CPT Code Changes for 2013 Academic Medicine, Multi-Specialty Medicine & Office-Based Practices

Transcription

1 CPT Code Changes for 2013 Academic Medicine, Multi-Specialty Medicine & Office-Based Practices Lisa Schroeder, CHC, CCS-P, CPC Compliance Program Director- Academic & Multi-Specialty Medicine This commentary is a summary prepared by McKesson s Revenue Management Solutions division and highlights certain changes, but not all changes, in 2013 CPT codes relating to the specialties of academic, multi-specialty and office-based medicine. This commentary does not supplant the American Medical Association s current listing of CPT codes, its documentation in the annual CPT Changes publications, and other related publications from American Medical Association, which are the authoritative source for information about CPT codes. Please refer to your 2013 CPT Code Book, annual CPT Changes publication, HCPCS Book and Payer Bulletins for additional information, including additions, deletions, changes and interpretations that may not be reflected in this document. CPT is a registered trademark of the American Medical Association ( AMA ). The AMA is the owner of all copyright, trademark and other rights to CPT and its updates. CPT codes, descriptions and other data are copyright 1966, 1970, 1973, 1977, 1981, American Medical Association. All rights reserved. 1

2 Overview Current Procedural Terminology (CPT) 2013 contains new and revised codes for a variety of specialty (excluding diagnostic, interventional, nuclear medicine, radiation oncology, Lab/Pathology and Anesthesia) procedures. Revenue Management Solutions (RMS), a division of McKesson, has prepared this summary to provide you with details on CPT code additions, deletions and modifications issued by the American Medical Association (AMA). CPT Nomenclature Reporting Neutrality The CPT code set issued by the AMA is a work of medical nomenclature which consists of a set of codes, descriptions, and guidelines that describe procedures and services performed by physicians and other qualified health care professionals. The CPT Editorial Panel is required to adhere to the policy of neutrality with respect to identifying who may perform a procedure or service that is described in the CPT code set. Throughout the CPT code set, the use of terms such as physician, qualified health professional, or individual, is not intended to indicate that other entities may not report the service. A large number of the 2013 CPT codes have been modified by adding after the term physician the following words: and other qualified health care professionals or the term physician has been completely removed from the description. For 2013, there are numerous CPT codes, guidelines and/or parenthetical instructions whose terminology has been revised with the intent of reporting neutrality on the CPT code set. Due to the large number of changes related to this issue, please refer to the CPT 2013 code set. Time Reporting Guidelines The CPT code set contains many codes with a time basis for code selection. The following standards should be applied to time measurement when selecting a CPT code (unless there are code or coderange specific instructions in guidelines, parenthetical instructions, or code descriptors to the contrary). Time is the face-to-face time with the patient. Phrases such as interpretation and report in the code descriptor are not intended to indicate in all cases that report writing is part of the reported time. A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes). A second hour is attained when a total of 91 minutes have elapsed. When codes are ranked in sequential typical times and the actual time is between two typical times, the code with the typical time closest to the actual time is used. See also the Evaluation and Management (E/M) Services Guidelines. Evaluation and Management (E/M) Services Guidelines New and Established Patient There have been revisions made to the evaluation and management guideline section on New and Established Patients. The following has been added after the term physician and other qualified health care professionals who may report evaluation and management services. In addition, CPT now states that when advanced practice nurses and physician assistants are working with physicians, they are considered as working in the exact same specialty and exact same subspecialties as the physician. Evaluation and Management (E/M) Services There were numerous changes made in the E/M section some of which include: (1) typical service times added to the observation or inpatient hospital care codes 99234, and 99236; (2) revised parenthetical notes included in prolonged services that reference psychotherapy codes and 90815, and (3) revisions made to the Inpatient Neonatal and Pediatric Critical Care Services and the Initial and Continuing Intensive Care Service guidelines. A new coding structure was added in the E/M services section that describes Complex Chronic Care Coordination Services and Transitional Care Management Services. The new structure includes three 2

