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Anesthesia Business Consultants, LLC Confidential Presentation Materials CPT U PDATES 2015 M ARYLAND AAHAM D ARLENE H ELMER, CMA, CPC, ACS-AN, CMPE, MBA.

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Presentation on theme: "Anesthesia Business Consultants, LLC Confidential Presentation Materials CPT U PDATES 2015 M ARYLAND AAHAM D ARLENE H ELMER, CMA, CPC, ACS-AN, CMPE, MBA."— Presentation transcript:

1 Anesthesia Business Consultants, LLC Confidential Presentation Materials CPT U PDATES 2015 M ARYLAND AAHAM D ARLENE H ELMER, CMA, CPC, ACS-AN, CMPE, MBA A PPROVED AHIMA ICD-10 T RAINER J ANUARY 16, 2015

2 Anesthesia Business Consultants, LLC Confidential Presentation Materials Disclaimer 2 Anesthesia Business Consultants, LLC (“ABC”) has provided this In-Service presentation, handouts and supplemental documentation and information (collectively, the “Presentation”) as a service to its clients. The Presentation is for general informational purposes only and should not be taken as legal advice or understood to create a legal contract or other covenant or agreement of any kind between ABC. Although the information found in this Presentation is believed to be reliable, no warranty, expressed or implied, is made regarding the accuracy, adequacy, completeness, legality, reliability, or usefulness of any information, either isolated or in the aggregate. The information in the Presentation is supplemental to, and not a substitute for, the AMA CPT-4 Codebook, any federal or state regulations, or payer/carrier contract or policies. There is no guarantee that the use of this material will prevent differences of opinion with payers/carriers/or regulators in payment and/or reimbursement disputes. It is further noted that any and all liability arising from the use of materials or information and/or presented at the seminar is the sole responsibility of the participant, and his/her respective employer(s) who, by their attendance at this Presentation, evidences agreement to hold harmless the aforementioned parties, their employees and affiliates. The Presentation is intended to be used as a teaching “tool”. CPT® Codes are copyright by the American Medical Association.

3 Anesthesia Business Consultants, LLC Confidential Presentation Materials 3 CPT Updates 2015 Key new and deleted CPT code coming in 2015 Impact of changes on provider coding and billing Inside the numbers: 261 new codes, 128 revised codes and 146 deleted codes Significant changes in E/M section Spinal Procedures Cardiovascular Pathology/Lab Digestive

4 Anesthesia Business Consultants, LLC Confidential Presentation Materials Common Themes 4 Clarification of devices Pacemaker section – were pacing cardioverter defibrillators now implantable defibrillators New methods/approaches Electrophysiologic evaluation for single or dual chamber transvenous pacing cardioverter-defibrillators Deletion of low utilization codes Application of turnbuckle jacket Codes created for recognition of work New code created for “physician planning” Clarification when codes should not be billed together Electromyography codes in Urology section

5 Anesthesia Business Consultants, LLC Confidential Presentation Materials Social History 5 Age appropriate review of past and current activities that includes significant information about: Marital status and/or living arrangements Current employment Occupational history Military history (NEW for 2015) Use of drugs, alcohol, and tobacco Level of education Sexual history Other relevant social factors

6 Anesthesia Business Consultants, LLC Confidential Presentation Materials E/M Changes 6 New Codes: Chronic care management, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional per calendar month Code reported once per month Provided by clinical staff under direction of physician At home, assisted living or rest home Include face to face and non face to face Activities are located in the guidelines

7 Anesthesia Business Consultants, LLC Confidential Presentation Materials E/M Changes Advance care planning; first 30 minutes each additional 30 minutes (add on code) Face to face services between physician/healthcare practitioner and family to discuss advanced directives Patient does not need to be present No active management of medical issues need to be present Some E//M services may be reported but no critical care

8 Anesthesia Business Consultants, LLC Confidential Presentation Materials E/M Changes 8 Revised Codes: Complex chronic care management with moderate or high medical decision-making; 60 minutes per month each additional 30 minutes (add on code)

9 Anesthesia Business Consultants, LLC Confidential Presentation Materials Anesthesia 9 Deleted: Anesthesia for procedures on clavicle or scapula; radical surgery Anesthesia for procedure on thoracic spine and cord; thoracolumbar sympathectomy Anesthesia for procedures in lumbar region; chemonucleolysis

