264 new 2014 Complex Chronic Care Coordination Services ...• Preparation of special reports (code 99080) • Analysis of data (code 99090, 99091) • Transitional care management

2015Coding Changes

Gloria Kirkham CPC, CPC-I, COBGC317-454-7730

Fax317-261-2229

1

DisclaimerThe information contained in this presentation is intended solely for your personal reference. Such information is subject to change without notice, its accuracy is not guaranteed and it may not contain all material information concerning this topic. The Presenter makes no representation regarding, and assumes no responsibility or liability for, the accuracy or completeness of, or any errors or omissions in, any information contained herein.

2

264 new 143 deleted 134 revised

3

Evaluation and Management2014 Complex Chronic Care Coordination Services

– 99487 no face-to-face visit, first hour– 99488 one face-to-face visit, first hour– 99489 each additional 30 minutes

2015 Care Management Services— New Section heading— Two new subsections— Deletion of code 99488— Addition of code 99490

4

Evaluation and Management

• Why were the Chronic Care Management(CCM) Services Created?

• The goal was to recognize critical non-face-to-face time & services of advanced primary care.

• Payment is around $40.00-$43.00 (Not released yet)

5

Evaluation and Management• Not a per beneficiary/per month

payment (you must provide the service)• Coinsurance applies• In order to bill

– Practitioner must inform beneficiary– Obtain written agreement– Must provide beneficiary a copy of the

plan of care

6

Evaluation and ManagementPatients may be identified by practice-specific or other published algorithms that recognize:

– Multiple illnesses– Multiple medication use– Inability to perform activities of daily living– Requirement for a caregiver, and/or– Repeat admissions or ER visits

7


CCM-Incident to– Modified the policy adopted in CY 2014– Allow incident to billing for CCM with

“general supervision” when services provided by clinical staff

– CFR 410.26

8


Care Management Services– Provided by clinical staff, under the

direction of a physician or other QHP (Qualified Healthcare Provider)

– New code allows reporting for patients receiving at least 20 minutes of clinical staff time spent per calendar month.

• (Full Minutes, no ½)

9


To patients who reside:– At home– Domiciliary– Rest home– Assisted living facility

10

Evaluation and ManagementManagement and support services may include:

– Establishing– Implementing– Revising– Monitoring– Coordinating the care of other professionals and

agencies– Educating the patient or caregiver about the

patient’s condition, care plan, and prognosis

11


The Physician or QHP, provides or oversees the management and/or coordination of services, as needed, for all medical conditions, psychosocial needs, and is instrumental in the basic activities of daily living.

12


A patient’s care plan is a comprehensive plan of care for all health problems, which is based on a physical, mental, cognitive, social, functional, and environmental assessment of the patient.

13


Typically include/not all inclusive– Patient’s problem list, with expected outcome

and prognosis– Measurable treatment goals– Symptom management– Planned interventions– Medication management

14


– Community and/or social services ordered, and how the services of agencies and specialists not connected to the practice will be directed and/or coordinated

– Identification of individuals responsible for each intervention

– Requirement for periodic review, and, when applicable, revision of the care plan

15


CPT Codes 99487-99490 are reported only once per calendar month and may only be reported by the single physician or QHP who assumes the care management role with a particular patient for a the calendar month

16


Codes 99487-99489 are not reported if chronic care management services are performed within the postoperative period of a reported surgery performed by the same individual.

17

Evaluation and Management• Determining the clinical staff time spent in

performance of CCM Services for the month– Face to face time

• Spent with the patient and/or family, caregivers, other professionals, and agencies

– Non-face to face timeRevising, documenting, and implementing the care plan

18


• Only clinical staff can count time• When two or more clinical staff

members are meeting about the patient, only count the time of one clinical staff member.

19


• On the first visit do not count that time

• On days that an E/M service is reported do not count that time– 99201-99215; 99324-99337; 99341-

99350

20

Evaluation and Management• The care management office/practice

must have the following capabilities:– Provide 24/7 access to physicians or other QHP or clinical

staff including providing patients and caregivers with a means to make contact with health care professionals in the practice to address urgent needs regardless of the time of day or day of the week

– Provide continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments

21

Evaluation and Management– Provide timely access and management

for follow-up after an ER visit or facility discharge

– Use an electronic health record system so that care providers have timely access to clinical information

– Use a standardized methodology to identify patients who require care management services

22

Evaluation and Management– Have an internal care management process

or function whereby a patient identified as meeting and requirements for these services starts receiving them in a timely manner

– Use a form and format in the medical record that is standardized within the practice

– Be able to engage and educate patients and caregivers as well as coordinate care among all service professionals, as appropriate for each patient

23

Evaluation and Management• Additional E/M services may be reported

separately by the same physician or QHP during the same calendar month by using the appropriate E/M codes).

• However the following services are integral to the performance of care management services (codes 99487-99490)

24

Evaluation and Management• Care plan oversight services (codes

99339, 99340, 99374-99380)• Prolonged services without direct

patient contact (codes 99358-99359) • Anticoagulant management (codes

99363, 99364)

25

Evaluation and Management• Medical team conference (codes 99366,

99368)• Education and training (codes 98960-

98962, 99071, 99078)• Telephone services (codes 98966-98968,

99441-99443)• On-line medical evaluation (codes 98969,

99444)

26

Evaluation and Management• Preparation of special reports (code 99080)• Analysis of data (code 99090, 99091)• Transitional care management services

(codes 99495, 99496)• Medication therapy management services

(codes 99605-99607)• End stage renal disease services (codes

90951-90970)

27


• 99490 CCM services, at least 20 minutes of clinical staff time directed by a physician or other QHP, per month, with the following required elements:– Multiple (two or more) chronic conditions

expected to last at least 12 months, or until the death of the patient

28

Evaluation and Management– Chronic conditions place the patient at

significant risk of death, acute exacerbation/decompensation, or functional decline

– Comprehensive care plan established, implemented revised, or monitored

– If less than 20 minutes duration in a calendar month is spent, this service is not reported separately

29

Evaluation and Management• 99487 Complex Chronic Care Management

Services, required elements– Multiple (two or more) chronic conditions

expected to last at least 12 months, or until the death of the patient

– Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline

30

Evaluation and Management• Establishment or substantial revision

of a comprehensive care plan• Moderate or high complexity medical

decision making• 60 minutes of clinical staff time

directed by a physician or QHP, per calendar month

31


• +99489 Each additional 30 minutes of clinical staff time directed by a QHP per calendar month (List separately in addition to code for primary procedure)

• 99488 has been deleted. To report one or more face-to-face visits by the physician or QHP that are performed in the same month as 99487, use the appropriate E/M code

32

Evaluation and ManagementNOTE: Physicians or QHP may not report complex care management services if the care plan is unchanged or requires minimal change (eg. Only a medication is changed or an adjustment in a treatment modality is ordered)

33

Evaluation and ManagementTypical adult patients who receive complex chronic care management services are treated with three or more prescription medications and may be receiving other types of therapeutic interventions (eg, physical therapy, occupational therapy).

34


Typical pediatric patients receive three or more therapeutic intervention (eg, medications, nutritional support, respiratory therapy).

35

Evaluation and Management99497 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of forms, when performed), by the physician or QHP; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate

36


+99498 each additional 30 minutes (List separately in addition to code for primary procedure)

37

Evaluation and ManagementAdvance Care Planning; are used to report the face-to-face service between a physician or QHP and a patient, family member, or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms.

38

Evaluation and ManagementAn advance directive is 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.

39

Evaluation and ManagementExamples of written advance directives include, but are not limited to Health Care Proxy, Durable Power of Attorney for Health Care Living Will, and Medical Orders for Life-Sustaining Treatment (MOLST)

40


When using codes 99497, 99498, no active management of the problem(s) is undertaken during the time period reported.

