2014 Coding Changes

2014 Coding ChangesAAPC RICHMOND VA. CHAPTERJANUARY 2014

AAPC Richmond Va. Chapter - January 2014

2Overview & Objectives

Identify coding changes for the upcoming year (HIGHLIGHTS) CPT® HCPCS

What's new for 2014- over 330 coding changes


3

CPT®175 NEW CODES47 DELETED CODES107 REVISED CODES


4Evaluation & Management

Interprofessional Telephone/Internet Consultations (99446 - 99449) four new codes

Time-based!! must document a minimum of 5 minutes to report 99446 Time includes review of medical record, diagnostic test, verbal & written communication

Request from treating physician to consultant for opinion and/or treatment advice to assist in the diagnosis and/or management of the patient

no face to face w/ patient Complex and/or urgent situations where a timely face-to-face service with the

consultant may not be feasible New patient to consultant or Established patient with new problem or exacerbation of

an existing patient No face-to-face with consultant last 14 days or next 14 days Report only once in a seven day period


5Evaluation & Management (cont.)

Complex Chronic Care Coordination Services(99487 - 99489) Codes did not change Guidelines revised to detail:

Typical adult patients Typical pediatric patients Requirements for care

coordination offices/practices

Requirements: Provide 24/7 access to clinical staff Use standardized methodology to

identify CCCC patients Internal process whereby identified

patients being receiving treatment in a timely manner

Standardized medical record form and format

Engage and educate patients and caregivers and coordinate care among all service professionals


6Evaluation & Management (cont.)

Transitional Care Management Services(99495 - 99496) Codes did not change/ just revised Can report for new or established patients Separately reported E&M cannot be reported on the same

day Discharge service may not be used as required face-to-face

visit


7Integumentary - Lund-Browder (No more “Rule of Nines” in CPT)

Area Birth-1yr

1-4 Yrs 5-9 Yrs 10-14 Yrs

15 Yrs Adult

Head 19 17 13 11 9 7Neck 2 2 2 2 2 2Trunk* 13 13 13 13 13 13Buttock* 2.5 2.5 2.5 2.5 2.5 2.5Genitalia 1 1 1 1 1 1U Arm* 4 4 4 4 4 4L Arm* 3 3 3 3 3 3Hand* 2.5 2.5 2.5 2.5 2.5 2.5Thigh* 2.5 6.5 8 8.5 9 9.5Leg* 5 5 5.5 6 6.5 7Foot* 3.5 3.5 3.5 3.5 3.5 3.5


8Integumentary - Breast Procedures

New biopsy with localization codes: Include localization devices, when performed Include imaging of the biopsy specimen, when performed Differ based on type of guidance

Stereotactic (19081, +19082) Ultrasound (19083, +19084) MRI (19085, +19086)


9Integumentary - Breast Procedures (cont.)

New introduction codes for localization devices Differ based on type of guidance

Mammographic (19281, +19282) Stereotactic (19283, +19284) Ultrasound (19285, +19286) MRI (19287, +19288)


10Musculoskeletal

Tumor resections Changed terminology from: Malignant neoplasm to sarcoma

New and revised codes for removal of foreign body and removal of prosthesis Specifically describes what is removed foreign body or

prosthesis


11Respiratory

Pleural catheter & thoracentesis Parenthetical notes revised to state not to report in

conjunction when performed on the same side of the chest


12Cardiovascular

Pacemaker or Pacing Cardioverter Defibrillator Guidelines revised

Relocation of skin pocket: requires creation of a new skin pocket Revision of skin pocket, not reported separately Subcutaneous implantable defibrillator system

TAVI/TARI new code for transapical exposure


13Cardiovascular (cont.)

New codes Fenestrated Endovascular Repair of the Visceral and

Infrarenal Aorta (34841 - 34848) Transcather placement of an intravascular stent(s) (37217,

37236 - 37239) Vascular Embolization and Occlusion (37241 - 37244)


14Digestive - BIG CHANGES

Endoscopy codes: specifically rigid and flexible esophagoscopy= significant changes

13 new codes Description revision for nearly all remaining

codes New parenthetical instructions


15Digestive - BIG CHANGES

Esophagoscopy (43191 - 43232) Esophagogastroduodenoscopy (43233 -

43259) Endoscopic Retrograde

Cholangiopancreatography - ERCP (43260 - 43278)

Abdomen, Peritoneum, and Omentum - Introduction, Revision, and Removal


16Digestive (cont.)