3 new codes in the Chronic Care Coordination Services section and two new codes in the Transitional Care Management Services section. Observation or Inpatient Care Services (Including Admission and Discharge Services) Typical service times have been added to the codes for observation or inpatient hospital care services provided to patients admitted and discharged on the same date (99234, 99235, and 99236). Revised Codes Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date.. Typically, 40 minutes are spent at the bedside and on the patient s hospital floor or unit Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date.. Typically, 50 minutes are spent at the bedside and on the patient s hospital floor or unit Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date.. Typically, 55 minutes are spent at the bedside and on the patient s hospital floor or unit. Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Pediatric Critical Care Patient Transport Two codes and have been established to report non-face-to-face physician supervision of inter-facility pediatric critical care transport, 24 months of age or younger. Code is intended to describe supervision by a control physician of inter-facility 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, and add-on code is intended to describe each additional 30 minutes. New Codes Supervision by a control physician of inter-facility 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 3

4 and report; first 30 minutes each additional 30 minutes (List separately in addition to code for primary procedure) Evaluation and Management (E/M) Services Guidelines Neonatal and Pediatric Critical Care The Neonatal and Pediatric Critical Care guidelines were revised to provide clarification regarding reporting codes 99468, 99469, and in relation to other facility codes (newborn care services, time-based critical care services), based on whether the physician or other qualified health care professional is the receiving individual or transferring individual providing care to the patient, and whether the individual(s) is part of the same or different groups within the same facility. The revised guidelines now make it clear that when an individual provides normal newborn services (99460, 99461, 99462) and the neonate or infant becomes critically ill and treated by a different individual in a different group, the first individual may report either the normal newborn services, or if he or she has provided critical care services, may report code 99291, 99292, but not both the normal newborn care services and the critical care services. The receiving individual reports initial or subsequent inpatient neonatal or pediatric critical care ( ), as appropriate based on the patient s age. However, if the patient becomes critically ill on the same day they received normal newborn care (99460, 99461, and 99462) and critical care services are assumed by the same individual or group, the group or individual may report initial critical care service code with modifier 25, in addition to the normal newborn code. Also, the guidelines now include instructions that prevent the reporting of both time-based critical care services (99291, 99292) and Inpatient Neonatal and Pediatric Critical Care services ( ), when reported by the same individual or different individual within the same group for the same patient on the same day. Clarification has also been provided that the initial Inpatient Pediatric Critical Care codes and can only be used once per hospital stay in a given facility, and if a patient is readmitted to pediatric critical care unit during the same stay, the readmission to the unit is coded using the subsequent inpatient pediatric critical care codes or 99476, depending on the patient s age. The guidelines have also been revised to clarify the intended age range for codes and 99292, stating that codes are intended for children 6 years of age or older, and not the former definition, older than five years of age. Complex Chronic Care Coordination Services & Transitional Care Management Services Due to a request that was received from CMS to the AMA/Specialty Society RVS Update Committee (RUC) to review all evaluation and management services, a joint CPT/RUC Chronic Care Coordination workgroup was formed. The workgroup was charged to look at new CPT codes for services that are important to chronic care management. In response, a new coding structure for the E/M section has been created to include guideline language, new codes and descriptors, and instructional parenthetical notes to describe Complex Chronic Care Coordination Services and Transitional Care Management Services. 4

5 Specifically, this new coding structure includes a new heading for Complex Chronic Care and Transitional Care and new guidelines that define the types of services, professionals, and patients receiving these services. The guidelines also instruct users on how to accurately report these new services. Numerous parenthetical notes were added throughout the E/M and Medicine subsections to instruct appropriate reporting of these services in conjunction with other E/M services. It is important to note that CMS is currently considering the services for these new CPT codes as bundled services. CMS will continue to explore payment approaches and is developing proposals to promote primary care within a fee-for-service payment structure. CMS is considering adoption of these codes in future rulemaking 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 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 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) 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 and, Face-to-face visit, within 14 calendar days of discharge 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 and, Face-to-face visit, within 7 calendar days of discharge 5