10 Anesthesia Business Consultants, LLC Confidential Presentation Materials Surgery 10 Surgery New guidelines for vertebroplasty/vertebral augmentation New codes for open treatment of rib fractures New codes added/revised for arthrocentesis and ablation therapy procedures Cardiovascular System Changes to guidelines for pacemaker and implantable defibrillator Subsection for extracorporeal membrane oxygenation Revised guidelines/codes for endovascular revascularization services

11 Anesthesia Business Consultants, LLC Confidential Presentation Materials Surgery 11 Digestive Extensive changes for lower endoscopy procedures with new guidelines and codes for Stomal Endoscopy Renamed colon and rectal section Nervous system New injection codes for myelography New codes for transversus abdominus plane block

12 Anesthesia Business Consultants, LLC Confidential Presentation Materials Surgery 12 Global package definition Definition was revised to clarify who can perform these services and identify what services are included in addition to the operation Furnished by physician or other qualified health care professional E/M services subsequent to the decision for surgery (use to say “one E/M service”) Further changes – CMS has approved final rule- CMS will transition post op days to ZERO Current 10 day procedures = CY 2017 Current 30 day procedures = CY2018 Surgical RVU’s will be reevaluated to account for surgery only

13 Anesthesia Business Consultants, LLC Confidential Presentation Materials Musculoskeletal 13 New Codes: Arthrocentesis, aspiration and/or injection, small joint or bursa; without ultrasound guidance** Arthrocentesis, aspiration and/or injection, intermediate joint or bursa with ultrasound guidance, with permanent recording and reporting** Arthrocentesis, aspiration and/or injection, major joint or bursa; with ultrasound guidance, with permanent recording and reporting** **when codes are changed to include ultrasound guidance you can no longer bill for the guidance separately

14 Anesthesia Business Consultants, LLC Confidential Presentation Materials Musculoskeletal 14 New Codes: Ablation therapy for reduction or eradication of 1 or more bone tumors including adjacent soft tissue when involved by tumor extension, percutaneous, including imagining guidance when performed; cryoablation Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 1-3 ribs ribs or more ribs ** codes include moderate sedation so anesthesia cannot be billed separately as well as image guidance

15 Anesthesia Business Consultants, LLC Confidential Presentation Materials Musculoskeletal 15 New Codes: Percutaneous vertebroplasty, 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic lumbosacral each additional cervicothoracic or lumbosacral vertebral body (add on code)

16 Anesthesia Business Consultants, LLC Confidential Presentation Materials Musculoskeletal 16 New Codes: Percutaneous vertebral augmentation, including cavity creation using mechanical device, 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic lumbar each additional thoracic or lumbar vertebral body (add on code)

17 Anesthesia Business Consultants, LLC Confidential Presentation Materials Musculoskeletal 17 New Codes: Total disc arthroplasty, anterior approach, including discectomy with end plate preparation; second level cervical (add on code)** Arthrodesis, sacroiliac joint, percutaneous or minimally invasive, with image guidance, incudes obtaining bone graft when performed, and placement of transfixing device ** ** Category III code deleted to create Category I code

18 Anesthesia Business Consultants, LLC Confidential Presentation Materials Musculoskeletal 18 Revised Codes: Arthrocentesis, aspiration and/or injection, small joint or bursa; without ultrasound guidance Arthrocentesis, aspiration and/or injection, intermediate joint or bursa; without ultrasound guidance Arthrocentesis, aspiration and/or injection, major joint or bursa; without ultrasound guidance

19 Anesthesia Business Consultants, LLC Confidential Presentation Materials Musculoskeletal 19 Revised Codes: Ablation, therapy for reduction or eradication of 1 or more bone tumors including adjacent soft tissue when involved by tumor extension, percutaneous, including image guidance when performed; radiofrequency Arthrodesis, open, sacroiliac joint, including instrumentation when performed Injection of contrast for knee arthrography

20 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 20 New Codes: 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** Insertion of subcutaneous implantable defibrillator electrode** **Category III code deleted to make Category I code. Check guidelines

21 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 21 New Codes: Removal of subcutaneous implantable defibrillator electrode Repositioning of previously implanted subcutaneous implantable defibrillator electrode Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis** additional prosthesis(es) during same session (add on code)** **Category III code deleted to make Category I code. Codes include angiography and radiological supervision/interpretation to guide the repair

22 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 22 New Codes: Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by a physician; initiation, veno-venous initiation, veno-arterial daily management, each day, veno-venous daily management, each day, veno-arterial insertion of peripheral cannula(e), percutaneous, birth through 5 years of age