41

Evaluation and ManagementSpecific Modifiers for Distinct

Procedural Services http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8863.pdfMLN Matters® Number: MM8863

42


• Release Date: August 15, 2014

• Effective Date: January 1, 2015

• Implementation Date: January 5, 2015

43

Evaluation and ManagementContractors shall use the following as the definition for the CR implementation date:

The implementation date identified in a change request is the date by which Medicare fee-for- service contractors shall apply all changes detailed in the business requirements, unless otherwise specified. It is the date when all necessary updates to infrastructure, business processes and/or supporting technology changes shall be completed and operational in order to execute new/modified policy and procedure.

Note: Implementation dates and effective dates are frequently not the same day. The Implementation date is the same for all business requirement(s) listed within a specific CR, unless otherwise specified.

Contractors shall use the following as the definition for CR effective date:

The effective date identified in a change request is the date on which any new rules, laws, processes and/or policies become active.

44


(CMS) is establishing four new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.”

45

Evaluation and Management• The primary issue associated with the -59

modifier is that it is defined for use in a wide variety of circumstances, such as to identify:

• Different encounters; • Different anatomic sites; and • Distinct services.

46

Evaluation and Management• The -59 modifier is • Infrequently (and usually correctly) used to

identify a separate encounter; • Less commonly (and less correctly) used to

define a separate anatomic site; and • More commonly (and frequently incorrectly)

used to define a distinct service.

47


CMS believes that more precise coding options coupled with increased education and selective editing is needed to reduce the errors associated with this overpayment.

48

Evaluation and Management• XE Separate Encounter, A Service That Is Distinct Because It

Occurred During A Separate Encounter, • XS Separate Structure, A Service That Is Distinct Because It

Was Performed On A Separate Organ/Structure, • XP Separate Practitioner, A Service That Is Distinct Because It

Was Performed By A Different Practitioner, and • XU Unusual Non-Overlapping Service, The Use Of A Service

That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service.

49

Evaluation and ManagementCMS will continue to recognize the -59 modifier, but notes that Current Procedural Terminology (CPT) instructions state that the -59 modifier should not be used when a more descriptive modifier is available. While CMS will continue to recognize the -59 modifier in many instances, it may selectively require a more specific - X{EPSU} modifier for billing certain codes at high risk for incorrect billing.

50

Evaluation and ManagementFor example, a particular NCCI PTP code pair may be identified as payable only with the -XE separate encounter modifier but not the -59 or other -X{EPSU} modifiers. The -X{EPSU} modifiers are more selective versions of the -59 modifier so it would be incorrect to include both modifiers on the same line.

51

Musculoskeletal System

20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes), without ultrasound guidance

20604 with ultrasound guidance, with permanent recording and reporting

– (Do not report 20600, 20604 in conjunction with 76942)

52

Musculoskeletal System

20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance

20606 with ultrasound guidance, with permanent recording and reporting.

– (Do not report 20605, 20606 in conjunction with 76942)

53

Musculoskeletal System20610 Arthrocentesis, aspiration and/or

injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance

20611 with ultrasound guidance, with permanent recording and reporting

– (Do not report 20610, 20611 in conjunction with 27370, 76942)

54

Musculoskeletal System21811 Open treatment of rib

fracture(s) with internal fixation includes thoracoscopic visualization when performed unilateral/ 1-3 ribs

21812 4-6 ribs21813 7 or more ribs

For bilateral procedure, report with modifier 50

55

Musculoskeletal System22510 Percutaneous vertebroplasty

(bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance cervicothoracic

22511 lumbosacral+22512each additional cerviothoracic or

lumbosacral vertebral body (List separately in addition to code for primary procedure)

56

Musculoskeletal System22513 Percutaneous vertebral

augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty(, 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic

22514 lumbar+22515 each additional thoracic

or lumbar vertebral body (List separately in addition to code for primary procedure)

57

Musculoskeletal System27279 Arthrodesis, sacroiliac joint,

percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device

27280 Arthrodesis, open, sacroiliac joint, including obtaining bone graft, including instrumentation, when performed

For bilateral procedures report modifier 50

58

Cardiovascular System

Category III codes 0319T-0328T related to subcutaneous implantable defibrillator procedures have been deleted and replaced with 33270-33273

59

Cardiovascular System#33270 Insertion or replacement of

permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed.

60

Cardiovascular System#33271 Insertion of subcutaneous

implantable defibrillator electrode#33272 Removal of subcutaneous

implantable defibrillator electrode#33273 Repositioning of previously

implanted subcutaneous implantable defibrillator electrode

61

Cardiovascular SystemNew subsection:Extracorporeal Membrane Oxygenation or Extracorporeal Life Support ServicesECMO and /or ECLS procedures

New Introductory guidelines

New Family of codes 33946-33989

62

Cardiovascular SystemCodes 33960 and 33961 were originally developed for use in the neonatal population for severe postpartum respiratory insufficiency, However this treatment has evolved and is now being provided to a variety of adults with severe influenza, pneumonia, and respiratory distress syndrome, as well as to pediatric patients.

63


As a result, codes 33960, 33961, and 36822 have been deleted, and the Cardiac Assist guidelines have been revised to remove reference to deleted code 36822.

64


ECMO/ECLS is a procedure that provides cardiac and/or respiratory support to the heart and/or lungs, which allows them to rest and recover when sick or injured.

65

Cardiovascular SystemECMO/ECLS supports the function of the heart and/or lungs by continuously pumping some of the patient’s blood out of the body to an oxygenator where oxygen is added to the blood, carbon dioxide is removed, and the blood is warmed before it is returned to the patient.

66

Cardiovascular SystemThere are two methods that can be used to accomplish ECMO/ECLS.One method is Venoarterialextracorporeal life support, which supports both the heart and the lungs. Venoarterial ECMO/ECLS requires that two cannulae are placed: one in a large vein and one in a large artery.

67

Cardiovascular SystemThe other method is Venovenousextracorporeal life support, Venovenous ECMO/ECLS is used for lung support only and requires one or two cannula(e), which are placed in a vein.

68

Cardiovascular SystemThe insertion, repositioning, and the removal of the cannula(e) are surgical procedures that can be performed percutaneously, open or by sternotomyor thoracotomy approach and are done on different days.

69


Codes 33946-33989 will facilitate proper reporting of physician work and allow the appropriate professionals who are involved in the treatment of these complex patients to report their services.

70

Cardiovascular SystemCodes 33946 and 33947 describe the initial insertion of the cannulation of the ECMO/ECLS circuit and setting of parameters performed by the physician, which involves determining the necessary ECMO/ECLS device components, blood flow, gas exchange, and other necessary parameters to manage the circuit. For insertion of a cannulation for extracorporeal circulation, report codes 33951-33956

71

Cardiovascular SystemCodes 33948 and 33949 describe the daily management of the ECMO/ECLS circuit and monitoring parameters requiring physician oversight to ensure that specific features of the interaction of the circuit with the patient are met. ECMO therapy is very invasive and requires constant one-on-one monitoring, assessment, and adjustments.

72

Cardiovascular SystemIt would not be appropriate to append modifier 63 to 33946-33949. It would also not be appropriate to report the daily management codes 33948 and 33949 on the same day in conjunction with the initiation codes 33946 and 33947

73


For more information on these codes see the manual provided.

74

Digestive SystemIn 2014 CPT code set, the Esophagus/Endoscopy section was restructured into three subsections: Esophagoscopy, Esophagogastroduodenoscopy (EGD), and Endoscopic Retrograde Cholangiopancreatography(ERCP). In those subsections, the codes were revised, deleted, and added to bundle services that were commonly performed together and to describe current practice more accurately.

75

Digestive SystemIn the 2015 CPT code set, changes have been made to the Intestines and Rectum Endoscopy subsections for the same purposes. A Colonoscopy decision tree has been added to help users select the appropriate colonoscopy code.

