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Health Budgets & Financial Policy 18 Jan 0800 and 20 Jan 1400 Presented by the TMA UBO Support Team Log into:

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Presentation on theme: "Health Budgets & Financial Policy 18 Jan 0800 and 20 Jan 1400 Presented by the TMA UBO Support Team Log into:"— Presentation transcript:

1 Health Budgets & Financial Policy 18 Jan 2011 @ 0800 and 20 Jan 2011 @ 1400 Presented by the TMA UBO Support Team Log into: and enter your full name, MTF location, and Service for credit from your Service. Please note, you must also dial in for audio: Dial in number: 877-694-5777 Participant Code: 6944507 Please be sure to mute your telephone upon entry, and do not put it on hold during the session. You may submit a question at anytime by typing it into the “Question” field on the left and clicking “Send.” 1

2 Health Budgets & Financial Policy 2 Objectives Understand various CPT & HCPCS terminology Be aware of separate code and rate effective dates Review 2011 codes, highlighting notable changes applicable to MHS coding and billing Identify new CPT & HCPCS modifiers Know where to locate updates, tables, and resources Share this knowledge with others in your MTF

3 Health Budgets & Financial Policy Code Terms Explained In the MHS, CPT and HCPCS are referred to in separate terms CMS & TRICARE refer to them collectively as Level I and Level II Level I of the HCPCS is comprised of CPT, maintained by the AMA Captures professional and outpatient facility services 5 digits; always starts with a number Can end with a number, or letters T or F (Category II/III) Level II of the HCPCS is maintained by CMS Used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies 5 digits; always starts with a letter 3

4 Health Budgets & Financial Policy CPT/HCPCS Effective Dates for 2011 Codes and rates are effective January 1, 2011 in the civilian sector HCPCS updates occur on a quarterly basis, although most changes occur effective January 1 st of every year The MHS updates codes annually Codes available in late January 2011 for MHS use On track with MHS/MTF systems coordination MHS rates for new 2011 codes not available until mid- year Can create some billing lags and timely filing issues 4

5 Health Budgets & Financial Policy Review the Introduction Section of the CPT Book Introduction section: Coders need to be sure to look at page xii this year in the CPT book. A new standardized instruction regarding time has been added Another new feature is the inclusion of coding tips throughout the CPT book. These are specific to a topic, contain specific coding instructions, and note key term look ups Many of these coding tips are repeated throughout a major section of the CPT, while others may be specific to a single section of codes 5

6 Health Budgets & Financial Policy Review the Introduction Section of the CPT Book The AMA deleted the decision tree for determination of a new or established patient for 2011 However, added tables regarding E&M services in the introduction beginning with page xix Note that not all of the E&M services are represented in these tables Specifically note that intra-service time is considered to be face-to-face for office and outpatient services In the inpatient setting time may include non-face-to- face or floor/unit time regarding patient care 6

7 Health Budgets & Financial Policy 7 CPT CategoryAddsDeletionsRevisions Anesthesia000 E&M300 Surgery643254 Radiology585 Pathology/Lab16137 Medicine404123 Category II3127 Category III52142 TOTALS21111098 Summary of CPT Additions, Deletions & Revisions CPT code book has Appendices for all coding changes

8 Health Budgets & Financial Policy 8 Hospital Observation Services There are now subsequent observation care codes The key component requirements of history, exam, and decision making are similar to subsequent inpatient hospital services 99224, 99225, 99226 Subsequent observation services Note that the codes are re-sequenced to follow the initial observation care services (99218-99220) Observation status is key for reporting these services, not admission to a specific hospital department Reference Appendix H, Observation Services, and January 2011 MHS Coding Guidelines for detailed guidance Evaluation & Management Section

9 Health Budgets & Financial Policy Surgery Section Integumentary – 3 added, 2 deleted, 6 revised Debridement code changes were significant for 2011. Review definitions and instructions regarding debridement services Codes for debridement of an “open fracture” have been revised to be more specific regarding fractures Debridement of the dermis and epidermis is now reported with codes 97597 and 97598. This is a big departure from the codes 11040 and 11041 that have been deleted. The codes 97597-97598 remain dependent on size for reporting Codes 11042-11044 remain, but now include a size limitation of 20 square centimeters. To account for larger wound codes, 11045, 11046, and 11047 were added and re-sequenced to report the additional 20 square centimeters Debridement for surgical preparation of a site for grafting includes significant new instructions. One of the most notable is that codes 15002- 15005 are not to be used for debridement of chronic wounds 9

