CPT CHANGES 2015: What s New, Revised, and Deleted Cristina Bentin, CCS-P, CPC-H, CMA AHIMA Approved ICD-10-CM Trainer Coding Compliance Management, LLC cristina@ccmpro.com * 225.752.8390 Current Procedural Terminology (CPT) is copyright 2014 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT is a trademark of the American Medical Association.
Learning Objectives: 2015 CMS Final Rule Resources (CMS-1613-FC) AMA CPT Changes (NOT ALL INCLUSIVE) Integumentary Errata Musculoskeletal Urinary, Nervous, Eye Cardiovascular Digestive Radiology CMS ASC Resource Link http://www.cms.gov/center/provider- Type/Ambulatory-Surgical-Centers-ASC-Center.html
AMBULATORY SURGERY CENTER ASSOCIATION http://www.ascassociation.org/home/ http://www.ascassociation.org/educationevents/2015coding ASCA Member Resource Page/Links http://www.ascassociation.org/federalregulations/medicarepayments
ASCA 2015 Rate Calculator ASCA List of 2015 Device Intensive Procedures
AMA CPT 2015 Changes A COMPLETE LISTING OF ALL ADDITIONS, REVISIONS, DELETIONS CAN BE FOUND IN APPENDIX B OF THE AMA S 2015 PROFESSIONAL EDITION CPT MANUAL. AMA 11-07-2014 ERRATA Integumentary Breast - Excision
2015 Musculoskeletal System 22551 Spine Codes Added to CMS 2015 List of ASC Approved Procedures Neck spine fuse & removal below C2 $7842.24 22554 Neck spine fusion $7842.24 22612 Lumbar spine fusion $7842.24 22614 Spine fusion extra segment N1 63020 Neck spine disk surgery $2254.50 63030 Low back disk surgery $2254.50 63042 Laminotomy single lumbar $2254.50 63044 Laminotomy add l level L N1 63045 Laminectomy, cervical $2254.50 63047 Laminectomy, lumbar $2254.50 63056 Decompress spinal cord, lumbar $2254.50
2015 Musculoskeletal System 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance ($22.20)
2015 Musculoskeletal System 20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting ($37.95) 2015 Musculoskeletal System 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow, or ankle, olecranon bursa); without ultrasound guidance ($23.63)
2015 Musculoskeletal System 20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow, or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting ($41.17) 2015 Musculoskeletal System 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance ($28.64)
2015 Musculoskeletal System 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting ($47.97) CMS Reimbursement CPT 2014 Rate 2015 Rate 20600 $16.24 $22.20 20604 NA $37.95 20605 $17.03 $23.63 20606 NA $41.17 20610 $20.96 $28.64 20611 NA $47.97 VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS.
2015 Musculoskeletal System 20982 Ablation; therapy for reduction or eradication of 1 or more bone tumor(s) tumors (eg,osteoid osteoma, metastasis) radiofrequency including adjacent soft tissue when involved by tumor extension, percutaneous, including computed tomographic guidance (imaging guidance when performed; radiofrequency ($2062.56) 2015 Musculoskeletal System 20983 Ablation; therapy for reduction or eradication of 1 or more bone tumors (eg,metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including (imaging guidance when performed; cryoablation ($2062.56)
CMS Reimbursement CPT 2014 Rate 2015 Rate 20982 $2089.06 $2062.56 20983 NA $2062.56 VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS. 2015 Musculoskeletal System DELETION 22520 22520 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic (deleted in 2015) 22521 22521...lumbar (deleted in 2015) 22522 22522.each additional thoracic or lumbar vertebral body (deleted in 2015)
2015 Musculoskeletal System DELETION 22523 22523 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic (deleted in 2015) 22524 22524...lumbar (deleted in 2015) 22525 22525.each additional thoracic or lumbar vertebral body (deleted in 2015) 2015 Musculoskeletal System 22510 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic ($1426.27) 22511.lumbosacral ($1426.27) + 22512.each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure) (N1)
2015 Musculoskeletal System 22513 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance, thoracic ($3465.63) 22514.lumbar ($3465.63) + 22515.each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) (N1) 2015 Musculoskeletal System 22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), single interspace, cervical (Not on CMS list of approved ASC procedures)
