identify the orthotic(s)/posthetic(s) management and/or training.