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Julie A. Leu, CPC December 16, :30 – 11:30 a.m.

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Presentation on theme: "Julie A. Leu, CPC December 16, :30 – 11:30 a.m."— Presentation transcript:

1 Julie A. Leu, CPC December 16, 2004 9:30 – 11:30 a.m.
CPT Changes for 2005 Julie A. Leu, CPC December 16, 2004 9:30 – 11:30 a.m.

2 Overview of Changes for 2005
One new symbol: Indicates a code which typically includes conscious sedation Category I code changes: 130 codes added 26 codes deleted 60 code descriptors revised The conscious sedation “bullseye” symbol has been added to the list of CPT symbols for Intended to indicate those procedures in which the provision of conscious sedation is considered to be inherent, it would not be separately reported by the same physician performing the primary service. It is expected that if conscious sedation is provided to the patient as part of one of these services, that it would be provided by the same physician who is providing the service. Throughout the presentation, I’ve used the symbols as in CPT to indicate: New codes (Filled-in circle) Revised code descriptor (triangle) For deleted codes, I used an exclamation point.

3 Overview of Changes for 2005
Category II code changes: 11 codes deleted 14 codes added Category III Codes: 27 codes added 9 codes deleted 1 code descriptor revised

4 Overview of Changes for 2005
No modifiers deleted or revised Four new appendices: Appendix F - Summary of CPT Codes Exempt from Modifier 63 Appendix G - Summary of CPT Codes which Include Conscious Sedation Appendix H - Alphabetic Index of Performance Measures by Clinical Condition or Topic Appendix I - Genetic Testing Code Modifiers Apply to pathology/laboratory codes only

5 Evaluation and Management
Critical Care Services Change in guidelines for the section with reference to the age of the patient Neonate = 28 days of age or less Infant = 29 days through 24 months of age Formerly CPT utilized 30 days of age or less, and 31 days through 24 months 99293, revised to include “29 days through 24 months of age” 99295, revised to include “28 days of age or less” Revisions to the E&M section for 2005 consist solely of clarification of the neonatal age, for consistency between the CPT and ICD-9 code sets. The most commonly recognized definition of the neonatal period is beginning at birth and lasting through the 28th day following birth. Formerly, CPT utilized 30 days of age or less, causing confusion for both physicians and insurance carriers. A critically ill patient who is 29 days of age was previously reported using a neonatal CPT code and a NON-neonatal ICD-9 code. With this revision, the discrepancy was resolved. The Critical Care Services and Inpatient Neonatal and Pediatric Critical Care Services guidelines were all revised to reflect this change.

6 Anesthesia Guidelines revised in conjunction with creation of Appendix G If sedation is provided by the surgeon, CPT codes 99141, are to be reported. If sedation/anesthesia is provided by another physician (or under their supervision), the anesthesia codes are to be reported. CPT codes listed in Appendix G include the provision of sedation by the operating physician. Sedation, or conscious sedation is defined as moderate sedation/analgesia and is a drug-induced depression of consciousness during which patients respond knowlingly and intentionally to verbal commands. No interventions are required to maintain a patent airway, spontaneous ventilation is adequate, and cardiovascular function is usually maintained. It is NOT the more intense deep sedation/analgesia. Inclusion in Appendix G does not preclude separate reporting of the sedation service by an anesthesia code, as long as it is performed or supervised by a physician other than the operating physician. If a procedure listed in Appendix G should happen not to require sedation, the provider is NOT required to append the -52 modifier, to indicate reduced services.

7 Anesthesia One new code:
Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, under one year of age. Code is intended to describe the demanding and high risk administration of anesthesia associated with surgical repair of congenital heart lesions in children less than one year old. Previously, correction of congenital heart defects was only able to be performed after the child was able to grow for several years to allow enough maturity to endure surgery. Advances in technology and improvement in surgical techniques have altered that way of approaching these types of defects in children. Complete repair can now be performed at the earliest possible time, often shortly after birth.

8 Surgery – Integumentary System
Four new codes in the Skin, Subcutaneous and Accessory Structures Codes: Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum abdominal wall, with or w/o fascial closure external genitalia, perineum and abdominal wall, with or w/o fascial closure Removal of prosthetic material or mesh, abdominal wall for necrotizing soft tissue infection Codes thru were created to identify extensive debridement procedures necessary to treat necrotizing soft tissue infections, such as Fournier’s gangrene. In addition to the debridement procedure, transplantation or removal of organs, hernia and/or intestinal repair, or fistula repair may be necessary. As you can see by the descriptor language, these codes are reported according to the specific area that receives treatment. Add-on code has been established to report concurrent removal of mesh or other prosthetic device. Parenthetical notes have also been added to identify procedures that should be separately reported when performed in conjunction with the debridement; and identify a list of codes with which these codes should not be reported.