6 Quick Reference Evaluation and Management Changes CPT CODE ADDED DELETED REVISED

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8 Surgery Section There have been numerous changes made to the Surgery section, which include the addition of 47 new codes and the deletion of 11 codes. Several codes have also been revised, including revisions related to the nomenclature neutrality change described above. The Musculoskeletal section includes new codes for the revision of total shoulder arthroplasty and the revision of total elbow arthroplasty. The Respiratory section includes the addition of four new codes to report bronchoscopy services for bronchial valves and two codes for bronchial thermoplasty. The Respiratory section includes new thoracentesis codes, as well as a new heading, code, and guidelines for Thoracic Stereotactic Body Radiation Therapy (SRS/SBRT). A large number of changes have been made to the Cardiovascular System section, including the addition of codes and guidelines for Transcatheter Aortic Valve Replacement. Other changes include eight new codes that are created to address the duplication of work among the carotid angiography codes. Further changes to the Cardiovascular System section include the addition of a new subsection entitled, Transcatheter Thrombolytic Infusion, with guidelines and four new codes that replace deleted thrombolytic infusion codes and There are also changes to the Digestive System and the Nervous System sections. Integumentary System Through RUC analysis, code has been identified through the site of service screen and fastest growing screen as a potentially misvalued code. Therefore, code has been revised to clearly describe an island pedicle flap by adding the phrase requiring identification and dissection of an anatomically named axial vessel to the code descriptor. To clarify the reporting of this service, the crossreference note following has been moved to the introductory guidelines for the Other Flaps and Grafts subsection and revised to include more specific flaps. The introductory guidelines were further modified to include the phrase anatomically named within the first sentence by using more specific terminology to describe the flap. Revised Code Flap; island pedicle requiring identification and dissection of an anatomically named axial vessel Musculoskeletal System Spine (Vertebral Column) The moderate sedation symbol has been added to percutaneous vertebroplasty add-on code Moderate sedation is an inclusive component of code and should not be separately reported Revised Code Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic - each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) 8

9 Shoulder Due to the need for additional codes to provide greater clarity for reporting the removal and replacement of an artificial implant placed in previous total shoulder arthroplasty, two new total shoulder revision codes were added for Codes and 23474, were added for revision of a total shoulder arthroplasty that includes the removal of an artificial prosthesis (ie, humeral and/or glenoid component[s]) and replacement with a new prosthesis (artificial implant) in the same shoulder at the same time. Originally, the removal component of the shoulder revision procedure was reflected in codes and and was reported separately. Because the removal of the prosthesis is included in codes and 23474, an exclusionary note has been added following codes 23331, and 23473, to indicate that codes 23331, and 23473, should not be reported together. The term revision in the new codes refers to removal of a prosthesis and replacement with a new prosthesis at the same time Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid Component humeral and glenoid component Humerus (Upper Arm) and Elbow Due to the need for additional codes for reporting revision of a total elbow arthroplasty, including the removal of the prosthesis and replacement with a new prosthesis (artificial implant) two new codes were added for Originally, the removal component of the elbow revision procedure (24363) was reported separately with code 24160, but codes and were not recognized when reported together and payment denials occurred. The new codes describe the revision of a total elbow arthroplasty that includes the removal of an artificial prosthesis (ie, humeral and/or ulnar component[s]) and replacement with a new prosthesis (artificial implant) in the same elbow. The term revision in the new codes refers to removal of a prosthesis and replacement with a new prosthesis at the same time. A series of instructional parenthetical notes have been added to disallow the use of in conjunction with or and to reference the new revision of elbow codes following the total elbow arthroplasty code Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component humeral and ulnar component 9