76

Decision to undergo

Colonoscopy

Diagnostic Procedure

Does Not Reach Splenic Flexure

Flexible Sigmoidoscopy

(45330)

Beyond Splenic Flexure, But Not To the Cecum

Colonoscopy (45378; Modifier

53)

To Cecum

Colonoscopy (45378, No Modifier)

Therapeutic Procedure

Does Not Reach Splenic Flexure

Flexible Sigmoidoscopy (45331‐45347)

Beyond Splenic Flexure, But Not To the Cecum

Colonoscopy (45379‐45398; Modifier 52)

To Cecum

Colonoscopy (45379‐45398; No Modifier)

77

Digestive SystemDefinition of Colonoscopy –RevisedColonoscopy Is the examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum or small intestine proximal to an anastomosis

78

Digestive SystemDefinition of Colonoscopy through StomaColonoscopy through Stoma is now defined as the examination of the colon, from the colostomy stoma to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis

79

Digestive System

Definition of ProctosigmoidoscopyProctosigmoidoscopy is the examination of the rectum and may include examination of a portion of the sigmoid colon

80

Digestive System

Definition of SigmoidoscopySigmoidoscopy is the examination of the entire rectum, sigmoid colon and may include examination of a portion of the descending colon.

81

Digestive System2014 CPT Code

2015 HCPCS Code

Long Descriptor

44383 G6018 Ileoscopy, through stoma; with transecdoscopic stent placement (includes predilation)

44393 G6019 Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

44397 G6020 Colonoscopy through stoma; with transendoscopicstent placement (includes predilation)

44799 G6021 Unlisted procedure, intestine

82

Digestive System2014 CPT Code

2015 HCPCS Code

Long Descriptor

45339 G6022 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

45345 G6023 Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation)

45383 G6024 Colonoscopy, flexible, proximal to splenic

45387 G6025 Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)

83

Digestive System2014CPT Code

2015 HCPCS Code

Long Descriptor

0226T G6025 Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed

0227T G6027 Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); with biopsy(ies)

84

Digestive SystemIf the patient is Medicare (Original, Medicare Advantage), and :

– If the code has not changed from 2014 to 2015

– Physicians report the CPT code

– If the code has changed from 2014 to 2015

– Physicians report the G code

– If the code is new for 2015– Physicians report the CPT code

85

Digestive SystemStent placement:New codes include pre- and post-dilation and guide wire passage.Use 74360 if fluoroscopic guidance is performed.

86

Digestive SystemStent Placement OLD NEW

Colonoscopy through Stoma

44397 44402

Flexible Sigmoidoscopy

45345 45347

Colonoscopy 45387 45389

87

Digestive SystemEndoscopic Mucosal Resection

Not separately reportable with biopsy, submucosal injection, snare, or band ligation for the same lesion. (Now included)

88

Digestive SystemBalloon Dilation of multiple strictures can be reported with modifier 59 for each additional stricture dilatedUse 74360 if fluoroscopic guidance is performed(Not separately reportable with ablation or stent placement procedures)

89

Digestive SystemBottom line: If 2 or more procedures are reported together 75% of the time it is likely they are or will be bundled.

Review this section in detail

90

Digestive SystemEffective January 1, 2015, Anesthesia professionals who furnish a separately payable anesthesia service in conjunction with a colorectal cancer screening test should include the 33 modifier on the claim line with the anesthesia service.(At the time of preparing this presentation a Change Request (CR) has not been released. Please watch for it).

91

Urinary System

52441Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant

+52442 each additional permanent adjustable transprostaticimplant (List separately in addition to code for primary procedure)

92

Nervous System4 new bundled codes have been added for myelography procedures 62302 Myelography via lumbar injection,

including radiological supervision and interpretation; cervical

62302 thoracic62304 lumbosacral62305 2 or more regions (eg,

lumbar/lhoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)

93

Nervous SystemThe existing injection and radiological supervision and interpretation codes for myelography (77240, 77255, 77265, and 72270) have been retained.These procedures are occasionally performed by two physicians; one performs the contrast injection and the second provides the radiological supervision and interpretation.

94

Nervous System4 codes have been established to report administration of local anesthetic for postoperative pain control and abdominal wall analgesia, including imaging guidance when performed.

95

Nervous System64486 Transverus abdominis plane (TAP)

block (abdominal plane block, rectus sheath block) unilateral by injection(s) i(includes imaging guidance, when performed)

64487 by continuous infusion(s) (includes imaging guidance when performed)

64488 Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral, by injections (includes imaging guidance, when performed)

64489 by continuous infusions (includes imaging guidance, when performed)

96

Nervous SystemBecause more than 50% of the time these services are typically performed bilaterally, codes 64486 and 64487are intended to report the transversusabdominis plane (TAP) block performed unilaterally, and codes 64488 and 64489 are intended to report bilateral services

97

Radiology/Diagnostic UltrasoundCode 76641 is intended to describe a complete ultrasound examination of all four quadrants of the breast, the retroareolar region, and the axilla when performed.

98

Radiology/Diagnostic Ultrasound

Code 76642 is intended to describe a focused ultrasound examination of the breast, with a limited assessment of one or more of the elements included in code 76641, but not all, and of the axilla when performed.

99


Codes 76641 and 76642 should be reported only once per breast per session.

100


Mamography77061, 77062, and 77063 have been established to report diagnostic and screening breast tomosynthesis, unilateral and bilateral procedure.

101

Radiology/Diagnostic UltrasoundBreast tomosynthesis is a digital tomographic, technique performed using multiple low-dose X-ray exposures, which are obtained as the X-ray tube swings in an arc around the compressed breast. The resulting image-data are reconstructed using standard computer algorithms to produce a series of sequential stacked slices through the breast.

102

Radiology/Diagnostic Ultrasound77061 Digital breast tomosynthesis;

unilateral77062 bilateral+77063 Screening digital breast

tomosynthesis, bilateral (List separately in addition to code for primary procedure)(Use 77063 in conjunction with 77057)

103

Radiology/Diagnostic Ultrasound77080 and 77082 has been identified as being reported 75% of the time. As a result, code 77082 has been deleted and new code 77085, which bundles the bone density study and vertebral fracture assessment, was created, In addition, code 77086 was created to report vertebral fracture assessment via DXA.

104

Rad

iolo

gy/D

iagn

ostic

Ultra

soun

d

In r

espo

nse

to t

he a

naly

sis

iden

tifie

ngth

ese

code

s ar

e fr

eque

ntly

rep

orte

d to

geth

er, th

e fa

mily

of

tele

ther

apy

and

brad

hyth

erap

yis

odos

epl

anni

ng c

odes

ha

s be

en u

pdat

ed t

o re

flect

the

cu

rren

t pr

actic

e

105

Rad

iolo

gy/D

iagn

ostic

Ultra

soun

dN

ew c

odes

77306 a

nd 7

7307 h

ave

been

es

tabl

ishe

d to

rep

ort

com

bine

d te

leth

erap

yis

odos

ew

ith b

asic

dos

imet

ry c

alcu

latio

n(s)

.

Sec

ondl

y, n

ew c

odes

77316, 77317, 77318

have

bee

n es

tabl

ishe

d to

rep

ort

com

bine

d br

achy

ther

apy

isod

ose

plan

ning

with

bas

ic

dosi

met

ry c

alcu

latio

n(s)

.

106

2015

CPT

Cod

ing

Upd

ates

Glo

ria K

irkha

m C

PC, C

PC-I,

CO

BG

C

gkirk

ham

@is

man

et.o

rg

Indi

ana

Sta

te M

edic

al A

ssoc

iatio

n 32

2 C

anal

Wal

k In

dian

apol

is In

dian

a 46

202

Tabl

e of

Con

tent

s

Eval

uatio

n an

d M

anag

emen

t ....

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.... 1

M

uscu

losk

elet

al S

yste

m ..

