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Disclaimer

Current Procedural Terminology (CPT) is copyright © 2014 American Medical Association. All rights reserved.

This document will highlight the changes for CPT codes in 2014, but will not include ALL changes. Our goal is to help you understand new codes and the reasoning for some of the organizational changes to CPT.

It is every individual’s responsibility to read and absorb the changes in the CPT manual every year.

Although every reasonable effort has been made to assure the accuracy of the information within this document, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services.

The Changes

Category I Codes• 107 New• 40 Deleted• 103 Revised

Category II Code• 47 New• 1 Revised

Resequenced Code• Now total 120

(16 added)

Change Management

Comb through the CPT book for all code changes andinstructions that impact your practice.

– Train Coders on change requirements

– Train Physicians on documentation requirements

– Inform your Billing Dept. so that an impact analysis can be performed

Evaluation & Management

No deletionsNo revisionsNew guidelines

– Neonatal Intensive Care Unit (NICU), complex and transitional care services reporting neutrality

Six new codes


NICU/Pediatric Critical care New guidelines

– Services included during pediatric patient transport that may not be reported separately:

• Routine monitoring evaluations, interpretation of cardiac output measurements, pulse oximetry, blood gases and information data stored in computers, gastric intubation, temporary transcutaneous pacing, ventilatory management, vascular access procedures.

– Only the communication time spent by the supervising physician is reported for 99485


Complex Chronic Care Coordination ServicesNew guidelines

• Editorial revisions defining patient population, practice capabilities, the care plan, and reporting requirements.

• Defines care plan as including physical, mental, cognitive, social, functional and environmental assessment, with problem list, expected outcome and prognosis, measurable treatment goals, symptom management, interventions, medication management, community social services ordered, timeline for review, and any revisions.


A new category of E&M services has been introduced in CPT2014• Interprofessional telephone/internet assessment and

management services • What is it?

– A non-face-to-face patient assessment and management service by a physician with specific specialty expertise, requested by the patient’s attending/primary MD/QHP.

– Typically provided in complex and/or urgent situations that do not allow for a timely face-to-face service (eg, distance)

New codes 99446 - 99449


New codes• 99446 - Interprofessional telephone/Internet assessment and

management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review

– 99447 11-20 minutes of medical consultative discussion and review – 99448 21-30 minutes of medical consultative discussion and review – 99449 31 minutes or more of medical consultative discussion and

review


Who reports it?– The physician with specific specialty expertise (the consultant) who:

• Has not had a face-to-face encounter with the patient within the last 14 days

• Cannot accept transfer of care until after the consultationWhat is included? Review of:

• Pertinent records• Laboratory studies • Imaging studies• Medication profile• Pathology specimens

– Greater then 50% of the time reported must be devoted to medical consultative verbal/internet discussion


How are the codes reported?– Only one code should be reported by

the consultant– Code is chosen based on the time

spent for the entirety of the service– Should not be reported more than

once in a 7 day period

• However, if more than one telephone/internet contact is required to complete the service –report a single code for the cumulative discussion and information review time.


New codesInpatient Neonatal and Pediatric Critical Care

– 99481 Total body systemic hypothermia in critically ill neonate per day (List separately in addition to code for primary procedure)

– 99482 Selective head hypothermia in a critically ill neonate per day (List separately in addition to code for primary procedure)


Inpatient Neonatal and Pediatric Critical CareHow are the codes reported?

– Therapeutic hypothermia for brain injury caused by birth asphyxia and hypoxic ischemic encephalopathy (HIE)

– For example, 33 degrees C (91.4 degrees F) for 72 hours– Cool-Cap® system (99482)– These are add-on codes– Codes out of sequence, following 99476

Integumentary

New image-guided drainage code

Complex repair deletion

Breast excision revisions regarding guidance

Integumentary

New code• 10030 Image-guided fluid collection drainage by catheter (eg,

abscess, hematoma, seroma, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck), percutaneous

Deleted code• 13150 Repair, complex, eyelids, nose, ears and/or lips;

1.0 cm or less

Integumentary

Breast ExcisionCode changes

– Nine new comprehensive codes have replaced the existing biopsy (19102/19103), clip (19295), and localization (19290/19291) procedure codes.

– Procedure codes will now include any procedures commonly performed at the time of biopsy (clip placement, specimen radiograph, etc.)

– Codes are based on the type of radiologic guidance, which is now included in the code, and also based on the number of lesions treated.