10 Respiratory System Trachea and Bronchi Codes 31647, 31648, 31649, and have been added to report bronchoscopy services for the insertion and removal of bronchial valves. These codes are intended to replace Category III codes 0250T, 0251T, and 0252T when these services are performed. Each of the codes includes additional descriptor information that was formerly included as part of the Category III codes, which were used to identify these services. To accommodate the changes made, additional parenthetical notes have been included following existing codes and to: (1) exclude report of the bronchial valve insertion codes in addition to code (which is inherently included as part of these services); and (2) to direct users to the correct codes to report for removal of implanted bronchial valves ( ). In addition, bronchoscopy with injection of contrast material for segmental bronchography code has been deleted, as bronchography has now been replaced by use of computed tomography. A parenthetical note has been added directing users to unlisted code in the event that this procedure is performed. Because many of these procedures inherently include moderate sedation, the moderate sedation symbol has been included for those codes with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), initial lobe with removal of bronchial valve(s), initial lobe with removal of bronchial valve(s), each additional lobe (List separately in addition to code for primary procedure) 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]) Codes and have been added to report bronchial thermoplasty. These codes replace Category III codes 0276T and 0277T. To accommodate the placement for these codes and to allow better identification of these procedures, a new section heading has been added to the CPT code set to identify bronchial thermoplasty procedures Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe with bronchial thermoplasty, 2 or more lobes 10

11 Lungs and Pleura Codes have been developed to identify pleural fluid aspiration (32554, 32555) and percutaneous pleural drainage (32556, 32557) procedures. These codes were developed to more accurately identify the type of procedure being provided (thoracocentesis versus drainage). To accommodate the addition of the new codes, codes have been deleted, and parenthetical notes placed to direct users to the appropriate codes to report: (1) biopsy of the lung or mediastinum using a percutaneous needle (32405); and (2) aspiration of the pleural space (using a needle or a catheter) without imaging (32554) or with imaging (32555). Tube thoracostomy code has been revised to identify that this is an open procedure by adding the term open to the descriptor language Revised Code Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure) Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance with imaging guidance Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance with imaging guidance Because current approved technology allows stereotactic body radiation (SRS/ SBRT) to be performed in the thoracic region of the body, a new code (32701), guidelines, and a new heading have been added to the Respiratory System section for reporting thoracic target delineation for SRS/SBRT. Code is intended to describe noncranial or nonspinal stereotactic radiosurgery, or stereotactic body radiation therapy performed in the thoracic region of the body. New Code Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment 11

12 Cardiovascular System Heart and Pericardium The Category III codes 0256T, 0258T, and 0259T for transcatheter aortic valve replacement procedures have been moved to Category I status, with new guidelines and parenthetical notes established to instruct users on the appropriate reporting of the new codes in the Surgery/Cardiovascular System/Cardiac Valves/ Aortic Valve subsection. Category III code 0257T has been deleted and replaced with Category III code 0318T for the transapical approach for transcatheter aortic valve placement. New codes and 0318T are used to report transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI). Codes and 0318T include the work, when performed, of percutaneous access, placing the access sheath, balloon aortic valvuloplasty, advancing the valve delivery system into position, repositioning the valve as needed, deploying the valve, temporary pacemaker insertion for rapid pacing (33210), and closure of the arteriotomy when performed. Codes and 0318T also include open arterial or cardiac approach. Angiography, radiological supervision, and interpretation performed to guide TAVR or TAVI are included in these codes (eg, guiding valve placement, documenting completion of the intervention, and assessing the vascular access site for closure) Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach open femoral artery approach open axillary artery approach open iliac artery approach transaortic approach (eg, median sternotomy, mediastinotomy) cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (eg, femoral vessels) (List separately in addition to code for primary procedure) cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg, femoral, iliac, axillary vessels) (List separately in addition to code for primary procedure) cardiopulmonary bypass support with central arterial and venous cannulation (eg, aorta, right atrium, pulmonary artery) (List separately in addition to code for primary procedure) 12