2015 Musculoskeletal System Instructional parenthetical notes under CPT 22856: (Do not report 22856 in conjunction with 22554, 22845, 22851, 63075, 0375T, when performed at the same level) (For additional interspace cervical total disc arthroplasty, see 22858, 0375T) 2015 Musculoskeletal System # + 22858.second level, cervical (List separately in addition to code for primary procedure) (not on CMS list) (Use 22858 in conjunction with 22856) (Do NOT report 22858 in conjunction with 0375T, when performed at the same level)
2015 Musculoskeletal CAT III Addition CAT III CODE 0375T CATEGORY III DESCRIPTOR Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), cervical, three or more levels (Not on CMS list of approved ASC procedures) (Do not report 0375T in conjunction with 22851, 22856, 22858 when performed at the same level) 2015 Musculoskeletal CAT III Deletion CAT III CODE DELETION 0092T CAT III DESCRIPTOR Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), each additional interspace, cervical
CMS Reimbursement CPT 2014 Rate 2015 Rate 22510 NA $1426.27 22511 NA $1426.27 +22512 NA (N1) 22513 NA $3465.63 22514 NA $3465.63 +22515 NA (N1) 22856 NA NA +22858 NA NA VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS. Musculoskeletal Category III Revisions CAT III CODE 0200T 0201T CATEGORY III DESCRIPTOR Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed ($1426.27) Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed ($1426.27)
2015 Musculoskeletal System 27279 Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device ($7842.24) (For bilateral procedure, report 27279 with modifier 50) Musculoskeletal CAT III Deletion CAT III CODE DELETION 0334T CAT III DESCRIPTOR Sacroiliac joint stabilization for arthrodesis, percutaneous or minimally invasive (indirect visualization), includes obtaining and applying autograft or allograft (structural or morselized), when performed, includes image guidance when performed (eg, CT or fluoroscopic)
2015 Musculoskeletal System 27280 Arthrodesis, open, sacroiliac joint, including obtaining bone graft, including instrumentation, when performed (Not on CMS list of approved ASC procedures) (For percutaneous/minimally invasive arthrodesis of the sacroiliac joint without fracture and/or dislocation, use 27279) CMS Reimbursement CPT 2014 Rate 2015 Rate 0200T $1422.98 $1426.27 0201T $1422.98 $1426.27 27279 NA $7842.24 27280 NA NA 0232T 54.28 N1 VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS.
2015 Urinary System Two New Codes (52441, 52442) New or revised parenthetical notes 2015 Urinary System 52441 Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant (not on CMS approved ASC list) + 52442.; each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure) (not on CMS approved ASC list)
2015 Urinary System Instructional parenthetical notes below CPT 52442: (To report removal of implant(s), use 52310) (For insertion of a permanent urethral stent, use 52282. For insertion of a temporary prostatic urethral stent, use 53855) CMS Reimbursements CPT 2014 Rate 2015 Rate 52005 $1108.88 $1142.74 52007 $1108.88 $1142.74 52010 $297.76 $300.88 52204 $1108.88 $1142.74 52214 $1108.88 $1142.74 52224 $1108.88 $1142.74 52234 $1108.88 $1142.74 52235 $1108.88 $1142.74 52240 $1108.88 $1142.74 52250 $1108.88 $1142.74 52260 $665.55 $672.51
2015 Nervous System 2015 Nervous System Addition of 4 Myleography injection codes: CPT 62302, 62303, 62304, 62305 (N1 payment indicator) Addition of 4 Tap Block codes: CPT 64486, 64487, 64488, 64489 (N1 payment indicator) Deletion of 2 nerve transection codes: CPT 64752 (vagus nerve, transthoracic) CPT 64761 (pudendal nerve) Deletion of 1 anastomosis code: CPT 64870 (facial-phrenic)
2015 Nervous System 62302 Myelography via lumbar injection, including radiological supervision and interpretation; cervical (N1 payment indicator) 62303.; thoracic(n1 payment indicator) 62304.; lumbosacral (N1 payment indicator) 62305.; 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical) (N1 payment indicator) 2015 Nervous System Tap Block 64486 Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)(n1 payment indicator) 64487.; by continuous infusion(s) (includes imaging guidance, when performed) (N1 payment indicator)