9 Surgery – Integumentary System
One revised, three new Breast codes: Mastectomy,partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); Placement of radiotherapy afterloading balloon catheter into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy concurrent with partial mastectomy Code was revised to include alternative terms in the descriptor used for partial mastectomy. Three codes were added in the Breast Introduction subsection to describe catheter placement and subsequent catheter removal for interstitial radioelement application in the breast following partial mastectomy. Code should be reported when the catheter is placed on a separate date from the partial mastectomy. Add-on code should be reported when the catheter is placed after the partial mastectomy during the same operative session. (Does not include the mastectomy procedure, itself)

10 Surgery – Integumentary System
One revised, three new Breast codes: Placement of radiotherapy afterloading brachytherapy catheters into the breast for interstitial radioelement application following (at the time of or subsequent to) partial mastectomy, includes imaging guidance New guidelines at the beginning of Breast Excision subsection New code describes placement of catheters for radiotherapy afterloading brachytherapy following a partial mastectomy. IT is reported whether the catheters are placed at the time of or subsequent to the partial mastectomy. The new guidelines prior to the Breast, Excision subsection codes have been added to clarify appropriate reporting of breast biopsies, partial mastectomy, total mastectomy, and excision or resection of chest wall tumors, with the appropriate code ranges provided for each. Of note, it is stated that the open excision of breast lesion procedures vary from the partial mastectomy procedures in that the latter includes specific attention to adequate surgical margins.

11 Surgery – Musculoskeletal System
Five new codes Two new codes in the Femur subsection: Autologous chondrocyte implantation, knee Osteochondral allograft, knee, open In conjunction with the deletion of Category III codes 00012T, 00013T, and 00014T, five codes and nine cross-references were established to more accurately report techniques to provide hyaline or hyaline-like repair for articular knee defects. Code was established to report performance of an open procedure of the knee for implantation of previously obtained autologous chondrocytes for the treatment of diseased or injured articular cartilage. Several weeks or months prior to the procedure, a biopsy specimen is taken from the patient and sent out for cellular expansion of the graft. Close attention must be paid to the parenthetical note regarding the procedures which are inherent in the implantation. Evaluation of the cells for implantation prior to the procedure is also inherent and not separately billable. Code was established to report open implantation of an osteochondral allograft in the knee performed for the treatment of moderate to large chondral or osteochondral defects.

12 Surgery – Musculoskeletal System
Three new codes in the Arthroscopy subsection: Arthroscopy, knee, surgical; osteochondral autografts (eg, mosaicplasty) (includes harvesting of the autograft) osteochondral allograft meniscal transplantation, (includes arthrotomy for meniscal insertion), medial or lateral Two codes were established to report arthroscopic oseochondral mosaicplasty - a resurfacing technique which consists of the mosaic-like transplantation of multiple, small-sized cylindrical osteochondral grafts to provide a smooth resurfaced area. Code specifically reports autograft harvest and implantation, a procedure that typically requires the placement of multiple grafts, but the code is reported only once per procedure, regardless of the # of grafts harvested and implanted. Code reports arthroscopic placement of osteochondral allograft Code reports arthroscopic meniscal knee transplantation (of an allograft) in the medial or lateral compartments.

13 Surgery – Respiratory System
Two new codes in the Larynx/Endoscopy subsection: Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s) reconstruction with graft(s) (includes obtaining autograft) Codes and were added to the Larynx/Endoscopy subsection to describe direct operative laryngoscopy with removal of non-neoplastic lesion(s) of the vocal cord using the operating microscope or telescope. Code is to be reported when reconstruction with local tissue flap(s) is performed. Code should be reported when reconstruction with graft(s) is performed

14 Surgery – Respiratory System
Four new codes, two revised codes in the Trachea and Bronchi/Endoscopy subsection: Endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with tracheal/bronchial dilation or closed reduction of fracture with placement of tracheal stent(s) Revisions to the bronchoscopy section have been made to distinguish among airway stents placed in the trachea vs. the bronchus or bronchi. Code has been revised to describe placement of single or multiple tracheal stent(s), with cross references added directing the use of new codes 31631, 31636, and 31637

15 Surgery – Respiratory System
Trachea and Bronchi/Endoscopy subsection: 31636 Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with placement of bronchial stent(s) (includes tracheal/bronchial dilation as required), initial bronchus each additional major bronchus stented with revision of tracheal or bronchial stent inserted at previous session New code was established to report stenting of the first or initial mainstem bronchus, and code was established as an add-on code, to be reported when a second stent is placed in a different or more distal bronchus. Code has been added for revision or adjustment of tracheal or bronchial stents placed at a previous session. Dilation is inherent in all the tracheobronchial stent procedure and should not be reported separately. Dilation performed w/o further therapeutic intervention is reported with Finally, add-on code (listed on the previous slide), has been added to describe endobronchial ultrasound to be reported in conjunction with primary bronchoscopic procedures. A parenthetic note instructs the coder to report this add-on code with codes that follow it in the section, through 31638, also through

16 Surgery – Respiratory System
Lungs and Pleura One new code in the Incision subsection: Insertion of indwelling tunneled pleural catheter with cuff CPT code was created to report insertion of a tunneled catheter into the pleural space for drainage and management of pleural effusions. The technique of subcutaneous tunneling is intended to accommodate the long-term placement of the catheter, and drainage of the pleural effusion over a prolonged period (typically greater than 4 weeks)

17 Surgery – Respiratory System
Lungs and Pleura, con’t. One revised and two new codes in the Lung Transplantation subsection: Donor pneumonectomy (including cold preservation), from cadaver donor Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; unilateral bilateral Codes and were added to the Lung transplantation subsection of the Respiratory section to describe backbench preparation of a cadaver donor lung allograft prior to lung transplantation. Code was revised to no longer include preparation and maintenance of cadaver allograft, since this work is now separately reportable with the two new backbench preparation codes. New guidelines were added at the beginning of the Lung Transplantation subsection describing the three distinct components of physician work involved in lung allotransplantation: Cadaver Donor pneumonectomy, backbench work, and Recipient allotransplantation

