It’s the time of year again to be aware of the CPT changes and updates for 2015.
Musculoskeletal System
Joint Procedures – New codes for joint aspiration and/or injection have been created to include ultrasound guidance. The existing codes were revised to state “not using ultrasound guidance.” However, one thing to keep in mind is that these procedures are sometimes done under fluoroscopic guidance which was not addressed with the new codes.
20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting
20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow, or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting
20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting
Vertebroplasty/Kyphoplasty – The existing codes for vertebroplasty and kyphoplasty have been deleted for 2015 and new codes have been created to include all imaging guidance. Sacroplasty did not yet receive a new code, but the existing Category III code has been revised to include all imaging guidance.
22510 Percutaneous vertebroplasty (bone biopsy included when performed), one vertebral body, unilateral, or bilateral injection, inclusive of all imaging guidance; cervicothoracic
22511 Percutaneous vertebroplasty (bone biopsy included when performed), one vertebral body, unilateral, or bilateral injection, inclusive of all imaging guidance; lumbosacral
22512 Percutaneous vertebroplasty (bone biopsy included when performed), one vertebral body, unilateral, or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure)
22513 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), one vertebral body, unilateral, or bilateral cannulation, inclusive of all imaging guidance; thoracic
22514 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), one vertebral body, unilateral, or bilateral cannulation, inclusive of all imaging guidance; lumbar
22515 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), one vertebral body, unilateral, or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)
0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, one or more needles, includes imaging guidance and bone biopsy, when performed
0201T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, two or more needles, includes imaging guidance and bone biopsy, when performed
Cardiovascular System
Pacemaker and Implantable Defibrillator – Four new codes were developed for subcutaneous implantable defibrillators. These devices differ from transvenous implantable pacing cardioverter-defibrillators in that subcutaneous defibrillators do not provide antitachycardia pacing or chronic pacing.
33270 Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed
33271 Insertion of subcutaneous implantable defibrillator electrode
33272 Removal of subcutaneous implantable defibrillator electrode
33273 Repositioning of previously implantable defibrillator electrode
Revisions were made to CPT codes 33215 – 33220, 33223 – 33225, 33240 – 33264, 33243 – 33249 regarding the phrase “pacing cardioverter-defibrillator.” The new language is “implantable defibrillator.” Review the new introductory language of the CPT book for pacemakers and implantable defibrillators. Examples of new language:
- 2014 – 33243 – Removal of single or dual chamber pacing cardioverter-defibrillator electrode(s); by thoracotomy
- 2015 – 33243 – Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy
Implantable and Wearable Cardiac Device Evaluations – Changes have been added to the introductory language for implantable and wearable device evaluations. These changes were added to replace implantable cardioverter-defibrillator with implantable defibrillator and language to accommodate the two new codes for subcutaneous defibrillator into the coding guidelines.
- 93260 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified healthcare professional; implantable subcutaneous lead defibrillator system
- 93261 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified healthcare professional; includes connection, recording, and disconnection per patient encounter; implantable subcutaneous lead defibrillator
Transcatheter Placement of Intravascular Stent – It was identified that the cervical carotid stent codes 37215 and 37216 do not follow the standard endovascular intervention convention of allowing for either open or percutaneous vascular access so for 2015 there is an editorial change to add the phrase “open or percutaneous.”
- 37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection
- 37216 Without distal embolic protection
- 37218 Transcatheter placement of intravascular stent(s),intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation
Extracorporeal Membrane Oxygenation – For 2015 the extracorporeal membrane oxygenation (ECMO) codes 33960, 33961, and 36822 were deleted and replaced with 25 new codes. New codes 33946 – 33989 deal with:
- Initiation
- Daily Management
- Cannulation (Further defined by age)
- Insertion
- Repositioning
- Removal
- Age of patient
Digestive System – There are significant changes coming to coding for lower GI endoscopic procedures in CPT 2015. These changes follow similar revisions to the upper GI endoscopy codes in CPT 2014 and mark the conclusion of a multiple-year effort to update the terminology of the GI endoscopy codes.
In recent years, the CPT Editorial Panel has been replacing the terminology “with or without” in codes throughout the CPT book with “including, when performed” in an effort to standardize the language and make the code descriptors more accurate. Previously, all GI endoscopy family base codes contained the language “diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure).” In CPT 2014, “with or without” was replaced by “including, when performed” for esophagoscopy, esophagogastroduodenoscopy (EGD), and endoscopic retrograde cholangiopancreatography (ERCP). The same terminology reconciliation will be made to ileoscopy, pouchoscopy, flexible sigmoidoscopy, colonoscopy through stoma, and colonoscopy in CPT 2015. This represents an editorial change and does not change the way the codes are reported.
