2010 CPT

1. 2010 CPT What’s new for the New Year Katherine Kannard, CPC, CPC-I, CPMA

2. Agenda • Re-sequencing guidelines  • 2010 CPT changes • Consultations • New, deleted and revised codes that will affect your coding and reimbursement- Evaluation &Management through Pathology & Laboratory Sections

3. What is CPT? Current Procedural Terminology (CPT) codes are numbers assigned to tasks and services that a medical practitioner provides to a patient. They are then put to use by insurers to determine the amount of payments that the practitioner stands to get.

4. Who creates, changes, and deletes the CPT codes? CPT codes are developed and maintained by American Medical Association (AMA). There are specific procedures within the AMA to evaluate recommendations to changes in the CPT code set.

5. Why CPT Changes? There are approximately 500 changes for 2010. Codes can change for several reasons • To address payment problems • To make codes more easily understood and utilized • To be more specific about certain procedures So it is vital to know about the changes so that you will get proper payment from insurance companies.

6. Resequencing In the past when the AMA created a new code and the section had run out of numbers in a sequence, they would delete the existing codes and assign the entire section to a new code range with the required space. Now the AMA will no longer move whole groups of codes. Instead, they will utilize a code that is out of numeric order and can even originate from an entirely different section. This action also allows the AMA to put in place a new rule for deleted codes which will be to not reuse a deleted code for a period of 10 years.

7. Resequencing The AMA is taking multiple steps to make sure it is clear to everyone what is happening. In the print version of the CPT book, the resequenced number will be out of numeric order but grouped with the other codes in the content section that it pertains to. A new symbol of # has been created to assist coders in identifying it as a resequenced code. There is also a place holder at the proper spot in the numeric order to direct coders to where the code can be found.

8. Evaluation & Management Codes Initial & Subsequent Nursing Facility Codes (99304-99310) and Annual Nursing Home Assessment (99138) have been revised-removing with the patient and/or family and/or caregiver. New language is “at the bedside and on the patient’s facility floor or unit.”

9. Evaluation & Management Codes Prolonged Evaluation & Management Services (99358-99359) have had the examples deleted from the code description.

10. Evaluation & Management Consultation Codes Effective January 1, 2010 CMS will eliminate the use of all consultation CPT/HCPCS codes. • Inpatient (99251-99255) • Office/Outpatient (99241-99245) for various places of service with the exception of telehealth G-codes

11. Evaluation & Management Consultation Codes Instead of consultation codes, providers are instructed to bill • Initial hospital care (99221-99223) • Initial nursing facility care (99304-99306) • Initial office visits (99201-99205) Theses are to be used as applicable in relation to the place of service. CMS will develop a modifier for the admitting provider to append to the initial care code.

12. Evaluation & Management Consultation Codes CMS is considering increasing the work RVUs for initial hospital and nursing facility visits by approximately 0.3% and increasing the work RVUs for both new and existing office visits by about 6%. CMS is also considering adjusting the practice and malpractice expense RVUs for the initial visit codes to recognize their increased usage.

13. Evaluation & Management Consultation Codes Implications Currently for Medicare Members: • You will no longer use the consultation codes • You will no longer need to document the name of the requesting provider or provide a written report unless medically appropriate • For transfers of care, providers will bill an initial visit code instead of the current subsequent visit code. • Check with commercial and Medicaid MCCs on their policy of consultation codes. • Medicare as secondary payer will not recognize consult codes even if the primary carrier pays for the consult.

14. Anesthesia Codes No major changes just grammatical corrections

15. Surgery Codes For the Integumentary Section, there are 2 new codes added for adjacent tissue transfers . Code number 14300 has been deleted. • 14301-Adjacent tissue transfer or rearrangement, any area; defect 30.1 to 60.0 sq cm • 14302-Each additional 30.0 sq cm, or part thereof (Add-on Code) 1 description change in the Integumentary Section • 19295- Image guided placement, metallic localization, clip, percutaneous, during breast biopsy/aspiration (Add-on Code)

16. Surgery Codes For the Musculoskeletal Section, there are • 42 new codes added and 9 description changes • 21011-21014 Excisions of tumors, soft tissue of face or scalp subcutaneous or subfascial defined by less than 2cm or greater than 2 cm • 21015 changed description to add less than 2 cm with a new code of 21016 being added for 2cm or greater • 21555 Excision of tumor, soft tissue of neck or anterior thorax, subcutaneous changed description to add less than 3cm with a new code of 21552 (resequenced) is for 3cm or greater • 21556 Excision of tumor, soft tissue of neck or anterior thorax, subfascial changed description to add less than 5cm with a new code of 21554(resequenced) is for 5cm or greater