10 Health Budgets & Financial Policy Surgery Section Musculoskeletal – 5 added, 1 deleted, 11 revised Code 20000 has been deleted and instructions state cutaneous or subcutaneous incision and drainage (I&D) is now reported with codes 10060-10061. Code 20005 was revised and is the only I&D code for soft tissue Spine allografts were revised to include osteopromotive material (20930) and emphasize that these codes are specific to spine surgery (20931) Two new codes were added for cervical anterior arthrodesis, 22551 and 22552 Three new codes were added for hip arthroplasty, 29914-29916 10

11 Health Budgets & Financial Policy Surgery Section Respiratory – 4 added Three new codes, 31295-31297, will be used to report nasal or sinus endoscopy with (balloon) dilation. Code selection is based upon the sinus treated Early treatment of respiratory disease can now be reported with code 31634 for bronchoscopy with balloon occlusion and includes occlusive substance administration. Moderate (conscious) sedation and fluoroscopic guidance are included 11

12 Health Budgets & Financial Policy Surgery Section Cardiovascular – 19 added, 19 deleted, 12 revised The largest changes for 2011 were in the cardiology and cardiovascular sections Treatment of complex congenital cardiac anomalies is coded using new codes for hybrid procedures, 33620 and 33621 16 new codes to report lower extremity endovascular revascularization for occlusive disease – 37220-37235 The code revisions eliminate the previous component coding methodology and reflect the inclusion of imaging guidance and reporting Hemic/Lymphatic – 1 added A new code, 38900, is used to map or identify sentinel lymph node. This may be by injection of nonradioactive dye. This add-on code is used with: 19302, 19307, 38500, 38510, 38520, 38530, 38542, 38740, and 38745 12

13 Health Budgets & Financial Policy Surgery Section Mediastinum/Diaphragm – 4 deleted Some codes in the esophageal and diaphragmatic section overlapped or represented duplicate procedures. Deleted codes in this section were moved to describe new techniques and approaches To synchronize with additions to the 43000 series for esophageal procedures according to the type and approach of procedure performed Digestive – 18 added, 4 deleted, 7 revised New codes 43283 for laparoscopic esophageal lengthening procedures and 43338 for open esophageal lengthening procedures Repair of paraesophageal hiatal hernia is reported with new codes 43332- 43337. Codes are selected based upon approach and use of mesh 49327 was added for laparoscopic placement of radiation therapy interstitial devices. If the approach is open, use new code 49412 13

14 Health Budgets & Financial Policy Surgery Section Urinary – 1 added, 2 revised Code 53860 was added to report micro-remodeling of the bladder neck and proximal urethra using transurethral radiofrequency for female patients Male/Female Genital System – 1 added, 2 revised Code 55876 was revised to include needle or other approach for placement of interstitial devices into the prostate for radiation therapy Code 57156 was added for placement of vaginal afterloading apparatus Code 57155 was modified with the change of tandem as a singular term Nervous System – 8 added, 2 deleted, 9 revised Three new add-on codes were added to report stereotactic computer assistance for intradural cranial (61781), extradural cranial (61782), and spinal (61783) procedures. These codes replace 61795 New code 64611 for Chemodenervation injection of parotid and submandibular salivary glands 14

15 Health Budgets & Financial Policy Surgery Section Eye/Ocular Adnexa – 4 added, 2 revised Two new codes were added for self-retaining (65778) or sutured single layer (65779) amniotic membrane placed on the ocular surface to facilitate wound healing New codes for treatment of glaucoma via transluminal dilation of Schlemm’s (aqueous outflow) canal is reported with 66174 and 66175 if a retention device or stent is used Auditory – 2 revised Changes in the provision of surgery necessitated the revision of codes 69801 and 69802. The descriptions deleted the obsolete technique, “without cryosurgery including other nonexcisional destructive procedures” and "single or multiple perfusions." Additional guidelines indicate that 69801 may only be reported once per day 15

16 Health Budgets & Financial Policy Radiology Section 16 New codes for reporting combination CT scan of abdomen and pelvis Transluminal atherectomy codes deleted to accommodate addition of new codes 37220- 37235 and 0234T-0238T 76150 and 76350 are obsolete Extremity ultrasound codes changed to differentiate between limited and complete examinations

