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

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Presentation on theme: "CPT Changes for 2005 Julie A. Leu, CPC December 16, 2004 9:30 – 11:30 a.m."— Presentation transcript:

1 CPT Changes for 2005 Julie A. Leu, CPC December 16, :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

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”

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.

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.

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

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

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

11 Surgery – Musculoskeletal System – Five new codes – Two new codes in the Femur subsection: Autologous chondrocyte implantation, knee Osteochondral allograft, knee, open

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

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) 31546reconstruction with graft(s) (includes obtaining autograft)

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)

15 Surgery – Respiratory System –Trachea and Bronchi/Endoscopy subsection: 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 31638with revision of tracheal or bronchial stent inserted at previous session

16 Surgery – Respiratory System –Lungs and Pleura –One new code in the Incision subsection: Insertion of indwelling tunneled pleural catheter with cuff

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 32856bilateral

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

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.

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)

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)

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 37216without distal embolic protection

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) 43645with gastric bypass and small intestine reconstruction to limit absorption

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

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

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  and revised  Five new codes (47143 – 47147)

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

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.

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

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)

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

33 Surgery – Nervous System –Three new codes, three revised Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments; 63051with 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)

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.

35 Surgery – Eye and Ocular Adnexa – One new code, one revised ▲ Ciliary body destruction; cyclophotocoagulation, transscleral cyclophotocoagulation, endoscopic

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

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)

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

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.

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

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

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)

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

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

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

46 Pathology Code Changes Immunology section, four new codes and one revised code: ▲ Immunofixation electrophoresis; serum other fluids with concentration (eg, urine, CSF)

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.

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 8 markers to 15 markers or more markers

49 Pathology Code Changes Cytogenetic Studies Section Genetic Testing Modifiers (Appendix I) for use with cytogenetic studies procedures, CPT codes through

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 88361using computer assisted technology Surgical Pathology section

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

52 Pathology Code Changes – Reproductive Medicine Procedures, one revised code: ▲ Storage, (per year); oocyte(s)

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

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

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

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

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)

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

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

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

61 Medicine Section Changes Central motor evoked potential study (transcranial motor stimulation); upper limbs lower limbs

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

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

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, 97814) to this new subsection.

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.

66 Category III Codes – Eight Category II codes have been deleted and converted to Category I codes for – 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


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