17. Surgery Codes For the Musculoskeletal Section-continued • 21557 Radical resection of tumor, soft tissue of neck or anterior thorax, description to add less than 5cm with a new code of 21558 is for 5cm or greater • 21930 Excisions of tumors, soft tissue of back or flank description to add subcutaneous less than 3cm with a new code of 21931 for 3cm or greater • 21932 New codes of excisions of tumors, soft tissue of back or flank subfascial less than 5cm with a new code of 21933 for 5cm or greater • 21935 Radical resection of tumor, soft tissue of back or flank description to add less than 5cm with a new code of 21936for 5cm or greater

18. Surgery Codes For the Musculoskeletal Section-continued • 22520 changed the wording from “one” to the numeral of “1” in the description • 22521changed from using a long description to using the same description as 22520 and using lumbar in place of thoracic. • 22900 Description removed the words “tumor” and ”desmoid” and added subfascial (eg. intramuscular) less than 5 cm and added new code 22901 for 5cm or greater • 22902 new code was added for excision of tumor, soft tissue of abdominal wall subcutaneous less than 3 cm with 22903 added for 3 cm or greater • 22904 new code for radical resection of tumor , soft tissue of abdominal wall less than 5cm and 22905 added for 5cm or greater

19. Surgery Codes For the Musculoskeletal Section-continued • 23075 Description removed the word “tumor” and added the words less than 3cm with a new code 23071 (resequenced) for 3cm or greater • 23076 Description removed the words “deep “ and “or” while adding less than 5cm with a new code of 23073 (resequenced) for 5 cm or greater • 23077 Description added less than 5cm with a new code of 23078 for 5 cm or greater • 23200 and 23210 Description replaced the word “for” with “of” • 23220 Removed the word “bone” while 23221 and 23222 were deleted

20. Surgery Codes For the Musculoskeletal Section-continued • 24075 Excisions of tumors, soft tissue of upper arm or elbow area description to add subcutaneous less than 3cm with a new code of 24071 (resequenced) for 3cm or greater • 24076 Excisions of tumors, soft tissue of upper arm or elbow area description to add subfascial less than 5cm with a new code of 24073 (resequenced) for 5cm or greater • 24077 Radical resection of tumor, soft tissue of upper arm or elbow area description to add less than 5cm with a new code of 24079 for 5cm or greater • 24150 and 24152 Description replaced the word “for” with “of” while 24151 and 24153 were deleted

21. Surgery Codes For the Musculoskeletal Section-continued • 25075 Excisions of tumors, soft tissue of forearm or wrist area description to add subcutaneous less than 3cm with a new code of 25071 (resequenced) for 3cm or greater • 25076 Excisions of tumors, soft tissue of forearm or wrist area description to add subfascial less than 3cm with a new code of 25073 (resequenced) for 3cm or greater • 25077 Radical resection of tumor, soft tissue of forearm or wrist area description to add less than 3cm with a new code of 25078 for 3cm or greater • 25170 Description replaced the word “for” with “of”

22. Surgery Codes For the Musculoskeletal Section-continued • 26115 Excisions of tumors or vascular malformation, soft tissue of hand or finger description to add subcutaneous less than 1.5cm with a new code of 26111 (resequenced) for 1.5cm or greater • 26116 Excisions of tumors, soft tissue or vascular malformation of hand or finger description subfascial removed the word “deep ‘and “or” while adding less than 1.5cm with a new code of 26113(resequenced) for 1.5cm or greater • 26117 Radical resection of tumor, soft tissue of hand or finger description to add less than 3cm with a new code of 26118 for 3cm or greater • 26250,26260 , and 26262 Description removed the example tumor • 26255 and 26261 were deleted

23. Surgery Codes For the Musculoskeletal Section-continued • 27047 Description removed the word “tissue” and added less than 3 cm with new code 27043 (resequenced) is for 3 cm or greater • 27047 Description removed the word “deep” and added less than 5cm with new code 27045(resequenced) is for 5cm or greater • 27409 Description removed the example of malignant neoplasm and added less than 5 cm while new cod 27059 is for 5cm or greater • 27075-27078 Description removed the words “or infection” • 27079 was deleted

24. Surgery Codes For the Musculoskeletal Section-continued • 27327 Excisions of tumors, soft tissue of thigh or knee area description to add subcutaneous less than 3cm with a new code of 27337(resequenced) for 3cm or greater • 27328 Excisions of tumors, soft tissue of thigh or knee area description subfascial removed the word “deep ‘and “or” while adding less than 5cm with a new code of 27339(resequenced) for 5cm or greater • 27329 Radical resection of tumor, soft tissue of thigh or knee area description to add less than 5cm with a new code of 27364 for 5cm or greater • 27365 Description removed the word “bone”

