1. 2015 CPT Changes Tamara Carey, CPC, CPMA

2. Evaluation and Management Numerous changes were made; –Addition of “military history” to the social history element (pg. 7) –Revision of inpatient neonatal and pediatric critical care guidelines (pg. 42) –Deletion of intensive care codes 99481, 99482; addition of 99184 which combines the services (guideline pg. 43) –Section title change; “Complex Chronic Care Coordination => “Care Management Services” –New subsection; “Chronic Care Management”, “Complex Chronic Care Management”. (pg. 45)

3. Evaluation and Management Maternity Care and Delivery Guidelines (pg. 342) –Pregnancy confirmation during a problem-oriented or preventive visit is not considered a part of antepartum care. –Report using the appropriate E/M code for that visit. –Antepartum care includes the initial prenatal history and physical examination.

4. Evaluation and Management 2014 Complex Chronic Care Coordination Services –99487 – no face-to-face visit, first hour –99488 – one face-to-face visit, first hour –99489 – each additional 30 minutes 2015 –New section heading (Care Management Services, pg. 45) –Two new subsections –Deletion of code 99488 –Addition of code 99490

5. Evaluation and Management Care Management Services –Chronic Care Management Services 99490 (pg. 46) At least 20 minutes of clinical staff time is spent, directed by a physician or QHP, per calendar month –Complex Chronic Care Management Services 99487, at least 60 minutes 99489, each additional 30 minutes (pg. 47)

6. Evaluation and Management CCM – Incident-to –CMS/Medicare will allow incident to billing for CCM with “general supervision” for services provided by clinical staff –All other incident-to regulations apply

7. Evaluation and Management Advance Care Planning (pg. 49) New section in E/M –Guidelines –Two new codes; 99497 and 99498 No active management of problem(s) is undertaken during the time period reported. An E/M may be reported separately on the same day except for; –Critical care, inpatient neonatal and pediatric critical care, initial and continuing intensive care services.

8. Surgical Package Definition Page 62 Revised to address the inclusive E/M Clarification as to who can perform these services

9. Musculoskeletal Pg. 101 3 new codes for Arthrocentesis, aspiration and/or injection – small, intermediate, major joint or bursa with ultrasound –20604, 20606, 20611 Existing codes were revised – without ultrasound –20600, 20605, 20610

10. Musculoskeletal Pg. 105 One revised and one new code for bone tumor ablation via radiofrequency or cryoablation –20982 (RF) –20983 (cryo) Pg. 110 –3 new codes for open treatment of rib fracture(s) 21811, 21812, 21813 Number of ribs

11. Musculoskeletal Pg. 114 – Percutaneous Vertebroplasty and Vertebral Augmentation –Coded 22520, 22521, 22522, 22523, 22524, 22525 were deleted –New codes 22510, 22511, 22512, 22513, 22514, 22515 New codes includes moderate sedation. Old codes addressed Kyphoplasty/Vertebroplasty of the thoracic or lumbar areas –Procedures in the cervical area were reported with an unlisted code.

12. Musculoskeletal Pg. 120 Total Disc Arthroplasty/Additional level –Revised code 22856 (parent code), single interspace cervical –New code 22858, second level, cervical three or more levels code 0375T, only (pg. 677) Pg. 142 Arthrodesis – sacroiliac joint –New code 27279 –Revised code 27280

13. Cardiovascular Pg. 185, Pacemaker or Implantable Defibrillator section. –Many Cat III codes => Cat I codes –Guidelines distinguish between implantable defibrillators w/transvenous leads from those w/subcutaneous leads Two categories of Implantable Defibrillators –Transvenous implantable pacing cardioverter- defibrillators (ICD) Leads are intra-cardiac placed via veins Has pacemaker capabilities Uses a combination of anti-tachycardia pacing, low-energy cardioversion, or defibrillating shocks to treat ventricular tachycardia or ventricular fibrillation

14. Cardiovascular Subcutaneous Implantable defibrillator (S-ICD) –One lead – located subcutaneously –Lacks pacemaker capabilities –Only provides defibrillating shocks – cannot provide anti-tachycardia pacing –New codes 33270 – 33273 (pg. 191) Transvenous revised codes 33215 – 33220, 33233 - 33225, 33240, 33230, 33231, 33241, 33262 (pg. 188)