23 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 23 New Codes: insertion of peripheral cannula(e), percutaneous, 6 years and older insertion of peripheral cannula(e), open, birth through 5 years of age insertion of peripheral cannula(e), open, 6 years and older insertion of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age

24 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 24 New Codes: insertion of central cannula(e) by sternotomy or thoracotomy, 6 years and older reposition peripheral cannula(e), percutaneous, birth through 5 years of age reposition peripheral cannula(e), percutaneous, 6 years and older reposition peripheral cannula(e), open, birth through 5 years of age

25 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 25 New Codes: reposition peripheral cannula(e), open, 6 years and older reposition of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age reposition of central cannula(e) by sternotomy or thoracotomy, 6 years and older removal of peripheral cannula(e), percutaneous, birth through 5 years of age

26 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 26 New Codes: removal of peripheral cannula(e), percutaneous, 6 years and older removal of peripheral cannula(e), open, birth through 5 years of age removal of peripheral cannula(e), open, 6 years and older removal of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age removal of central cannula(e) by sternotomy or thoracotomy, 6 years and older

27 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 27 New Codes: Arterial exposure with creation of graft conduit to facilitate arterial perfusion for ECMO/ECLS (add on code) Insertion of left heart vent by thoracic incision for ECMO/ECLS Removal of left heart vent by thoracic incision for ECMO/ECLS

28 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 28 New Codes: Physician planning of a patient-specific fenestrated visceral aortic endograft requiring a minimum of 90 minutes of physician time Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation **If these services are relevant to your specialty recommend additional coding education

29 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 29 Revised Codes: Repositioning of preciously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator

30 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 30 Revised Codes: Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator Relocation of skin pocket for implantable defibrillator Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator

31 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 31 Revised Codes: Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (add on code) Insertion of implantable defibrillator pulse generator only; with existing single lead with existing dual leads with existing multiple leads Removal of implantable defibrillator pulse generator only

32 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 32 Revised Codes: Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy by transvenous extraction Insertion or replacement of permanent implantable defibrillator system with transvenous lead(s), single or dual chamber electrode(s); by transvenous extraction

33 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 33 Revised Codes: Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system dual lead system multiple lead system Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection without distal embolic protection

34 Anesthesia Business Consultants, LLC Confidential Presentation Materials Cardiovascular 34 Revised Codes: Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral, or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and all angioplasty within the same vessel, when performed; initial artery each additional artery (add on code) ** these codes will not be allowed when a stent is placed in the lower extremity for reasons other than occlusive disease

35 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 35 Gastroenterology Restructured section into 3 subsections Esophagoscopy Esophagogastroduodenoscopy (EGD) Endoscopic Retrograde Cholangiopancreatography (ERCP) Changes have been made to intestines and rectum endoscopy section for the same purpose Colonoscopy tree has been added Endoscopy, small intestine and stomal subsection has been divided into two sections – one for small intestine and one for stomal endoscopy **Recommend additional education for the changes in this section

36 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 36 New Codes: Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus, with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed Ileostomy, through stoma; with transendoscopic balloon dilation with placement of endoscopic stent

37 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 37 New Codes: Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) with endoscopic stent placement with endoscopic mucosal resection with directed submucosal injection(s), any substance with transendoscopic balloon dilation

38 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 38 New Codes: with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures 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

39 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 39 New Codes: with decompression, including placement of decompression tube, when performed Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) with placement of endoscopic stent with endoscopic mucosal resection with band ligation(s)

40 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 40 New Codes: Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) with endoscopic stent placement with endoscopic mucosal resection with decompression, including placement of decompression tube, when performed with band ligation(s) Unlisted procedure, colon

41 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 41 New Codes: Anoscopy; diagnostic, with high-resolution magnification (HRA) and chemical agent enhancement, including collection of specimen(s) by brushing or washing, when performed diagnostic, with high-resolution magnification (HRA) and chemical agent enhancement, with biopsy, single or multiple Ablation, 1 or more liver tumor(s), percutaneous, cryoablation (image guidance will be reported separately)

42 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 42 Revised Codes: Esophagoscopy, rigid, transoral; with removal of foreign body(s) Esophagoscopy, flexible, transnasal; diagnostic including collection of specimen(s) by brushing or washing, when performed (separate procedure) Esophagoscopy, flexible, transoral; with removal of foreign body(s) with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

43 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 43 Revised Codes: Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s) with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) with removal of foreign body(s)

44 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 44 Revised Codes: Ileostomy, through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) Endoscopic evaluation of small intestinal pouch; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) with biopsy, single or multiple