Esophagoscopy Cricopharyngeus muscle (upper esophageal sphincter)

to and including the gastoesophageal junction Includes examination of the proximal region of the

stomach via retroflexion when performed Selecting code need to know if a rigid or flexible

scope is used Reason for separating the code is the different

types of anesthesia used


17Digestive (cont.)

Esophagogastroduodenoscopy (AKA: Upper GI) Cricopharyngeus muscle (upper esophageal

sphincter) to and including the duodenum Consistent terminology Explanation of proper modifier use

Duodenum deliberately not examined Modifier 52 - Repeat examination not planned Modifier 53 - Repeat examination planned


18Digestive (cont.)

ERCP Requires visualization of one or more of the ductal

systems Pancreatic Biliary

Altered postoperative anatomy Unlisted codes (47999 or 48999) for ERCP via

gastrostomy or via Roux-en-Y


19Digestive (cont.)

New codes for image-guided fluid collection draining by catheter (abdomen, peritoneum, and omentum) 49405 Visceral Percutaneous 49406 Peritoneal or Retroperitoneal, Percutaneous 49407 Peritoneal or Retroperitoneal, Transvaginal or

Transrectal


20Urinary

One new code Combination code

52356 Cystourethroscopy with ureteroscopywith lithotripsy including insertion of

indwelling ureteral stent(eg, Gibbons or double-J type)


21Nervous

New Codes in the Chemodenervation Section - Somatic Nerves 64616 Neck muscle(s) excluding larynx (unilateral) 64617 Larynx, unilateral, percutaneous

includes needle EMG guidance 64642 One extremity; 1 -4 muscles +64643 Each additional extremity, 1 - 4 muscles 64644 One extremity; 5+ muscles +64645 Each additional extremity, 5+ muscles 64646 Trunk muscles; 1 - 5 muscles 64647 Trunk muscles; 6+ muscles


22Eye & Ocular Adnexa

One new code - Anterior Sclera - Aqueous Shunt 66183 Insertion of anterior segment aqueous drainage

device, without extraocular reservoir, external approach

Replaces the category III code 0192T


23Auditory System

Guideline for cerumen removal 69210 Clarifies that an instrument is required Revised to report unilateral procedure (continue to use

modifier 50 for bilateral procedures) Added guidance from CPT® Assistant


24Radiology

Radiologic exam of spine 72040 now specifies “2 or 3 views instead of “3 or less”

Revisions to guidance codes and parenthetical references based on codes for which guidance is now included: Transcatheter Procedures- supervision included in new codes 37236-37239 Fluoroscopic Guidance Magnetic Resonance Guidance

Revisions to radiation oncology simulation guidelines: inappropriately described as “simulation”, more appropriately labeled as “planning”


25Pathology & Laboratory

New Molecular Pathology Table Expansion of molecular pathology parenthetical lists of

included items 10 New Therapeutic Drug Assay Codes


26Medicine

Vaccines - New Flu Codes Includes four strains (two type A and two type B) Patients age determines the code

Special Otorhinolaryngologic Services New speech related codes

Repair of Structural Heart Defects Two new percutaneous transcatheter repair codes

Intracardiac Electrophysiological Procedures/Studies 3 revised codes - all for comprehensive electrophysiologic evaluations


27Medicine (cont.)

Intraoperative Neurophysiology Guidelines revised to define specifically what the time monitoring

and time in the OR includes Monitoring - Time to set up, record, and interpret the baseline studies,

and to remove electrodes at the end of the procedure OR - Time is cumulative and only includes time physically present in the

room; may begin prior to incision Active Wound Care Management

One new code - low frequency non-contact non-thermal US for wound assessment (per day)


28Next Steps

Review all new codes, guidelines, and parenthetical Highlight the changes for your specialty

New guidelines/parenthetical printed in green. Look in the index for any changes. Update coding cheat sheets with the new codes Make sure super bills, charge masters are updated with the new

codes Load new codes into software Educate staff on changes


29Questions? & Reminders…

Current 2014 CPT 2014 CPT® Errata 2014 CPT® Changes: An Insider’s View CPT Assistant AHA Coding Clinic


30Contact Information

Presentation Prepared by- Chandra Stephenson, CPC, CPC-H, CPCO, CPMA, CPC-I, CANPC, CEMC, CFPC, CIMC, COSC

Presentation Presented by- Colleen Mescall, MHA/E, CPC, CPMA, CPC-I, 2014 RAC President, 2013-2015 National Advisory Board Member

Documents

2014 Coding Changes