AAHAM Western Region December 11, 2014

Chargemaster Changes for 2015 AAHAM Western Region December 11, 2014 Presented by: Terrance Wong Terrance Wong & Associates Healthcare Financial Consultants 350 Augusta Drive Palm Desert, CA 92211 (760) 779-8700 terrywong@terrancewongandassociates.com www.terrancewongandassociates.com Chargemaster Changes for 2015 The slides from this presentation are intended to be used in conjunction with the speaker s oral presentation. Some slides may be designed to illustrate inappropriate or erroneous examples. Consequently, the use of these handouts by themselves could be misleading. The slides in this presentation do not represent all of the CPT, HCPCS codes and Medicare OPPS changes for 2015, but rather a selection by the speaker for this presentation. Current Procedural Terminology (CPT ) copyright 2014 American Medical Association. All Rights Reserved 2015 Review Acute Care Hospital Chargemasters Sources of Issues AMA CPT Code Book - 2015 AMA Changes/An Insider s View CPT 2015 Final Rules for OPPS Clinical Laboratory Fee Schedule (CLFS) Final Determinations Medi-Cal will not be adopting 2015 CPT and HCPCS code changes on January 1, 2015 Associates 1

2015 Review Two Handouts Copies of Slides 2015 Annual Update Notes Note number refers to our internal numbering Not all notes are in this document, only those selected for this presentation 160 Notes Note 004 Arthrocentesis, Aspiration and/or Injection Three CPT codes revised Three CPT codes added Note 004 Arthrocentesis, Aspiration and/or Injection Prior to 2015 CPT code 20600 = small joint or bursa CPT code 20605 = intermediate joint or bursa CPT code 20610 = major joint or bursa Any radiology guidance was reported in addition For 2015 Existing CPT codes 20600, 20605 and 20610 revised to specify without ultrasound guidance New CPT codes 20604, 20606 and 20611 specify with ultrasound guidance and permanent recording and reporting Associates 2

Note 004 Arthrocentesis, Aspiration and/or Injection CPT code 76942 Ultrasound guidance should no longer be reported separately Instead, use new CPT code 20604, 20606 or 20611 as appropriate Fluoroscopic, CT and MRI guidance can still be reported separately Use with revised CPT code 20600, 20605 or 20610 as appropriate Note 006 Closed Treatment of Rib Fracture, Uncomplicated CPT code deleted, not replaced To report, use or include when factoring the selection of evaluation and management code. Note 012 Laryngoscopy with Injection Into Vocal Cord(s) HCPCS code C9742 added CPT code 31575 is the basis for the search, but does not necessarily mean (most likely does not mean) a code change in the CDM Associates 3

Note 013 Implantable Defibrillators Two Categories Transvenous implantable pacing cardioverterdefibrillator (ICD) Subcutaneous implantable defibrillator (S-ICD) Descriptor revisions for CPT codes in this note provides a contrast for new subcutaneous codes in Note 014. A table has been created in CPT 2015 to guide in the use of Pacemaker and Implantable Defibrillator codes Note 014 Subcutaneous Implantable Defibrillator Electrodes Prior to 2015 CPT Category III codes used Separate codes for insertion of S-ICD Separate codes for EP Evaluation, Interrogation Device Evaluation and Programming Device Evaluation Note 014 Subcutaneous Implantable Defibrillator Electrodes Seven CPT Category III codes deleted Replaced with four CPT codes 33270 addresses insertion or replacement of system and electrodes and evaluations and programming, when performed 33271 addresses insertion (only) of electrode 33272 addresses removal (only) of electrode 33272 addresses repositioning (only) of electrode Associates 4

Note 022 Transcatheter Placement of Intravascular Stent(s), Cervical Carotid Artery Two CPT codes revised Revised from just percutaneous to open or percutaneous Revised to specify including angioplasty, when performed and radiological supervision and interpretation Open is new Angioplasty when performed new Radiological S&I had been previously included through parenthetical notes Note 035 Ablation Liver Tumor(s), Percutaneous, Cryoablation One CPT code added Search by 47382, but does constitute a code change 47382 Ablation liver tumor, percutaneous by radiofrequency Note 042 Spine Myelography Prior to 2015 Report injection procedure using surgical CPT code 62284 Report imaging procedure using radiology CPT code (72240, 72255, 72265 or 77270) For 2015 Existing CPT codes intact Four CPT codes added for myelography CPT codes 62302, 62303, 62304 and 62305 includes both injection and radiological supervision and interpretation designed for when the same physician performs both the injection procedure and the radiological supervision and interpretation Associates 5