18 Surgery – Cardiovascular System
Heart and Pericardium Two new codes, two revised codes in Heart/Lung Transplantation subsection: Donor cardiectomy-pneumonectomy (including cold preservation) Backbench standard preparation of cadaver donor heart/lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, and trachea for implantation

19 Surgery – Cardiovascular System
Two new codes, two revised codes in Heart/Lung Transplantation subsection: Donor cardiectomy (including cold preservation) Backbench standard preparation of cadaver donor heart allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, pulmonary artery, and left atrium for implantation Codes and were added to the Heart and Pericardium Heart/Lung transplantation subsection of the Cardiovascular section to describe backbench preparation of a cadaver donor heart/lung allograft prior to transplantation. Codes and were revised to include cold preservation and to eliminate the inclusion of preparation and maintenance of the allograft. New guidelines were added at the beginning of the Heart/Lung Transplantation subsection describing the three distinct components of physician work involved in the transplantation: Donor cardiectomy, with or w/o pneumonectomy, backbench work, allotransplantation

20 Surgery – Cardiovascular System
Arteries and Veins Eight new codes, three deleted, one revised Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis ( two docking limbs) Codes and have been deleted. A parenthetical note has been added to instruct that code should be reported for direct aneurysm repair of other arteries, not otherwise specified. Code has been deleted due to a confusing redundancy of codes in the section. Category III code 0001T has been deleted and converted to Category I code to report endovascular abdominal aortic aneurysm repair using a modular bifurcated two-docking limb device. The two codes in the direct repair of aneurysm subsection of codes were deleted due to infrequent use. Code has been deleted and a parenthetical note added to explain proper reporting of various combinations of aorto-femoral bypass procedures.

21 Surgery – Cardiovascular System
Arteries and Veins, con’t. Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated second and subsequent veins treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Four codes were established to report endovenous ablation therapy for incompetent veins. The codes describe thermally induced ablation, consisting of percutaneous insertion of a catheter into the vein and is appropriately reported for obliteration of the longer veins of the upper and lower extremities. Next slide

22 Surgery – Cardiovascular System
Arteries and Veins, con’t. Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated second and subsequent veins treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) The ablation procedure, via either radiofrequency or laser modality, results in shrinkage of the diameter of the vein. Although percutaneous access is specified in the descriptor, the vein is occasionally accessed via a small cutdown. A small cutdown, if performed to achieve access, is also included in the procedure and would not be billed separately. Modifier 50 should be appended to the proc. code when the procedure is performed in both legs at the same session.

23 Surgery – Cardiovascular System
Arteries and Veins, con’t. Arteriovenous anastomosis, open, by upper arm cephalic vein transposition Transcatheter placement of an intravascular stent(s), (except coronary, carotid, and vertebral vessel), percutaneous, initial vessel Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection without distal embolic protection Code was added to the series of codes for permanent native hemodialysis access, to report performance of an upper arm cephalic vein transposition including tunneling for brachiocephalic anastomosis. Two codes have been added to describe percutaneous stent placement in the cervical portion of the extracranial carotid artery and are distinguished by the use or lack of use of embolic protection (a screen, filter, or basket deployed beyond the stent target site with the intent to capture any particles that break loose, while simultaneously allowing uninterrupted blood flow). Previously, these procedures were reported using Category III codes 0005T and 0007T

24 Surgery – Digestive System
18 new codes, five revised codes Upper gastrointestinal endoscopy ; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) with gastric bypass and small intestine reconstruction to limit absorption Cat. III code 0057T has been deleted and converted to Cat. I code to report thermal treatment of the esophagus by endoscopy for treatment of GERD. This proc. consists of the delivery of edoscopically guided radiofrequency thermal energy via electrodes to electrosurgically coagulate the muscle of the distal portion of the lower esophageal sphincter and/or gastric cardia, reducing reflux. Several new gastric restrictive codes were added to reflect the rapidly expanding field of bariatric surgery. 43644 and employ laparoscopic techniques to perform gastric restrictive procedures for morbid obesity.

25 Surgery – Digestive System
Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) Gastric restrictive procedure with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy Code was created to describe a surgical treatment for morbid obesity that combines moderate gastric restriction with a mechanism that promotes fat malabsorption. For consistency, an editorial revision was made to the existing open Roux-en-Y procedure descriptor, 43846, to designate short limb to be 150 cm or less, as specified in the laparoscopic code descriptor, This procedure has evolved in order to provide more effective treatment for patients with greater obesity. A parenthetical note directly below instructs the coder to report code for >150 cm Roux-en-Y procedure.

26 Surgery – Digestive System
Guidelines added to the Intestines/Excision subsection to address intestinal allotransplantation. Removal of transplanted intestinal allograft, complete Backbench standard preparation of cadaver or living donor intestine allograft prior to transplantation, including mobilization and fashioning of the superior mesenteric artery and vein Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; venous anastomosis, each arterial anastomosis, each New guidelines at the beginning of the Intestines Excision subsection clarify the 3 components of physician work involved in intestinal allotransplantation: cadaver or living donor enterectomy, backbench work, and recipient intestinal allotransplantation. Code was revised to include cold preservation and not to include preparation and maintenance of the allograft, since new codes 44715, 44720, and now describe the preparation and maintenance services.

