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2009 CPT & HCPCS Level II Updates & Billing Impacts Presenters: Susan Collins, MHSA, CPC, CCA, CPMA Lorrie Borchert, CPC, CPAM February 2009.

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Presentation on theme: "2009 CPT & HCPCS Level II Updates & Billing Impacts Presenters: Susan Collins, MHSA, CPC, CCA, CPMA Lorrie Borchert, CPC, CPAM February 2009."— Presentation transcript:

1 2009 CPT & HCPCS Level II Updates & Billing Impacts Presenters: Susan Collins, MHSA, CPC, CCA, CPMA Lorrie Borchert, CPC, CPAM February 2009

2 2 Note: Coding and Billing are Connected

3 3 Objectives Receive an overview of new, updated and deleted CPT® & HCPCS (Healthcare Common Procedure Coding System) Level II codes Be able to share this information with other staff (ie. coders & billers)

4 New CPT Codes CMS implements new Category I and III CPT codes and new Level II HCPCS annually. Codes are released to the public in the summer and through the fall taking effect on 1 January. CMS uses Level I and Level II HCPCS codes and descriptors to identify and group the services within each APC (Ambulatory Payment Classifications)

5 5 AMA The American Medical Association (AMA) copyrights Current Procedural Terminology (CPT). All rights reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein.

6 6 Overview of 2009 CPT Changes 152 New Codes 99 Deletions 174 Descriptor Changes 329 Grammatical Changes 2 Reinstated/Recycled 756 changes

7 7 Category I Breakdown of 2009 Changes SectionNew CodesDeletions Descriptor Changes Grammatical ChangesTotals EM Codes Anesthesia Integumentary Respiratory Cardiology Musculoskeletal Digestive Urinary Genital (M/F) Nervous Eye & Ocular Radiology Laboratory Medicine TOTALS

8 8 Evaluation &Management Neonatal and Pediatric Critical Care Additions: Initial hospital or birthing center care, per day, for E/M of normal newborn infant Initial care, per day, for E/M of normal newborn infant seen in other than hospital or birthing center Subsequent hospital care, per day, for E/M of normal newborn Initial hospital or birthing center care, per day, for E/M of normal newborn infant admitted and discharged on the same day.

9 9 Evaluation &Management Neonatal and Pediatric Critical Care Additions cont: Attendance at delivery (when requested by the delivering physician) and initial stabilization of newborn Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output Critical care services delivered by a physician, face-to-face, during an inter-facility transport of critically ill or critically injured pediatric patient, 24 months of age or less; first minutes of hands-on care during transport

10 10 Evaluation &Management Neonatal and Pediatric Critical Care Additions cont: each additional 30 minutes (List separately in addition to code for primary service) Initial inpatient neonatal critical care, per day, for the E/M of a critically ill neonate, 28 days of age or less Subsequent inpatient neonatal critical care, per day, for the E/M of a critically ill neonate, 28 days of age or less Initial inpatient pediatric critical care, per day, for the E/M of a critically ill infant or young child, 29 days through 24 months of age

11 11 Evaluation &Management Neonatal and Pediatric Critical Care Additions cont: Subsequent inpatient neonatal critical care, per day, for the E/M of a critically ill infant or young child, 29 days through 24 months of age Initial inpatient pediatric critical care, per day, for the E/M of a critically ill infant or young child, 2-5 years of age Subsequent inpatient neonatal critical care, per day, for the E/M of a critically ill infant or young child, 2-5 years of age

12 12 Evaluation &Management Neonatal and Pediatric Critical Care Additions cont: Subsequent intensive care, per day, for the E/M of the recovering very low birth weight infant (present body weight <1500 grams) Subsequent intensive care, per day, for the E/M of the recovering very low birth weight infant (present body weight of grams) Subsequent intensive care, per day, for the E/M of the recovering very low birth weight infant (present body weight of grams)

13 13 Evaluation &Management Deletions (crosswalk 99466) ( “ 99467) ( “ 99471) ( “ 99472) ( “ 99468) ( “ 99469) ( “ 99478) ( “ 99479) (crosswalk 99480) ( “ 99460) ( “ 99461) ( “ 99462) ( “ 99463) ( “ 99464) ( “ 99465)

14 14 Evaluation &Management Descriptor Changes The examples are removed from (+99354, , , ) The term “appropriate immunization(s)” was removed from the list of orders for the following codes: 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, and 99397