13 A new subsection has been established with a new heading, guidelines, and family of codes pertaining to percutaneous ventricular assist device procedures. The percutaneous ventricular assist device insertion Category III codes 0048T and 0050T have been moved to Category I status, two new subsection headings have been added distinguish transthoracic cardiac assist procedures from percutaneous cardiac assist procedures, with new guidelines and parenthetical notes established to instruct users on the appropriate reporting of the four new codes in the Surgery/ Cardiovascular System/Cardiac Assist subsection. Instructions have also been added to the Bypass Grafting subsections directing users to codes for percutaneous ventricular assist device insertion, removal, and repositioning. Open arterial exposure, when necessary to facilitate percutaneous ventricularassist device (VAD) insertion (33991, 33992), may be reported separately (34812). Because VAD removal of the entire device, including the cannulas, is inherent in codes 33977, 33978, and 33980, a new code (33992) has been added for removal of a percutaneous ventricular assist device at a separate and distinct session, but on the same day as insertion. In this circumstance, code should be reported with modifier 59 appended indicating a distinct procedural service has been performed. Repositioning of a VAD is not separately reportable when performed at the same session or when the repositioning does not require imaging guidance. However, code may be reported with modifier 59 appended when repositioning of a VAD is performed at a separate and distinct session Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only both arterial and venous access, with transseptal puncture Removal of percutaneous ventricular assist device at separate and distinct session from insertion Repositioning of percutaneous ventricular assist device with imaging guidance at separate and distinct session from insertion Vascular Injection Procedures Due to an analysis completed by the RUC, 8 new codes ( ) were created to address the duplication of work among the carotid angiography codes. In addition, angiography supervision and interpretation codes 75650, 75660, 75662, 75665, 75671, 75676, 75680, and were deleted because the work in these codes were also combined or bundled into codes Other corresponding changes to the CPT code set include a new subsection in the Vascular Injection Procedures section, titled Diagnostic Studies of Cervicocerebral Arteries, along with introductory guidelines that clarify the intent and use of codes In addition to providing specific guidance regarding intended use and appropriate reporting instructions for codes , the guidelines also convey instructions for appropriate use of modifiers 50 and 59 with codes The guidelines also offer guidance on how to appropriately report diagnostic angiography code 75774, 3-dimensional rendering codes or 76377, and ultrasound guidance code with codes

14 36221 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 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 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 angiography of the extracranial carotid and cervicocerebral arch, when performed 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 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 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 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) 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 14

15 artery) (List separately in addition to code for primary procedure) Transcatheter Procedures Due to an analysis completed by the RUC, thrombolytic infusion codes and have been deleted from the code set. In support of these deletions, radiology codes and have been revised. The services previously reported with codes and and components of and are now combined and reported with new transcatheter thrombolytic codes To accommodate these changes, the CPT code set now includes a new Transcatheter Thrombolytic Infusion subsection, four new transcatheter thrombolytic infusion procedure codes ( ), and introductory guidelines that explain the intent and appropriate use of these new codes. The new Transcatheter Thrombolytic Infusion guidelines instruct and clarify that: (1) or is used to report the initial day of transcatheter thrombolytic infusion(s), including when the follow-up arteriography or venography,and catheter position change or exchange is performed; (2) modifier 50 is reported in conjunction with codes 37211, when bilateral thrombolytic infusion is performed through a separate access site(s); (3) code is reported when continued transcatheter thrombolytic infusion(s) on subsequent day(s), other than initial day and final day of treatment, is performed; and (4) code is reported on the final day of transcatheter thrombolytic infusion(s). When initiation and completion of thrombolysis occur on the same day, only report codes or Catheter placement(s), diagnostic studies, and other percutaneous interventions provided may be reported separately. All fluoroscopic guidance and associated radiological supervision and interpretation is now included in codes Codes do not include ultrasound guidance for vascular access. However, code may be reported separately if all the required elements are performed. The guidelines also include a clarifying statement to allow reporting of distinctly separate E/M services in addition to the thrombolytic service when required. Codes are only reported once per date of treatment. CPT code along with the radiological supervision and interpretation code and their associated cross-references have been deleted for The services previously reported with codes and are now combined into code for reporting percutaneous transcatheter retrieval of intravascular foreign body with radiological supervision and interpretation. The cross-reference note following code has been revised by removing codes and and adding new code In addition, code has been deleted, as this exchange of a previously placed intravascular catheter during thrombolytic therapy is now an inclusive component of the new transcatheter therapy procedures ( ). Cross-reference notes have been added to direct users to report the new codes. In support of the changes to the Vascular Injection Procedures section, the exclusionary parenthetical note following code has been revised with the removal of deleted codes and and the addition of new codes