2015 Nervous System Tap Block 64488 Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)(n1 payment indicator) 64489.; by continuous infusions (includes imaging guidance, when performed) (N1 payment indicator) 2015 Nervous System DELETION 64752 Transection or avulsion of; vagus nerve (vagotomy), transthoracic (deleted in 2015) 64761 Transection or avulsion of: pudendal nerve (deleted in 2015 was paid @764.49 in 2014) 64870 Anastomosis; facial-phrenic (deleted in 2015 was paid @1582.01 in 2014)
Nervous System Reimbursements CPT 2014 Rate 2015 Rate 62310 $370.07 $368.37 62311 $370.07 $368.37 62318 $370.07 $368.37 62319 $370.07 $368.37 64479 $370.07 $368.37 64480 ---- ---- 64483 $370.07 $368.37 64484 ---- ---- 64490 $370.07 $368.37 64491 ---- ---- 64492 ---- ---- Nervous System Reimbursements CPT 2014 Rate 2015 Rate 64493 $370.07 $368.37 64494 ---- ---- 64495 ---- ---- 64633 $853.53 $805.75 64634 ---- ---- 64635 $853.53 $805.75 64636 ---- ---- 64415 $195.55 $204.32 64416 $370.07 $368.37 64417 $195.55 $204.32
CMS NCCI EDITS http://www.cms.gov/medicare/coding/nationalcorrectcodinited/index.html 2015 Eye and Ocular Adnexa
2015 Eye and Ocular Adnexa DELETION 66165 Fistulization of sclera for glaucoma; iridencleisis or iridotasis (deleted in 2015 was paid @ 966.16 in 2014) 2015 Eye and Ocular Adnexa 66179 Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft($1711.53) 66180.; with graft ($1711.53) (Do not report 66180 in conjunction with 67255)
2015 Eye and Ocular Adnexa 66184 Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft($960.64) 66185.; with graft ($960.64) (Do not report 66185 in conjunction with 67255) 2015 Eye and Ocular Adnexa 67399 Unlisted procedure, ocular extraocular muscle
2015 Misc. Category III Code Revision Eye and Ocular Adnexa CAT III CODE CATEGORY III DESCRIPTOR 0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; initial insertion ($1711.53) # + 0376T.; each additional device insertion (List separately in addition to code for primary procedure) (N1 payment indicator) 2015 Misc. Category III Code Addition Eye and Ocular Adnexa CAT III CODE 0356T CATEGORY III DESCRIPTOR Insertion of drug-eluting implant (including punctal dilation and implant removal when performed) into lacrimal canaliculus, each (not on CMS approved ASC list)
2015 Eye/Ocular Adnexa Reimbursements Vitrectomy CPT 2014 Rate 2015 Rate 67036 $1690.59 $1711.53 67039 $1690.59 $1711.53 67040 $1690.59 $1711.53 67041 $1690.59 $1711.53 67042 $1690.59 $1711.53 67043 $1690.59 $1711.53 2015 Eye/Ocular Adnexa Reimbursements Cataracts/Retinals CPT 2014 Rate 2015 Rate 66982 $975.58 $960.64 66983 $975.58 $960.64 66984 $975.58 $960.64 67101 $332.49 $456.11 67105 $236.57 $243.16 67107 $1690.59 $1711.53 67108 $1690.59 $1711.53 67110 $355.28 $486.90 67112 $1690.59 $1711.53
2015 Cardiovascular System 2015 Cardiovascular System Changes in Surgery and Medicine Cardiovascular Sections Implantable Defibrillator Procedures 25 Revised 6 New
2015 Cardiovascular System 33215 Repositioning of previously implanted transvenous pacemaker or pacing cardioverter implantable defibrillator (right atrial or right ventricular) electrode ($863.86) 33216 Insertion of a single transvenous electrode, permanent pacemaker or cardioverter implantable defibrillator ($5649.82) 33217 Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverter implantable defibrillator ($5649.82) 2015 Cardiovascular System 33218 Repair of single transvenous electrode, permanent pacemaker or pacing cardioverter implantable defibrillator ($1286.56) 33220 Repair of 2 transvenous electrodes for permanent pacemaker or pacing cardioverter implantable defibrillator ($1286.56) 33223 Relocation of skin pocket for cardioverter implantable defibrillator ($771.43)
2015 Cardiovascular System 33224 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator) ($7851.02) 2015 Cardiovascular System + 33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure) (N1)
2015 Cardiovascular System 33240 Insertion of pacing cardioverter implantable defibrillator pulse generator only; with existing single lead ($20,286.25) (Do not report 33240 in conjunction with 33271, 93260, 93261) 2015 Cardiovascular System # 33230 Insertion of pacing cardioverter implantable defibrillator pulse generator only; with existing dual leads ($20,286.25) # 33231 Insertion of pacing cardioverter implantable defibrillator pulse generator only; with existing multiple leads ($27,203.55) There codes follow the parent code 33240.