15 15 Musculoskeletal System Additions Application of multiplane (pins or wires in more than one plane), unilateral, external fixation w/stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment[s], assessment[s], and computation[s], of adjustment schedule[s] Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; exchange (ie, removal and replacement) of strut, each

16 16 Musculoskeletal System Additions 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 Revision including replacement of total disc arthroplasty (artificial disc) anterior approach, single interspace; cervical Removal of total disc, arthroplasty (artificial disc), anterior approach, single interspace; cervical

17 17 Musculoskeletal System Additions cont: Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle), unilateral Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle) with debridement of nonviable muscle, unilateral

18 18 Musculoskeletal System Deletions (crosswalk 0054T, 0055T) (crosswalk 0054T, 0055T)

19 19 Musculoskeletal System Descriptor Changes –For codes 15003, 15005, 15021, 15221, 15241, and 15341, the term “or part thereof” has been added –For codes and the term “balloon catheter” was changed to “expandable catheter (single or multichannel)

20 20 Musculoskeletal System Descriptor Changes cont –Codes 22857, 22862, & had changes due to addition of new codes, but without changes to the actual code descriptions –Codes changed to include terminology concerning fracture patterns of the pelvic bone –Codes & had addition of the term “or transfer (with muscle redirection or rerouting)” and change from “hamstring tendon to patella” to “thigh (eg, extensor or flexor)”

21 21 Cardiovascular System Additions: Bypass Graft Vein: Bypass graft, with vein; hepatorenal Bypass graft, with vein; tibial-tibial, peroneal-tibial, or tibial/peroneal trunk-tibial Bypass Graft Other Than Vein: Bypass graft, with other than vein; ilio-celiac Bypass graft, with other than vein; ilio-mesenteric Bypass graft, with other than vein; iliorenal

22 22 Cardiovascular System Additions: Bypass Graft Vein: Bypass graft, with vein; hepatorenal Bypass graft, with vein; tibial-tibial, peroneal-tibial, or tibial/peroneal trunk-tibial Bypass Graft Other Than Vein: Bypass graft, with other than vein; ilio-celiac Bypass graft, with other than vein; ilio-mesenteric Bypass graft, with other than vein; iliorenal Descriptor Change: This code was changed to an add-on code

23 23 Digestive System Additions: Tongue base suspension, permanent suture technique Submucosal ablation of the tongue base, radiofrequency, one or more sites, per session Endoscopic cannulation of papilla with direct visualization of common bile duct(s) and/or pancreatic duct(s) (List separately in addition to code(s) for primary procedure) Laparoscopy, surgical, esophagomyotomy (Heller type), w/fundoplasty, when performed Destruction of internal hemorrhoid(s) by thermal energy (eg, infrared coagulation, cautery, radiofrequency)

24 24 Digestive System Additions cont: Laparoscopy. Surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible Laparoscopy, Surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed): reducible Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated

25 25 Digestive System Additions cont: Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated

26 26 Digestive System Deletions (see 46083, 46930, 46999, , 46320, 46500, 46221, 46945, 46946, 46947) (see 46083, 46930, 46999, , 46320, 46500, 46221, 46945, 46946, 46947) (see 46083, 46930, 46999, , 46320, 46500, 46221, 46945, 46946, 46947)

27 27 Digestive System Descriptor Changes –Code had a spelling correction and –Code had the term “open” added

28 28 Urinary System Addition: Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance –This code was previously reported with a Category III code

29 29 Urinary System Deletions (crosswalk 52214) (crosswalk 52601, 52630) (crosswalk 52601, 52630) (crosswalk 52601, 52630) (crosswalk 55899)

30 30 Urinary System Descriptor Changes –Was changed to transurethral approach, had the term “longer than one year postoperative” removed, and a list of included additional procedures added – had the term “other than local” added to distinguish the included anesthesia

31 31 Nervous System Additions: Stereotactic Radiosurgery (Cranial): Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 simple cranial lesion Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional cranial lesion, simple (List separately in addition to code for primary procedure) Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 complex lesion Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional cranial lesion, complex (List separately in addition to code for primary procedure) Application of stereotactic headframe for stereotactic radiosurgery (List separately in addition to code for primary procedure

32 32 Nervous System Additions cont: Stereotactic Radiosurgery (Spinal) Stereotactic Radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion Stereotactic Radiosurgery (particle beam, gamma ray, or linear accelerator); each additional lesion (List separately in addition to code for primary procedure)