17 Health Budgets & Financial Policy Laboratory/Pathology Section 17 Addition of 80104 for qualitative drug screening by another method than chromatography Code 82925 revised to add-on code status, with instruction to report with 82951 when additional glucose tolerance tests are performed

18 Health Budgets & Financial Policy Medicine Section Immunization Admin/Vaccine 18 Two new codes replace the four deleted immunization administration codes; code 90460 is reported for the first component and code 90461 for each additional component It is important to note that these codes are for patients through age 18 when counseling is provided by a physician or other qualified health care professional Guidelines indicate that if counseling is not provided, codes 90471-90474 are to be reported ** HCPCS codes Q2035-Q2039 reflect influenza vaccines distinct to the manufacturer. Check with your Service coding POC for instructions on whether to use these codes in place of the CPT code 90658

19 Health Budgets & Financial Policy 19 Link to AMA website for “Reporting of CPT Codes for Influenza Vaccine Products & Vaccine Administration” report-cpt-codes-influenza.pdf report-cpt-codes-influenza.pdf Web-based Resource for Immunization Coding

20 Health Budgets & Financial Policy 20 Psychiatry – 2 added Two new codes were added for therapeutic repetitive transcranial magnetic stimulation treatment. Report code 90867 for treatment planning, and code 90868 for each session of treatment delivery and management. The treatment planning may only be reported once per course of treatment. This treatment is for clinical depression and replaced codes 0160T and 0161T Gastroenterology – 2 added, 7 deleted, 1 revised Codes for esophageal motility studies remain in the medicine section. Code 91010 was revised and now specifically includes the interpretation and report of 2-dimensional data. Code 91013 is a new add-on code used to report stimulation or perfusion during the 2-dimensional study Colon motility is reported for a minimum of six continuous hours of recording with code 91117. Note that provocation tests are included, as well as interpretation and report Medicine Section

21 Health Budgets & Financial Policy 21 Ophthalmology – 5 added, 1 deleted Computerized ophthalmic scanning of the eye is now reported with 92132 for anterior chamber, 92133 for posterior chamber and optic nerve, and 92134 for posterior chamber and retina. Instructional notes indicate that 92133 and 92134 cannot be together and that if both are performed only one is reported Remote imaging and detection or management of retinal disease is reported with codes 92227 and 92228. These codes are unilateral or bilateral. As with other telemedicine services, these codes are reported by the remote site performing the evaluation and not the transmission of the data Medicine Section

22 Health Budgets & Financial Policy 22 Cardiovascular – 20 added, 28 deleted, 10 revised Cardiovascular monitoring codes (93224-93272) were revised for 2011. A major change includes changing “wearable” to external when describing the electrocardiographic continuous recording and storage. In addition, these codes include monitoring for up to 48 hours The cardiac catheterization services no longer rely on approach, but now take a hierarchal approach. From a right heart catheter or a left heart catheter, the codes build and add components of the service such as angiography or ventriculography. In addition, the codes now include the injection and the supervision and interpretation. It will be critical to read the code descriptions as most cardiac catheter services will now be reported with a single code for the physician. There are two sets of codes, one for congenital heart disease (93530-93533), and the other for all other conditions (93451-93464) Cardiac catheter procedures that required five or more codes in 2010 may only require one code for 2011 Medicine Section

23 Health Budgets & Financial Policy 23 Noninvasive Vascular Studies – 3 revised The codes 93922-93924 for extremity arterial studies were revised for 2011. These changes include expanded guidelines for a limited bilateral and complete bilateral study. In addition, code 93924 was revised and includes specific guidelines related to evaluation of arteries at rest and following treadmill testing Neurology/Neuromuscular – 2 added, 3 revised Unattended sleep study is reported with 95800-95801 Code 95857 was changed to reflect the use of cholinesterase inhibitor challenge as the current test for myasthenia gravis Code 95953 was revised to indicate that the EEG monitoring in this service is unattended. The revision to code 95956 includes attendance by technologist or nurse during the EEG Medicine Section

24 Health Budgets & Financial Policy 24 Injections/Infusions/Chemo – 1 added, 1 deleted New code 96446 is used to report administration of chemotherapy using an indwelling port or catheter into the peritoneal cavity Physical Therapy – 2 revised Codes 97597 and 97598 have been revised to include a variety of debridement methods used to treat the epidermis and dermis. This is in keeping with the changes to codes 11042-11044. In addition, the area is defined for the initial 20 square centimeters (97597) and each additional 20 square centimeters (97598) Medicine Section