Note 042 Spine Myelography For myelography procedure performed by two separate physicians, use 2014 protocol: 62284 for injection procedure, lumbar 72240, 72255, 72265 or 72270, as appropriate, for radiological supervision and interpretation Search by 72240, 72255, 72265 and 72270 does not necessarily constitute code changes Note 050 Vertebroplasty, Vertebral Augmentation & Sacral Augmentation Vertebroplasty Three surgical CPT codes deleted Two radiology CPT codes deleted Three CPT codes added Includes imaging guidance Anatomic regions revised Vertebral Augmentation Three surgical CPT codes deleted Two radiology CPT codes deletes (same as above) Three CPT codes added Includes imaging guidance Note 050 Vertebroplasty, Vertebral Augmentation & Sacral Augmentation Sacral Augmentation (Sacroplasty) Two radiology CPT codes deleted (same as before) Two CPT Category III codes revised Includes imaging guidance when performed Associates 6

Note 052 Ultrasound - Breast One CPT code deleted Had previously indicated unilateral or bilateral Two CPT codes added Both codes represent unilateral only One represents complete study of all four quadrants study of retroareolar region study of axilla, if performed Note 052 Ultrasound - Breast One represents limited a focused ultrasound exam study of one or more, but not all elements of complete exam study axilla, if performed Note 056 Teletherapy Isodose Plan Three CPT codes deleted Had previously indicated simple, intermediate & complex Previous protocol called for basic dosimetry calculations to be reported separately using CPT code 77300. Two CPT codes added Simple (1 or 2 unmodified ports directed to a single area of interest) Complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations) Both include basic dosimetry calculations Associates 7

Note 056 Teletherapy Isodose Plan CPT code 77300 (basic dosimetry calculations) should not be reported with 77306 or 77307 Need to redefine the teletherapy isodose plan charges based on new code definitions Note 057 Brachytherapy Isodose Plan Three CPT codes deleted Previous protocol called for basic dosimetry calculations to be reported separately using CPT code 77300. Three CPT codes added New codes include basic dosimetry calculations CPT code 77300 (basic dosimetry calculations) should not be reported with 77316, 77317 or 77318 Note 059 Radiation Treatment Delivery Nine CPT codes deleted Previously represented delivery criteria Previously used various energy levels (MeV) Four CPT codes revised Assigned complexity level (defined by delivery criteria) Any energy level one MeV or greater Associates 8

Note 059 Radiation Treatment Delivery Complexity Levels Simple All of the following criteria are met (and none of the complex or intermediate criteria are met): single treatment area, one or two ports, and two or fewer simple blocks Intermediate All of the following criteria are met (and none of the complex criteria are met):2 separate treatment areas, 3 or more ports on a single treatment area, or 3 or more simple blocks Note 059 Radiation Treatment Delivery Complex 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, field-in-field or other tissue compensation that does not meet IMRT guidelines, or electron beam Complexity levels similar to previous delivery criteria, but not exact. Note 060 Intensity Modulated Radiation Treatment (IMRT) Delivery One CPT code and one CPT Category III code deleted Two CPT codes added Based on two complexity levels Simple Any of the following: prostate, breast, and all sites using physical compensator based IMRT Complex Includes all other sites if not using physical compensator based IMRT Associates 9

Note 061 Imaging Guidance for Target Volume for Delivery of Radiation Treatment Therapy Two CPT codes and one CPT Category III code deleted One CPT code added Non-specific as to modality of guidance Notes 063, 064 & 084 Laboratory Drug Assays Drug Assays Presumptive Drug Class Definitive Drug Class Therapeutic Drug Assays Chemistry Note 063 Presumptive Drug Class Screening Five CPT codes deleted Only two had been previously used by Medicare Five CPT codes added None of which will be used by Medicare Associates 10

Note 063 Presumptive Drug Class Screening Characteristics of New CPT codes Drug Class From Drug Class List A From Drug Class List B Methodology within Drug Class Non-TLC ( non-thin layer chromatography) TLC (thin layer chromatography) Number of Drug Classes Any number Single Service Unit Per date of service Each procedure Note 063 Presumptive Drug Class Screening Medicare will continue using HCPCS codes G0431 Drug screen, qualitative; multiple drug classes by high complexity test method, per patient encounter G0434 Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter To replace deleted CPT code 80102, Medicare will adopt new HCPCS code G6058 Drug confirmation, each procedure Note 064 Definitive Drug Testing 27 CPT codes deleted 58 CPT codes added None of which will be used by Medicare Associates 11