33 33 Nervous System Additions cont: Spine and Spinal Cord: Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes Extra Cranial Nerves, Peripheral Nerves, and Autonomic Nervous System: Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton’s neuroma) Destruction by neurolytic agent; plantar common digital nerve

34 34 Nervous Systems Deletions (crosswalk to , )

35 35 Nervous System Descriptor Changes –For code 62287, the term “aspiration” was removed –For code , the term “including open and endoscopically- assisted approaches” added –For the code 64449, the terminology referring to the daily management removed

36 36 REMEMBER: Coding and Billing are Connected Coding and Billing are Connected

37 37 Eye and Ocular Adnexa Additions: Anterior segment Keratoplasty (corneal transplant); endothelial Backbench preparation of corneal endothelial allograft prior to transplantation (List separately in addition to code for primary procedure)

38 38 Eye and Ocular Adnexa Descriptor Changes –The term “anterior” was added –The term “pseudophakia” was added

39 39 Radiology Additions: Clinical Brachytherapy Remote afterloading high dose rate radionuclide brachytherapy; 1 channel Remote afterloading high dose rate radionuclide brachytherapy; 2-12 channels Remote afterloading high dose rate radionuclide brachytherapy; over 12 channels Nuclear Medicine (Diagnostic) Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg. Parathyroid adenoma)

40 40 Radiology Deletions (crosswalk to for more specificity ) (crosswalk to for more specificity ) (crosswalk to for more specificity ) (crosswalk to for more specificity ) (no reference code given) (no reference code given)

41 41 Radiology Descriptor Changes –The term “contrast” was added to this code

42 42 Pathology & Laboratory Additions: Chemistry Myeloperoxidase (MPO) Onocoprotein; des-gamma-carboxy-prothrombin (DCP) Hematology and Coagulation Coagulation & fibrinolysis, functional activity, not otherwise specified (eg, ADAMTS-13), each analyte

43 43 Pathology & Laboratory Additions cont: Microbiology Infectious agent enzymatic activity other than virus (eg, sialidase activity in vaginal fluid) N Vivo (eg, Transcutaneous) Laboratory Procedures Bilirubin, total, transcutaneous Hemoglobin, quantitative, transcutaneous; per day; carboxyhemoglobin Hemoglobin, quantitative, transcutaneous, per day; methamoglobin

44 44 Pathology & Laboratory Deletion (crosswalk to 88720)

45 45 Pathology & Laboratory Descriptor Changes

46 46 Medicine Additions: Vaccines/Toxoids Human Papilloma virus (HPV) vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use Rotavirus vaccine, human, attenuated, 2 dose schedule, live, for oral use Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, inactivated (DTap-IPV), when administered to children 4 through 6 years of age, for intramuscular use Japanese encephalitis virus vaccine, inactivated, for intramuscular use

47 47 Medicine Additions: End-Stage Renal Disease Services End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face physician visits per month with 2 to 5 face-to-face visits physician visits per month with 1 face-to-face physician visit per month

48 48 Medicine Additions cont: End-Stage Renal Disease Services cont End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face physician visits per month with 2-3 face-to-face visits physician visits per month with 1 face-to-face physician visit per month

49 49 Medicine Additions cont: End-Stage Renal Disease Services cont End-stage renal disease (ESRD) related services monthly, for patients years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face physician visits per month with 2-3 face-to-face visits physician visits per month with 1 face-to-face physician visit per month

50 50 Medicine Additions cont: End-Stage Renal Disease Services cont End-stage renal disease (ESRD) related services monthly, for patients 20 years of age or older; with 4 or more face-to-face physician visits per month with 2-3 face-to-face visits physician visits per month with 1 face-to-face physician visits per month End-stage renal disease (ESRD) related services for home dialysis per full month, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents

51 51 Medicine Additions cont: End-Stage Renal Disease Services cont End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents End-stage renal disease (ESRD) related services for home dialysis per full month, for patient years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 20 years of age or older

52 52 Medicine Additions cont: End-Stage Renal Disease Services cont End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age End-stage renal disease (ESRC) related services for dialysis less than a full month of service per day; for patients 2-11 years of age End-stage renal disease (ESRC) related services for dialysis less than a full month of service per day; for patients years of age End-stage renal disease (ESRC) related services for dialysis less than a full month of service per day; for patients 20 years of age or older

53 53 Medicine Additions: Cardiography Wearable mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; physician review and interpretation with report Wearable mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and physician prescribed transmission of daily and emergent data reports.