2015 Cardiovascular System 33241 Removal of pacing cardioverter implantable defibrillator pulse generator only ($1286.56) (Do not report 33241 in conjunction with 93260, 93261) (Do not report 33241 in conjunction with 33230, 33231, 33240 for removal and replacement of the implantable defibrillator pulse generator. Use 33262, 33263, 33264, as appropriate, when pulse generator replacement is indicated) 2015 Cardiovascular System # 33262 Removal of pacing cardioverter implantable defibrillator pulse generator with replacement of pacing cardioverter implantable defibrillator pulse generator; single lead system ($20,286.25) # 33263...; dual lead system ($20,286.25) # 33264.; multiple lead system ($27,203.55)
2015 Cardiovascular System 33243 Removal of single or dual chamber pacing cardioverter implantable defibrillator electrode(s); by thoracotomy (not on CMS list) 33244 Removal of single or dual chamber pacing cardioverter implantable defibrillator electrode(s); by transvenous extraction (not on CMS list) 2015 Cardiovascular System 33249 Insertion or replacement of permanent pacing cardioverter implantable defibrillator system, with transvenous lead(s), single or dual chamber ($27,203.55) (Do not report 33249 in conjunction with 33216, 33217) (For removal and replacement of an implantable defibrillator pulse generator and transvenous electrode(s), use 33241 in conjunction with either 33243 or 33244 and 33249) (For insertion of transvenous implantable defibrillator lead(s), without thoracotomy, use 33216 or 33217)
# 33270 2015 Cardiovascular System Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed ($27,203.55) 2015 Cardiovascular System # 33271 Insertion of subcutaneous implantable defibrillator electrode ($5649.82) # 33272 Removal of subcutaneous implantable defibrillator electrode (not on CMS list) # 33273 Repositioning of previously implanted subcutaneous implantable defibrillator electrode ($1286.56)
2015 Cardiovascular Cat III Deletions Category III codes 0319T, 0320T, 0321T, 0322T, 0323T, 0324T, 0325T, 0326T, 0327T, 0328T have been deleted in 2015. To report, see CPT 33240, 33241, 33262, 33270, 33271, 33272, 33273, 93260, 93261, 93644. CMS Reimbursement CPT 2014 Rate 2015 Rate 33215 $841.96 $863.86 33216 $2542.22 $5649.82 33217 $2542.22 $5649.82 33218 $1280.34 $1286.56 33220 $1280.34 $1286.56 33223 $757.47 $771.43 33224 $9,285.61 $7851.02 +33225 $9,285.61 N1 VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS.
CMS Reimbursement CPT 2014 Rate 2015 Rate 33230 $22,881.67 $20,286.25 33231 $22,881.67 $27,203.55 33240 $22,881.67 $20,286.25 33241 $1280.34 $1286.56 33243 NA NA 33244 NA NA 33249 $29,599.81 $27,203.55 33262 $22,881.67 $20,286.25 VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS. CMS Reimbursement CPT 2014 Rate 2015 Rate 33263 $22,881.67 $20,286.25 33264 $22,881.67 $27,203.55 33270 NA $27,203.55 33271 NA $5649.82 33272 NA NA 33273 NA $1286.56 VERIFY CARRIER DOCUMENTATION, REPORTING, AND MEDICAL NECESSITY REQUIREMENTS.
2015 Digestive System Upper GI 2015 Digestive Section Rationale for Upper GI Changes Updated to reflect technology, devices, and techniques used in current practice. Standardized to allow for parallel concepts across the 3 sections.