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

. 3

Car

diov

ascu

lar

Sys

tem

.....

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

4

Dig

estiv

e Sys

tem

.....

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

... 6

U

rinar

y Sys

tem

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

8

Ner

vous

Sys

tem

.....

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

8 Ey

e an

d O

cula

r A

ndex

a ...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

. 8

Rad

iolo

gy/D

iagn

ostic

Ultr

asou

nd ..

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

9 Pa

thol

ogy

and

Labo

rato

ry ...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.. 10

M

edic

ine .

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.. 15

CP

T

CO

DI

NG

U

PD

AT

ES

2

01

5

1

Eval

uatio

n an

d M

anag

emen

t

# 9

9490 C

hron

ic c

are

man

agem

ent

serv

ices

, at

lea

st 2

0 m

inut

es o

f cl

inic

al s

taff

tim

e di

rect

ed b

y a

phys

icia

n or

oth

er q

ualif

ied

heal

th c

are

prof

essi

onal

. Pe

r ca

lend

ar m

onth

, w

ith t

he f

ollo

win

g re

quire

d el

emen

ts.

Mul

tiple

(tw

o or

mor

e) c

hron

ic c

ondi

tions

exp

ecte

d to

last

at

leas

t 12 m

onth

s, o

r un

til t

he d

eath

of

the

patie

nt;

C

hron

ic

cond

ition

s pl

ace

the

patie

nt

at

sign

ifica

nt

risk

of

deat

h,

acut

e ex

acer

batio

n/de

com

pens

atio

n, o

r fu

nctio

nal d

eclin

e;

C

ompr

ehen

sive

car

e pl

an e

stab

lishe

d, im

plem

ente

d, r

evis

ed,

or m

onito

red.

(C

hron

ic c

are

man

agem

ent se

rvic

es o

f le

ss tha

n 20 m

inut

es d

urat

ion,

in a

cal

enda

r m

onth

, ar

e no

t re

port

ed s

epar

atel

y)

Cod

es 9

9487,

99489,

99490 a

re r

epor

ted

only

onc

e pe

r ca

lend

ar m

onth

and

may

onl

y be

re

port

ed b

y th

e si

ngle

phy

sici

an o

r ot

her qu

alifi

ed h

ealth

car

e pr

ofes

sion

al w

ho a

ssum

es t

he c

are

man

agem

ent

role

with

a p

artic

ular

pat

ient

for

the

cal

enda

r m

onth

.

Car

e m

anag

emen

t se

rvic

es a

re m

anag

emen

t an

d su

ppor

t se

rvic

es p

rovi

ded

by c

linic

al s

taff

, und

er

the

dire

ctio

n of

a p

hysi

cian

or

othe

r qu

alifi

ed h

ealth

car

e pr

ofes

sion

al,

to a

pat

ient

res

idin

g at

ho

me

or in

a d

omic

iliar

y, r

est

hom

e, o

r as

sist

ed li

ving

fac

ility

.

Do

not

coun

t an

y cl

inic

al s

taff

tim

e on

a d

ay w

hen

the

phys

icia

n or

qua

lifie

d he

alth

car

e pr

ofes

sion

al r

epor

ts a

n E/

M s

ervi

ce.

CP

T

CO

DI

NG

U

PD

AT

ES

2

01

5

2

9

9487 C

ompl

ex c

hron

ic c

are

man

agem

ent

serv

ices

, w

ith t

he f

ollo

win

g re

quire

d el

emen

ts:

Mul

tiple

(tw

o or

mor

e) c

hron

ic c

ondi

tions

exp

ecte

d to

last

at

leas

t 12 m

onth

s,

or u

ntil

the

deat

h of

the

pat

ient

;

Chr

onic

co

nditi

ons

plac

e th

e pa

tient

at

si

gnifi

cant

ris

k of

de

ath,

ac

ute

exac

erba

tion/

deco

mpe

nsat

ion,

or

func

tiona

l dec

line;

Com

preh

ensi

ve c

are

plan

est

ablis

hed,

impl

emen

ted,

rev

ised

, or

mon

itore

d.

M

oder

ate

or h

igh

com

plex

ity m

edic

al d

ecis

ion

mak

ing

60 m

inut

es o

f cl

inic

al s

taff

tim

e di

rect

ed b

y a

phys

icia

n or

oth

er q

ualif

ied

heal

ca

re p

rofe

ssio

nal,

per

cale

ndar

mon

th

+

99489 e

ach

addi

tiona

l 30 m

inut

es o

f cl

inic

al s

taff

tim

e di

rect

ed b

y a

phys

icia

n or

oth

er q

ualif

ied

heal

th c

are

prof

essi

onal

, pe

r ca

lend

ar m

onth

(Li

st s

epar

atel

y in

ad

ditio

n to

cod

e fo

r pr

imar

y pr

oced

ure)

(Rep

ort

99489 in

con

junc

tion

with

99487)

AD

VA

NC

E C

ARE

PLA

NN

ING

99497 A

dvan

ce c

are

plan

ning

incl

udin

g th

e ex

plan

atio

n an

d di

scus

sion

of

adva

nce

dire

ctiv

es s

uch

as s

tand

ard

form

s (

with

com

plet

ion

of f

orm

s, w

en p

erfo

rmed

), b

y th

e ph

ysic

ian

or Q

HP;

firs

t 30 m

inut

es,

face

-to-

face

with

the

pat

ient

, fa

mily

m

embe

r(s)

, an

d/or

sur

roga

te

+99498

ea

ch a

dditi

onal

30 m

inut

es (

List

sep

arat

ely

in a

dditi

on t

o co

de f

or p

rimar

y pr

oced

ure)

CP

T

CO

DI

NG

U

PD

AT

ES

2

01

5

3

Mus

culo

skel

etal

Sys

tem

TRIG

GER

PO

INT IN

JEC

TIO

N

20600 A

rthr

ocen

tesi

s, a

spira

tion

and/

or inj

ectio

n, s

mal

l jo

int

or b

ursa

(eg

, fing

ers,

toe

s),

with

out

ultr

asou

nd g

uida

nce

20604 W

ith u

ltras

ound

gui

danc

e, w

ith p

erm

anen

t re

cord

ing

and

repo

rtin

g

(D

o no

t re

port

20600, 20604 in

con

junc

tion

with

76942)

20605

Art

hroc

ente

sis,

as

pira

tion

and/

or

inje

ctio

n,

inte

rmed

iate

jo

nt

or

burs

a (e

g,

tem

poro

man

dibu

lar,

wris

t, e

lbow

or

ankl

e, o

lecr

anon

bur

sa); w

ithou

t ul

tras

ound

gui

danc

e

20606 W

ith u

ltras

ound

gui

danc

e, w

ith p

erm

anen

t re

cord

ing

and

repo

rtin

g.

