December 01, 2014
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
CPR’s “Coding Corner” focuses on coding, compliance and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, managing editor for AAPC, a training and credentialing association for the business side of health care.
The new year brings over 250 new CPT® codes to report provider services, and nearly as many revised and deleted codes.
Several trends are evident in CPT® 2015, including an increased emphasis on patient care coordination and management services. For example, the Evaluation and Management portion of CPT® adds a new subcategory for Chronic Care Management (99490), to describe per month services to a defined subset of patients, “…when medical and/or psychosocial needs of the patient require establishing, implementing, revising or monitoring the care plan.”
In addition, a new subcategory and guidelines define Complex Chronic Care Management (99487 and 99489) to include the services described by 99490 (above), “…as well as establishment or substantial revision of a comprehensive care plan; medical, functional, and/or psychosocial problems requiring medical decision making of moderate or high complexity and clinical staff carte management services for at least 60 minutes, under the direction of a physician or other qualified health care professional.”
Time-based codes 99497 and 99498 are added to describe face-to-face advance care planning services. These services include, “counseling and discussing advance directives…. a document appointing an agent and/or recording the wishes of a patient pertaining to his/her medical treatment at a future time should he/she lack decisional capacity at that time.”
Also new in the Medicine section is a code for brief emotional/behavioral assessment, with scoring and documentation using standardized instrument (96127).
As part of another familiar trend, CPT® has created or revised many codes to include imaging guidance as part of the procedure, or to create separate codes for procedures with and without guidance. For example:
- 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance
- 20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting
In another example, 22510-22515 replace 22520-22525 (percutaneous vertebroplasty and percutaneous vertebral augmentation) to describe the same procedures, but including all imaging guidance (and bone biopsy, when performed).
A new subsection, guidelines and codes 33946-33989 are added for extracorporeal membrane oxygenation or extracorporeal life support services (cardiac and/or respiratory support to the heart and /or lungs), to report cardiac and respiratory support for patients whose heart and lungs are diseased or damaged beyond function.
New codes (62302-62303) describe radiographic exam with contrast to detect pathology of the spinal cord (myelography). New codes also describe unilateral (64486-64487) and bilateral (64488-64489) transversus abdominis plane (TAP) block. Also know as abdominal plane block or rectus sheath block, a TAP block is a peripheral nerve block to anesthetize the nerves supplying the anterior abdominal wall.
Unilateral, bilateral, and screening digital breast tomosynthesis (3-D mammography) are now coded to 77061-77063. Tomosynthesis provides a clearer, more accurate view, compared to digital mammography alone.
Teletherapy isodose planning and brachytherapy isodose planning codes undergo revision, and are now classified as simple, intermediate, or complex, while two new codes (77385, simple and 77386, complex) report intensity modulated radiation treatment delivery (IMRT), including guidance and tracking.
Codes describing radiation treatment delivery have been simplified, and include a “per day” code for superficial and/or ortho voltage (77401), as well as codes for simple (77402), intermediate (77407) and complex (77412) delivery. All treatment delivery codes are reported once per treatment session.
Drug screening codes are completely overhauled. Tests are now defined as either presumptive drug class procedures or definitive drug class procedures. Five codes (80300-80304) describe presumptive drug class screening, according to whether the drug falls into “drug class A” or “drug class B” (as defined by CPT®). Dozens of new codes describe definitive drug testing, according to the specific substance tested.
Two revised codes (97605 area 50 sq. cm or less, and 97606 area greater than 50 sq. cm) describe vacuum-assisted drainage collection (negative pressure wound therapy) using durable medical equipment. Two new codes (97607 and 97608) describe the same procedure using disposable equipment.
New hypothermia initiative code 99184 Initiation of selective head or total body hypothermia in the critically ill neonate … replaces 99481 and 99482, which are deleted from the E/M section for 2015.
The majority of CPT® category III codes deleted for 2015 are replaced by new Category I codes. For example, 0247T Open Treatment of rib fracture requiring internal fixation, unilateral; 5-6 ribs is deleted and replaced by 21812-21813 Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral….
Significant additions include new codes for radiostereometric analysis (RSA) of the spine (0348T) and upper (0349T) and lower (0350T) extremities; optical coherence tomography (0351T-0354T); various behavioral assessments (0359T-0363T); adaptive behavior treatment by protocol (0364T-0374T); and visual field assessment (0378T-0379T).