Integumentary

Breast ExcisionCode changes

– Codes 19102, 19103, 19290, 19291, 19295, and imaging guidance codes 77031 and 77032 have been deleted

– Replaced with new bundled breast biopsy codes 19081 – 19086 and new bundled breast localization device codes 19281 - 19288

Musculoskeletal

Overview– Revised introductory guidelines

• Excision of subcutaneous soft tissue tumors• Radical resection of soft tissue tumors

– New codes for removal of FB shoulder, deep and removal of prosthesis humeral and/or glenoid

– Revised codes for removal of prosthesis humeral and ulnarcomponents

– New cross-references

Musculoskeletal

Excision of subcutaneous soft connective tissue tumorsIntroductory guideline changes

– “(including simple or intermediate repair) involves the simple or marginal resection of tumors confined to subcutaneous tissue below the skin but above the deep fascia. These tumors are usually benign and are resected without removing a significant amount of surrounding normal tissue.”

Musculoskeletal

Radical resection of soft connective tissue tumorsIntroductory guideline changes

– “(including simple or intermediate repair) involves the resection of the tumor with wide margins of normal tissue. Appreciable vessel exploration and/or neuroplasty repair or reconstruction (eg, adjacent tissue transfer[s], flap[s]) should be reported separately.”

– “Extensive undermining….may require a complex repair which should be reported separately.”

– “Dissection or elevation of tissue planes to permit resection of the tumor is included in the excision.”

Musculoskeletal

Shoulder prosthesis– Codes 23331 and 23332 were deleted– Three new codes 23333 (FB removal shoulder, deep), 23334, 23335

• Created to delineate between removal of foreign body and prosthesis

• 23334 (one component, Humeral or Glenoid) • 23335 (both components) Humeral and Glenoid (total shoulder)

Musculoskeletal

Elbow prosthesis– Codes 24160 and 24164 were revised– Specify removal of prosthesis, including debridement and

synovectomy “when performed”

Application of Casts and Strapping– Lower Extremity codes 29581 and 29582 were revised– New parenthetical regarding what these codes CANNOT be reported in

addition to.

Cardiovascular

Aortic Valve– Cat III code 0318T was deleted and replaced with Cat I code;

• 33366, Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure (eg, left thoracotomy)

• Guidelines were updated to include the new code

Cardiovascular

Revised codes

33222 Revision or Relocation of skin pocket for pacemaker

33223 Revision or Relocation of skin pocket for cardioverter-defibrillator

• Revisions are reported with appropriate integumentary codes or with pacemaker insertion or replacement codes

• Note new implant codes for subcutaneous defibrillator systems, 0319T-0339T

Cardiovascular

Arteries and Veins• New subsection & guidelines

– Deleted Cat III codes 0078T – 0081T

• New Cat I codes 34841 – 34848– Fenestrated Endovascular Repair of the Visceral and Infrarenal Aorta

(FEVAR)

Cardiovascular

Fenestrated Endovascular Repair of the Visceral andInfrarenal Aorta (34841-34848)

– Fenestrate: to make an opening– Visceral and infrarenal aorta: aorta distal to the diaphragm (abdominal

aorta) from which arteries divide to nourish the abdominal organs – Code choice based on number of endoprostheses, and site – Previously reported with 0078T and 0081T (deleted)

Cardiovascular

New codes– Fenestrations (window) allow for selective catheterization of the

visceral and/or renal arteries and subsequent placement of an endoprosthesis

– Codes 34841 – 34844 and 34845 – 34848 define the total number of visceral and/or renal arteries requiring placement of an endoprosthesis through an aortic endograft fenestration

– Codes 34841 – 34844 report deployment of a fenestrated endoprosthesis that spans from the visceral aorta through the infrarenal aorta and does NOT extend into the common iliac arteries

– Codes 34845 – 34848 report deployment of a fenestrated endoprosthesis that spans from the visceral aorta through the infrarenal aorta into the common iliac arteries

Cardiovascular

Codes 34841 – 34848 include:

– Placement of unilateral or bilateral docking limbs (depending on the device) into the iliac system

– Any additional stent graft extensions that terminate in the aorta (34841-34844) or in the common iliac (34845 – 34848)