Enteroscopy and Colonoscopy – A new definition and instructions for reporting antegrade transoral small intestine endoscopy (i.e., enteroscopy) will be added to the section guidelines. Enteroscopy is defined by the most distal segment of small intestine that is examined; coding does not reflect the technology used to perform the examination.
Codes in the 44360 family for enteroscopy, not including ileum (44360–44373), are endoscopic procedures to visualize the esophagus through the jejunum using an antegrade approach. Codes in the 44376 family for enteroscopy, including ileum (44376–44379), are endoscopic procedures to visualize the esophagus through the ileum using an antegrade approach.
If an endoscope cannot be advanced at least 50 cm beyond the pylorus, see the appropriate code in the EGD family (43233, 43235–43259, 43266, 43270). If an endoscope can be passed at least 50 cm beyond pylorus, but only into jejunum, see the appropriate code in the enteroscopy, not including ileum family (44360–44373).
To report retrograde examination of small intestine via anus or colon stoma, use 44799, Unlisted procedure, small intestine.
The definition of a colonoscopy examination will be specifically defined in CPT as the examination of the entire colon, from the rectum to the cecum, and may include examination of the terminal ileum or small intestine proximal to an anastomosis. When performing a colonoscopy on a patient who is scheduled and 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 with appropriate documentation. For therapeutic examinations that do not reach the cecum, report the appropriate colonoscopy code with modifier 52 with appropriate documentation.
New codes for the colonoscopy family include endoscopic mucosal resection, band ligation, and decompression for pathologic distention. Revised codes address appropriate reporting of ablation and stent placement.
Urinary System – There are two new codes in the Vesical Neck and Prostate subsection.
52441 Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant
+52442 each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure)
Nervous System
Myelography – New myelography codes were created which include the supervision and interpretation. The existing code for myelogram injection has been revised but, with the introduction of the new codes, there is some uncertainty regarding the appropriate time to assign code 62284, as both seem to represent the injection portion of the procedure.
62284 Injection procedure for myelography and/or computed tomography, spinal lumbar (other than C1-C2 and posterior fossa)
62302 Myelography via lumbar injection, including radiological supervision and interpretation; cervical
62303 Myelography via lumbar injection, including radiological supervision and interpretation; thoracic
62304 Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacral
62305 Myelography via lumbar injection, including radiological supervision and interpretation; two or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)
Radiation Therapy – Radiation therapy codes underwent significant changes for 2015. Teletherapy isodose planning and brachytherapy codes now include the basic dosimetry calculation and intensity-modulated radiation therapy (IMRT) codes now include guidance and tracking. Also radiation treatment delivery codes were deleted in 2015.
77306 Teletherapy isodose plan; simple (one or two unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)
77307 Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)
77316 Brachytherapy isodose plan; simple (calculation[s] made from one to four sources, or remote afterloading brachytherapy, one channel), includes basic dosimetry calculation(s)
77317 Brachytherapy isodose plan; intermediate (calculation[s] made from five to 10 sources, or remote afterloading brachytherapy, two-12 channels), includes basic dosimetry calculation(s)
77318 Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s)
77385 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple
77386 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex
77387 Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed
Pathology and Laboratory – The qualitative drug screen codes (80100, 80101 and 80104) are being deleted and replaced with new codes. The 80102 drug confirmation code is also being eliminated to be replaced with drug-specific CPT codes. A useful table will be included in the code set that specifies which drugs are identified for each drug or drug class.
Drug procedures are divided into three subsections:
- Therapeutic Drug Assay
- Drug Assay
- Chemistry
with code selection dependent on the purpose and type of patient results obtained. Therapeutic Drug Assays are performed to monitor clinical response to a known, prescribed medication. Tests are now divided into two classes. Per CPT®:
- Presumptive drug class procedures are used to identify possible use or non-use of a drug or drug class. A presumptive test may be followed by a definitive test in order to specifically identify drugs or metabolites.
- Definitive drug class procedures are qualitative or quantitative tests to identify possible use or non-use of a drug. These tests identify specific drugs and associated metabolites, if performed. A presumptive test is not required prior to a definitive drug test.
The material for drug class procedures may be any specimen type unless otherwise specified in the code descriptor (eg, urine, blood, oral fluid, meconium, hair). Procedures can be qualitative (eg, positive/negative or present/absent), semi-quantitative or quantitative (measured) depending on the purpose of the testing. Therapeutic drug assay (TDA) procedures are typically quantitative tests and the specimen type is whole blood, serum, plasma, or cerebrospinal fluid.
When the same procedure(s) is performed on more than one specimen type (eg, blood and urine), the appropriate code is reported separately for each specimen type using modifier 59.
Medicine – New vaccine codes are 90630 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use and 90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (HPV), 3 dose schedule for intramuscular use.
New procedures include 93355 Transesophageal echocardiography (TEE) for guidance during structural interventions of the transcatheter intracardiac or great vessels and 96127 Brief emotional/behavioralassessment, with scoring and documentation using standardized instrument.