25 Health Budgets & Financial Policy 25 31 added, 4 new clinical conditions, 6 revised Codes end with “F” Category II CPT codes are supplemental tracking codes used to measure performance. They are intended to facilitate data collection regarding quality of care rendered by coding certain services and test results that support nationally established performance measures and have an evidence base as contributing to quality patient care Medicare uses these codes for physician quality reporting initiatives (PQRI) The use of these codes is optional. The codes are not required for correct coding and may not be used as a substitute for Category I codes There are no rates associated with these codes Category II Codes

26 Health Budgets & Financial Policy Category III Codes 52 added, 12 deleted, majority of deletes converted to Category I codes Codes end with “T” This section of CPT codes contains a temporary set of codes for emerging technologies, services, and procedures Intended to be used to substantiate widespread usage or to provide documentation for the Food and Drug Administration (FDA) approval process There are no rates associated with these codes 26

27 Health Budgets & Financial Policy CPT Modifiers No new CPT modifiers added in 2011 27

28 Health Budgets & Financial Policy 28 147 added, 291 deleted, 49 revised Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes The biggest change is that the ‘D’ codes are not included in the HCPCS Level II code set for 2011 HCPCS Code Update

29 Health Budgets & Financial Policy 29 G0157-G0164 – Identifies when skilled healthcare providers deliver home health and/or hospice therapy, evaluation and management, observation and assessment, and education and training services J Codes – Some of the codes that have been added were previous C codes. Also, many of the drug dosage amounts have changed. If using one of these codes, verify the amount given to the patient and report the appropriate number of units Q2035-Q2039 – These include influenza vaccination codes for patients three years and older Q4117-Q4121 – These new codes report dermal substitute matrices used to support the healing of ulcers, burns, and/or surgical and trauma wounds PQRI G codes – There are now 64 more PQRI codes that are available for reporting purposes. Included are risk-adjusted functional status change residual scores for various anatomical sites, influenza administration and pharmacologic therapy, among others ** Tobacco and smoking cessation G codes (G0436, G0437) ** Check with your Service coding POC regarding the correct use of these codes for “asymptomatic” patients C codes – These consist of injections, skin substitutes, and dermal fillers New HCPCS Codes

30 Health Budgets & Financial Policy 30 Many deletions for 2011 are PQRI G codes, between G0430 and G8521 (215 in all). Among them are: diabetic, heart failure and coronary artery disease services, osteoporosis and hearing assessments, chemotherapy and other cancer-related services, E- prescribing system codes, asthma services, end-stage renal disease (ESRD) patient services, influenza screening, and tobacco use cessation services codes Other deletions include injection codes C9255, C9256, C9258- C9269, and C9271; skin protection wheelchair seat cushion K codes – to be reported with new codes E2622-E2655; codes E0220, E0230, and E0238, now reported with new code A9273; and J codes, now to be reported with other J codes to accommodate for the discontinued codes Deleted HCPCS Codes

31 Health Budgets & Financial Policy 31 New HCPCS Modifiers AY - Item or service furnished to an ESRD patient that is not for ESRD treatment AZ - Physician providing a service in a dental health professional shortage area CS - Item or service related, in whole or part, to an illness, injury, or condition related to the 2010 Gulf Oil Spill DA - Oral health assessment by licensed health professional other than a Dentist GU - Waiver of liability statement issues as required by payer policy, routine notice GX - Notice of liability issues, voluntary under payer policy NB - Nebulizer system, any type, FDA-cleared for use with specific drug PT - Colorectal Cancer screening test, converted to diagnostic test or other procedure

32 Health Budgets & Financial Policy 32 View a public webinar on 2011 CPT & HCPCS changes J4Z2&pw=mediregs J4Z2&pw=mediregs Additional Resources Download HCPCS file:

33 Health Budgets & Financial Policy Summary 33 We have discussed highlights of the new 2011 CPT and HCPCS codes, as well as the new modifiers Please get the word out to your departments about these changes as soon as you can The vaccine, radiology and laboratory code changes were put in tables for distribution and education to these impacted departments Consider downloading the new HCPCS codes from the CMS site (free). However, CPT codes require an AMA licensing agreement to obtain. Contact your Service POC for further information

34 Health Budgets & Financial Policy Questions? Please contact the UBO Helpdesk if you have any questions or concerns at (703) 575-5385 or 34

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