27 Surgery – Digestive System
Colonoscopy, flexible, proximal to splenic flexure; with endoscopic ultrasound examination with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s) Hemorrhoidopexy (eg, for prolapsing internal hemorrhoids), by stapling New Liver Transplantation subsection 47133 and revised Five new codes (47143 – 47147) Prior to 2005, there were no codes to describe colonoscopy with endoscopic ultrasound of the entire colon. New code describes the proximal to splenic flexure flexible colonoscopy with endoscopic ultrasound examination. New code describes the same procedure with intramural or transmural fine needle aspiration/biopsy(s) Code was established to allow a method for coding repair of a hemorrhoid prolapse utilizing a staple technique. Different from the internal hemorrhoidectomy codes, which involve either excision and suture ligation or rubber band ligation of hemorrhoidal tissue, and use of the anoscope is included as part of the procedure. A new heading, new guidelines, and five new codes have been added to the Liver subsection of the Digestive System section to describe liver allotransplantation services. The new guidelines clarify the three distinct components of physician work involved in liver allotransplantation: donor hepatectomy, backbench work, and recipient liver allotransplantation

28 Surgery – Digestive System
Donor pancreatectomy (including cold preservation), with or without duodenal segment for transplantation Backbench standard preparation of cadaver donor pancreas allograft prior to transplantation, . . . Backbench reconstruction of cadaver donor pancreas allograft prior to transplantation, venous anastomosis, each Following the form of the other organ transplantation sections, the guidelines for Pancreas transplantation have been added, describing the three distinct components. Also following form, the donor code was revised to include cold preservation and to not include preparation and maintenance of the allograft from the cadaver donor, with new codes describing the preparation and/or reconstruction of the allograft prior to transplantation.

29 Surgery – Urinary System
Seven new codes, five deleted, five revised New Renal Transplantation subsection guidelines Codes 50300, 50320, and were revised New codes and report “standard” backbench services performed on living or cadaver donor renal allograft prior to transplantation. New codes 50327, 50328, and report backbench reconstruction procedures performed on living or cadaver donor renal allograft prior to transplantation. The new guidelines indicate the services included in renal AUTOtransplantation, as well as the three distinct components of physician work involved in renal allotransplantation. Note the “standard” vs. “reconstructive” distinction

30 Surgery – Urinary System
Instillation of therapeutic agent into renal pelvis and/or ureter through established nephrostomy, pyelostomy or ureterostomy tube (eg, anticarcinogenic or antifungal agent) Codes 50559, 50578, 50959, and have been deleted and can be reported utilizing the radiation oncology codes (eg, 77778) Cystourethroscopy, with fulguration . . .; SMALL bladder tumor(s) (0.5 up to 2.0 cm) Cystourethroscopy with transurethral resection or incision of ejaculatory ducts Code was created to report instillation(s) of therapeutic agent into the renal pelvis and/or ureter. This proc. is usually done to treat urothelial tumors in patients where preserved renal function is advantageous to a total or partial nephrectomy or multiple endoscopic tumor ablations. The next four codes were deleted as the condition (invasive transitional cell cancer of the upper urinary tract) is fairly uncommon and is rarely treated through combined endoscopic and radiation therapy. If radiation therapy is utilized, it is to be reported with the appropriate rad. therapy codes. Code was revised to specify that it is to be used to report fulguration or resection of tumors greater than or equal to .5 cm to those measuring < 2.0 cm Code has been deleted and replaced by code for the purpose of placing it in the more appropriate anatomical area. (Vesical Neck and Prostate, instead of Ureter and Pelvis.

31 Surgery – Female Genital System
Five new codes, one revised Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus) intra-peritoneal approach (uterosacral, levator myorrhaphy) Code was established as an add-on code to reflect the extra time and work involved in performing the insertion of prosthetic material in conjunction with a primary pelvic floor defect repair. Code was revised to describe a vaginal extra-peritoneal colpopexy with sacrospinous or iliococcygeus ligament fixation. Previously, this code reported a sacrospinous ligament fixation only. Many gynecologic and urologic surgeons perform similar suspensions using primarily iliococcygeus fixation. Many gynecologic and urologic surgeons also perform similar vaginal suspensions utilizing an intra-peritoneal approach (often performed in conjunction with hysterectomies) by using the uterosacral ligaments or the levator musculature for the suspension points, hence, the new code

32 Surgery – Female Genital System
Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when performed Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy Uterine cryoablation therapy previously was reported with Category III code 0009T. This procedure utilizes extreme cold and ultrasound as opposed to thermal ablation, which utilizes heat and hysteroscopy, and is designed to diagnose/treat excessive, frequent, or irregular menstruation, metrorrhagia and premenopausal menorrhea. Code was established to report hysteropic fallopian tube cannulation and placement of permanent tiny implants for elective female sterilization. Since this procedure avoids abdominal incisions, it is considered less invasive than more traditional methods of sterilization. Code was created for reporting bilateral salpingo-oophorectomy with total omentectomy and total abdominal hysterectomy for malignancy. This procedure is performed in women with gynecological malignancies with omental metastasis, and for whom it is not necessary to remove the pelvic or paraaortic lymph nodes.

