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January 2014 Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS

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Presentation on theme: "January 2014 Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS"— Presentation transcript:

1 January 2014 Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS Matthew H. Lawney MSPT, MBA, CHC,

2 2 Agenda Breast Biopsy Procedures Pacemaker, Cardiac Defibrillators Angiography Vascular Embolism and Occlusion Questions and Discussion

3 3 Increased Packaging for Imaging Guidance CMS is considering conditionally packaging all imaging services performed with a surgical procedure Comments have been requested This is also an increasing pattern under CPT

4 4 Breast Biopsy Changes – Pre-Op Needle Localization Procedures

5 5 Pre-Op Needle Localization The following codes are deleted: – – Preoperative needle placement, breast – – Each additional – Stereotactic guidance for breast bx or needle placement, each lesion – – Mammo guidance for needle placement, each lesion

6 6 Pre-Op Needle Localization The following codes are not deleted, but cannot be reported for breast biopsy guidance: – – US guidance for needle placement or biopsy – – MRI guidance for needle placement of biopsy The following codes are not deleted, but cannot be reported for breast biopsy specimen exams: – – Radiologic exam of surgical specimen – – US exam of surgical specimen

7 7 Placement of Localization Devices w/o the Biopsy The following codes are new in 2014: – Placement of localization device (e.g., clip, wire), first lesion, using mammographic guidance – Each additional lesion – Placement of localization device (e.g., clip, wire), first lesion, using stereotactic guidance – Each additional – Placement of localization device (e.g., clip, wire), first lesion, using ultrasound guidance – Each additional – Placement of localization device (e.g., clip, wire), first lesion, using MRI guidance – Each additional

8 8 Pre-Op Needle Localization Breast Bx and , excision breast lesion identified by pre-op needle loc, open, have not been changed Pre-op needle placement (19290/19291) has been replaced: – 19281/19282, stereotactic guidance replaces 19290/19291/19295/ /19284, ultrasound guidance replaces 19290/19291/19295/ /19286, MRI guidance replaces 19290/19291/77021

9 9 Breast Biopsy Changes – Needle Core and Vacuum Assisted Bx Under Guidance

10 10 Breast Bx Under Guidance The following codes are deleted: – – Bx of breast, needle core, using imaging – – Bx of breast, vacuum assisted, using imaging – – Image guided placement of a clip during breast bx/aspiration, report in addition to primary procedure – Stereotactic guidance for breast bx or needle placement, each lesion

11 11 Breast Bx Under Guidance The following codes are not deleted, but cannot be reported for breast biopsy guidance: – – US guidance for needle placement or biopsy – – MRI guidance for needle placement of biopsy The following codes are not deleted, but cannot be reported for breast biopsies: – – Rad exam of surgical specimen – – Us exam of surgical specimen

12 12 Breast Bx Under Guidance The following codes are new in 2014 (19102/19103): – – Bx breast, w/ placement of localization device (e.g., clip), and imaging of the biopsy specimen, first lesion, using stereotactic guidance – Each additional lesion – – Bx breast, w/ placement of localization device (e.g., clip), and imaging of the biopsy specimen, first lesion, using ultrasound guidance – Each additional – – Bx breast, w/ placement of localization device (e.g., clip), and imaging of the biopsy specimen, first lesion, using MRI guidance – Each additional

13 13 Breast Bx Under Guidance New codes include: Image guided biopsy Placement of localization device Guidance – whether stereotactic, US, or MRI Placement of post-op clip (19295) Imaging of the biopsy specimen (76098) If more than one imaging is performed, report the additional procedure for each additional modality If an open, incisional biopsy is performed after image guided biopsy, report 19101, bx breast, open, incisional

14 14 Breast Bx Without Guidance Breast biopsies without image guidance are still reported with: 19000, breast bx; percutaneous, needle core, not using imaging (separate procedure) 19101, … open/incisional

15 15 Bx Under Guidance Modified NCCI Policy: “If a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with mammographic guidance (e.g., 19281,19282), the physician should not separately report a post procedure mammography code (e.g., 77051, 77052, , G0202-G0206) for the same patient encounter. The radiologic guidance codes include all imaging by the defined modality required to perform the procedure.”