(Do

not

repo

rt 2

0605, 20606 in

con

junc

tion

with

76942)

20610 A

rthr

ocen

tesi

s, a

spira

tion

and/

or in

ject

ion,

maj

or jo

int

or b

ursa

(eg

, sh

ould

er,

hip,

kn

ee, su

bacr

omia

l bur

sa);

with

out

ultr

asou

nd g

uida

nce

20611 W

ith u

ltras

ound

gui

danc

e, w

ith p

erm

anen

t re

cord

ing

and

repo

rtin

g

(D

o no

t re

port

20610, 20611 in

con

junc

tion

with

27370, 76942)

OTH

ER P

RO

CED

URES

20982 A

blat

ion

ther

apy

for

redu

ctio

n or

era

dica

tion

of 1

or

mor

e bo

ne t

umor

s (e

g,

met

asta

sis)

incl

udin

g ad

jace

nt s

oft

tissu

e w

hen

invo

lved

by

tum

or e

xten

sion

, pe

rcut

aneo

us, in

clud

ing

imag

ing

guid

ance

whe

n pe

rfor

med

, ra

diof

requ

ency

20983

Cry

obla

tion

FRA

CTU

RE

AN

D/O

R D

ISLO

CA

TIO

N

21811 O

pen

trea

tmen

t of

rib

fra

ctur

e(s)

with

inte

rnal

fix

atio

n in

clud

es t

hora

cosc

opic

vi

sual

izat

ion

whe

n pe

rfor

med

uni

late

ral/

1-3

rib

s

21812

4-6

rib

s

21813

7 o

r m

ore

ribs

PERC

UTA

NEO

US V

ERTEB

RO

PLA

STY

AN

D V

ERTEB

RA

L A

UG

MEN

TA

TIO

N

22510 P

ercu

tane

ous

vert

ebro

plas

ty (bo

ne b

iops

y in

clud

ed w

hen

perf

orm

ed), 1

ver

tebr

al b

ody,

un

ilate

ral o

r bi

late

ral i

njec

tion,

incl

usiv

e of

all

imag

ing

guid

ance

cer

vico

thor

acic

22511

lum

bosa

cral

+

22512

each

add

ition

al c

ervi

otho

raci

c or

lum

bosa

cral

ver

tebr

al b

ody

(Lis

t se

para

tely

in

addi

tion

to c

ode

for

prim

ary

proc

edur

e)

22513 P

ercu

tane

ous

vert

ebra

l aug

men

tatio

n, in

clud

ing

cavi

ty c

reat

ion

(fra

ctur

e re

duct

ion

and

bone

bio

psy

incl

uded

whe

n pe

rfor

med

) us

ing

mec

hani

cal d

evic

e (e

g, k

ypho

plas

ty(, 1

ver

tebr

al

body

, un

ilate

ral o

r bi

late

ral c

annu

latio

n, in

clus

ive

of a

ll im

agin

g gu

idan

ce; th

orac

ic

22514

lum

bar

+22515

each

add

ition

al t

hora

cic

or lu

mba

r ve

rteb

ral b

ody

(Lis

t se

para

tely

in a

dditi

on t

o co

de f

or p

rimar

y pr

oced

ure)

ARTH

RO

DES

IS

27279 A

rthr

odes

is, sa

croi

liac

join

t, p

ercu

tane

ous

or m

inim

ally

inva

sive

(in

dire

ct v

isua

lizat

ion)

, w

ith im

age

guid

ance

, in

clud

es o

btai

ning

bon

e gr

aft

whe

n pe

rfor

med

, an

d pl

acem

ent

of

tran

sfix

ing

devi

ce

CP

T

CO

DI

NG

U

PD

AT

ES

2

01

5

4

Car

diov

ascu

lar Sys

tem

PA

CEM

AKER

OR IM

PLA

NTA

BLE

DEF

IBRIL

IATO

R

#33270 In

sert

ion

or r

epla

cem

ent

of p

erm

anen

t su

bcut

aneo

us im

plan

tabl

e de

fibril

lato

r sy

stem

, w

ith s

ubcu

tane

ous

elec

trod

e, in

clud

ing

defib

rilla

tion

thre

shol

d ev

alua

tion,

indu

ctio

n of

ar

rhyt

hmia

, ev

alua

tion

of s

ensi

ng f

or a

rrhy

thm

ia t

erm

inat

ion,

and

pro

gram

min

g or

rep

rogr

amm

ing

of s

ensi

ng o

r th

erap

eutic

par

amet

ers,

whe

n pe

rfor

med

.

#33271 In

sert

ion

of s

ubcu

tane

ous

impl

anta

ble

defibr

illat

or e

lect

rode

#33272 R

emov

al o

f su

bcut

aneo

us im

plan

tabl

e de

fibr

illat

or e

lect

rode

#33273 R

epos

ition

ing

of p

revi

ousl

y im

plan

ted

subc

utan

eous

impl

anta

ble

defibr

illat

or e

lect

rode

EXTRA

CO

RPO

REA

L M

EMBRA

NE

OX

YG

ENA

TIO

N O

R E

XTRA

CO

RPO

REA

L LI

FE

SU

PPO

RT S

ERV

ICES

Ex

trac

orpo

real

mem

bran

e ox

ygen

atio

n (E

CM

O)/ex

trac

orpo

real

life

sup

port

(EC

LS) pr

ovid

ed b

y ph

ysic

ian;

initia

tion;

ven

o-ve

nous

33947

initi

atio

n, v

eno-

arte

rial

33948

daily

man

agem

ent,

eac

h da

y, v

eno-

veno

us

33949

daily

man

agem

ent,

eac

h da

y, v

eno-

arte

rial

33951

inse

rtio

n of

per

iphe

ral (

arte

rial a

nd/o

r ve

nous

) ca

nnul

a(e)

, pe

rcut

aneo

us,

birt

h th

roug

h 5 y

ears

of

age

(incl

udes

flu

oros

copi

c gu

idan

ce, w

hen

perf

orm

ed)

33952

inse

rtio

n of

per

iphe

ral (

arte

rial a

nd/o

r ve

nous

) ca

nnul

a(e)

, pe

rcut

aneo

us,

6 y

ears

an

d ol

der

(incl

udes

flu

oros

copi

c gu

idan

ce, w

hen

perf

orm

ed)

33953

inse

rtio

n of

per

iphe

ral (

arte

rial a

nd/o

r ve

nous

) ca

nnul

a(e)

, op

en,

birt

h th

roug

h 5

year

s of

age

33954

inse

rtio

n of

per

iphe

ral (

arte

rial a

nd/o

r ve

nous

) ca

nnul

a(e)

, op

en,

6ye

ars

and

olde

r

33955

inse

rtio

n of

cen

tral

can

nula

(e)

by s

tern

otom

y or

tho

raco

tom

y, b

irth

thro

ugh

5

year

s of

age

33956

inse

rtio

n of

cen

tral

can

nula

(e)

by s

tern

otom

y or

tho

raco

tom

y, 6

yea

rs a

nd o

lder

33957

repo

sitio

n pe

riphe

ral (

arte

rial a

nd/o

r ve

nous

) ca

nnul

a(e)

, pe

rcut

aneo

us,

birt

h th

roug

h 5 y

ears

of

age

(incl

udes

flu

oros

copi

c gu

idan

ce, w

hen

perf

orm

ed)

33958

repo

sitio

n pe

riphe

ral (

arte

rial a

nd/o

r ve

nous

) ca

nnul

a(e)

, pe

rcut

aneo

us,

6 y

ears

an

d ol

der

(incl

udes

flu

oros

copi

c gu

idan

ce, w

hen

perf

orm

ed)

33959

repo

sitio

n pe

riphe

ral (

arte

rial a

nd/o

r ve

nous

) ca

nnul

a(e)

, op

en,

birt

h th

roug

h 5

year

s of

age

(in

clud

es f

luor

osco

pic

guid

ance

, w

hen

perf

orm

ed)

#33962

repo

sitio

n pe

riphe

ral (

arte

rial a

nd/o

r ve

nous

) ca

nnul

a(e)

, op

en, 6 y

ears

and

old

er

(incl

udes

flu

oros

copi

c gu

idan

ce,

whe

n pe

rfor

med

)

#33963

repo

sitio

n of

cen

tral

can

nula

(e)

by s

tern

otom

y or

tho

raco

tom

y, b

irth

thro

ugh

5

year

s of

age

(in

clud

es f

luor

osco

pic

guid

ance

, w

hen

perf

orm

ed)

#33964

repo

sitio

n of

cen

tral

can

nula

(e)

by s

tern

otom

y or

tho

raco

tom

y,

6 y

ears

and

ol

der

(incl

udes

flu

oros

copi

c gu

idan

ce,

whe

n pe

rfor

med

)