33 Surgery – Nervous System
Three new codes, three revised Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments; with reconstruction of the posterior bony elements (including the applica-tion of bridging bone graft and non-segmental fixation devices (eg, wire, suture, mini-plates), when performed) Laminoplasty is an alternative approach for posterior decompression of the cervical spinal cord. Two new laminoplasty codes have been added for decompression of the cervical spine in the treatment of conditions like cervical spondylosis with myelopathy, or cervical stenosis. Unlike the existing posterior cervical decompression codes included in CPT that involve complete removal of of the posterior elements of the spine, the new codes involve proc. That leave portions of the posterior elements intact.

34 Surgery – Nervous System
Osteoplastic reconstruction of dorsal spinal elements, following primary intraspinal procedure Codes 61685, 63685, and all were revised to include the replacement of stimulation or drug delivery devices. Add-on code was created to report osteoplastic reconstruction commonly performed in pediatric patients following primary intraspinal procedures (removal of spinal cord tumors or arteriovenous malformations) that include a laminectomy. To limit post-surgical spinal deformity, the dorsal elements of the spinal segment (eg, the laminae, spinous processes, etc) are replaced into the spine to recreate normal anatomic architecture.

35 Surgery – Eye and Ocular Adnexa
One new code, one revised Ciliary body destruction; cyclophotocoagulation, transscleral cyclophotocoagulation, endoscopic Code was added to describe endoscopic photocoagulation of the ciliary body for the treatment of glaucoma. This technique requires a surgical incision for insertion of the endoscope through the anterior segment to provide direct visualization of the tissue to be coagulated. The existing photocoagulation code has been revised to indicate that this procedure is performed externally (or transscleral) w/o an incision (which was the only surgical approach in use at the time it was added to CPT in The new code, 66711, which includes the endoscopic approach, differentiates the intraocular proc. From the extra-ocular proc. Described in 66710, which carries less surgical risk.

36 Radiology Code Changes
Thirteen new codes, 14 revised, 11 deleted Introductory guidelines for the subsections related to selective catheterization imaging Aorta and Arteries Veins and Lymphatics Transcatheter Procedures revision to the cross reference only The guideline revisions and additions clarify the conditions under which it is appropriate for a provider to report both a diagnostic angiogram/venogram radiological supervision and interpretation service AND an interventional therapeutic vascular radiological supervision and interpretation service. The revision to the cross reference following code directs the coder to Category III codes 00075T and 00076T in order to report the Rad. S&I for transcatheter placement of extracranial vertebral or intrathoracic carotid artery stents, which was previously reported with Cat. III code 0007T

37 Radiology Code Changes
Dual energy x-ray absorptiometry (DXA), bone density study, one or more sites; axial skeleton (eg, hips, pelvis, spine) vertebral fracture assessment Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter quantitative A-scan only B-scan (with or without superimposed nonquantitative A-scan) Code and its corresponding cross reference were revised to indicate that the nomenclature for this technology has been revised to be referred to as “DXA” as the recognized acronym for this technology. In addition, code was added to identify vertebral fracture assessment, VFA, using the DXA technology. Guidelines at the beginning of the Diagnostic Ultrasound section have been added to assist users in determining the appropriate criteria for reporting complete vs limited examinations. The ophthalmic ultrasound codes have been revised to distinguish unique services by separating out B-scan probe 76512, from diagnostic quantitative A-scan 76511, in order to reflect the differences in difficulty and time required to perform this procedure. The quantitative diagnostic A-scan described by is done at a few centers for the management of intraocular tumors. Code has been added to describe performance of both a B-scan and quantitative A-scan performed at the same patient encounter.

38 Radiology Code Changes
Doppler velocimetry, fetal; umbilical artery middle cerebral artery Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Guidelines added for Non-Obstetrical Ultrasounds Infusion or instillation of radioelement solution (includes three months follow-up care) Urea breath test, C-14 (isotopic); acquisition for analysis Two codes have been added to assess blood flow of umbilical artery (76820) and the fetal middle cerebral artery (76821) to evaluate fetal anemia and fetal growth restriction caused by placental vascular resistance. the revision to code consists of removal of the terms “cardiovascular system” as by definition, echocardiography is an evaluation of the cardiovascular system. Language in the new guidelines preceding the Non-obstetrical ultrasounds is intended to assist users in determining if the required criteria are met for a complete vs. limited pelvic ultrasound. It is also clarifies that should be used to report a complete MALE pelvic ultrasound. Code was revised to clarify that this code describes urea breath test studies using the C-14 isotope, a radioactive substance.

39 Radiology Code Changes
Code descriptors for and were revised to include attenuation correction, when performed, for myocardial perfusion single photon emission computed tomography (SPECT). Code has been eliminated and six new codes, , added for reporting tumor imaging by positron emission tomography (PET). Code has been deleted. HCPCS Level II codes may be used to report the diagnostic radiopharmaceuticals used. Attenuation correction imaging corrects distortions in SPECT images caused by overlying tissue and scattered photons. It requires professional interpretation of data generated by the attenuation correction system. The code revisions take into account the additional professional, technical, and acquisition time, as well as the add’l hardware and software resources associated with the technique.