25. Surgery Codes For the Musculoskeletal Section-continued • 27615 Radical resection of tumor, soft tissue of leg or ankle area description to add less than 5cm with a new code of 27616 for 5cm or greater • 27618 Excisions tumor, description added” soft tissue of “ leg or ankle area subcutaneous and also added less than 3cm with a new code of 27632 (resequenced) for 3cm or greater • 27619 Excisions of tumors, soft tissue of leg or ankle area description subfascial removed the word “deep ‘and “or” while adding less than 5cm with a new code of 27634(resequenced) for 5cm or greater • 27640 Description removed the words “or exotosis” • 27645-27647 Description removed the word “bone”

26. Surgery Codes For the Musculoskeletal Section-continued • 28043 Excisions of tumors, added “soft tissue” of foot “or toe” subcutaneous removed the word “tissue” and added less than 1.5 cm with a new code of 28039(resequenced) for 1.5cm or greater • 28045 Excisions of tumors, soft tissue of foot or toe description subfascial removed the word “deep “while adding less than 1.5cm with a new code of 28041(resequenced) for 1.5cm or greater • 28046 Radical resection of tumor, soft tissue of foot and added “or toe” to the description and added less than 3cm with a new code of 28047 for 3cm or greater • 28171-28175 Description removed the word “bone” • 29229 was deleted • 29581 New code added for application of multi-layer venous wound compression system, below knee

27. Surgery Codes For the Respiratory Section • 30801 Description removed the words “Cautery and or” and mucosa while adding “soft tissue and the examples (eg. Electrocautery, radiofrequency ablation, or tissue volume reduction) • 30802 Description added the example (ie. Submucosal) • 31622 Description removed the words “with or without” and added in the words “including” and “when performed” • 31626 New code for bronchoscopy with placement of fiducial markers, single or multiple • 31627 New add-on code for bronchoscopy with computer-assisted ,image-guided navigation • 31641-31656 Description removed the words “Bronchoscopy (rigid or flexible)”

28. Surgery Codes For the Respiratory Section-continued • 32552 New code for removal of indwelling tunneled plueral catheter with cuff • 32553 New code for interstitial device(s) for radiation therapy guidance, percutaneous, intra-thoracic, single or multiple • 32560 Description changed to remove the word “chemical” and add “Instillation via chest tube/catheter agent for” pleurodesis. The example, of talc was also added. • 32561 New code for Instillation, via chest tube/catheter, agent for fibrinolysis; initial day with 32562 being added for each subsequent day

29. Surgery Codes For the Cardiovascular Section • 33216 Description removed the words “single chamber electrode” and “single chamber pacing” while adding “single” to describe how many electrodes • 33217 Description removed the words “dual chamber” and “dual chamber pacing” while adding “Insertion of 2 transvenous” to the beginning of the description. • 33223 Description removed the words “single or dual chamber pacing” • 33782 New code for Aortic root translocation with ventricular septal defect and pulmonary stenosis repair without ositum re-implantation with 33783 being added for with re-implantation of 1 or both coronary ostia • 33981-33983 New codes for replacement of extracorporeal and intracorporeal ventricular assist devices. • 36145 was deleted and 2 new codes 36147 and 36148 took its place for introductions of need and/or catheter, arteriovenous shunt for dialysis. 36147 being for initial access and 36148 for additional access

30. Surgery Codes For the Cardiovascular Section-continued • 36481 Description was marked as change but the only thing that changed was the addition of another reference of the CPT assistant • 36834 was deleted • 37183 Description was marked as change but the only thing that changed was the addition of another reference of the CPT assistant • 37760 Description removed the words ”with or without” and added “including” skin graft, “when performed” open “1 leg” • 37761 New code added for ligation of perforator vein (s), subfascial, open, including ultrasound guidance, when performed, 1 leg

31. Surgery Codes For the Digestive Section • 42894 Description was changed adding the words “or fasciocutaneous” flap “or free muscle, skin, or fascial flap with microvascular anastomosis • 43281 New code for laparoscopy, surgical, repair of paraesophogeal hernia includes fundoplasty, when performed; without implantation of mesh while 43281 is to be used for with implantation of mesh. • 43761 Description changed removing the word “the” and adding :a naso-or oro-” • 43775 New code for laparoscopy, surgical gastric restrictive procedure longitudinal gastrectomy (ie. sleeve gastrectomy) • 45170 was deleted and replace with 2 new codes 45171 excision of rectal tumor, transanal approach not including muscularis propria and 45172 including muscularis propria