#33965

rem

oval

of

perip

hera

l (ar

tria

l and

/or

veno

us)

cann

ula(

e),

perc

utan

eous

, bi

rth

thro

ugh

5 y

ears

of

age

#33966

rem

oval

of

perip

hera

l (ar

tria

l and

/or

veno

us)

cann

ula(

e),

perc

utan

eous

, 6 y

ears

an

d ol

der

CP

T

CO

DI

NG

U

PD

AT

ES

2

01

5

5

#33969

rem

oval

of

perip

hera

l (ar

teria

l and

/or

veno

us)

cann

ula(

e),

open

, bi

rth

thro

ugh

5

year

s of

age

#33984

rem

oval

of

perip

hera

l (ar

teria

l and

/or

veno

us)

cann

ula(

e),

open

, 6 y

ears

and

old

er

#33985

rem

oval

of

cent

ral c

annu

la(e

) by

ste

rnot

omy

or t

hora

coto

me,

birt

h th

roug

h 5

year

s of

age

#33986

rem

oval

of

cent

ral c

annu

la(e

) by

ste

rnot

omy

or t

hora

coto

my,

6 y

ears

and

old

er

#+

33987 A

rter

ial e

xpos

ure

with

cre

atio

n of

gra

ft c

ondu

it (e

g, c

him

ney

graf

t) t

o fa

cilit

ate

arte

rial

perf

usio

n fo

r EC

MO

/EC

LS (Li

st s

epar

atel

y in

add

ition

to

code

for

prim

ary

proc

edur

e)

#33988 In

sert

ion

of le

ft h

eart

ven

t by

tho

raci

c in

cisi

on (eg

, st

erno

tom

y, t

hora

coto

my)

for

EC

MO

/EC

LS

#33989 R

emov

al o

f le

ft h

eart

ven

t by

tho

raci

c in

cisi

on (eg

, st

erno

tom

y, t

hora

coto

my)

for

EC

MO

/EC

LS

CP

T

CO

DI

NG

U

PD

AT

ES

2

01

5

6

Dig

estiv

e Sys

tem

EN

DO

SC

OPY

, STO

MA

4438

0 Ile

osco

py, t

hrou

gh s

tom

a; d

iagn

ostic

, inc

ludi

ng c

olie

ctio

n of

spe

cim

en(s

) by

brus

hing

or

was

hing

, whe

n pe

rfor

med

(se

para

te P

roce

dure

#44

381

w

ith tra

nsen

dosc

opic

bal

loon

dila

tion

#44

401

Col

onos

copy

thr

ough

sto

ma;

with

abl

atio

n of

tum

or(s

), p

olyp

(s), o

r ot

her le

sion

(s)

(incl

udes

pre

-and

pos

t-di

latio

n an

d gu

ide

wire

pas

sage

, w

hen

perf

orm

ed)

4440

2 w

ith e

ndos

copi

c st

ent p

lace

men

t (in

clud

ing

pre-

and

post

-dila

tion

and

guid

e w

ire

pass

age,

whe

n pe

rfor

med

)

4440

3 w

ith e

ndos

copi

c, m

ucos

al res

ectio

n

4440

4 w

ith d

irect

ed s

ubm

ucos

al in

ject

ion(

s), an

y su

bsta

nce

4440

5 w

ith tra

nsen

dosc

opic

bal

loon

dila

tion

4440

6 w

ith e

ndos

copi

c ul

tras

ound

exa

min

atio

n, lim

ited

to t

he s

igm

oid,

des

cend

ing,

tr

ansv

erse

, or

asc

endi

ng c

olon

and

cec

um a

nd a

djac

ent st

ruct

ures

4440

7 w

ith t

rans

endo

scop

ic u

ltras

ound

gui

ded

intr

amur

al o

r tr

ansm

ural

fin

e ne

edle

as

pira

tion/

biop

sy(s

), in

clud

es en

dosc

opic

ul

tras

ound

ex

amin

atio

n lim

ited

to th

e si

gmoi

d,

desc

endi

ng, tr

ansv

erse

, or as

cend

ing

colo

n an

d ce

cum

and

adj

acen

t st

ruct

ures

4440

8 w

ith de

com

pres

sion

(for

pa

thol

ogic

di

sten

tion)

(e

g, vo

lvul

us,

meg

acol

on),

incl

udin

g pl

acem

ent of

dec

ompr

essi

on tub

e, w

hen

perf

orm

ed

CP

T

CO

DI

NG

U

PD

AT

ES

2

01

5

7

#

45346 S

igm

oido

scop

y, f

lexi

ble;

with

abl

atio

n of

tum

or(s

), p

olyp

(s),

or

othe

r le

sion

(s)

(incl

udes

pre

-and

pos

t-di

latio

n an

d gu

ide

wire

pas

sage

, w

hen

perf

orm

ed)

45347

with

pla

cem

ent

of e

ndos

copi

c st

ent

(incl

udes

pre

- an

d po

st-

dila

tion

and

guid

e w

ire p

assa

ge,

whe

n pe

rfor

med

)

45349

with

end

osco

pic

muc

osal

res

ectio

n

45350

with

ban

d lig

atio

n(s)

(eg

, he

mor

rhoi

ds)

45388

Col

onos

copy

, fle

xibl

e; w

ith a

blat

ion

of t

umor

(s),

pol

yp(s

), o

r ot

her

lesi

on(s

) (in

clud

es p

re-a

nd p

ost-

dila

tion

and

guid

e w

ire p

assa

ge,

whe

n pe

rfor

med

)

45389

with

end

osco

pic

sten

t pl

acem

ent

(incl

udes

pre

-and

pos

t-di

latio

n an

d gu

ide

wire

pas

sage

, w

hen

perf

orm

ed)

#

45390

w

ith e

ndos

copi

c m

ucos

al r

esec

tion

45393

with

dec

ompr

essi

on (

for

path

olog

ic d

iste

ntio

n) (

eg,

volv

ulus

, m

egac

olon

),

incl

udin

g pl

acem

ent

of d

ecom

pres

sion

tub

e, w

hen

perf

orm

ed

#

45398

w

ith b

and

ligat

ion(

s) (

eg,

hem

orrh

oids

)

LAPA

RO

SC

OPY

#

45399 U

nlis

ted

proc

edur

e, c

olon

AN

US

46601 A

nosc

opy;

dia

gnos

tic, w

ith h

igh

reso

lutio

n m

agni

ficat

ion

(HRA

0 (eg

, co

lpos

cope

, op

erat

ing

mic

rosc

ope)

and

che

mic

al a

gent

enh

ance

men

t, in

clud

ing

colle

ctio

n of

spe

cim

en(s

) by

br

ushi

ng o

r w

ashi

ng, w

hen

perf

orm

ed

46607 w

ith h

igh-

reso

lutio

n m

agni

ficat

ion

(HRA

) (e

g, c

olpo

scop

e, o

pera

ting

mic

rosc

ope)

and

ch

emic

al a

gent

enh

ance

men

t, w

ith b

iops

y, s

ingl

e or

mul

tiple

LIV

ER/O

TH

ER P

RO

CED

URES

47383 A

blat

ion,

1 o

r m

ore

liver

tum

or(s

), p

ercu

tane

ous,

cry

oabl

atio

n

Decisio

n to

unde

rgo

Colono

scop

y

Diagno

stic

Proced

ure

Does Not Reach

Splenic Flexure

Flexible

Sigm

oido

scop

y (45330)

Beyond

Splen

ic

Flexure, But Not

To th

e Ce

cum

Colono

scop

y (45378;

Mod

ifier 53)

To Cecum

Colono

scop

y (45378, N

o Mod

ifier)

Therapeu

tic

Proced

ure

Does Not Reach

Splenic Flexure

Flexible

Sigm

oido

scop

y (45331

‐45347)

Beyond

Splen

ic

Flexure, But Not

To th

e Ce

cum

Colono

scop

y (45379

‐45398;