45 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 45 Revised Codes: Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) with removal of foreign body(s) with control of bleeding, any method with removal of tumor(s), polyp(s) or other lesion(s) by hot biopsy forceps Unlisted procedure, small intestine

46 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 46 Revised Codes: Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) with removal of foreign body(s) with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps with control of bleeding, any method with decompression, including placement of decompression tube, when performed with transendoscopic balloon dilation

47 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 47 Revised Codes: Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) with removal of foreign body(s) with biopsy, single or multiple with directed submucosal injection(s), any substance with control of bleeding, any method with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

48 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 48 Revised Codes: with removal of tumor(s), polyp(s), or other lesion(s) by snare technique with transendoscopic balloon dilation with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures

49 Anesthesia Business Consultants, LLC Confidential Presentation Materials Digestive 49 Revised Codes: 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 Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

50 Anesthesia Business Consultants, LLC Confidential Presentation Materials Urinary 50 New Codes: Cystourethroscopy with insertion of permanent adjustable transprostatic implant; single implant each additional permanent adjustable transprostatic implant (add on code)

51 Anesthesia Business Consultants, LLC Confidential Presentation Materials Maternity 51 Guidelines in Maternity Care/Delivery section have been revised to clarity that pregnancy confirmation during a problem-oriented or preventative visit is not considered part of the antepartum care and can/should be reported separately using the appropriate E/M code Further classification in Guidelines state that antepartum care also includes the initial prenatal history and physical exam Post partum guidelines have been moved to reflect chronological order of events.

52 Anesthesia Business Consultants, LLC Confidential Presentation Materials Nervous 52 New Codes: Myelography via lumbar injection, including radiological supervision and interpretation; cervical thoracic lumbosacral or more regions

53 Anesthesia Business Consultants, LLC Confidential Presentation Materials Nervous 53 New Codes: Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed) by continuous infusion(s) (includes imaging guidance, when performed) Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance when performed) by continuous infusions (includes imaging guidance when performed) ** added to indicate provision of anesthesia of the abdominal wall primarily for post op pain control

54 Anesthesia Business Consultants, LLC Confidential Presentation Materials Nervous 54 Revised Codes: Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment Injection procedure for myelography and/or computed tomography, lumbar (other than C1-C2 and posterior fossa)

55 Anesthesia Business Consultants, LLC Confidential Presentation Materials Eye and Ear 55 New Codes: Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft **These codes were found to be reported 73% of the time, new codes were developed to reflect with or without grafts

56 Anesthesia Business Consultants, LLC Confidential Presentation Materials Eye and Ear 56 Revised Codes: Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft Unlisted procedure, extraocular muscle

57 Anesthesia Business Consultants, LLC Confidential Presentation Materials Radiology 57 New Codes: Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete** limited** **New codes to report limited and complete breast ultrasound procedures **Both include axilla if performed **Many changes to parenthetical notes and cross references to reflect changes throughout CPT

58 Anesthesia Business Consultants, LLC Confidential Presentation Materials Radiology 58 New Codes Digital breast tomosynthesis; unilateral** bilateral** Screening digital breast tomosynthesis, bilateral (add on code) **Cannot report with regular screening mammo codes **Medicare using G codes for screening **Codes do not include coverage CMS will pay for diagnostic tomo Unclear how commercial payors will handle

59 Anesthesia Business Consultants, LLC Confidential Presentation Materials Radiology 59 New Codes: Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton, including vertebral fracture assessment** Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA) Teletherapy isodose plan; simple, includes basic dosimetry calculation(s) complex, includes basic dosimetry calculation(s) **combo code for assessment and bone density

60 Anesthesia Business Consultants, LLC Confidential Presentation Materials Radiology 60 New Codes: Brachytherapy isodose plan; simple, includes basic dosimetry calculation(s) intermediate, includes basic dosimetry calculation(s) complex, includes basic dosimetry calculation(s)

61 Anesthesia Business Consultants, LLC Confidential Presentation Materials Radiology 61 New Codes: Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple complex Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed

62 Anesthesia Business Consultants, LLC Confidential Presentation Materials Radiology 62 Revised Codes: Radiation treatment delivery, superficial and/or ortho voltage, per day Radiation treatment delivery, >1MeV; simple intermediate complex

63 Anesthesia Business Consultants, LLC Confidential Presentation Materials Radiology 63 Significant changes to the code set for these services New codes established to report combined teletherapy isodose with basic dosimetry calculations as well as combine codes for brachytherapy isodose planning with basic dosimetry May codes deleted and parenthetical notes added to direct users to appropriate codes. All new guidelines added as well as Radiation Management and Treatment table added to provider clarity Recommend extra education for this specialty