40 Radiology Code Changes
Radiopharmaceutical therapy, by oral admninistration Radiopharmaceutical therapy, by intravenous administration Radiopharmaceutical therapy, by intracavitary administration Radiopharmaceutical therapy, by interstitial radioactive colloid administration Radiopharmaceutical therapy, by intra-articular administration Radiopharmaceutical therapy, by intra-arterial particulate administration Comprehensive changes to the Therapeutic Radiology subsection include new introductory guidelines to explain the appropriate use of the injection codes. The revised descriptors differentiate the route of administration, ie, intravascular, intra-articular, intracavitary, etc. Codes 79000, 79001, 79020, 79030, and have been deleted and code established for reporting radiopharmaceutical therapy by oral administration. Codes and have also been deleted and created for reporting radiopharmaceutical therapy by intravenous administration Code was deleted and code added for reporting radiopharm. therapy by intra-arterial admin. Codes 79200, 79300, and were revised to indicate the route of admin. Code has been deleted. HCPCS level II codes may be used to report the use of therapeutic radiopharmaceuticals.

41 Pathology Code Changes
Chemistry Section – six new codes and three revised: Albumin; ischemia modified Elastase, pancreatic (EL-1), fecal, quantitative or semi-quantitative. Helicobacter pylori, blood test analysis for urease activity, non-radioactive isotope CPT code was established to report the different methodologies of albumin testing for cadiovascular events preceded by ischemia. A venous blood sample is tested using the Albumin Cobalt Binding test to assess if biochemical features of ischemia are present. Code was added to report a non-invasive stool test for the determination of exocrine pancreatic function. It describes a new analyte (PE1, pancreatic elastase-1) utilizing an existing methodology (enzyme-linked, hence the EL-1) The Radiology, Pathology, and Medicine sections of the CPT code set have been updated to include codes and instructional cross-references for reporting H. pylori breath test and blood test analyses. CPT code was created to describe a blood test analysis for urease activity.

42 Pathology Code Changes
Helicobacter pylori, breath test analysis for urease activity, non-radioactive isotope. Helicobacter pylori, drug administration Lactoferrin, fecal, qualitative Pregnancy-associated plasma protein-A (PAPP-A) Codes and were revised to clarify that the intent of these procedures is to report breath test analysis for urease activity. Code was established to report qualitative determination of lactoferrin in feces. Previously, no code specifically identified the specific analyte Lactoferrin. This test is used to determine the presence of intestinal inflammation, differentiate inflammatory from non-inflammatory gastrointestinal disease, monitor patient response to therapy, and predict inflammatory bowel disease recurrence. CPT code was established to describe testing for pregnancy associated plasma protein-A. It is a screening test to identify women at highest risk of carrying a fetus with Down syndrome, trisomy 18, or other chromosomal abnormality. An increased risk does not mean that the pregnancy is affected with the condition, but rather indicates that further testing (eg, amniocentesis) is warranted.

43 Pathology Code Changes
Protein; electrophoretic fractionation and quantitation Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF) Genetic Testing Modifiers (Appendix I) for use with molecular diagnostic procedures, CPT codes through Code was revised and was added to provide a more specific and accurate description of electrophoresis methods and specimen sources for protein and immunofixation eletrophoresis procedures. Specifically, code was revised to report analysis of serum. Code was established to describe a protein electrophoresis procedure for fluids other than serum with concentration. A fairly extensive collection of modifiers was added in Appendix I for use with the molecular diagnostic codes. They are two digit, alpha-numeric modifiers with the first digit (numeric) indicating the disease type, and the second digit (alpha) indicating the disease/gene. Reporting guidelines have been added to the section, also.

44 Pathology Code Changes
Hematology and Coagulation section one revised code: Blood count; reticulocytes, automated, including one or more cellular parameters (eg, reticulocyte hemoglobin content, immature reticulocyte fraction, reticulocyte volume, RNA content), direct measurement Indented code was revised to describe multiple different, yet clinically similar automated cellular parameters and to clarify that this code describes a direct measurement.

45 Pathology Code Changes
Immunology section, four new codes and one revised code: B cells, total count Natural killer (NK) cells, total count Stem cells (ie, CD34), total count To address the significant growth in clinical flow cytometric applications and the number of antibodies used to evaluate hematologic conditions, three new procedure codes have been established in the Immunology section. They are: 86064 to report total B cell count, 86379 to report Natural Killer cells, total count and 86587 describes total count of stem cells (ie, CD34) These codes are intended to be used only for quantitative purposes and do not include an interpretive report. 86379

46 Pathology Code Changes
Immunology section, four new codes and one revised code: Immunofixation electrophoresis; serum other fluids with concentration (eg, urine, CSF) Code was revised and added to provide a more accurate description of electrophoresis methods. Code now specifies an analysis of serum, while reports immunofixation electrophoresis procedures for fluids other than serum, with concentration.

47 Pathology Code Changes
Microbiology section, one new code and one revised code: Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate Infectious agent antigen detection by immunoassay with direct optical observation; repiratory syncytial virus. The descriptor for code was revised to provide a mechanism for reporting each plate. Code was developed to report detection of RSV antigen by immunoassay with direct optical observation. Currently codes do exist for RSV antigen by immunofluorescent technique (87420) and by enzyme immunoassay technique, multiple step method (87420), however there was no code for RSV for tests using antigen detection by immunassay with direct optical observation. The service reported by includes physician performance or supervision of a nasal wash to collect a suitable specimen. Alternatively, a nasal swab can be used to collect a nasal specimen and dipped into a solution provided with the kit. A sample of the prepared solution or nasal wash is then pipetted onto the rapid test and in 15 minutes the test results are read and interpreted as positive or negative.