Mod

ifier 52)

To Cecum

Colono

scop

y (45379

‐45398;

No Mod

ifier)

CP

T

CO

DI

NG

U

PD

AT

ES

2

01

5

8

Urin

ary

Sys

tem

V

ESIC

AL

NEC

K A

ND

PRO

STA

TE

52441 C

ysto

uret

hosc

opy,

with

inse

rtio

n of

per

man

ent

adju

stab

le t

rans

pros

tatic

impl

ant;

si

ngle

impl

ant

+52442

each

add

ition

al p

erm

anen

t ad

just

able

tra

nspr

osta

tic im

plan

t (L

ist

sepa

rate

ly in

add

ition

to

code

for

prim

ary

proc

edur

e)

Ner

vous

Sys

tem

IN

JEC

TIO

N, D

RA

INA

GE,

OR A

SPI

RA

TIO

N

62302 M

yelo

grap

hy v

ia lu

mba

r in

ject

ion,

incl

udin

g ra

diol

ogic

al s

uper

visi

on a

nd

inte

rpre

tatio

n; c

ervi

cal

62302

thor

acic

62304

lum

bosa

cral

62305

2 o

r m

ore

regi

ons

(eg,

lum

bar/

lhor

acic

, ce

rvic

al/t

hora

cic,

lum

bar/

cerv

ical

, lu

mba

r/th

orac

ic/c

ervi

cal)

INTRO

DU

CTIO

N/IN

JEC

TIO

N O

F A

NES

TH

ETIC

AG

ENT (N

ERV

E BLO

CK

),

DIA

GN

OSTIC

OR T

HER

APE

UTIC

64486 T

rans

veru

s ab

dom

inis

pla

ne (

TA

P) b

lock

(ab

dom

inal

pla

ne b

lock

, re

ctus

she

ath

bloc

k) u

nila

tera

l by

inje

ctio

n(s)

i(in

clud

es im

agin

g gu

idan

ce,

whe

n pe

rfor

med

)

64487 b

y co

ntin

uous

infu

sion

(s)

(incl

udes

imag

ing

guid

ance

whe

n pe

rfor

med

)

64488 T

rans

vers

us a

bdom

inis

pla

ne (

TA

P) b

lock

(ab

dom

inal

pla

ne b

lock

, re

ctus

she

ath

bloc

k) b

ilate

ral,

by in

ject

ions

(in

clud

es im

agin

g gu

idan

ce, w

hen

perf

orm

ed)

64489 b

y co

ntin

uous

infu

sion

s (in

clud

es im

agin

g gu

idan

ce,

whe

n pe

rfor

med

)

Eye

and

Ocu

lar A

ndex

a

AQ

UEO

US S

HU

NT

66179 A

queo

us s

hunt

to

extr

aocu

lar

equa

toria

l pla

te r

eser

voir,

ext

erna

l app

roac

h;

with

out

graf

t

66185

with

gra

ft

CP

T

CO

DI

NG

U

PD

AT

ES

2

01

5

9

Rad

iolo

gy/D

iagn

ostic

Ultr

asou

nd

CH

EST

76641 U

ltras

ound

, br

east

, un

ilate

ral,r

eal t

ime

with

imag

e do

cum

enta

tion,

incl

udin

g ax

illa

whe

n pe

rfor

med

; co

mpl

ete

76642

limite

d

BREA

ST,

MA

MM

OG

RA

PHY

77061 D

igita

l bre

ast

tom

osyn

thes

is;

unila

tera

l

77062

bila

tera

l

+

77063 S

cree

ning

dig

ital b

reas

t to

mos

ynth

esis

, bi

late

ral (

List

sep

arat

ely

in a

dditi

on t

o co

de f

or p

rimar

y pr

oced

ure)

(U

se 7

7063 in

con

junc

tion

with

77057)

RA

DIA

TIO

N T

REA

TM

ENT D

ELIV

ERY

#77385 In

tens

ity m

odul

ated

rad

iatio

n tr

eatm

ent

deliv

ery

(IMRT),

incl

udes

gui

danc

e an

d tr

acki

ng,

whe

n pe

rfor

med

; si

mpl

e

#77386

com

plex

#77387 G

uida

nce

for

loca

lizat

ion

of t

arge

t vo

lum

e fo

r de

liver

y of

rad

iatio

n tr

eatm

ent

deliv

ery,

incl

udes

intr

afra

ctio

n tr

acki

ng,

whe

n pe

rfor

med

BO

NE/

JOIN

T S

TU

DIE

S

#770

85 D

ual-e

nerg

y X

-ray

abs

orpt

iom

etry

(D

XA

), b

one

dens

ity s

tudy

, 1 o

r m

ore

site

s; a

xil

skel

eton

(eg

, pe

lvis

, sp

ine)

, in

clud

ing

vert

ebra

l fra

ctur

e as

sess

men

t

#770

86 V

erte

bral

fra

ctur

e as

sess

men

t vi

a du

al-e

nerg

y X

-ray

abs

orpt

iom

etry

(D

XA

)

MED

ICA

L RA

DIA

TIO

N P

HY

SIC

S, D

OSIM

ETRY

, TREA

TM

ENT D

EVIC

ES,

AN

D

SPE

CIA

L SER

VIC

ES

7730

6 Te

leth

erap

y is

odos

e pl

an; si

mpl

e (1

or

2 un

mod

ified

por

ts d

irect

ed t

o a

sing

le a

rea

of

inte

rest

,) in

clud

es b

asic

dos

imet

ry c

alcu

latio

n(s)

7730

7

com

plex

(m

ultip

le tr

eatm

ent

area

s, ta

ngen

tial

prot

s, th

e us

e of

w

edge

s,

bloc

king

, ro

tatio

nal

beam

, or

sp

ecil

beam

co

nsid

erat

ions

).

Incl

udes

ba

sic

dosi

met

ry

calc

ulat

ion(

s)

7731

6 Br

achy

ther

apy

isod

ose

plan

; sim

ple

(cal

cula

tion(

s) m

ade

from

1 to

4 s

ourc

es, o

r rem

ote

afte

rload

ing

brad

ythe

rapy

, 1

chan

nel),

incl

udes

bas

ic d

osim

etry

cal

cula

tion(

s)

7731

7

inte

rmed

iate

(ca

lcul

atio

n(s)

mad

e fr

om 5

to 1

0 so

urce

s, o

r rem

ote

afte

rload

ing

brac

hyth

erap

y, 2

-*12

cha

nnel

(s), in

clud

es b

asic

dos

imet

ry c

alcu

latio

n(s)

7731

8

com

plex

(ca

lcul

atio

n(s)

mad

e fr

om o

ver

10 s

ourc

es o

r re

mot

e af

terlo

adin

g br

achy

ther

apy,

ove

r 12

cha

nnel

(s) in

clud

es b

asic

dos

imet

ry c

alcu

latio

n(s)

CP

T

CO

DI

NG

U

PD

AT

ES

2

01

5

10

Path

olog

y an

d La

bora

tory

PR

ESU

MPT

IVE

DRU

G C

LASS S

CREE

NIN

G

#80300 D

rug

scre

en ,

any

num

ber

of d

rug

clas

ses

from

Dru

g C

lass

Lis

t A

; an

y nu

mbe

r of

non

-TLC

dev

ices

or

proc

edur

es,

(eg

imm

unoa

ssay

) ca

pabl

e of

bei

ng#

rea

d by

dire

ct o

ptic

al o

bser

vatio

n, in

clud

ing

inst

rum

ente

d-as

sist

ed w

hen

perf

orm

ed (

eg,

dips

ticks

, cu

ps,

card

s, c

artr

idge

s),

per

date

of

serv

ice

#80301

sing

le d

rug

clas

s m

etho

d, b

y in

stru

men

ted

test

sys

tem

s (e

g, d

iscr

ete

mul

ticha

nnel

che

mis

try

anal

yzer

s ut

ilizi

ng im

mun

oass

ay o

r en

zym

e as

say)

