December 01, 2016
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, the managing editor for AAPC, a training and credentialing association for the business side of health care.
CPT® 2017 will be implemented January 1, and brings with it a number of significant changes in coding. The most significant changes will include revised conscious sedation billing guidelines, expanded telemedicine services and a new category of codes to describe procedures related to dialysis.
Conscious sedation now separately billable
CPT® no longer defines conscious sedation (as an inherent part of any procedure. A total of 441 (mostly endoscopic) codes no longer include moderate sedation. Conscious sedation, when performed and properly documented, now may be reported separately. New conscious sedation codes 99151-99157 are reported according to patient age and the timed duration of the service.
Note: The Centers for Medicare and Medicaid Services (CMS) determined that the moderate sedation work for certain esophageal dilation, biliary endoscopy and endoscopic retrograde cholangiopancreatography procedures differs from that of other endoscopy procedures. In response, CMS augments the new moderate sedation CPT® codes with a gastrointestinal (GI) endoscopy-specific moderate sedation code, G0500, to be applied instead of CPT® 99151-99152 when reporting moderate sedation to Medicare patients in addition to GI endoscopy services specified within the 2017 Physician Fee Schedule Final Rule.
Expanded telemedicine services
For 2017, CPT® introduces modifier 95, which may be appended to designated Evaluation and Management (E/M) service, Medicine and Category III codes (identified in the CPT® manual with a star) to describe telemedicine services. CPT® instructs: “The totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.” Interactive telecommunications equipment must include audio and video, and the patient and provider must be able to communicate and interact in real time.
New medicine codes for health assessments
E/M code 99420 is deleted and replaced by two new medicine codes to describe health risk assessments, either for a patient (96160) or a patient caregiver (96161), for the benefit of the patient.
Spinal instrumentation updates
Code 22851 is deleted and replaced by three, more precise add-on codes to describe biomechanical devices placed in the intervertebral disc space (with and without arthrodesis, 22853 and 22859, respectively), or attached to vertebral bodies (22854).
Also new, 22867-22870 describe interlaminar/interspinous process stabilization/distraction devices, marketed under several brand names (e.g., X STOP®, NuVasive®), to treat the symptoms of spinal stenosis (pain, cramping and muscle weakness, etc.), with or without open decompression or fusion. The device is implanted between the vertebral spinous processes and is opened or expanded to distract (open) the neural foramen and decompress the nerves.
Laryngoplasty code 31582 is deleted and replaced by four new codes (31551-31554), each describing laryngoplasty for laryngeal stenosis (congenital or acquired narrowing of the airway) by various methods.
Code 31591 Laryngoplasty, medialization, unilateral describes a procedure to alleviate vocal cord weakness or paralysis. The surgeon creates a window in the thyroid cartilage and places a small implant to move the affected vocal fold and hold it in place, so that the functioning vocal fold can close for normal voice and swallowing.
Additionally, 31592 Cricotracheal resection describes excision of a portion of the airway just below the larynx (most commonly to treat stenosis). The larynx and trachea are sewn back together.
More options for varicose vein treatment
New codes 36473 and add-on 36474 involve a combination of mechanical and chemical methods to ablate varicose veins. An intraluminal device is used to disrupt bloodflow and “scratch” the interior surface of a vein, into which medication is then infused.
New dialysis circuit codes
The dialysis circuit is created to allow easy, repeated access to blood vessels to perform hemodialysis. CPT® 2017 introduces nine new codes under the added subhead “Dialysis Circuit,” along with several pages of definitions and instructions.
Code 36901 reports imaging of the dialysis circuit. Code 36902 describes the same service, with the addition of transluminal balloon angioplasty of the peripheral dialysis segment; 36903 describes all the services in 36902, plus transcatheter placement of intravascular stent(s) in the peripheral dialysis segment with all necessary imaging and radiological supervision and interpretation (S&I). Other codes in this group describe transluminal mechanical thrombectomy and/or infusion to treat any/all thrombus without (36904) and with balloon angioplasty (36905) and transcatheter intravascular stent placement (36906). Add-on codes describe angioplasty of the central dialysis segment (36907), stenting in the central dialysis segment (36908), and permanent vascular embolization or occlusion in the dialysis circuit (36909).
Angioplasty adds radiological S&I
CPT® 2017 deletes eight codes to report transluminal balloon angioplasty and replaces them with four new codes (37246-37249) that simplify reporting. The new codes includes all necessary imaging and radiological S&I.
Spinal injections now specify with/without imaging
Codes 62311-62318 are deleted and replaced by 62320-62327 to better differentiate epidural or subarachnoid injections performed with and without imaging guidance, by spinal region.
Fluoroscopic guidance for needle placement (77002) becomes a specified add-on code for 2017, as does fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (77003). CPT® parenthetical instructions provide a full listing of primary codes with which you may report 77002 and 77003.
Mammography codes are overhauled to simplify reporting. Five codes become three (77065, 77066 and 77067), all of which include computer-aided detection to aid in detecting breast cancer, when performed.
Path and lab
New codes to report presumptive drug class screening (80305-80307) are selected based on the method used to perform the test(s). Each of the new codes may be reported once, per test, regardless of the number of drug classes tested.
New codes 81413 and 81414 report genomic sequence analysis of at least 10 or two genes (respectively). The tests identify cardiac conditions such as Brugada syndrome, long QT syndrome, short QT syndrome and catecholaminergic polymorphic ventricular tachycardia.
Code 81422 now reports genomic sequence analysis for fetal chromosomal microdeletions, and a unique code (87483) is added to identify central nervous system infections.
Medicine sees many refinements, few new codes
Nine influenza vaccine codes are revised and are now reported by dosage, not patient age. For example, 90686 eliminates the requirement “when administered to individuals 3 years and older” and adds “0.5 mL dosage.” Code 90674 is added to improve reporting of quadrivalent (e.g., Flucelvax®) vs. trivalent (90661) vaccine.
CPT® adds introductory text to the Psychotherapy section, designating 90832-90838 as “psychotherapy for the individual patient, although times are face-to-face services with patient and may include informant(s). Patient must be present for all or majority of the service.” The phrase “and/or family member” is removed from the code descriptors. Look to 90846 or 90847 when “utilizing family psychotherapy techniques such as focusing on family dynamics.” Do not report 90846 or 90847 for services of less than 26 minutes.
Three new codes are added to describe repair of a paravalvular leak. A paravalvular leak occurs at the annulus of a replacement valve. Code 93590 describes placement of an initial occlusion device (plug) to block a leak at the mitral valve, using a catheter; 93591 describes placement of an initial occlusion device (plug) to block a leak at the aortic valve, using a catheter; and 93592 describes placement of each additional plug beyond the initial occlusion device to block a leak at the aortic or mitral valve, using a catheter.
New code 96377 reports application of on-body injectors (e.g., OnPro®), including cannula insertion. The system automatically provides timed injections (for example, for oncology patients requiring chemotherapy injections).
New, time-based physical therapy, occupational therapy and athletic training evaluation codes (97161-97172) are similar to E/M codes found in the 99000 series, but are specific to therapy.