48 Pathology Code Changes
Cytopathology section, one deleted code (88180) and five new codes: Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker each additional marker Flow cytometry, interpretation; 2 to markers to 15 markers or more markers The number of clinical flow cytometric applications has grown significantly in the past few years and in response to the changing medical environment, two codes have been established to report the technical component of flow cytometry and three codes to report flow cytometric interpretations. Code and add-on code describe the technical component of flow cytometry procedures. Codes 88187, 88188, are intended to describe flow cytometry interpretation. Code continues to describe flow cytometry procedures for each cell cycle or DNA analysis.

49 Pathology Code Changes
Cytogenetic Studies Section Genetic Testing Modifiers (Appendix I) for use with cytogenetic studies procedures, CPT codes through Guidelines for this section of codes provide direction for coders as to when the modifiers from Appendix I would be appropriately appended.

50 Pathology Code Changes
Surgical pathology section, three new codes and two revised codes: Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, each antibody; manual using computer assisted technology Surgical Pathology section In situ hybridization (ISH) has rapidly gained acceptance in the pathology and oncology communities as a definitive diagnostic marker for certain cancers. Code was established to describe manual morphometric analysis, with codes and revised for number sequencing purposes. An important parenthetical note following instructs the coder not to report in conjunction with or for the same antibody

51 Pathology Code Changes
In situ hybridization (eg, FISH), each probe Morphometric analysis, in situ hybridization, (quantitative or semi- quantitative), each probe; using computer assisted technology manual Surgical Pathology section Codes and were established to describe morphometric analysis in situ hybridization for manual vs. computer assisted methods. The new codes in this section describe a quantitative or semiquantitative procedure, reflecting substantially more work in comparison to a qualitative analysis.

52 Pathology Code Changes
Reproductive Medicine Procedures, one revised code: Storage, (per year); oocyte(s) Code was revised to replace the word “oocyte” with “oocytes”.

53 Medicine Section Changes
Immunization administration under 8 years of age (includes percutaneous, intradermal, subcutaneous or intramuscular injections), when the physician counsels the patient/family; first injection (single or combination vaccine/toxoid), per day each additional injection, per day Immunization administration under age 8 years (includes intranasal or oral routes of administration.) ; first administration (single or combination vaccine/toxoid), per day each additional administration, per day A new series of codes for immunization administration which incorporates the work of physician immunization counseling for young children (under age 8) has been added. Also within this section, code was revised to remove the phrase “jet injection” as this method is seldom used for administration.

54 Medicine Section Changes
Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), for use in individuals younger than 7 years, for intramuscular use The descriptor language for has been revised to reflect the age group (younger than 7 years) for which this toxoid/vaccine was intended. Code was established to report injection of thimerosal-free influenza injections for individuals 3 years and above.

55 Medicine Section Changes
Gastroenterology Subsection: Esophagus, gastroesophageal reflux test; with nasal catheter pH elecrode(s) placement; recording, analysis and interpretation with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation Codes and were deleted and replaced by codes and These codes have been added to specifically identify nasal insertion of pH catheters (91034) or mucosal attachment of telemetry pH electrodes (91035) for detection of GERD. The telemetry-based system involves placement of a monitoring capsule that is temporarily inserted and attached to the pt’s esophagus. The capsule monitors the presence of acid and transmits pH levels via radiofrequency telemetry to an external receiver that the patient wears for up to 72 hrs. After a period of several days, the capsule is sloughed by the body and passes through the pt’s digestive tract.

56 Medicine Section Changes
Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation prolonged (>1 hr, up to 24 hrs) Esophageal balloon distension provocation study Rectal sensation, tone, and compliance test Codes and are used to describe gastroesophageal impedance monitoring, with containing a speficfic time range in its descriptor to clearly define what constitutes a prolonged period. Impedance monitoring measures sphincter function and esophageal muscular function. Code was added to report esophageal balloon distension provocation study in which serial insufflations of air or water are used to determine the threshold which reproduces symptomatic response from the patient. The patient is made unaware of the volumes so as not to influence the test results, which are used to evaluate recurrent unexplained chest pain and dysphagia. Anal retention = compliance? NO, code was added to identify measurement of rectal sensation, rectal tone and compliance of the rectal wall in response to controlled balloon distention of the rectum. Specifically, it describes a comprehensive assessment of sensory, motor, and biomechanical function of the rectum in patients with IBS, constipation, and/or fecal incontinence.

57 Medicine Section Changes
Special Otorhinolaryngologic Services: Evaluation of central auditory function, with report; initial 60 minutes each additional 15 minutes Assessment of tinnitus (includes pitch, loudness matching, and masking) Code was deleted and re-numbered into the Evaluative and Therapeutic Services subsection in the Medicine section of CTP. Two codes were established to more accurately describe central auditory function testing services as they are currently performed and to allow reporting multiple individual tests performed during a clinic visit. New code reports the initial 60 minutes of evaluation during which time a single test may be performed repeatedly or a battery of tests performed. Code was added to report tinnitus assessment to include pitch, loudness monitoring, and masking. Intended to be performed bilaterally. Tinnitus = self-perceived sounds. Can be caused by ototoxicity, a side-effect of chemotherapy and can be severe enough to interfere with sleep.