Note 064 Definitive Drug Testing Characteristics of New CPT codes Move from specific drugs to drug classes Most based on the number of reported analytes Code can be reported only once per date of service Note 064 Definitive Drug Testing Medicare will not be using the new structure and new CPT codes for Definitive Drug Testing Medicare will continue using a structure based on specific drug or existing drug class For each of the 27 deleted CPT codes, Medicare has created a new Level II HCPCS code (G-code) Note 065-083 Specific Definitive Drug Testing Codes Notes 065 through 083 crosswalk deleted CPT codes to Revamped Drug Class CPT code(s) (in most cases there is more than one CPT code from which to choose, based on the number of analytes New Level II HCPCS codes used by Medicare Associates 12

Notes 084 086 Therapeutic Drug Assays Six CPT codes deleted Replacement CPT codes addressed in Definitive Drug Testing section Medicare will continue using existing and new CPT codes for TDA Notes 084 086 Therapeutic Drug Assays Used to monitor clinical responses to known prescribed medication Specimen for procedure is whole blood, serum, plasma, or cerebral spinal fluid Reporting of digoxin (note 084) and valporic acid (note 085) revised Existing codes revised to represent total A CPT code added for each to represent free Notes 084 086 Therapeutic Drug Assays Gabapentin was revised to reflect whole blood, serum and plasma as the only specimens allowed when using this code (note 86) Associates 13

Note 098 Column Chromatography/Mass Spectrometry Four CPT codes revised Codes represent a methodology of an analyte not elsewhere specified Text was added to specify non-drug analyte Text revision is a product of the Drug Assay codes being revamped Parenthetical notes added referring the use of Drug Assay codes and/or specific analyte codes in Chemistry for drug analytes Note 109 Volatiles One CPT code revised Removed as parenthetical examples are Carbon tetrachloride Dichlorethane Dichlomethane Isopropyl alcohol Methanol Text revision is a product of the Drug Assay codes being revamped Note 109 Volatiles Use existing CPT code 82441 Chlorinated hydrocarbons, screen for Carbon tetrachloride Dichlorethane Dichlomethane CPT payers use new CPT code 80320 Alcohols for Isopropyl alcohol Methanol Medicare continues to use CPT code 84600 Associates 14

Note 112 Infectious Agent Detection by Nucleic Acid for Influenza Virus Three CPT codes revised 87501 descriptor revised so that the use of reverse transcription is included when performed 87502 & 87503 descriptors revised to clarify that amplified probe technique is also multiplex Note 114 Human Papillomavirus (HPV) Three CPT codes deleted Based on technique Direct probe technique Amplified probe technique Quantification Three CPT codes added Based on risk type Low-risk type (e.g. 6, 11, 42, 43, 44) High-risk type (e.g. 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) Types 16 and 18 only, and includes 45, if performed Note 114 Human Papillomavirus (HPV) If both low- and high-risk HPV types are performed in a single assay, only one code should be reported, 87624, the high risk code Associates 15

Note 115 Infectious Agent Detection by Nucleic Acid for Respiratory Virus Three CPT codes revised 87631, 87632 & 87633 descriptor revised so that the use of reverse transcription is included when performed 87631, 87632 & 87633 descriptors revised to clarify that amplified probe technique is also multiplex Note 120 Morphometric Analysis, Tumor Immunocytochemistry Two codes revised 88360 & 88361 revised from each antibody to per specimen, each single antibody stain procedure Technology allows for multiple antibodies to be tested per specimen Only one unit of service should be reported per specimen Likely requires restructuring of price of any current charge Note 121 In Situ Hybridization One CPT code revised 88365 revised from each probe to per specimen; initial single probe stain procedure Two CPT codes added 88364 as add-on code for each additional single probe stain procedure 88366 for each multiplex probe stain procedure Associates 16

Note 122 Morphometric Analysis, In-Situ Hybridization, Computer-Assisted Technology One CPT code revised 88367 revised from each probe to per specimen; initial single probe stain procedure Two CPT codes added 88373 as add-on code for each additional single probe stain procedure 88374 for each multiplex probe stain procedure Note 123 Morphometric Analysis, In-Situ Hybridization, Manual One CPT code revised 88368 revised from each probe to per specimen; initial single probe stain procedure Two CPT codes added 88369 as add-on code for each additional single probe stain procedure 88377 for each multiplex probe stain procedure Note 126 Human Papillomavirus Vaccine One CPT code added For HPV types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent, 3 dose schedule Pending FDA approval Associates 17