32. Surgery Codes For the Digestive Section-continued • 46200 Description was changed removing the words “with or without” and adding the words “including” sphincterectomy “when performed” • 46210 and 46211 were deleted • 46220 Description was changed removing the words “papillectomy or” and adding the words “external papilla”. They also removed “separate procedure” from the description • 46221 Description changed from Hemorrhoidectomy simple ligature (ie rubber band) to Hemorrhoidectomy internal by rubber band ligation(s) • 46230 Description changed removing the words “external hemorrhoid tags and/or” while adding “external” papillae “or tags, anus” • 46250 Description changed removing the word “complete” and adding “2 or more columns/groups”

33. Surgery Codes For the Digestive Section-continued • 46255 Description changed removing the word “simple” and adding the phrase “single column/group” • 46258 Description was changed removing the words “with or without” and adding the words “including” fissurectomy “when performed” • 46260 Description changed removing the word “complete” and adding “2 or more columns/groups” • 46262 Description was changed removing the words “with or without” and adding the words “including” fissurectomy “when performed” • 46275 Description was changed removing the word “submuscular” and replacing it with “intersphincteric” • 46280 Description changed removing the word “complex” and replacing it with “transsphincteric, suprasphincteric, extrasphincteric” or multiple and also changed the words “with or without” to “including” and “when performed”

34. Surgery Codes For the Digestive Section-continued • 46320 Description changed removing the word “enucleation” and the words ‘thrombotic hemorrhoid” and adding “thrombosed hemorrhoid” • 46707 New code for repair of anorectal fistula with plug • 46937 and 46938 were deleted • 46945 Description change removing the words “of internal hemorrhoids” and “procedure” and added words for the code to read : hemorrhoidectomy, internal by ligation other than rubber band; single hemorrhoid column/group • 46946 Description changed replacing the words “multiple procedures” with “2 or more hemorrhoid columns/groups” 47382 and 47525 Description was marked as change but the only thing that changed was the addition of another reference of the CPT assistant • 47382 and 47525 Description was marked as change but the only thing that changed was the addition of another reference of the CPT assistant • 49411 New code for placement of interstitial device(s) for radiation therapy guidance

35. Surgery Codes For the Urinary Section • 50200 Description was marked as change but the only thing that changed was the addition of another reference of the CPT assistant • 51726 Description changed replacing “eg” with “ie” in the example • 51727 New code for a complex cystometrogram with urethral pressure profile studies • 51728 New code for a complex cystometrogram with voiding pressure studies • 51729 New code for a complex cystometrogram with urethral pressure profile studies and voiding pressure studies • 51772 and 51795 were deleted • 51797 Description changed replacing “voiding pressure (AP)” with “voiding pressure studies”

36. Surgery Codes For the Urinary Section-continued • 52282 Description changed adding the word “ permanent” to the shunt description • 53855 New code for insertion of a temporary prostatic urethral stent including urethral measurement

37. Surgery Codes For the Male and Female Genital Sections • 55873 Description changed adding the words” and monitoring” and removing “for interstitial cryosurgical probe placement” • 55876 Description changed adding the word “percutaneous” and removing the words “via needle, any approach” • 57426 New code for revision (including removal) of prosthetic vaginal graft, laproscopic approach • 59897 Description changed adding the words “when performed”

38. Surgery Codes • For the Male and Female Genital Sections • 55873 Description changed adding the words” and monitoring” and removing “for interstitial cryosurgical probe placement” • 55876 Description changed adding the word “percutaneous” and removing the words “via needle, any approach” • 57426 New code for revision (including removal) of prosthetic vaginal graft, laproscopic approach • 59897 Description changed adding the words “when performed”

39. Surgery Codes For the Endocrine Section 63660 was deleted and replaced with 63661-63662 for removal of spinal neurostimlator electrode arrays and plate/paddles, respectively. Also there are new codes 63663-63664 for revisions of spinal neurostimlator electrode arrays and plate/paddles, respectively. 64470-64476 were deleted 64490-64492 New codes for injections diagnostic or therapeutic agent paravertebral facet joint with image guidance cervical or thoracic with separate codes for single level (64490), second level (64491) and third and any additional levels(64492) 64493-64495 New codes for injections diagnostic or therapeutic agent paravertebral facet joint with image guidance lumbar or sacral with separate codes for single level (64493), second level (64494) and third and any additional levels(64495)