58 Medicine Section Changes
Electronic analysis of pacing cardioverter-defibrillator . . .; single chamber or wearable cardioverter-defibrillator system, without reprogramming single chamber or wearable cardioverter-defibrillator system, with reprogramming. Initial set-up and programming by a physician of wearable cardioverter-defibrillator includes initial programming of system, establish- ing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events Code was established to report the initial set-up and programming of a wearable cardioverter-defibrillator by a physician. Codes and were revised to include the wearable cardioverter-defibrillator system with the devices in the electronic analysis. 93741 or would NOT be reportable with 93745; and it would not be appropriate to report an E&M service by the same provider on the same day that is reported. The wearable cardioverter-defibrillator is a system that is worn outside the body, rather than implanted in the chest, by patients who are at risk for sudden cardiac arrest and who are not candidates for an implantable cardiac defibrillator.

59 Medicine Section Changes
Noninvasive Vascular Diagnostic Studies Transcranial Doppler study of the intracranial arteries; vasoreactive study emboli detection without intravenous microbubble injection emboli detection with intravenous microbubble injection Three new TCD (Transcranial Doppler) codes have been added for cerebrovascular reactivity testing (93890) and embolus detection monitoring (93892 and 93893). All three tests require additional equipment, laboratory time, and expertise not included in the standard TCD exam codes and Explanatory notes have been added to the section to define the terms “complete” and “limited” utilized in the codes and

60 Medicine Section Changes
Bronchodilation responsiveness, spirometry as in 94010, pre- and post- bronchodilator administration Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen(s), cold air, methacholine) High altitude simulation test (HAST), with physician interpretation and report with supplemental oxygen titration Codes and have been revised to clarify that the admininstration of the bronchodilator is not included in spirometry. Codes and were added to the Pulmonary Subsection of the Medicine Section to describe high altitude simulation testing.

61 Medicine Section Changes
Central motor evoked potential study (transcranial motor stimulation); upper limbs lower limbs Codes and were established to describe central motor evoked potential studies for the upper limbs and lower limbs. Transcranial electrical motor stimulation is a method that allows for stimulation of the motor area of the cerebral cortex and recording from peripheral muscles of the upper and lower extremities. During surgical procedures involving the spinal cord, transcranial electrical motor stimulation is a method that allows for physician interpretation of motor responses in order to determine is a significant change in responses has occurred.

62 Medicine Section Changes
Eletronic analysis of implanted neurostimulator pulse generator system . . complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour each additional 30 minutes after first hour Codes 95971, 95972, and have been revised to exclude brain stimulation Two new codes, and have been added for analysis and programming of DBS and the existing codes have been revised to exclude deep brain stimulation. DBS involves more complex technology, with more side effects, risk, and clinical features to measure. Deep brain stimulator systems are implanted predominantly in patients with Parkinson’s disease and essential tremor, who are not adequately controlled with medications.

63 Medicine Section Changes
Developmental testing; extended (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report The descriptor for code was revised to include reporting ANY extensive developmental testing and was further revised by having the “per hour” specification removed as this type of testing takes an average of 85 minutes.

64 Medicine Section Changes
Physical Medicine and Rehabilitation One code deleted (97601) and four added (97597, 97598, 97605, 97606) to the Active Wound Care Management subsection Accupuncture Two codes deleted (97780, 97781) and four added ( 97810, 97811, 97813, ) to this new subsection. The Active Wound Care Management Care Section has been updated to include revised introductory guidelines, and revised codes to report selective debridement based on total surface area of the wound(s) size and new procedures to describe negative pressure wound therapy techniques based on area wound(s) size. Cross references indicate that these codes should not be reported in conjunction with debridement codes thru New Accupunture service codes are reported based upon 15-minute increments of personal (face-to-face) contact with the patient, not the duration of acupuncture needle(s) placement and whether electrical stimulation is utilized or not.

65 Category II Codes For 2005, all of the 2004 Category II codes have been deleted and renumbered. Four new codes have been added to represent Maternity Care Management. Eight new categories of codes have been added to accommodate the addition and organization of the existing and future Category II codes. Category II codes are supplemental tracking codes that can be used for performance measurement. Theorectically, the use of Category II codes will decrease the need for record abstraction and chart review, thereby minimizing the administrative burden on physicians and other health care professionals. Appendix H contains info. about the performance measures and their origins. Existing codes report tobacco use assessment, tobacco use cessation intervention, blood pressure measurement, etc.

66 Category III Codes Eight Category II codes have been deleted and converted to Category I codes for 2005. Twenty-seven Category III codes were added for 2005, including a code for online evaluation and management service with guidelines specifically to instruct for appropriate coding (0074T) One Category III code, revised Of the new codes in Category III, there is a series for: Reporting percutaneous transcatheter placement of extracranial vertebral or intracranial carotid artery stents, Ultrasound ablation of uterine leiomyomata Acoustic heart sound recording and computer analysis CT colonoscopy (virtual colonoscopy), and Percutaneous intradiscal annuloplasty In addition, HCPCS codes are being published this month. Millie Johnson distributed a memo outlining Medicare’s changing coverage and code assignments for, in particular, ESRD services and chemotherapy administration. (G codes)


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