2015 Digestive System Rigid Esophagoscopy 43180 Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker s diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed. ($1066.74) (For diverticulectomy of hypopharynx or esophagus (open), see 43130, 43135) 2015 Digestive System Rigid Esophagoscopy 43194 Esophagoscopy, rigid, transoral; with removal of foreign body(s) ($583.67) (Do not report 43194 in conjunction with 43191, 43197, 43198) (If fluoroscopic guidance is performed, use 76000) (For flexible transoral esophagoscopy with removal of foreign body(s), use 43215)
2015 Digestive System Flexible Esophagoscopy 43197 Esophagoscopy, flexible, transnasal; diagnostic, includes including collection of specimen(s) by brushing or washing when performed (separate procedure) ($408.68) (Do not report 43197 in conjunction with 31575, 43191, 43192, 43193, 43194, 43195, 43196, 43198, 43200-43232, 43235-43259, 43266, 43270, 92511) 2015 Digestive System Flexible Esophagoscopy 43215 Esophagoscopy, flexible, transoral; with removal of foreign body(s) ($583.67) 43216 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery ($1049.73)
2015 Digestive System Esophagogastroduodenoscopy (EGD) 43247 Esophagogastroduodenoscopy, flexible transoral; with removal of foreign body(s) ($408.68) 43250 Esophagogastroduodenoscopy, flexible transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery ($583.67) EGD Reimbursements CPT 2013 Rate 2014 Rate 2015 Rate 43235 $349.83 $370.38 $408.68 43236 $349.83 $370.38 $408.68 43237 $520.05 $559.63 $583.67 43238 $520.05 $559.63 $583.67 43239 $349.83 $370.38 $408.68 43240 $520.05 $559.63 $1049.73 43241 $349.83 $370.38 $408.68 43242 $520.05 $559.63 $583.67 43243 $349.83 $370.38 $408.68 43244 $520.05 $559.63 $583.67
2015 Digestive System Lower GI 2015 Digestive System Lower Endoscopy 2015 Endoscopy, Small Intestine 2014 Intestines (Except Rectum) 2014 Endoscopy, Small Intestine and Stomal 2015 Endoscopy, Stomal
2015 Digestive System Endoscopy Small Intestines Editorial Directive Antegrade transoral small intestinal endoscopy(enteroscopy) is defined by the most distal segment of small intestine that is examined. 44360-44373 Enteroscopy - esophagus through jejunum, antegrade 44376-44379 Enteroscopy - esophagus through the ileum, antegrade approach 2015 Digestive System Endoscopy Small Intestines Editorial Directive If an endoscope cannot be advanced at least 50 cm beyond the pylorus, see 43233, 43235-43259, 43266, 43270 (i.e. EGD codes) If an endoscope can be passed at least 50 cm beyond pylorus but only into the jejunum, see 44360, 44361, 44363, 44364, 44365, 44366, 44369, 44370, 44372, 44373. *Surgeon MUST document the extent he goes so the coder will know the coding series to review.*
2015 Digestive System Endoscopy Editorial Change including collection of specimen(s) by brushing or washing, when performed replaces with or without collection of specimen(s) 2015 Digestive System Endoscopy, Small Intestine 44360 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($467.23) 44363..with removal of foreign body(s) ($467.23)
ENDOSCOPY, STOMAL ILEOSCOPY AND POUCHOSCOPY 2015 Digestive System Endoscopy, Stomal Ileoscopy and Pouchoscopy Instructional parenthetical notes: Colonoscopy through stoma is the exam of the colon, from the colostomy stoma to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis. Report colonoscopy via stoma (44388-44408) for endoscopic exam of a patient who has undergone segmental resection of the colon (eg, hemicolectomy, sigmoid colectomy, low anterior resection) and has a colostomy) Report ileoscopy via stoma (44380, 44381, 44382, 44384) for endoscopic examination of a patient who has an ileostomy.