– Proximal abdominal aortic extension prosthesis(es)– Introduction of guide wires and catheters non-selectively into the

aorta and selectively into the visceral and/or renal arteries.– Balloon angioplasty within the target treatment zone of the endograft,

either before or after deployment– Fluoroscopic guidance and radiological supervision and interpretation

in conjunction with fenestrated endovascular aorta repair

Cardiovascular

Codes 34841 – 34848 don’t include:

– Distal extension prosthesis(es) that terminate in the internal iliac, or common femoral artery(s)

– Catheterizations of the hypogastric artery(s) and/or arterial families outside the treatment zone of the graft

– Exposure of the access vessel (eg, 34812)– Extensive repair of an artery (eg, 35226, 35286)– Interventional procedures performed at the time of fenestrated

endovascular abdominal aortic aneurysm repair

Cardiovascular

New code 37217 Transcatheter placement of intravascular stent(s), intrathoracic

common carotid artery or innominate artery by retrograde treatment

– Approach against the flow of arterial blood– Typically via open ipsilateral cervical carotid exposure– Includes angioplasty, radiological S&I

Cardiovascular

37212 includes:

– Carotid artery open surgical exposure and standard closure of the arteriotomy by suture

– All retrograde access and catheterization of the vessel, traversing the lesion

– Any radiological supervision and interpretation directly related to the intervention when performed ( i.e., includes diagnostic angiogram)

– Imaging performed to document completion of the intervention in addition to the intervention(s) performed (i.e., the stenting and angioplasty)

Cardiovascular

37217 does not include:

– Carotid artery revascularization services (eg, 33891, 35301, 35509, 35510, 35601, 35606) performed during the same session may be reported separately, when performed

Cardiovascular

Endovascular Stent Placement (Open or Percutaneous),TranscatheterCode changes

– Codes 37205 – 37208, 75960 were deleted– New codes 37236 – 37239– Codes 37236, 37237 describe transluminal intravascular stent

insertion in an artery– Codes 37238, 37239 describe transluminal intravascular stent

insertion in a vein– Report codes 37237 and/or 37239 as appropriate, when additional,

separate and distinct vessels are treated in the same session

Cardiovascular

Codes 37236 – 37239 include:

– All balloon angioplasty(s) performed in the treated vessel including treatment of a lesion outside the stented segment but in the same vessel

– Any pre-dilation (whether performed as a primary or secondary angioplasty ie, failed PTA requiring stent salvage

– Post-dilation following stent deployment– Use of larger/smaller balloon to achieve therapeutic result– Radiological supervision and interpretation directly related to the

intervention(s) performed– Closure of arteriotomy by pressure, application of an arterial closure

device or standard closure of the puncture by suture– Imaging performed to document completion of the intervention

Cardiovascular

Codes 37236 – 37239 don’t include:

– Angioplasty in a separate and distinct vessel– Non-selective and/or selective catheterization(s) (eg, 36005, 36010-

36015, 36200, 36215-36218, 36245-36248)– Extensive repair or replacement of an artery (eg, 35226 or 35286)– Ultrasound guidance (76937) for vascular access– Intravascular ultrasound (ie, 37250, 37251)– Initial diagnostic angiography (as defined under “Vascular Procedures”

in the CPT Radiology section)

Cardiovascular

New codes

37241 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural road mapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)

37242 arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)

37243 for tumors, organ ischemia, or infarction

37244 for arterial or venous hemorrhage or lymphatic extravasation

Digestive

Deleted abscess drainage codes

– 32201 (pneumonostomy code discussed in Respiratory section) – 44901 Incision and drainage of appendiceal abscess; percutaneous– 47011 Hepatotomy; for percutaneous drainage of abscess or cyst, 1 or 2 stages – 48511 External drainage, pseudocyst of pancreas; percutaneous– 49021 Drainage of peritoneal abscess or localized peritonitis, exclusive of

appendiceal abscess; percutaneous– 49041 Drainage of subdiaphragmatic or subphrenic abscess; percutaneous– 49061 Drainage of retroperitoneal abscess; percutaneous

(Urinary/Female)

– 50021 Drainage of perirenal or renal abscess; percutaneous– 58823 Drainage of pelvic abscess, transvaginal or transrectal approach,

percutaneous (eg, ovarian, pericolic)

Digestive

New drainage codes Abdomen, Peritoneum, and Omentum

49405 Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, spleen, lung/mediastinum), percutaneous

