MEMORANDUM. Carol Ghere, MT (ASCP) SI, Compliance Officer CPT4 Code Changes from American Medical Association (AMA)

Transcription

1 MEMORANDUM TO: FROM: RML Clients Carol Ghere, MT (ASCP) SI, Compliance Officer DATE: January 2, 2015 SUBJECT: 2015 CPT4 Code Changes from American Medical Association (AMA) 2015 CPT4 Code Changes from AMA The American Medical Association (AMA) CPT code changes for 2015 will become effective on January 1, CPT4 codes for both presumptive and definitive drug classes have been changed in Presumptive codes have been grouped into two drug classes, and for the most part drug screening, which billed multiples of per drug, are being replaced by a single code for any quantity. The definitive drug codes also have new CPT codes. Medicare is choosing not to honor the new drug CPT codes and instead has published a list of G codes to be used. There are specific G codes for each definitive drug. A single code, G6058, is the code to be used for confirmation testing for all definitive drugs. HPV testing has new codes and there have been some revisions for microbiology PCR testing. Anatomic pathology has some unique code changes for 2015 related to immunohistochemical stains and FISH testing. The first stain will be billed with the current CPT code, but there are new codes for additional stains on the same specimen. Prostate biopsies consisting of multiple specimens must be billed to Medicare with a G0416. Gross and microscopic exam for prostate needle biopsies, any method or any number of specimens, will bill the G0416. G0417 through G0419 have been deleted. In 2014, G0416 only applied to biopsies with greater than 10 specimens. Other payers will continue to be billed an for each biopsy submitted. A complete list of RML procedures that have new, deleted, or revised AMA CPT codes for 2015 can be found on our website at and clicking on the billing section at the top of the page. The listing includes the test code, test name, CPT from 2014 and the new 2015 CPT code. We are also listing the new G codes supplied by Medicare. For anatomic pathology, we have provided a more detailed explanation of the new codes for stains. The listed CPT codes reflect RML s interpretation of CPT coding requirements. We recommend that you confirm the correct CPT s to use for billing. These suggested code changes are being made based on review of the AMA and Medicare guidelines. We will publish any new or updated information as soon as it is made available from any regulatory body or reference laboratory. Should you have any other questions or need additional information, please contact RMLBillingTelcorAnalysts@sjmc.org.

2 Listed in order of RML Test Code Numbers HPV 16/ N/A HPV 16RFLX N/A THORAZINE G PREGRABAL S ETH U BILL G FENTANYL U G BUTALBITAL G MORPHINE G SECOBARB G DIHYDTEST G DIAZEPAM G LORAZEPAM G MATERNT N/A MATERNT21P N/A x 12 DIURET S U - URINE SCREEN N/A METHADO UR G PENTOBARB G BARB QN 80345X6 G6043X AMOBARB G BUTABARB G VALPR FREE N/A OPIATE SC G METHADO QN G ACETAMIN G ALCOHOL G ALCOHOL G DRUG C ETH - CORD ETOH METABOLITE G ETH/SB G CLONAZEPA G PHENOBARB G HYDROCOD S G SALICYLATE G NORTRIPTL G DOXEPIN G GC ETH U G METHSUXMD G OXYCODON S G FLUNTR SCR G FLUNTR URI G X 8 PAIN MGMT DRUG PANEL G SYNTHETIC CANNABINOID UR SCR x 5 DRUG F SCR G x 10 DRUG F S G x 6 DRUG B SCR G x 5 ER DRUG B G x 5 ER DRUG B G COCAINE SC G ACETAMIN U G AMPHET U G BARB U G BENZO U G ETH U DET G OPIATES U G PCP U G0431