64 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 64 New Codes: Digoxin; free Valproic acid dipropylacetic acid); free Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, capable of being read by direct optical observation, including instrumental-assisted when performed, per date of service single drug class method, by instrumented test systems, per date of service

65 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 65 New Codes: Drug screen, presumptive, single drug class from Drug Class List B, by immunoassay or non-TLC chromatography without mass spectrometry, each procedure Drug screen, any number of drug classes, presumptive, single or multiple drug class method; thin layer chromatography procedure(s) (TLC), per date of service not otherwise specified presumptive procedure, each procedure

66 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 66 Drug Testing Presumptive Used to determine possible use or non-use of a drug May be followed by definitive testing to determine specific drug Definitive Qualitative or Quantitative tests to identify possible use or non use of a drug Identifies specific drugs Presumptive is not required Any specimen can be used More than one test requires 59 modifier

67 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 67 New Codes: Alcohols Alcohol biomarkers; 1 or or more Alkaloids, not otherwise specified Amphetamines; 1 or or or more Anabolic steroids; 1 or or more

68 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 68 New Codes: Analgesics, non-opioid; 1 or or more Antidepressants, serotonergic class; 1 or or more Antidepressants, tricyclic and other cyclicals; 1 or or more

69 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 69 New Codes: Antidepressants, not otherwise specified Antiepileptics, not otherwise specified; or more Antipsychotics, not otherwise specified; or more Barbiturates

70 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 70 New Codes: Benzodiazepines; or more Buprenorphine Cannabinoids, natural Cannabinoids, synthetic; or more Cocaine Fentanyl Gabapentin, non-blood

71 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 71 New Codes: Heroin metabolite Ketamine and norketamine Methadone Methylenedioxyamphetamines Methylphenidate Opiates, 1 or more Opioids and opiate analogs; 1 or or or more

72 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 72 New Codes: Oxycodone Pregabalin Propoxyphene Sedative hypnotics (non-benzodiazepines) Skeletal muscle relaxants; 1or or more Stimulants, synthetic Tapentadol

73 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 73 New Codes: Tramadol Stereoisomer (enantiomer) analysis, single drug class Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; or more FLT3, gene analysis; tyrosine kinase domain (TKD) variants (eg, D835, I836)

74 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 74 New Codes: MLH1 (mutL homolog1, colon cancer, nonpolyposis type 2)(eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; promoter methylation analysis PCA3/KLK3 (prostate cancer antigen 3 [non-protein coding]/kallikrein-related peptidase 3 [prostate specific antigen]) ratio (eg, prostate cancer)

75 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 75 New Codes: Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); genomic sequence analysis panel, must include sequencing of at least 9 genes, including FBN1, TGFBR1, TGFBR2, COL3A1, MYH11, ACTA2, SLC2A10, SMAD3, and MYLK duplication/deletion analysis panel, must include analyses for TGFBR1, TGFBR2, COL3A1, MYH11

76 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 76 New Codes: Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis sequence analysis, each comparator exome (eg, parents, siblings) (add on code) reevaluation of previously obtained exome sequence (eg, updated knowledge or unrelated condition/syndrome) Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21

77 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 77 New Codes: Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis sequence analysis, each comparator genome(eg, parents, siblings) (add on code) reevaluation of previously obtained genome sequence (eg, updated knowledge or unrelated condition/syndrome)

78 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 78 New Codes: Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome, Pendred syndrome); genomic sequence analysis panel, must include sequencing of at least 60 genes, including CDH23, CLRB1, GJB2, GPR98, MTRNR1, MY07A, MY015A, PCDH15, OTOF, SLC26A4, TMC1, TMPRSS3, USH1C, USH1G, USH2A, and WFS duplication/deletion analysis panel, must include copy number analyses for STRC and DFNB1 deletions in GJB2 and GJB6 genes

79 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 79 New Codes: Hereditary colon cancer syndromes (eg, Lynch syndrome, familial adenomatosis polyposis); genomic sequence analysis panel, must include analysis of at least 7 genes, including APC, CHEK2, MLH1, MSH2, MSH6, MUTYH, and PMS duplication/deletion gene analysis, must include analysis of at least 8 genes, including APC, CHEK2, MLH1, MSH2, MSH6, MUTYH, PMS2, and EPCAM