, pe

r da

te o

f se

rvic

e

# 8

0302 D

rug

scre

en,

pres

umpt

ive,

sin

gle

drug

cla

ss f

rom

Dru

g C

lass

Lis

t B,

by

imm

unoa

ssay

(eg

, EL

ISA

) or

non

-TLC

chr

omat

ogra

phy

with

out

mas

s sp

ectr

omet

ry (

eg,

GC

, H

PLC

), e

ach

proc

edur

e

#80303 D

rug

scre

en,

any

num

ber

of d

rug

clas

ses,

pre

sum

ptiv

e, s

ingl

e or

mul

tiple

dru

g cl

ass

met

hod;

thi

n la

yer

chro

mat

ogra

phy

proc

edur

e(s)

(TLC

) (e

gm a

cid,

neu

tral

, al

kalo

id

plat

e),

per

date

of

serv

ice

#80304

not

othe

rwis

e sp

ecifi

ed p

resu

mpt

ive

proc

edur

e (d

g, T

OF,

MA

LDI,

LDTD

, D

ESI,

DA

RT),

eac

h pr

oced

ure

DEF

INIT

IVE

DRU

G T

ESTIN

G

#80320 A

lcoh

ols

#80321 A

lcoh

ol b

iom

arke

rs;

1 o

r 2

#80322

3 o

r m

ore

#80323 A

lkal

oids

, no

t ot

herw

ise

spec

ified

#80324 A

mph

etam

ines

; 1 o

r 2

#80325

3 o

r 4

#80326

5 o

r m

ore

#80327 A

nabo

lic s

tero

ids;

1 o

r 2

#80328

3 o

r m

ore

#80329 A

nage

sics

, no

n-op

iod;

1 o

r 2

#80330

3-5

#80331

6 o

r m

ore

#80332 A

ntid

epre

ssan

ts,

sero

tone

rgic

cla

ss;

1 o

r 2

#80333

3-5

#80334

6 o

r m

ore

#80335 A

ntid

epre

ssan

ts,

tric

yclic

and

oth

er c

yclic

als;

1 o

r 2

#80336

3-5

#80337

6 o

r m

ore

#80338 A

ntid

epre

ssan

ts,

not

othe

rwis

e sp

ecifi

ed

#80339 A

ntie

pile

ptic

s, n

ot o

ther

wis

e sp

ecifi

ed;

1-3

#80340

4-6

#80341

7 o

r m

ore

#80342 A

ntip

sych

otic

s, n

ot o

ther

wis

e sp

ecifi

ed;

1-3

#80343

4-6

#80344

7 o

r m

ore

#80345 B

arbi

tura

tes

CP

T

CO

DI

NG

U

PD

AT

ES

2

01

5

11

#80346 B

enzo

diaz

epin

es;

1-1

2

#80347

13 o

r m

ore

#80348 B

upre

norp

hine

#80349 C

anna

bino

ids,

syn

thet

ic,

1-3

#80350 C

anna

bino

ids,

syn

thet

ic;

1-3

#80351

4-6

#80352

7 o

r m

ore

#80353 C

ocai

ne

#80354 F

enta

nyl

#80355 G

abap

entin

, no

n-bl

ood

#80356 H

eroi

n m

etab

olite

#80357 K

etam

ine

and

nork

etam

ine

#80358 M

etha

done

#80359 M

ethy

lene

diox

yam

phet

amin

es (

MD

A,

MD

EA,

MD

MA

)

#80360 M

ethy

lphe

nida

te

#80361 O

piat

es,

1 o

r M

ore

#80362 O

piod

s an

d op

iate

ana

logs

, 1 o

r 2

#80363

3 o

r 4

#80364

5 o

r m

ore

#80365 O

xyco

done

#80366 P

rega

balin

#80367 P

ropo

xyph

ene

#80368 S

edat

ive

hypn

otic

s (n

on-b

enzo

diaz

epin

es)

#80369 S

kele

tal m

uscl

e re

laxa

nts;

1 o

r 2

#80370

3 o

r m

ore

#80371 S

timul

ants

, sy

nthe

tic

#80372 T

apen

tado

l

#80373 T

ram

adol

#80374 S

tere

oiso

mer

(en

antio

mer

) an

alys

is,

sing

le d

rug

clas

s

#80375 D

rug(

s) o

r su

bsta

nce(

s),

defin

itive

, qu

alita

tive

or q

uant

itive

, no

t ot

herw

ise

spec

ified

; 1-3

#80376

4-6

#80377

7 o

r m

ore

TH

ERA

PEU

TIC

DRU

G A

SSA

YS

80163 D

igox

in;

free

#80165 V

alpr

oic

acid

(di

prop

ylac

etic

aci

d);

free

MO

LEC

ULA

R P

ATH

OLO

GY

81246 F

LT3 (

fms-

rela

ted

tyro

sine

kin

ase

3)

(eg,

acu

te m

yelo

id le

ukem

ia),

gen

e an

alys

is;

tyro

sine

kin

ase

dom

ain

(TK

D)

varia

nts

(eg,

D835,

I836)

#81288 M

LH1 (

mut

L ho

mal

og 1

, co

lon

canc

er,

nonp

olyp

osis

typ

e 2)

(eg,

her

edita

ry

non-

poly

posi

s co

lore

ctal

can

cer,

Lyn

ch s

yndr

ome)

gen

e an

alys

is;

prom

oter

met

hyla

tion

anal

ysis

81313 P

CA

3/K

LK3 (

pros

tate

can

cer

antig

en 3

[no

n-pr

otei

n co

ding

]/ka

llikr

ein-

rela

ted

pept

ides

3 [

pros

tate

spe

cific

ant

igen

]) r

atio

(eg

, pr

osta

te c

ance

r)

CP

T

CO

DI

NG

U

PD

AT

ES

2

01

5

12

GEN

OM

IC S

EQU

ENC

ING

PRO

CED

URES

AN

D O

TH

ER M

OLE

CU

LAR M

ULT

IAN

ALY

TE

ASSA

YS

81410 A

ortic

dys

func

tion

or d

ilatio

n (e

g, M

arfa

n sy

ndro

me,

Loe

ys D

ietz

syn

drom

e,

Ehle

r D

anlo

s sy

ndro

me

type

IV,

arte

rial t

ortu

osity

syn

drom

e);

geno

mic

seq

uenc

e an

alys

is p

anes

, m

ust

incl

ude

sequ

enci

ng o

f at

leas

t 9 g

enes

, in

clud

ing

FBN

1,

TG

FBR1,

TG

FBR2,

CO

L3A

1,

MY

H1,

AC

TA

2,

SLC

2A

10,

SM

AD

3,

and

MY

LK

81411

du

plic

atio

n/de

letio

n an

alys

is p

anel

, m

ust

incl

ude

anal

yses

for

TG

FBR1,

TG

FBR2,

MY

H11,

and

CO

L3A

1

81415 E

xom

e (e

g, u

nexp

lain

ed c

onst

itutio

nal o

r he

ritab

le d

isor

der

or s

yndr

ome0

; se

quen

ce a

naly

sis

+81416

sequ

ence

ana

lysi

s, e

ach

com

para

tor

exom

e (e

g, p

aren

ts,

sibl

ings

) (li

st

sepa

rate

ly in

add

ition

to

code

for

prim

ary

proc

edur

e)

81417

re-e

valu

atio

n of

pre

viou

sly

obta

ined

exo

me

sequ

ence

(eg

, up

date

d kn

owle

dge

or u

nrel

ated

con

ditio

n/sy

ndro

me)

Documents

264 new 2014 Complex Chronic Care Coordination Services ...• Preparation of special reports (code 99080) • Analysis of data (code 99090, 99091) • Transitional care management