54 54 Medicine Additions: Cardiovascular Device Monitoring – Implantable & Wearable Devices Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; single lead pacemaker system dual lead pacemaker system multiple lead pacemaker system single lead implantable cardioverter-defibrillator system dual lead implantable cardioverter-defibrillator system multiple lead implantable cardioverter-defibrillator system implantable loop recorder system

55 55 Medicine Additions cont: Cardiovascular Device Monitoring – Implantable & Wearable Devices (continued) Peri-procedural device evaluation and programming of device system parameters before or after a surgery, procedure, or test with physician analysis, review and report; single; dual, or multiple lead pacemaker system Single, dual, or multiple lead implantable cardioverter- defibrillator system Interrogation device evaluation (in person) with physician analysis; review and report, includes connection, recording and disconnection per patient encounter; single, dial, or multiple lead pacemaker system

56 56 Medicine Additions cont: Cardiovascular Device Monitoring – Implantable & Wearable Devices (continued) Single, dual, or multiple lead implantable cardioverter- defibrillator system, including analysis of heart rhythm derived data elements Implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors Implantable loop recorder system, including heart rhythm derived data analysis Wearable defibrillator System

57 57 Medicine Additions cont: Cardiovascular Device Monitoring – Implantable & Wearable Devices (continued) Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with physician analysis, review and report(s), up to 90 days Interrogation device evaluation(s) (remote); up to 90 days; single, dual, or multiple lead pacemaker system with interim physician analysis, review(s) and report(s) Single, dual, or multiple lead implantable cardioverter-defibrillator system with interim physician analysis, review(s) and report(s) Single, dual, or multiple lead implantable cardioverter-defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

58 58 Medicine Additions cont: Cardiovascular Device Monitoring – Implantable & Wearable Devices (continued) Interrogation device evaluation(s) up to 30 days; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, physician analysis, review(s) and report(s) Implantable loop recorder system, including analysis of recorded heart rhythm data, physician analysis, review(s) and report(s) Implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

59 59 Medicine Additions: Echocardiography Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler Echocardiography, and with color flow Doppler echocardiography Echocardiography, transthoracic, real-time with image documentation (2D) includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous eletrocardiographic monitoring, with physician supervision Use of echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure)

60 60 Medicine Additions: Neurology and Neuromuscular Procedures Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording) Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day

61 61 Medicine Additions: Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other highly complex Drug or highly Complex biologic Agent Administration Intravenous infusion, hydration; initial, 31 minutes to 1 hour each additional hour (List separately in addition to code for primary procedure) Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour Each additional hour (List separately in addition to code for primary procedure) Additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure) Concurrent infusion (List separately in addition to code for primary procedure)

62 62 Medicine Additions cont: Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other highly complex Drug or highly Complex biologic Agent Administration (continued) Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s) Each additional 1 hour (List separately in addition to code for primary procedure) Additional pump set-up with establishment of new subcutaneous infusion site(s) (List separately in addition to code for primary procedure) Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous of intramuscular

63 63 Medicine Additions cont: Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other highly complex Drug or highly Complex biologic Agent Administration (continued) Intra-arterial Intravenous push, single or initial substance/drug Each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure) Each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure) Unlisted therapeutic, prophylactic, or diagnostic intravenous or intra-arterial injection or infusion

64 64 Medicine Deletions (crosswalk 96360) ( “ 96361) ( “ 96365) ( “ 96366) ( “ 96367) ( “ 96368) ( “ 96369) ( “ 96370) ( “ 96371) ( “ 96372) ( “ 96373) (crosswalk 96374) ( “ 96375) ( “ 96376) ( “ 96379) (see , 90963, 90967) (see , 90964, 90968) (see , 90965, 90969) (see , 90966, 90970)

65 65 Medicine Deletions Deletions cont: (crosswalk , 90963, 90967) ( “ , 90964, 90968) ( “ , 90965, 90969) ( “ , 90966, 90970) ( “ 93285, 93291, 93298) 93731, ( “ 93288, 93294, 93280) (crosswalk 93293) ( “ 93288, 93294, 93279) ( “ 93288, 93294, 93279) ( “ 93293) ( “ 93282, 93292) ( “ 93282, 93292) 93743, ( “ 93289, 93295, 93283) 93760, (no reference code given)

66 66 Medicine Descriptor Changes

67 67 Inpatient Only The inpatient list specifies those services that are only paid when provided in an inpatient setting because of the nature of the procedure. Criteria used to determine if the procedure is “IP Only”: -- The underlying physical condition of the patient -- The need for at least 24 hours of postoperative recovery time or monitoring before the patient can be safely discharged.