80 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 80 New Codes: Nuclear encoded mitochondrial genes, genomic sequence panel, must include analysis of at least 100 genes, including BCS1L, C10orf2, COQ2, COX10, DGUOK, MPV17, OPA1, PDSS2, POLG, POLG2, RRM2B, SCO1, SCO2, SLC25A4, SUCLA2, SUCLG1, TAZ, TK2, AND TYMP Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, 5-50 genes, interrogation for sequence variants and copy number variants or rearrangements, if performed

81 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 81 New Codes: Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, DNA and RNA analysis when performed, 5-50 genes, interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels if performed Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, DNA and RNA analysis when performed, 51 or greater, interrogation for sequence variants and copy number variants or rearrangements, if performed

82 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 82 New Codes: Whole mitochondrial genome (eg, Leigh syndrome, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes [MELAS], myoclonic epilepsy with ragged-red fibers [MERFF], neuropathy, ataxia, and retinitis pigmentosa [NARP], Leber hereditary optic neuropathy [LHON]), genomic sequence, must include sequence of analysis of entire mitochondrial genome with heteroplasmy detection Whole mitochondrial genome large sequence deletion analysis panel (eg, Kearns-Sayre syndrome, chronic progressive external ophthalmoplegia), including heteroplasmy detection, if performed

83 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 83 New Codes: X-linked intellectual disability (XLID) (eg, syndromic and non-syndromic XLID); genomic sequence analysis panel, must include sequencing of at least 60 genes, including ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL, RPS6KA3, AND SLC16A duplication/deletion gene analysis, must include analysis of at least 60 genes, including ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL, RPS6KA3, AND SLC16A2

84 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 84 New Codes: Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score Growth stimulation expressed gene 2 (ST2, Interleukin 1 receptor like-1) Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium difficile, E.coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets

85 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 85 New Codes: gastrointestinal pathogen, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 6-11 targets gastrointestinal pathogen, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, targets

86 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 86 New Codes: Human Papillomavirus (HPV), low-risk types Human Papillomavirus (HPV), high-risk types Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed Infectious agent antigen detection by immunoassay with direct optical observation; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies

87 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 87 New Codes: Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (add on code) each multiplex antibody stain procedure In situ hybridization (eg. FISH), per specimen; each additional single probe stain procedure (add on code) each multiplex probe stain procedure

88 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 88 New Codes: Morphometric analysis, in situ hybridization (quantitative or semi-quantitative) manual, per specimen; each additional single probe stain procedure (add on code) each multiplex probe stain procedure Morphometric analysis, in situ hybridization (quantitative or semi-quantitative) using computer-assisted technology, per specimen; each additional single probe stain procedure (add on code) each multiplex probe stain procedure Cryopreservation, mature oocyte(s)

89 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 89 Revised Codes: Digoxin; total Valproic acid (dipropylacetic acid); total Gabapentin, whole blood, serum, or plasma Quantitation of therapeutic drug, not elsewhere specified Molecular pathology procedure, Level Molecular pathology procedure, Level Molecular pathology procedure, Level Molecular pathology procedure, Level 6

90 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 90 Revised Codes: Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), non-drug analyte not elsewhere specified; qualitative, single stationary and mobile phase quantitative, single stationary and mobile phase 82543stable isotope dilution, single analyte, quantitative, single stationary and mobile phase stable isotope dilution, multiple analyte, quantitative, single stationary and mobile phase

91 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 91 Revised Codes: Volatiles (eg, acetic anhydride, diethylether) Blood typing, serologic; ABO Rh (D) antigen testing of donor blood using reagent serum, each antigen test antigen screening for compatible unit using patient serum, per unit screened RBC antigens, other than ABO or Rh (D), each Rh phenotyping, complete

92 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 92 Revised Codes: Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, includes reverse transcription, when performed, and amplified probe technique, each type or subtype influenza virus, for multiple types or sub-types, includes multiplex reverse transcription and multiplex amplified probe technique, first 2 types or sub-types influenza virus, for multiple types or sub-types, includes multiplex reverse transcription and multiplex amplified probe technique, each additional influenza virus type or sub-type beyond 2 (add on code)

93 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 93 Revised Codes: respiratory virus, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets respiratory virus, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 6-11 targets respiratory virus, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, targets

94 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 94 Revised Codes: Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual using computer-assisted technology

95 Anesthesia Business Consultants, LLC Confidential Presentation Materials Pathology 95 Revised Codes: In situ hybridization (eg. FISH), per specimen; initial single probe stain procedure Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; initial single probe stain procedure Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; initial single probe stain procedure