15. Cardiovascular “Battery Change” (pg. 186) –Do not report 33233 or 33241 –Report based on the number of final existing leads Revision of Skin Pocket –Included in 33206 – 33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273 Relocation of Skin Pocket –Includes all work associated w/the initial pocket (opening, I&D, and closure Defibrillator Threshold Testing (DFT) –Separately reported w/transvenous system, but not subcutaneous

16. Cardiovascular Pg. 195 – Transcatheter Mitral Valve Repair Converted Cat III codes => Cat I –33418 and 33419 Guidelines specify that 33419 is only reported once per session –Include the work, when performed, of percutaneous access, placing the access sheath, transseptal puncture, advancing the repair device delivery system into position, repositioning the device as needed, and deploying the device. –Angiography, radiological S&I, and interpretation performed to guide TMVR are included.

17. Cardiovascular Pg. 205 – Extracorporeal Membrane Oxygenation (ECMO) or Extracorporeal Life Support Services (ECLS) –Deleted codes 33960 and 33961, identified by CMS as potentially misvalued codes –Patient population has changed from premature neonates to adults with severe influenza, pneumonia and respiratory distress syndrome –Specialty societies submitted a code change proposal –CPT Editorial Panel created an entirely new family of codes

18. Cardiovascular ECMO/ECLS Definition –This is a procedure that provides cardiac and/or respiratory support to the heart and/or lungs –Two methods can be used; Veno-arterial, will support both the heart and lungs. Requires that two cannula(e) are placed – one in a large vein and one in a large artery Veno-venous, is used for lung support only and requires one or two cannula(e), which are placed in a vein –CPT code series 33946 – 33989 (some resequenced codes)

19. Cardiovascular ECMO Code Grouping –Initiation –Daily Management –Cannulation (further defined by age and method) Insertion Repositioning Removal

20. Cardiovascular Pg. 212 Fenestrated Endovascular Repair (FEVAR) New code created to report the physician planning for a patient-specific manufactured fenestrated visceral aortic endograft CPT code 34839 –Requires a minimum of 90 minutes of physician time –Code guidelines specify what is included in this code; Review of high resolution cross-sectional images (eg, CT, CTA, MRI, and the utilization of 3D software for iterative modeling of the aorta and device in multi-planar views and center line of flow analysis

22. Digestive Variety of changes throughout this chapter –Addition of “separate procedure” designation –Editorial change – “with or without collection of specimen” => “including collection of specimen(s) when performed” –Control of bleeding instruction –Endoscopy, ablation or stent – includes pre/post dilation, and guide wire passage, if performed –Definition of Colonoscopy, revised “…examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum or small intestine proximal to an anastomsis”

23. Digestive Pg. 278 – Endoscopy, Small Intestine –Antegrade transoral small intestinal endoscopy (enteroscopy) is defined by the most distal segment of small intestine that is examined Guidelines showing code assignment based on visualizing the esophagus through the jejunum or ileum Guidelines showing code assignment based on how far down the endoscope can be passed Retrograde exam of the small intestine via anus or colon stoma, use 44799

24. Digestive Colonoscopy and modifiers 52 and 53 (pg. 279) –“When performing a screening or diagnostic endoscopy on a patient who is scheduled or prepared for a total colonoscopy, if the physician is unable to advance the colonoscope to the cecum or colon-small intestine anastomosis due to unforeseen circumstances, report 45378 with modifier 53…” –“For therapeutic examinations that do not reach the cecum, report the appropriate therapeutic colonoscopy code with modifier 52…”

25. Digestive CPT has provided a colonoscopy decision tree to assist coders in selecting the appropriate code. (pg. 284) –Typo in bottom row, far right box. “Colonoscopy (45379-45398 No Modifier”) CMS delayed publishing wRVUs for the lower endoscopy codes –Ileoscopy, pouchoscopy, flexible sigmoidoscopy, colonoscopy, colonoscopy through stoma Identification of some of the codes as potentially misvalued

26. Digestive How to report lower GI codes in 2015, if the patient has Medicare (Original, Advantage); –If the code has not changed from 2014 to 2015 Physicians report the CPT code –If the code has changed from 2014 to 2015 Physicians report the G code –If the code is new for 2015 Physicians report the CPT code