16 37197 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 Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervisionand interpretation, initial treatment day 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 Hemic and Lymphatic System There have been several changes and additions made to the CPT code set to clarify appropriate use of these services. First, a new subsection heading in the Hemic and Lymphatic Systems section for Transplantation and Post-Transplantation Cellular Infusions has been added along with introductory language and guidelines for appropriate reporting of these services. Second, codes 38240, 38241, and have been editorially revised. Third, code has been established to report HPC boost. Fourth, the parenthetical notes following code have been revised to provide direction for appropriate reporting of these services. Last, a cross-reference has been added in the Pathology and Laboratory/ Transfusion Medicine section of the CPT code set following code directing users to the appropriate code for reporting allogeneic lymphocyte infusion (38242). Revised Codes Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor autologous transplantation Allogeneic lymphocyte infusions 16

17 New Code HPC boost Digestive System Esophagus CPT Code has been deleted. As a result, a parenthetical note has been added to direct users to report code to identify upper gastrointestinal endoscopy. Codes 43206, 43252, and Pathology Laboratory code have been established to identify real-time cellular observation of mucosal tissue (intestinal) during an endoscopy procedure. Both services inherently include moderate sedation. These procedures also include diagnostic injection procedures required for administration of the contrast agent for the procedure Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) with optical endomicroscopy Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) with optical endomicroscopy Intestines (Except Rectum) Code has been established for reporting physician work provided for assessing donors and overseeing preparation of fecal microbiota. The service inherently includes: (1) development of the slurry that will be instilled into the recipient digestive tract, and (2) assessment of the donor specimen, including physician review of the results of testing for Clostridium difficile toxins in the donor stool as well as serologic testing of the donor s specimen for hepatitis A, B, and C viruses, HIV-1, HIV-2, and syphilis. New Code Preparation of fecal microbiota for instillation, including assessment of donor specimen 17

18 Urinary System Bladder Code has been established for reporting chemodenervation of the bladder for neurogenic incontinence. Existing codes and are specific to the chemodenervation of the internal anal sphincter, parotid and submandibular salivary glands, muscle innervated by facial nerve, neck muscles, extremity and/or trunk muscles, eccrine glands, and extraocular muscle. A parenthetical note was added following code indicating that supply of the chemodenervation agent is reported separately. New Code Cystourethroscopy, with injection(s) for chemodenervation of the bladder Nervous System Code was editorially revised to state including image guidance, if performed to clarify that image guidance is included in this procedure and should not be reported separately when performed. Revised Code sacral nerve (transforaminal placement) including image guidance, if performed Code has been added for 2013 to report chemodenervation of muscle(s) innervated by facial, trigeminal, cervical spinal, and accessory nerves, bilateral (eg, for chronic migraine). Code is reported only once per session. An exclusionary parenthetical note has been added following code 64615, to preclude reporting code with chemodenervation codes 64612, 64613, and Code has been revised to include the term unilateral, and code has been revised by removing s from the term extremity. Instructional parenthetical notes were added following this family of codes, instructing users that codes are used only once per session. A clarification has been added to the Destruction of Neurolytic Agent guidelines indicating that when reporting chemodenervation codes, the supply of the chemodenervation agent is reported separately. Revised Codes Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm) extremity and/or trunk muscle(s) (eg, for dystonia, cerebral palsy, multiple sclerosis) 18