16 16 Changes in APC Reimbursement

17 17 Changes in APC Reimbursement

18 18 Pacemaker/Pacing Cardio- defibrillator (ICD) Changes

19 19 Modified Guidelines Revision of a skin pocket is included in , Pocket revisions that include I&D of hematoma/wound infection or debridement may be separately reported Relocation of a skin pocket – when performed as part of an explant of an existing generator followed by replacement with a new generator, the pocket relocation is reported separately – Revision/relocation of skin pocket, pacemaker … ICD

20 20 Subcutaneous ICDs Category III codes 0319T-0328T These are for subcutaneous ICDs (S-ICDs) FDA recently approved a new type “A subcutaneous implantable defibrillator system is an implantable technology that uses a subcutaneous pulse generator attached to a single subcutaneous electrode to treat ventricular tachy-arrhythmias.”

21 21 Angiography/Embolism Changes

22 22 Angiography Changes CPT is moving to bundled imaging codes for angiography when the procedures are performed under guidance more than 75% of the time The codes for endovascular revascularization were previously bundled with the guidance when performed on peripheral vessels in the lower extremity The new change is for intravascular stenting of vessels other than the lower extremity, cervical carotid, intracranial, intracoronary, extracranial or intrathoracic

23 23 Lower Extremity Revascularization New combination codes created in 2011: Reported for lower extremity revascularization services performed for occlusive disease Built on progressive hierarchy with more intensive services inclusive of less intensive services Includes: accessing/selectively catheterizing the vessel, traversing the lesion, radiology S&I directly related, embolic protection, closure of the arteriotomy, imaging to document completion

24 24 Transcatheter Stent Placement Changes The following codes have been deleted: – Transcath placement of a stent, percutaneous, initial vessel – Each additional – Transcath placement of a stent, open, initial vessel – Each additional – Guidance of stent placement

25 25 Transcatheter Stent Placement Changes The following codes have been added: – Transcath placement of a stent, open or percutaneous, initial artery, including imaging and angioplasty within the same vessel – Each additional – Transcath placement of a stent, open or percutaneous, initial vein, including imaging and angioplasty within the same vessel – Each additional

26 26 Transcatheter Stent Placement Changes Code selection based on: Arterial versus venous Initial “vessel” versus additional “vessel”

27 27 Transcatheter Stent Placement Changes The new codes not for areas where other, more specific codes exist Report just one code when there is more than one stent in a single vessel New codes include: PTA [percutaneous angioplasty] in the treated vessel Any pre-dilation Post dilation Radiological S&I Closure by pressure or closure device or suture

28 28 Transcatheter Stent Placement Changes New codes do not include: PTA in a separate vessel Both selective and non-selective vascular catheterization Extensive repair of a artery (e.g., 35228, 35286) US guidance for vascular access (e.g., 76937) Initial dx angiography (as defined by CPT)

29 29 Vascular Embolization and Occlusion The following code has been deleted: – Tranacath occlusion/embolization (e.g, tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, an method, non-central nervous system, non-head / neck Was frequently reported with these codes: Transcatheter therapy, embolization, any method, radiological supervision and interpretation Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis

30 30 Vascular Embolization and Occlusion is now bundled with and Head/neck embolization remains the same: Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; non-central nervous system, head or neck (extracranial, brachiocephalic branch)

31 31 Vascular Embolization and Occlusion New Codes: Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) - AV access branch embolization … arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms) – translumbar AAA sac coil embolization or splenic artery aneurysm embolization

32 32 Vascular Embolization and Occlusion New Codes Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction (e.g., uterine fibroid embolization, tumor embolization, chemoembolization) …for arterial or venous hemorrhage or lymphatic extravasation (e.g., embolization of vessel perforation or GI bleeding source embolization)

33 33 Vascular Embolization and Occlusion Embolization includes: All radiological S&I Intra-procedural guidance and road mapping necessary to document completion of the procedure Embolization does not include: Selective and non-selective vascular catheterization(s) US guidance for vascular access (76937) Intravascular ultrasound (37250, 37251) Initial dx angiography (as defined by CPT)

34 34 Vascular Embolization and Occlusion Stenting and Embolization for Aneurysm Treatment: When stent is placed for providing a latticework for deployment of embolization coils (e.g., aneurysm embolization), the embolization code is reported rather than the stent code If a covered stent is deployed as the sole management of an aneurysm, extra-vascularisation, then he stent deployment code should be reported rather than the embolization code

35 35 Questions and Discussion

36 36 Contact Us Richard Cooley Phone: Matthew Lawney Phone: Jean Russell Phone:

37 37

38 38 CPT ® Current Procedural Terminology (CPT®) Copyright 2013 American Medical Association All Rights Reserved Registered trademark of the AMA

39 39 Disclaimer Information and opinions included in this presentation are provided based on our interpretation of current available regulatory resources. No representation is made as to the completeness or accuracy of the information. Please refer to your payer or specific regulatory guidelines as necessary.


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