68 68 Who Makes Inpatient Procedure Changes? CMS determines that Inpatient Only procedures may need a status change to allow them to be performed in the outpatient setting. The following criteria is used to determine Inpatient Only Status: –The procedure is being performed in numerous hospitals on an outpatient basis –It has been determined the procedure can be appropriately and safely performed in an ASC –A person or entity has proposed a procedure on the Inpatient only list to become an addition to the ASC (Ambulatory Surgical Centers) list

69 69 Inpatient Only Procedures List of Additions: 0062T Percutaneous intradiscal annuloplasty, any method, except electrothermal, unilateral or bilateral including fluoroscopic guidance; single level +0063T One or more additional levels (List separately in addition to 0062T for primary procedure) Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level one or more additional levels (List separately in addition to code for primary procedure) (new code) 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

70 70 Inpatient Only Procedures List of Additions cont: (new code) Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical (new code) Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical (new code) Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle), unilateral (new code) Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle), with debridement of nonviable muscle, unilateral

71 71 Inpatient Only Procedures List of Additions cont: (new code) Bypass graft, with vein; hepatorenal (new code) tibial-tibial, peroneal-tibial, or tibial/peroneal trunk- tibial (new code) Bypass graft, with other than vein; ilio-celiac (new code) ilio-mesenteric (new code) iliorenal (new code) Tongue base suspension, permanent suture technique (new code) Laparoscopy, surgical, esophagomyotomy (Heller type), with fundoplasty, when performed

72 72 Inpatient Only Procedures List of Deletions: Acellular dermal replacement, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children each additional 100 sq cm or less, or 1 % of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) Acellular dermal replacement, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children each additional 100 sq cm or less, or 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

73 73 Inpatient Only Procedures List of Deletions cont: Thrombectomy, direct or with catheter; axillary and subclavian vein, by arm incision Exchange transfusion, blood; other than newborn Laparoscopy, surgical; with insertion of intraperitoneal cannula or catheter, permanent with revision of previously placed intraperitoneal cannula or catheter, with removal of intraluminal obstructive material if performed with omentopexy (omental tacking procedure) (List in separately in addition to code for primary procedure)

74 74 Inpatient Only Procedures List of Deletions cont: Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure) Injection, anesthetic agent; femoral nerve, continuous infusion by catheter (including catheter placement) lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement)

75 has been deleted –To report prolonged physician services. Coders should review the guidelines in the E/M section when reporting Modifier Change

76 76 Device Intensive Additions Arthroplasty, elbow; with distal humeral prosthetic replacement with distal humerus and proximal ulnar prosthetic replacement (eg, total elbow) Arthroplasty, radial head; with implant Arthroplasty with prosthetic replacement; distal radius distal ulna Arthroplasty, knee, condyle and plateau; medial OR lateral compartment

77 77 Device Intensive Additions List of Additions cont: Keratoprosthesis Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy with mastoidectomy Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy with mastoidectomy

78 78 Device Intensive Deletions Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure) Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure) Insertion of a transvenous electrode; single chamber (one electrode) permanent pacemaker or single chamber pacing cardioverter-defibrillator dual chamber (two electrodes) permanent pacemaker or dual chamber pacing cardioverter-defibrillator Insertion of tunneled centrally inserted central venous access device, requiring two catheters via two separate venous access sites; with subcutaneous port(s)

79 79 New HCPCS Codes A6545C9898 A9284C9899 A9580D0417 C8929D0418 C8930D3222 C9245D5991 C9246E0487 C9247E0656 C9248E0657 C9356E0770 C9358E1354 C9359E1356 E1357G0406 E1358G0407 E2230G0408 E2231G0409 E2295G0410 G0398G0411 G0399G0412 G0400G0413 G0402G0414 G0403G0415 G0404G0416 G0405G0417

