March 01, 2016
Area(s) of Interest: Emergency Medicine 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.
The CPT® 2016 codebook introduced nearly 350 code changes from the previous year.
Among the highlights was the unveiling of two new codes to report prolonged services provided by clinical staff under the direct supervision of a physician or other qualified provider (99415, 99416). These time-based services are reported in addition to a primary outpatient evaluation and management (E/M) service, 99201-99215, as follows:
|Total Duration of Prolonged Services||Codes|
|< 45 minutes||Not separately reported|
|75-104 minutes||99415, 99416|
|105-134 minutes||99415, 99416 x 2|
Changes to the Integumentary chapter of CPT® are limited to the introduction of two new codes (10035, +10036) for placement of fiducial markers in soft tissue. The codes include imaging guidance, and are reported per lesion (rather than per individual marker placed).
Endobronchial ultrasound (EBUS), which combines ultrasound with bronchoscope to visualize the airway and adjacent structures, gains three new codes (31652 and 31653 for biopsy of mediastinal and/or hilar lymph node stations or structures, and 31654 for EBUS with diagnostic or therapeutic intervention(s) for peripheral lesion(s)). Moderate sedation, when performed, is an included component of EBUS.
Non-coronary intravascular ultrasound codes 37250 and 37251 were deleted and replaced by new add-on codes (37252 and 37253) that bundle all associated radiological supervision and interpretation (S&I) services.
New codes for cholangiography (visualization of the bile ducts) describe injection of the contrast medium (47531, existing access and 47532, new access); placement/revision/removal of biliary drainage catheter (47533-47537); stent placement (47538-47540); access for rendezvous procedure (47541); and more (e.g., removal of stones from the biliary ducts, 47544). The new codes include imaging guidance (e.g., fluoroscopy) and associated radiological S&I.
New codes 50430 and 50431 describe antegrade nephrostogram and ureterogram (imaging procedures for diagnostic assessment of the urinary system). There are also revised and replacement codes for urinary catheter procedures (e.g., 50433 describes percutaneous nephrostomy to place a nephroureteral catheter that drains internally and externally, via new access). These procedures includes diagnostic nephrostogram and ureterogram (if performed), as well as imaging guidance and associated radiological S&I. Additional codes are added to describe percutaneous conversion of a nephrostomy catheter to nephroureteral catheter (50434), and removal and replacement of an existing nephrostomy catheter (50435).
CPT® 2016 adds 61645 for thrombolysis for intracranial arteries using mechanical thrombectomy (clot removal) or infusion. Diagnostic angiography, fluoroscopic guidance, selective catheterization and thrombolytic injection(s) are included; however, you may separately report diagnostic angiography of a non-treated vascular territory. Also included are neurologic and hemodynamic monitoring of the patient, and closure by manual pressure, arterial closure device or suture.
Also new are codes for prolonged administration of pharmacologic agent(s) in any intracranial artery, for any reason other than thrombolysis (61650 and 61651).
Removal of impacted cerumen (ear wax) by lavage now has its own code (69209), and no longer is reported as an E/M service. You may still report 69210 for removal of cerumen requiring instrumentation.
CPT® 2016 adds three codes to report thoracic paravertebral block (PVB) by injection (64461, single and 64462, additional) or continuous infusion (64463).
New codes describing radiologic exam of the spine (72081-72084) now provide greater specificity as to the number of views (e.g., 72083 Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (e.g., scoliosis evaluation); 4 or 5 views). Similar changes affect codes describing radiologic exam of the hip(s) and pelvis (e.g., 73502 Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views).
Clinical brachytherapy codes are significantly revised. For example, codes to describe remote afterloading of high dose rate radionuclide interstitial or intracavitary brachytherapy are reported according to the number of channels used (77770, one channel; 77771 two to -12 channels; and 77772 over 12 channels). Also added are new codes for skin surface brachytherapy (77767-77768).
Many changes to the Pathology and Laboratory chapter clarify the method(s) used to perform various tests (with little effect on code application). A new panel was added to report an obstetric panel with HIV testing (80081). Ten new codes are added to the Multianalyte Assays with Algorithmic Analyses (MAAA) section, to report risk scores for rheumatoid arthritis; coronary artery disease; heart transplant rejection; and oncology including colon, colorectal, gynecologic, lung, and thyroid.
Many codes that describe obsolete vaccines were deleted, and the descriptors for other vaccine codes were revised to improve clarity (with no effect on code application). In a few cases, revisions are more substantial. For example, the descriptor for 90647 is revised to delete “3-dose schedule,” and to specify the vaccine as “Haemophilus influenzae type b.” Code 90625 was added for live cholera vaccine, as were two codes for meningococcal recombinant protein and outer membrane vesicle vaccine (90620, 90621).
Code 95972, for electronic analysis of implanted neurostimulator pulse generator system, was revised to eliminate the time element (“up to one hour”). Code 95973 (previously used to report each additional 30 minutes of electronic analysis beyond the first hour) was deleted.
Finally, Special Dermatological Procedures added a new series of codes (96931-96936) to describe reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin. The technique allows for imaging of skin lesions in vivo (no biopsy is necessary).