19 New Code muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine) Eye and Ocular Adnexa CPT code has been deleted and combined into code 65800, with a change in terminology to state with removal of aqueous, which adequately encompasses both the diagnostic aspiration of aqueous and therapeutic release of aqueous. Revised Code Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueous CPT Code was editorially revised to clarify the depth and type of biopsy required for eyelid skin lesions when malignancy is suspected. This type of biopsy is classified as incisional biopsy, and it involves incision of the top and bottom layers of the lid margin. Code was also revised to distinguish it from biopsy codes and listed in the Integumentary System section. A parenthetical note following code directs users to codes and for biopsy involving the skin and subcutaneous layer, and codes for shaving of epidermal or dermal lesions was also added. Revised Code Incisional biopsy of eyelid skin including lid margin Quick Reference Surgery Changes CPT CODE ADDED DELETED REVISED

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21 Medicine Codes The Medicine section includes a total of 51 new codes for 2013 and 47 deleted codes. Several codes have also been revised. Many guidelines throughout the Medicine section have also been revised with the addition of explicit code-range listings. Among the various changes in the Vaccines, Toxoids subsection is four influenza vaccine codes that have been editorially revised. The Psychiatry subsection has undergone major changes for 2013 with a totally new coding structure. Among the numerous changes is the deletion of 24 individual psychotherapy codes, which have been replaced with a new series of six psychotherapy codes. The Cardiovascular subsection has codes and guidelines as well as the deletion of intracardiac ablation codes and the addition of three new codes, which combine comprehensive electrophysiologic evaluation with intracardiac ablation of arrhythmogenic focus services. 21

22 Other changes to the Medicine section include the revision of the allergy testing codes and many changes to the Neurology and Neuromuscular subsection. Sleep testing, nerve conduction tests, intraoperative neurophysiology, and autonomic function tests are all areas with new and revised codes. Vaccines, Toxoids A vaccine product code, 90653, was added for an adjuvanted influenza vaccine. Code appears in the CPT codebook with the US Food and Drug Administration (FDA) approval pending symbol. The administration of the vaccine is separately reported using Immunization Administration for Vaccines/Toxoids codes ( ). New Code Influenza vaccine, inactivated, subunit, adjuvanted, for intramuscular use Influenza virus vaccine product codes 90655, 90656, 90657, and have been revised to specify trivalent to prepare for the new quadrivalent influenza vaccines, which is expected to be available for use in Revised Codes Influenza virus vaccine, trivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use Influenza virus vaccine, trivalent, split virus, when administered to children 6-35 months of age, for intramuscular use Influenza virus vaccine, trivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use Code for reporting Lyme Disease vaccine product introduced to the market in 1998 and added to CPT 1999 code set was deleted, as it is no longer available. A new vaccine product code was added for a quadrivalent intranasal live influenza virus vaccine which received FDA approval in February

23 New Code Influenza virus vaccine, quadrivalent, live, for intranasal use The vaccine product code for reporting the whole cell Pertussis vaccine composed of whole cells of killed Bordetella pertussis bacilli, combined with Diphtheria and tetanus toxoids (DTP) was deleted, as it is no longer used in the United States. Code to report preservative containing tetanus and diphtheria toxoid (Td) vaccine was deleted for 2013 to eliminate confusion, because no Td product currently on the market is considered preservative containing. A vaccine product code was added for a 2-dose hepatitis B vaccine enhanced with an immunostimulatory adjuvant. The 3-dose hepatitis B vaccine code has been revised to state 3 dose schedule to differentiate it from new code New Code Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use Revised Code Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use Psychiatry A new coding structure has been added to the Psychiatry section to facilitate an accurate reflection of the different work performed by physicians and other qualified health care professionals. The new series of codes added to the Psychiatry section captures changes in the way psychotherapy services are provided. As part of this restructuring, the introductory guidelines in the Psychiatry section have been revised to provide appropriate instruction on the reporting of Evaluation and Management (E/M) services for treatment of psychiatric conditions. A new subsection has been added to the Psychiatry section for reporting interactive complexity. Add-on code was established to report interactive complexity in conjunction with the following new psychiatric codes: Psychiatric Diagnostic Evaluation (90791, 90792); Psychotherapy (90832, 90834, 90837); Psychotherapy performed with an E/M service (90833, 90836, 90838, , , ); and Group Psychotherapy (90853). Code may not be reported with an evaluation and management service that is not provided in conjunction with a psychotherapy service. New guidelines and parenthetical notes have been added in the Interactive Complexity section to provide instruction on the appropriate reporting of code Interactive complexity will be reported in addition to primary procedure codes when communication difficulties are present and it becomes necessary to 23