2015 Digestive System Endoscopy, Stomal Ileoscopy and Pouchoscopy 44380 Ileoscopy, through stoma; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($467.23) # 44381.with transendoscopic balloon dilation ($467.23) 44384.with placement of endoscopic stent (includes pre-and post-dilation and guide wire passage, when performed) ($467.23) 2015 Digestive System Endoscopy, Stomal Ileoscopy and Pouchoscopy 44385 Endoscopic evaluation of small intestinal pouch (abdominal eg, Kock pouch, ileal reservoir [S or pelvic J]pouch; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($432.94) 44386.with biopsy, single or multiple ($432.94)
2015 Digestive System Endoscopy, Stomal Colonoscopy Through Stoma 44388 Colonoscopy through stoma; diagnostic, with or without (including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($432.94) 44390.with removal of foreign body(s) ($432.94) 44391.with control of bleeding, (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) any method ($432.94) 44392.with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery ($432.94) 2015 Digestive System Endoscopy, Stomal Colonoscopy Through Stoma 44401 Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) ($432.94) 44402.; with endoscopic stent placement (including pre- and post-dilation and guide wire passage, when performed) ($432.94) 44403.; with endoscopic mucosal resection ($432.94)
2015 Digestive System Endoscopy, Stomal Colonoscopy Through Stoma 44404.; with directed submucosal injection(s), any substance ($432.94) 44405.; with transendoscopic balloon dilation ($432.94) 44406.; with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures ($432.94) 2015 Digestive System Endoscopy, Stomal Colonoscopy Through Stoma 44407.; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures ($432.94) 44408.; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ($432.94) (Do not report 44408 more than once per session)
2015 Digestive System Other Procedures 44799 Unlisted procedure, small intestine (For unlisted laparoscopic procedure, intestine except rectum, use 44238) (For unlisted procedure, colon, use 45399) DELETION 2015 Digestive System Colonoscopy Through Stoma 44393...;with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (deleted in 2015) Use 44401 in 2015 44397.;with transendoscopic stent placement (includes predilation) (deleted in 2015) Use 44402 in 2015
2015 Digestive System Colon and Rectum - Endoscopy Instructional parenthetical notes: Colonoscopy via stoma (44388-44408) Proctosigmoidoscopy (45300-45327) Flexible sigmoidoscopy (45330-45347) Anoscopy (46600, 46604, 46606, 46608, 46610, 46611, 46612, 46614, 46615) Ileoscopy via stoma (44380, 44381, 44382, 44384) * When bleeding occurs as a result of an endoscopic procedure, control of bleeding is not reported separately during the same operative session. 2015 Digestive System Colon and Rectum - Endoscopy Instructional parenthetical notes: Report pouch endoscopy codes 44285, 44386 for endoscopic examination of a patient who has undergone resection of colon with ileo-anal anastomosis (eg, J- pouch). Report flexible sigmoidoscopy (45330-45347) for endoscopic examination during which the endoscope is not advanced beyond the splenic flexure (keep reading all parentheticals and editorial directives).. * NOTE: Do your carriers and MAC agree? Verify with MAC LCDs, Transmittals, and Carrier directives.*
AMA 11-07-2014 Errata Revise the colonoscopy decision tree illustrated on page 284 of the 2015 CPT Prof book to indicate that when performing a therapeutic procedure to the cecum, report colonoscopy codes 45379-45398 with No Modifier. DO YOUR SPECIFIC CARRIERS AND/OR MAC AGREE? SOME CARRIER AND MAC DIRECTIVES STATE WHEN SCHEDULED AS COLONOSCOPY CODE AS COLONOSCOPY WITH APPLICATION OF APPROPRIATE MODIFIER. VERIFY! VERIFY! Does NOT Reach Splenic Flexure Flexible Sigmoidoscopy (45330) AMA CPT Decision Tree 2015 Decision to Undergo Colonoscopy Diagnostic Beyond Splenic Flexure But Not to Cecum Colonoscopy (45378; Modifier 53) To Cecum Colonoscopy (45378; No Modifier AMA STATES DIAGNOSTIC OR SCREENING IN CPT MANUAL. DO YOUR SPECIFIC CARRIERS AND/OR MAC AGREE? VERIFY DEFINITIONS, TERMS, REPORTING WITH CARRIER DIRECTIVES. DON T GET CONFUSED WITH DIAGNOSTIC, SCREENING, THERAPEUTIC TERMS IN CPT WITH INDIVIDUAL CARRIER DIAGNOSIS CODE SELECTION, SEQUENCING DETERMINATION. This chart reflects AMA CPT decision tree 2015 AMA CPT Professional Edition pg 284. It is not the interpretation of all carriers/macs. Facilities must verify carrier directives and local coverage determinations (LCDs) prior to CPT code selection and reporting. Commercial carrier directives will often differ from individual MAC/CMS LCD policies.