80 80 New HCPCS Codes – 2009 Continued G0418G8495 G0419G8496 G8485G8497 G8486G8498 G8487G8499 G8488G8500 G8489G8501 G8490G8502 G8491G8503 G8492G8504 G8493G8505 G8494G8506 G8507G8519 G8508G8520 G8509G8521 G8510G8522 G8511G8523 G8512G8524 G8513G8525 G8514G8526 G8515G8527 G8516G8528 G8517G8529 G8518G8530

81 81 New HCPCS Codes – 2009 Continued G8531G8543 G8532G8544 G8533J0641 G8534J1267 G8535J1453 G8536J1459 G8537J1930 G8538J1953 G8539J2785 G8540J3101 G8541J3300 G8542J7186 J7606L6722 J8705L8604 J9033Q4100 J9207Q4101 J9330Q4102 K0672Q4103 L0113Q4104 L6711Q4105 L6712Q4106 L6713Q4107 L6714Q4108 L6721Q4109

82 82 New HCPCS Codes – 2009 Continued Q4110 Q4111 Q4112 Q4114 S2118 S2270 S3628 S3711 S3860 S3861 S3862 S9433 Changed Codes: A6010A6204 A6011A6205 A6021A6206 A6022A6207 A6023A6208 A6024A6209 A6196A6210 A6197A6211 A6198A6212 A6199A6213 A6203A6214

83 83 HCPCS Changed Codes – 2009 Continued A6215A6233 A6219A6234 A6220A6235 A6221A6236 A6222A6237 A6223A6238 A6224A6239 A6228A6240 A6229A6241 A6230A6242 A6231A6243 A6232A6244 A6245A6259 A6246A6260 A6247A6261 A6248A6262 A6251A6266 A6252A6407 A6253A9502 A6254C8921 A6255C8922 A6256C8923 A6257C8924 A6258C8925

84 84 HCPCS Changed Codes – 2009 Continued C8927D4260 C8928D4261 D0486D5211 D1203D5212 D1204E0764 D3310G0129 D3320G0248 D3330G0250 D4210G0275 D4211G8417 D4240G8418 D4241G8419 G8420G8447 G8427G8448 G8428G8457 G8429G8485 G8430G8486 G8431G8487 G8433J0270 G8437J0348 G8438J1572 G8439J2788 G8440J2790 G8446J3301

85 85 HCPCS Changed Codes – 2009 Continued J7639J9110 J9000J9120 J9001J9150 J9010J9151 J9015J9160 J9017J9165 J9020J9170 J9040J9181 J9045J9185 J9050J9190 J9098J9200 J9100J9201 J9206J9270 J9208J9300 J9209J9310 J9211J9320 J9213J9340 J9214J9350 J9215J9355 J9216J9357 J9230J9360 J9265J9390 J9266J9600 J9268K0669

86 86 HCPCS Changed Codes and Deleted Codes – 2009 Continued K0899L8681 L3905 L8689 L4360L8695 Deleted Codes: C9003J7344 G0300J9182 G0314L7612 G0321S2075 G0332C9237 J1751G0308 Deleted Codes cont. G0315G0323 G0322G0366 G0344J3100 J1752J7347 J7346L3890 L2860L7614 L7613S2077 S2076C9239 C9238G0310 G0309G0317 G0316G0324

87 87 HCPCS Deleted Codes – 2009 Continued Deleted Codes cont. G0367J7349 J7340L5994 J7348L7622 L5993S9092 L7621C9723 S2135G0312 C9240G0319 G0311G0326 G0318G0377 G0325J7342 G0368J7602 J7341J5995 S0141 G0297 G0313 G0320 G0327 G0394 J7343 J7603 L7611 S0143

88 88 HCPCS Reinstated Codes – 2009 Reinstated codes: J7611 Albuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, 1 mg. J7612 Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, 0.5 mg. J7613 Albuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 1 mg. J7614 Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 0.5 mg.

89 89 Summary Please share these updates with other billers and coders at your facility REMEMBER: Coding and Billing are Connected

90 90 Questions ?

91 91 References (OPPS Final Rule Federal Register)http://edocket.access.gpo.gov/2008/pdf/E pdf American Medical Association, CPT %202007%20CPT%20Changes- WEB.ppt#272,2,Objective 1 CPT Changes: An Insider’s View 2009, Ingenix “2009 CPT & OPPS Changes”, presentation by Sandra Draper, 12/18/2008, Precyse Solutions, LLC


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