3 Listed in order of RML Test Code Numbers OPI 300 UR G PROPOXY U G PROPOXY UR G THC U G TRICYCL SC G BENZ SC G ETHANOL SC G SALIC SC G ACETAM SC G DESIPRAMI G IMIPRAMIN G AMITRIPTL G DRUG ABUSE G DRUG ABUS G THC GC/MS G UNK SUBPNL G AMPHET QNT G METHAM QNT G OPI-FR QT G x 9 DRUG BRMLK G X 11 UR DRG SC G COCAI QNU G AMPH/METAM G BENZO QN S G NICOTINE U G NICOT QN S G X 10 UDS INFANT G AMPHET UR G X 12 UDS CLIN G X 5 UDS CLIN G PCP UR G COCAINE UR G THC UR G ETHANOL SC G MEPERI QN G OXYCODON G BUPRENO UR G BARB CONF G BENZ CONF G GC PROPOX G GC METHD G GC PCP G OPIATE GCU 80361; G6056X x 10 MEDTOX 4055 MECONIUM X9 (BO) G X 9 PACIFIC TOX HIGH COMPLEXITY G X 11 PACIFIC TOX PAIN BLOOD PANEL G PACIFIC TOX MODERATE COMPEXITY G ACETAMINOPHEN CONFIRMATION G XPT ETOH ALCOHOL QUANT G AMPHETAMINES QUANT G XPTB CARIS (CARISOPRODOL) G BENZODIAZEPINE QUANT G BUPRENORPHINE QUANT G CARISOPRODOL QUANT (MEPROBAMATE) G6058

4 Listed in order of RML Test Code Numbers COCAINE QUANT G XPTB ALPRZ ALPRAZOLAM SERUM/PLASMA G XPT HEROIN (6MAM) QUANT G FENTANYL, URINE QUANT G KETAMINE QUANT CONFIRMATION G MEPERIDINE, QUANT G METHADONE, QUANT G ;82649 XPT OPIATE G6058X OXYCODONE, URINE QUANT G PROPOXYPHENE QUANT G TRAMADOL QUANT G XPT NICO G XPT TAPENT G X 9 PTOX PAIN G X 10 UDS INDUST 10 PANEL G HPVPAPHI N/A HPV ONLY N/A FLU A PCR N/A FLU B PCR N/A PM AMPHETAMINES CONFIRM G BILL PM BENZODIAZEPINES CONFRM G PREGRABAL S

5 Listed in order of 2014 CPT code ETH U BILL G OPIATE SC G DRUG C ETH - CORD ETOH METABOLITE G ETH/SB G FLUNTR URI G UNK SUBPNL G METHADO UR G SYNTHETIC CANNABINOID UR SCR ACETAMIN U G AMPHET U G BARB U G BENZO U G ETH U DET G OPIATES U G PCP U G OPI 300 UR G PROPOXY U G PROPOXY UR G THC U G TRICYCL SC G BENZ SC G ETHANOL SC G SALIC SC G ACETAM SC G AMPHET UR G PCP UR G COCAINE UR G THC UR G ETHANOL SC G OXYCODON G BUPRENO UR G XPTB ALPRZ ALPRAZOLAM SERUM/PLAS G x 12 DIURET S U - URINE SCREEN N/A X 9 PACIFIC TOX HIGH COMPLEXITY G x 10 DRUG F S G X 10 UDS INFANT G x 10 MEDTOX 4055 MECONIUM X9 (BO) G X 10 UDS INDUST 10 PANEL G X 11 UR DRG SC G X 11 PACIFIC TOX PAIN BLOOD PANEL G X 12 UDS CLIN G x 5 DRUG F SCR G x 5 ER DRUG B G X 5 UDS CLIN G x 6 DRUG B SCR G X 8 PAIN MGMT DRUG PANEL G x 9 DRUG BRMLK G X 9 PTOX PAIN G x 5 ER DRUG B G GC ETH U G THC GC/MS G BARB CONF G BENZ CONF G GC PROPOX G0431