40. Radiology Codes For the Diagnostic Radiology Section • 72291 Description changed removing the word “ or” between the words vertebroplasty and verterbral augmentation and adding to the description “ or sacral augmentation (sacroplasty)” and adding “or sacrum” • 72292 Description was marked as change but the only thing that changed was the addition of another reference of the CPT assistant • 74261 New code for CT colonography, diagnostic, including image postprocessing without contrast material and 74262 with contrast material including non-contrast images, if performed • 74263 New code for CT colonography, screening, including image postprocessing • 75558, 75560, 75662, and 75564 were deleted • 75565 New add on code for cardiac MRI for velocity flow mapping

41. Radiology Codes For the Diagnostic Radiology Section-continued • 75571 New code for Calcium Scoring CT without contrast material • 75572 New Code for CT evaluation of Pulmonary veins cardiac structure and morphology with contrast material • 75573New Code for CT evaluation of Congenital Heart Disease cardiac structure and morphology with contrast material • 75574 New code for CCTA CT viewing the heart, coronary arteries and bypass grafts with contrast material • 75790 was deleted and replaced with 75791 Angiography, arteriovenous shunt complete evaluation of dialysis access including fluoroscopy, image documentation and report (includes injections of contrast and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava), radiological supervision and interpretation

42. Radiology Codes For the Radiologic Guidance, Radiation Oncology, and Nuclear Medicine Sections • 77003 Description changed removing the words “paravertebral facet join, paravertebral facet joint nerve” • 77338 New code for Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan • 78451 New code for Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) • 78452 New code for multiple studies

43. Radiology Codes For the Nuclear Medicine Section-continued • 78453 New code for Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) • 78454 New code for multiple studies • 78460-78465 were deleted • 78478-78480 were deleted

44. Pathology & Laboratory For the Panel & Chemistry Sections • 80055 Description change adding the words “non-treponemal antibody” • 82306 Description change removing “Calcifedial (25 OH” and “3” and adding “25 hydroxy, includes fraction(s), if performed” • 82307 was deleted • 82652 Description change removing “Dihydroxyvitamin D” and adding “dihydroxy, includes fraction(s), if performed” • 82784 Description change adding “immunoglobulin” • 82785 Description was marked as change but the only thing that changed was the addition of another reference of the CPT assistant • 82787 Description change adding the word “eg” in the example • 83516 Semicolons were changed to commas

45. Pathology & Laboratory For the Chemistry Section-continued • 83518 Description change adding the words “qualitative or semiquantitative” • 83519 Description change removing the words “ Immunoassay, analyte” and “radiopharmaceutical technique and replacing them with “radioimmunoassay” • 83520 Description change adding the word “quantitative” • 83986 Description change removing “except blood” and replacing it with “not otherwise specified” • 83987 New code for pH; exhaled breath condensate • 84145 New code for Procalcitonin (PCT) • 84431 New code for Thromboxane metabolite(s), including thromboxane if performed, urine

46. Pathology & Laboratory For the Immunology Section • 86305 New code for Human epididymis protein 4 (HE4) • 86352 New code for Cellular function assay involving stimulation (eg, mitogen or antigen) and detection of biomarker (eg, ATP) • 86592 Description change adding the words “non-treponemal antibody” • 86593 Description was marked as change but the only thing that changed was the addition of another reference of the CPT assistant • 86780 New code for Antibody; Treponema pallidum • 86781 was deleted • 86825 New code for Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometry); first serum sample or dilution • 86826 New add on code for Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometry); each additional serum sample or sample dilution (List separately in addition to primary procedure)

47. Pathology & Laboratory For the Microbiology Section 87149 Description change adding the words “DNA or RNA” and “direct probe technique, per culture or isolate, each organism probed 87150 New code for Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed 87153 New code for Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16S RNA gene) 87493 New code for Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique

48. Pathology & Laboratory For the Microbiology Section • 88312 Description changed removing the words ” list separately in addition to code for primary service)” and adding “including interpretation and report” • 88313 Description changed adding “including interpretation and report” • 88314 Description changed adding “including interpretation and report” and ” (list separately in addition to code for primary service)” • 88387 New code for Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); each tissue preparation (eg, a single lymph node) • 88388 New add on code for 88387 adding in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (eg, a single lymph node) (List separately in addition to code for primary procedure) • 88378 New code for Hemoglobin (Hgb), quantitative, transcutaneous

49. Pathology & Laboratory For the Reproductive Medicine Procedures Section • 89398 New code for unlisted reproductive medicine laboratory procedure

50. Resources • www.cms.gov • www.cdc.gov • www.ama.com