96 Anesthesia Business Consultants, LLC Confidential Presentation Materials Medicine 96 New Codes: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use Human Papilloma virus vaccine types 6, 11, 16, 18, 31, 33, 42, 52, 58, nonavalent (HPV), 3 dose schedule, for intramuscular use Liver elastography, mechanically induced shear wave (eg, vibration), without imaging, with interpretation and report Corneal hysteresis determination, by air impulse stimulation, unilateral or bilateral, with interpretation and report

97 Anesthesia Business Consultants, LLC Confidential Presentation Materials Medicine 97 Medicine services15 new and 16 revised Changes to: Vaccine codes: especially new flu vaccine code Psychiatry subsections and parenthetical notes and new adaptive behavior treatment codes (Category III) Cardiovascular subsection guidelines and definitions updated New Echocardiography codes Subsection change in several areas.

98 Anesthesia Business Consultants, LLC Confidential Presentation Materials Medicine 98 New Codes: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead defibrillator system Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator system

99 Anesthesia Business Consultants, LLC Confidential Presentation Materials Medicine 99 New Codes: Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s), real-time image acquisition and documentation, guidance with quantitative measurements, probe manipulation, interpretation, and report, including diagnostic transesophageal echocardiography and, when performed, administration of ultrasound contrast, Doppler, color flow, and 3D ** New code to report TEE during interventional cardiac procedures **New guidance and parenthetical notes added to provider additional instruction

100 Anesthesia Business Consultants, LLC Confidential Presentation Materials Medicine 100 New Codes: Electrophysiologic evaluation of subcutaneous implantable defibrillator Bioimpedance spectroscopy (BIS), extracellular fluid analysis for lymphedema assessment(s) Quantitative carotid intima media thickness and carotid atheroma evaluation, bilateral Brief emotional/behavioral assessment, with scoring and documentation, per standardized instrument

101 Anesthesia Business Consultants, LLC Confidential Presentation Materials Medicine 101 New Codes: Negative pressure wound therapy, utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters total wound(s) surface area greater than 50 square centimeters ** new codes intended for negative pressure therapy using disposable non-DME; therefore existing codes revised to stipulate use of DME

102 Anesthesia Business Consultants, LLC Confidential Presentation Materials Medicine 102 New Codes: Initiation of selective head or total body hypothermia in the critically ill neonate, includes appropriate patient selection by review of clinical, imaging and laboratory data, confirmation of esophageal temperature probe location, evaluation of amplitude EEG, supervision of controlled hypothermia, and assessment of patient tolerance of cooling** Application of topical fluoride varnish by a physician or other qualified health care professional **Codes 99481abd deleted new code includes all components

103 Anesthesia Business Consultants, LLC Confidential Presentation Materials Medicine 103 Revised Codes: Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine, (DTaP-HepB-IPV), for intramuscular use Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use

104 Anesthesia Business Consultants, LLC Confidential Presentation Materials Medicine 104 Revised Codes: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system dual lead transvenous implantable defibrillator system multiple lead transvenous implantable defibrillator system

105 Anesthesia Business Consultants, LLC Confidential Presentation Materials Medicine 105 Revised Codes: Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements

106 Anesthesia Business Consultants, LLC Confidential Presentation Materials Medicine 106 Revised Codes: Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional single, dual, or multiple lead pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support

107 Anesthesia Business Consultants, LLC Confidential Presentation Materials Medicine 107 Revised Codes: Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator Electronic analysis of implanted neurostimulator pulse generator system; complex spinal cord, or peripheral (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, up to 1 hour

108 Anesthesia Business Consultants, LLC Confidential Presentation Materials Medicine 108 Revised Codes: Developmental screening, with scoring and documentation, per standardized instrument** Negative pressure wound therapy, utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters total wound(s) surface area greater than 50 square centimeters **specifically excludes the emotional/behavioral assessment

109 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category II 109 Claims based performance measures reporting Revision and new codes for esophageal biopsy Revision of esophageal biopsies with dx of Barrett’s esophagus New codes for identification of adenoma and other neoplasm detection New footnote measures developed by GI societies

110 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 110 Codes for new technology may or may not be covered 39 new codes added 6 codes revised 26 codes deleted 3 codes deleted 23 codes changed to Category I codes Also 3 new subsections, guidelines and 16 codes added for assessment and treatment in the Adaptive Behavioral subsection Codes created for assessment and treatment of patients of any age with deficient adaptive or maladaptive behaviors, i.e. autism spectrum disorders, developmental disabilities, head trauma