27. Digestive How to report lower GI codes in 2015, if the patient has Commercial Medicaid, Exchange, etc. –Physicians should report the 2015 CPT code, unless instructed otherwise by the payor –Facilities report the 2015 CPT code regardless if the code as changed, and regardless of payer G codes are not valued in the OPPS fee schedule

28. Digestive 2014 CPT Code 2015 G Code Descriptor 44383G6018Ileoscopy, thru stoma; with transendoscopic stent placement (includes predilation) 44393G6019Colonoscopy thru stoma; w/ablation of tumor(s)…..not amenable to removal by hot biopsy forceps, bipolar cautery or snare 44397G6020Colonoscopy thru stoma; w/transendoscopic stent placement (includes predilation) 44799G6021Unlisted procedure, intestine 45339G6022Sigmoidoscopy, flexible; w/ablation of tumor(s)...not amenable to removal by hot biopsy forceps, bipolar cautery or snare 45345G6023Sigmoidoscopy, flexible; w/transendoscopic stent placement 45383G6024Colonoscopy, flexible, proximal to splenic flexure; w/ablation of tumor(s)…not amenable to removal by hot biopsy forceps, bipolar cautery or snare 45387G6025Colonoscopy, flexible, proximal to splenic flexure; w/transendoscopic stent placement (includes predilation)

29. Digestive Cologard test –CMS established HCPCS code G0464 for the Cologard test Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (e.g., KRAS, NDRG4 and BMP3)

30. Nervous Pg. 363 Myelography – 4 new codes –62302 - cervical –62303 - thoracic –62304 - lumbosacral –62305 – 2 or more regions Complete procedure codes

31. Radiology Pg. 428 Chest –New introductory guidelines –Two new codes 76641, 76642 –76641 represents a complete ultrasound exam of all four quadrants of the breast and the retroareolar region Includes US of the axilla if performed –76642 represents a focused US exam of the breast limited to the assessment of one or more, but not all US exam of axilla included if performed

32. Radiology Pg. 434 Digital Breast Tomosynthesis –77061 (unilateral), 77062 (bilateral), and +77063 (screening bilateral) CMS is delaying valuing 77061, 77062 –CMS will recognize +77063 to be reported when tomosynthesis is used in addition to 2-D mammogram –CMS created G2079, Diagnostic digital breast tomosynthesis, unilateral or bilateral (List separately in addition to G0204 or G0206)

33. Path & Lab Changes for 2015 –Drug Testing (pg. 467) Major revision of entire area Pg. 471, Presumptive Drug Class (80300 – 80304) –Drug Class List A –Drug Class List B Pg. 472, Definitive Drug Class –Table provided starting on page 474 –Select based on the type of drug, and for some, the number of drug –Example, 80330 Analgesics, non-opioid; 3-5

34. Medicine Pg. 552 –Revision to the immunization injection instructions Modifier 51 is not required when reporting 90476 – 90479 and 90460 – 90474 Pg. 553 –Two new codes 90651 and 90630 90651 has been established for a vaccine that protects against nine (nonavalent) types of HPV (6, 11, 16, 18, 31, 33, 45, 52, 58) 90630 was established for a quadrivalent intradermal influenza virus vaccine anticipated to receive FDA approval by the end of 2014, and available for use in the 2015/2016 flu season

35. Medicine Pg. 620 –Code 96110 was revised to better distinguish it from the new brief emotional/behavioral assessment code 96127 96110 describes an assessment that is focused on identification of childhood and adolescent developmental levels (eg, fine and gross motor skills, cognitive level, receptive/expressive and pragmatic language abilities, etc.) 96127 has been established to report the service associated with the administration of a standardized behavioral and emotional assessment instrument (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale) primarily for, but not limited to children and adolescents.

36. Medicine Pg. 637 –Instruction regarding the use of selective head or total body hypothermia code 99184. –Includes all of the service components required of this procedure, the review of; Imaging Laboratory data Confirmation of esophageal temperature probe location Evaluation of amplitude EEG Supervision of controlled hypothermia, and Assessment of patient tolerance of cooling

37. Medicine Pg. 637 –Code 99188 was established to report the application of topical fluoride varnish by a physician or QHP for the prevention of dental caries –This code is intended for use only by a physician or QHP, and only for patients that are at high risk for caries –When performed by clinical staff, i.e. RN, LPN, etc. this service cannot be reported –CMS will not cover this service for 2015

38. THANK YOU FOR YOUR TIME! Questions????