Note 127 Influenza Vaccine One CPT code revised 90654 revised from non-specific to trivalent (IIV3) One CPT code added 90630 added for quadrivalent (IIV4) Pending FDA approval Intended to replace last season s vaccine Note 135 Implantable Defibrillator Evaluations Two Categories Transvenous implantable pacing cardioverterdefibrillator (ICD) Subcutaneous implantable defibrillator (S-ICD) Descriptor revisions for CPT codes in this note provides a contrast for new subcutaneous codes in Note 136. Note 136 Subcutaneous Implantable Defibrillator Evaluations Three CPT Category III codes deleted Three CPT codes added In support of CPT codes being added specific to insertion, removal and repositioning of a subcutaneous implantable defibrillator (note 14) CPT codes added for programming, interrogation and electrophysiologic evaluation of a subcutaneous implantable defibrillator Associates 18

Note 139 Echocardiography, Transesophageal (TEE) One CPT code added 93355 for transesophageal echocardiography during interventional cardiac procedures Existing TEE codes should not be used in conjunction with interventional cardiac procedures Note 145 Negative Pressure Wound Therapy Two Level II HCPCS codes deleted G0456 & G0457 for procedures using a mechanicallypowered device, not durable equipment Two CPT codes revised Existing CPT codes 97605 & 97606 revised to represent utilizing durable medical equipment (DME) Two CPT codes added 97607 & 97608 added to represent utilizing disposable, non-durable medical equipment One HCPCS code deleted One HCPCS code added Note 146 Hyperbaric Oxygen Exchange HCPCS code C1300 for G0277 Exact same descriptor, including time element of per 30 minutes. Associates 19

Note 146 Hyperbaric Oxygen CPT code 99183 continues to exist for CPT payers (per session) Level III HCPCS codes continue to exist for Medi-Cal Z7606 1 st 15 minutes Z7608 subsequent 15 minutes Note 150 Drug Codes Deleted & Replaced Temporary codes replaced with a more permanent new HCPCS code Some codes include a change in reporting dose Note change in dose for codes shaded in note box Note 151 Drugs/Biologicals Added Codes added for drugs and biologicals not elsewhere noted Associates 20

Note 154 Biologicals Added Codes added for biologicals not elsewhere noted Note 156 Status Indicator Changes - Favorable Favorable Light Packaged (N) to Payable (A, F, G, K and L) Non-reportable (B, E and M) to Payable (A, F, G, K and L) Non-reportable (B, E and M) to Packaged (N) See extended note page Note 157 Status Indicator Changes Unfavorable Unfavorable Light Payable (A, F, G, K and L) to Non-reportable (B, E and M) Packaged (N) to Non-reportable (B, E and M) Payable (A, F, G, K and L) to Packaged (N) See extended note page Associates 21

Note 160 Medicare Modifier 59 Subsets 59 - Distinct Procedural Service Four subsets of Modifier 59 created XE Separate Encounter, a service that is distinct because it occurred during a separate encounter XS Separate Structure, a service that is distinct because it was performed on a separate organ/structure Note 160 Medicare Modifier 59 Subsets XP Separate Encounter, a service that is distinct because it was performed by a different practitioner XU Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service Note 160 Medicare Modifier 59 Subsets Use in place of 59, not in addition to 59 Modifier 59 can still be reported by itself, but subset modifiers provide a better explanation Associates 22

Note 160 Medicare Modifier 59 Subsets Reference: CMS Transmittal 1422, dated August 14, 2014 http://www.cms.gov/regulations and Guidance/Guidance/Transmittals/Downloads/R1422OTN.p df Medi-Cal Reminder 2015 CPT and HCPCS codes adds, revisions and deletions not applicable to Medi-Cal. 2014 CPT and HCPCS codes still in effect for Medi-Cal for services on or after 01-01-15. Chargemaster Changes for 2015 AAHAM Western Region December 11, 2014 Presented by: Terrance Wong Terrance Wong & Associates Healthcare Financial Consultants 350 Augusta Drive Palm Desert, CA 92211 (760) 779-8700 terrywong@terrancewongandassociates.com www.terrancewongandassociates.com Associates 23