6 Listed in order of 2014 CPT code GC METHD G GC PCP G DRUG ABUSE G DRUG ABUS G PACIFIC TOX MODERATE COMPEXITY G AMITRIPTL G DIAZEPAM G LORAZEPAM G CLONAZEPA G FLUNTR SCR G BENZO QN S G BENZODIAZEPINE QUANT G BILL PM BENZODIAZEPINES CONFRM G DESIPRAMI G VALPR FREE N/A DOXEPIN G IMIPRAMIN G NORTRIPTL G SALICYLATE G ALCOHOL G MATERNT N/A MATERNT21P N/A ACETAMIN G ACETAMINOPHEN CONFIRMATION G ALCOHOL G XPT ETOH ALCOHOL QUANT G AMPHET QNT G METHAM QNT G AMPH/METAM G AMPHETAMINES QUANT G PM AMPHETAMINES CONFIRM G BUTALBITAL G SECOBARB G PENTOBARB G BARB QN 80345X6 G6043X AMOBARB G BUTABARB G PHENOBARB G COCAINE SC G COCAI QNU G COCAINE QUANT G PREGRABAL S HYDROCOD S G ;82649 XPT OPIATE G6058X DIHYDTEST G XPTB CARIS (CARISOPRODOL) G CARISOPRODOL QUANT (MEPROBAMAT G METHADO QN G METHADONE, QUANT G METHSUXMD G NICOTINE U G NICOT QN S G XPT NICO G FENTANYL U G6056

7 Listed in order of 2014 CPT code MORPHINE G OXYCODON S G OPI-FR QT G MEPERI QN G OPIATE GCU 80361; G6056X BUPRENORPHINE QUANT G XPT HEROIN (6MAM) QUANT G FENTANYL, URINE QUANT G KETAMINE QUANT CONFIRMATION G MEPERIDINE, QUANT G OXYCODONE, URINE QUANT G PROPOXYPHENE QUANT G TRAMADOL QUANT G XPT TAPENT G THORAZINE G HPV 16/ N/A HPV 16RFLX N/A HPVPAPHI N/A HPV ONLY N/A FLU A PCR N/A FLU B PCR N/A

8 Tests with Deleted Codes Note x 5; DRUG B ER 80301; G0431;G x 5 ER DRUG B G ALCOHOL G X 9; PACIFIC TOX PAIN3 PANEL 80301; G0431; G X 9 PACIFIC TOX HIGH COMPLEXITY G PACIFIC TOX MODERATE COMPEXITY G X8; 82570; 83986; PAIN MGMT DRUG PANEL , G No longer billing PH or Creat with panels X 8 PAIN MGMT DRUG PANEL G PM OXIDANT X 11; 82570; UDS MED PR G0431 No longer billing PH or Creat with panels ; PAIN MGMT TRYCYCLIC CONFIRM G6058x ;80160; 80166;80174; TRICYCLICS QUANT (5) G6805X = 3-5 Tricyclics ;83789 XPT NSAID-NSAID QUANT (2) 80329;83789 G60038; XPT NSAID SALICYLATE G XPT NSAID ANALYTE UNSPECIFIED ; BARBITURATES QUANT 80184; ;G XPT PHENOBAR XPT PENTOB ETAL G x2; 87798x2 VRESP PCR N/A

9 Anatomic Pathology New Codes New RML Surgical Pathology Related Primary Code Procedure Code in Bold st Stain Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure) Each additional Stain TC Technical Component Immunohistochemistry or immunocytochemistry, per specimen; each Multiplex Stain multiplex antibody stain procedure 88344TC Technical Component st Stain In situ hybridization (eg, FISH), per specimen; each additional single Each additional Stain probe stain procedure (List separately in addition to code for primary procedure) 88364TC Technical Component In situ hybridization (eg, FISH), per specimen; each multiplex probe stain procedure Multiplex Stain TC Technical Component st Stain Morphometric analysis, in situ hybridization (quantitative or semiquantitative), Each additional Stain manual, per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure) 88369TC Technical Component Morphometric analysis, in situ hybridization (quantitative or semiquantitative), manual, per specimen; each multiplex probe stain procedure Multiplex Stain TC Technical Component Prostate Biopsies for Medicare G0416 Surgical pathology; gross and microscopic exam for prostate needle biopsies, any method, any number of specimens. Non Mecicare Continue to Bill per biopsy.