DO YOUR SPECIFIC CARRIERS AND/OR MAC AGREE? SOME CARRIER AND MAC DIRECTIVES STATE WHEN SCHEDULED AS COLONOSCOPY CODE AS COLONOSCOPY WITH APPLICATION OF APPROPRIATE MODIFIER. VERIFY! AMA CPT Decision Tree 2015 Decision to Undergo Colonoscopy Therapeutic 2015 AMA ERRATA NO MODIFIER- FACILITIES NEED TO MAKE CHANGE IN BOOK! Does NOT Reach Splenic Flexure Beyond Splenic Flexure But Not to Cecum To Cecum Flexible Sigmoidoscopy (45331-45347)) Colonoscopy (45379-45398 Modifier 52) Colonoscopy (45379-45398_ No Modifier This chart reflects AMA CPT decision tree 2015 AMA CPT Professional Edition pg 284. It is not the interpretation of all carriers/macs. Facilities must verify carrier directives and local coverage determinations (LCDs) prior to CPT code selection and reporting. Commercial carrier directives will often differ from individual MAC/CMS LCD policies. 2015 Digestive System Colon and Rectum Endoscopy Sigmoidoscopy 45330 Sigmoidoscopy, flexible; diagnostic, with or without (including collection of specimen(s) by brushing or washing, when performed (separate procedure) ($99.89) 45332.with removal of foreign body(s) ($453.53) 45333.with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery ($270.60) 45334.with control of bleeding, (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) any method ($453.53)
2015 Digestive System Colon and Rectum Endoscopy Sigmoidoscopy 45337 Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of volvulus decompression tube, any method when performed ($453.53) 45340.with dilation by transendoscopic balloon, 1 or more strictures, dilation ($453.53) (For transendoscopic balloon dilation of multiple strictures during the same session, use 45340 with modifier 59 for each additional stricture dilated) DELETION 2015 Digestive System Colon and Rectum Endoscopy Sigmoidoscopy 45339...;with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (deleted in 2015) Use 45346 in 2015 45345.;with transendoscopic stent placement (includes predilation) (deleted in 2015) Use 45347 in 2015
2015 Digestive System Colon and Rectum Endoscopy Sigmoidoscopy # 45346 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) ($453.53) 45347.; with placement of endoscopic stent (including pre- and post-dilation and guide wire passage, when performed) ($453.53) 45349.; with endoscopic mucosal resection ($453.53) 2015 Digestive System Colon and Rectum Endoscopy Sigmoidoscopy 45350.; with band ligation(s) (eg, hemorrhoids) ($453.53) (Do not report 45350 more than once per session) (To report control of active bleeding with band ligation(s), use 45334)
2015 Digestive System Colon and Rectum Endoscopy Colonoscopy DELETION 45355 Colonoscopy, rigid or flexible, transabdominal via colotomy, single or multiple (deleted in 2015) Use 45399 in 2015 2015 Digestive System Colon and Rectum Endoscopy Colonoscopy 45378 Colonoscopy, flexible proximal to splenic flexure; diagnostic, with or without (including collection of specimen(s) by brushing or washing, with or without colon decompression when performed (separate procedure) ($432.94) 45379.with removal of foreign body(s) ($432.94) 45380.with biopsy, single or multiple ($432.94) 45381.with directed submucosal injection(s), any substance ($432.94)
2015 Digestive System Colon and Rectum Endoscopy Colonoscopy 45382.; with control of bleeding, (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) any method ($432.94) 45384.with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery ($432.94) 45385.with removal of tumor(s), polyp(s), or other lesion(s) by snare technique ($432.94) 45386.with dilation by transendoscopic balloon, 1 or more strictures dilation ($432.94) DELETION 2015 Digestive System Colon and Rectum Endoscopy Colonoscopy 45383...;with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (deleted in 2015) Use 45388 in 2015 45387.;with transendoscopic stent placement (includes predilation) (deleted in 2015) Use 45389 in 2015
2015 Digestive System Colon and Rectum Endoscopy Colonoscopy # 45388 Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) ($432.94) 45389.; with endoscopic stent placement (including pre- and post-dilation and guide wire passage, when performed) ($432.94) # 45390.; with endoscopic mucosal resection ($432.94) 2015 Digestive System Colon and Rectum Endoscopy Colonoscopy 45391.; with endoscopic ultrasound examination, limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures ($432.94) 45392.; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures ($432.94)