24 involve other family members, translators, third-party payers, agencies and school representatives, including compliance with mandates for reporting abuse and or neglect. It may also involve addressing any language barriers that may exist between the patient and physician or other qualified health care professional. New Code Interactive complexity (List separately in addition to the code for primary procedure) The Psychiatric Diagnostic Procedures section was revised with new codes, deleted codes, and new guidelines to describe psychiatric diagnostic procedures. Two new codes for psychiatric diagnostic evaluation (90791, 90792) have been established to replace codes and which were deleted for Codes and differentiate between diagnostic services done with medical services (90792) and without medical services (90791). The interactive component of the diagnostic evaluation is now captured by the new interactive complexity add-on code 90785, which may be reported in conjunction with the new psychiatric diagnostic evaluation codes and Psychiatric diagnostic evaluation Psychiatric diagnostic evaluation with medical services CPT codes 90804, 90805, 90806, 90807, 90808, have been deleted. To report, see psychotherapy codes 90832, 90834, or psychotherapy add-on codes when performed with an evaluation and management service [90833, 90836, 90838, , , ]. CPT codes 90810, 90811, 90812, 90813, 90814, have been deleted. To report interactive psychotherapy, report in conjunction with psychotherapy codes 90832, 90834, or psychotherapy add-on codes when performed with an evaluation and management service [90833, 90836, 90838, , , ]. CPT codes 90816, 90817, 90818, 90819, 90821, have been deleted. To report, see psychotherapy codes 90832, 90834, or psychotherapy add-on codes when performed with an evaluation and management service [90833, 90836, 90838, , , ]. CPT codes 90823, 90824, 90826, 90827, 90828, have been deleted. To report interactive psychotherapy, report in conjunction with psychotherapy codes 90832, 90834, or psychotherapy add-on codes when performed with an evaluation and management service [90833, 90836, 90838, , , ]. A new series of psychotherapy codes ( ) and guidelines have been were established to replace the individual psychotherapy codes The differences between the codes are highlighted below: Site of service is no longer a criterion for code selection. Time specifications were changed to be consistent with CPT convention. 24

25 Individual is not in the code titles and psychotherapy time may include face-to-face time with family members, as long as the patient is present for part of the session. Interactive psychotherapy codes were replaced with reporting psychotherapy in conjunction with an interactive complexity add-on code 90785, expanding the types of communication difficulties that are recognized. Codes for individual psychotherapy without medical evaluation and management services (90804, 90806, 90808, 90810, 90812, 90814, 90816, 90818, 90821, 90823, 90826, 90828) were replaced with psychotherapy codes 90832, 90834, Codes for psychotherapy with medical evaluation and management services (90805, 90807, 90809, 90811, 90813, 90815, 90817, 90819, 90822, 90824, 90827, 90829) were replaced with psychotherapy add-on codes 90833, 90836, 90838, which are to be reported in conjunction with codes for E/M services. To report both an E/M code and a psychotherapy add-on code, the two services must be significant and separately identifiable. The psychotherapy code must be documented separately. Time associated with activities used to meet criteria for the E/M service is not included in the time used for reporting the psychotherapy service and the time must be reported separately Psychotherapy, 30 minutes with patient and/or family member 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) Psychotherapy, 45 minutes with patient and/or family member 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) Psychotherapy, 60 minutes with patient and/or family member 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) New codes have been added for Psychotherapy for Crisis when psychotherapy services are provided to a patient, who presents in high distress with complex or life threatening circumstances that require urgent and immediate attention. A new subsection, Psychotherapy for Crisis, new guidelines, and two new codes (90839 and 90840) have been established to report services performed in these circumstances. The codes may not be reported with the psychiatric diagnostic evaluation codes (90791, 90792), the psychotherapy codes ( ), or