111 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 111 New Codes: 0340T Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance 0341T Quantitative pupillometry with interpretation and report, unilateral or bilateral 0342T Therapeutic apheresis with selective HDL delipidation and plasma reinfusion 0345T Transcatheter mitral valve repair percutaneous approach via the coronary sinus

112 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 112 New Codes: 0346T Ultrasound, elastography (add on code) 0347T Placement of interstitial device(s) in bone for radiostereometric analysis (RSA) 0348T Radiologic examination, radiostereometric analysis (RSA); spine 0349T upper extremity(ies) 0350T lower extremity(ies)

113 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 113 New Codes: 0351T Optical coherence tomography of breast or axillary lymph node, excised tissue, each specimen; real-time intraoperative 0352T interpretation and report, real-time or referred 0353T Optical coherence tomography of breast, surgical cavity; real-time intraoperative 0354T interpretation and report, real-time or referred

114 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 114 New Codes: 0355T Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report 0356T Insertion of drug-eluting implant (including punctal dilation and implant removal when performed) into lacrimal canaliculus, each 0357T Cryopreservation; immature oocyte(s) 0358T Bioelectrical impedance analysis whole body composition assessment, supine position, with interpretation and report

115 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 115 New Codes: 0359T Behavior identification assessment, by the physician or other qualified health care professional, face-to-face with patient and caregivers), includes administration of standardized and non-standardized tests, detailed behavioral history, patient observation and caregiver interview, interpretation of test results, discussion of findings and recommendations with the primary guardian(s)/caregiver(s), and preparation of report

116 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 116 New Codes: 0360T Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; first 3o minutes of technician time, face-to-face with the patient 0361T each additional 30 minutes of technician time, face-to-face with the patient (add on code)

117 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 117 New Codes: 0362T Exposure behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by physician or other qualified health care professional with the assistance of one or more technicians; first 30 minutes of technician(s) time, face-to-face with the patient 0363T each additional 30 minutes of technician(s) time, face-to-face with the patient (add on code)

118 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 118 New Codes: 0364T Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; first 30 minutes of technician time 0365Teach additional 30 minutes of technician time (add on code) 0366T Group adaptive behavior treatment by protocol, administered by technician, face-to-face with two or more patients; first 30 minutes of technician time 0367T each additional 30 minutes of technician time (add on code)

119 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 119 New Codes: 0368T Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional with one patient; first 30 minutes of patient face-to-face time 0369T each additional 30 minutes of patient face-to- face time (add on code)

120 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 120 New Codes: 0370T Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present) 0371T Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present)

121 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 121 New Codes: 0372T Adaptive behavior treatment social skills group, administered by physician or other qualified health care professional face-to-face with multiple patients 0373T Exposure adaptive behavior treatment with protocol modification requiring two or more technicians for sever maladaptive behavior(s); first 60 minutes of technicians' time, face-to-face with patient 0374T each additional 30 minutes of technicians' time, face-to-face with patient (add on code)

122 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 122 New Codes: 0375T 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 0376T Insertion of anterior aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; each additional device insertion (add on code) 0377T Anoscopy with directed submucosal injection of bulking agent for fecal incontinence

123 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 123 New Codes: 0378T Visual field assessment, with concurrent real time data analysis and accessible data storage with patient initiated data transmitted to a remote surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional 0379T technical support and patient instructions, surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional

124 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 124 New Codes: 0380T Computer-aided animation and analysis of time series retinal images for the monitoring of disease progression, unilateral or bilateral, with interpretation and report

125 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 125 Revised Codes: 0075T Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; initial vessel 0076T each additional vessel (add on code) 0191T Insertion of anterior aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; initial insertion

126 Anesthesia Business Consultants, LLC Confidential Presentation Materials Category III 126 Revised Codes: 0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or a mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed 0201T Percutaneous sacral augmentation (sacroplasty), bilateral injection(s), including the use of a balloon or a mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed

127 Anesthesia Business Consultants, LLC Confidential Presentation Materials HCPCs Modifier Changes 127 Modifier 59 is the most widely used Often utilized to bypass NCCI edits Modifier is associated with the most abuse, leading to audits, reviews and even fraud and abuse. 4 new modifiers created X(EPSU) modifiers 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 XP - Separate practitioner, 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

128 Anesthesia Business Consultants, LLC Confidential Presentation Materials References CPT Professional Edition Codebook 2015 CPT Changes Insiders View

129 Anesthesia Business Consultants, LLC Confidential Presentation Materials Questions 129


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