2015 Digestive System Colon and Rectum Endoscopy Colonoscopy 45393.; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ($432.94) # 45398.; with band ligation(s) (eg, hemorrhoids) ($432.94) # 45399 Unlisted procedure, colon (not on CMS approved ASC list) Colonoscopy Reimbursements CPT 2014 Rate 2015 Rate 45378 $407.05 $432.94 45379 $407.05 $432.94 45380 $407.05 $432.94 45381 $407.05 $432.94 45382 $407.05 $432.94 45384 $407.05 $432.94 45385 $407.05 $432.94 45386 $407.05 $432.94 45391 $407.05 $432.94 45392 $407.05 $432.94
CMS G Codes for 2015 Final Rule (CMS-1612-FC) CMS delayed publishing updated wrvu for the lower endoscopy codes (ileoscopy, pouchoscopy, flex sigmoidoscopy, colonoscopy through stoma, colonoscopy) surveyed for this cycle. For 2015, CMS established G codes to mirror those 2014 CPT codes that were deleted in 2015. For 2015, CMS maintained the wrvu of these 2014 code values, pending a decision on how to address removing moderate sedation from the endoscopy codes Result: Stay tuned rrrrrrrr CMS G Codes for 2015 Physician Reporting-Medicare Patients DELETED 2014 CPT NEW OR REVISED 2015 CPT NEW 2015 HCPCS 44383 44384 G6018 44393 44401 G6019 44397 44402 G6020 44799 G6021 45339 45346 G6022 45345 45347 G6023 45383 45388 G6024 45387 45389 G6025 0226T 46601 G6026 0227T 46607 G6027
CMS G Codes 2015 Facility Reporting Medicare Patients ASC facilities report 2015 CPT codes: No. Regardless of whether the code is new or has not changed No. Regardless of payor ASC Facilities do not report G codes G6018- G6027. Not valued. 2015 Misc. Category III Code Addition Digestive CAT III CODE 0355T CATEGORY III DESCRIPTOR Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report (not on CMS approved ASC list)
2015 Digestive System Anus Endoscopy Anoscopy DESCRIPTOR 46600 Anoscopy; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure) (N1) 46601.; diagnostic, with high-resolution magnification (HRA) (eg, colposcope, operating microscope) and chemical agent enhancement, including collection of specimen(s) by brushing or washing, when performed (N1) 2015 Digestive System Anus Endoscopy Anoscopy DESCRIPTOR 46607.; with high-resolution magnification (HRA) (eg, colposcope, operating microscope) and chemical agent enhancement, with biopsy, single or multiple ($453.53)
2015 Digestive System Anus Endoscopy CAT III Deletions CAT III CODE DELETION 0226T 0227T Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed (originally reimbursed @29.52 in 2014 but deleted in 2015) Use 46601 in 2015 (N1).;with biopsy(ies) Use 46607 in 2015 ($453.53) 2015 Misc. Category III Code Addition Anoscopy CAT III CODE 0377T CATEGORY III DESCRIPTOR Anoscopy with directed submucosal injection of bulking agent for fecal incontinence ($1425.69) (Do not report 0377T in conjunction with 46600)
2015 Digestive System Liver Other Procedures Ablation DESCRIPTOR 47383 Ablation, 1 or more liver tumor(s), percutaneous, cryoablation ($2245.03) (For imaging guidance and monitoring, see 76940, 77013, 77022) report per carrier. 2015 Radiology Key Points (Information below does not encompass all changes) 15 additions; 23 deletions; 4 revisions in 2015 Addition of 2 Breast ultrasound codes: CPT 76641-76642 (CMS N1 payment indicator) Addition of 2 Teletherapy isodose codes: CPT 77306-77307 (approx. 60.00 CMS reimbursement) Addition of 3 Brachytherapy isodose codes: CPT 77316-77318 (approx. 60.00-175.00 CMS reimbursement) Addition of 2 modulated radiation treatment delivery codes: CPT 77385 (simple)-77386 (complex) (approx. 275.00 CMS reimbursement)
Continued 2015 Radiology Key Points (Information below does not encompass all changes) Revision - 4 radiation treatment delivery codes: CPT 77401-77412 (approx. 20-100.00 CMS reimbursement) Deletion - 2 Radiological S & I percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty) codes: CPT 72291 72292 are deleted in 2015. To report, see 22510, 22511, 22512, 22513, 22514, 22515, 0200T, 0201T) 2015 Misc. Category III Code Addition Respiratory CAT III CODE 0340T CATEGORY III DESCRIPTOR Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance ($2245.03)
AMERICAN MEDICAL ASSOCIATION http://www.ama-assn.org/ama/pub/physician-resources/solutions-managingyour-practice/coding-billing-insurance/cpt/about-cpt/errata.page
ASCA Online Continuing Education Go to www.ascassociation.org/ce/webinars Enter the five digit code given at the end of the webinar Complete the evaluation of the webinar Print the continuing education certificate QUESTIONS? Please Contact: Cristina Bentin CCS-P, CPC-H, CMA AHIMA Approved ICD-10-CM Trainer Coding Compliance Management, LLC cristina@ccmpro.com * 225.752.8390