49406 peritoneal or retroperitoneal, percutaneous

49407 peritoneal or retroperitoneal, transvaginal or transrectal

Digestive

26 new, 41 revised, 17 deleted codes – Selection based on

– Approach: Transoral or transnasal– Scope: Flexible or rigid – Additional clarity to procedure performed – Some new concepts

• Most comprehensive change in CPT this year

Digestive

Two new transnasal esophagoscopy (TNE) codes:– 43197 and 43198– Performed to evaluate the esophagus from its inlet through the

gastroesophageal junction.– Includes the nasal cavity (one or both sides), nasopharynx,

hypopharynx, and the larynx

Digestive

Transoral esophagoscopy

– In 2013 – codes 43200 – 43232 described either rigid or flexible transoral esophagoscopy

– In 2014, rigid and flexible transoral esophagoscopy procedures have been separated into two distinct code families;

• 43200 – 43232 flexible scope• 43191 – 43196 rigid scope

Digestive

Endoscopic Mucosal Resection (EMR)Two new codes

– 43211 - esophagoscopy– 43254 - EGD

• EMR can include injection-assisted, cap-assisted, and ligation-assisted techniques

• All techniques involve;– Identification and demarcation of the lesion;– Submucosal injection to lift the lesion, and– Endoscopic snare resection

Digestive

Esophagoscopy, EGD, and ERCPCode changes

– Stent placement codes 43219, 43256, 43268 were deleted– New codes added that include pre/post-dilation and guidewire

passage, when performed

• 43212 – esophagoscopy• 43266 – EGD• 43274 – ERCP (includes sphincterotomy)

– Code 43241 was revised for consistency

Digestive

DilationCode changes

– 43220 (esophagoscopy) and 43249 (EGD)• Revised to specify transendoscopic balloon dilation <30 mm in

diameter– 43214 (esophagoscopy) and 43233 (EGD)

• New codes added for upper endoscopy with balloon dilation of ≥ 30 mm

• Fluoroscopic guidance is included• High risk services due to size of balloon and risk of perforation

– Code 43456 was deleted, replaced with 43213• Esophagoscopy, retrograde dilation, fluoroscopy is included

Digestive

EGD with endoscopic ultrasound (EUS)

– Codes 43237, 43238 revised• Report if EUS is performed of the esophagus, stomach OR

duodenum and adjacent structures– Codes 43242, 43259 revised

• Report if EUS is performed of the esophagus, stomach ANDduodenum, or

• A surgically altered stomach where the jejunum is examined distal to the anastomosis

Neurology

• Chemodenervation• Deletion of codes 64613, 64614• New codes 64616, 64617, 64642 – 64647• New and revised parenthetical notes

Neurology

Code 64616 added to describe chemodenervation of neckmuscle other than muscles of the larynx• Describes a unilateral procedure, for bilateral services

append modifier 50

– Parenthetical directs coder to 95873 and 95874 for chemodenervationguided by a needle EMG or performed by muscle electrical stimulation.

– It would not be appropriate to report more than one guidance code for any unit of 64616.

Neurology

64617 – same unilateral/bilateral guidance as64616

– Includes all intralaryngeal muscles that might be injected– Includes local-topical anesthesia, if used– EMG guidance is included in code descriptor

• Diagnostic EMG of larynx is coded 95865

Neurology

Chemodenervation – Extremity

– New codes, guidelines and parenthetical notes added to report these codes

• Codes 64642 – 64645 are reported once per extremity• Report only one base code(s), i.e. 64642 or 64644 per session• Report one or more units of add-on codes 64643 or 64645 for each

additional extremity injected

– Document what muscle(s) were injected and how many units of Botox was administered in each injection

Neurology

Chemodenervation – Trunk muscle(s)

– Two new codes; 64646 and 64647– Parenthetical note added to direct the user to report either 64646 or

64647 once per session– There is no bilateral code or modifier allowed, just count the total

number of trunk muscles injected

• 64646 = 1 – 5 muscle(s)• 64647 = 6 or more muscles

Ophthalmology

Surgery – Eye and Ocular Adnexa

– Codes 65778 and 65779 were revised

– The phrase “for wound healing” was removed because it restricted the use of these codes for this purpose• The amniotic membrane is also

utilized for protection of the transplanted cornea from infection and for promotion of wound healing

– Substitute the term “self-retaining” with the term “without sutures”

Ophthalmology

Anterior Sclera

– Aqueous Shunt– New code 66183, replaced Cat. III code 0192T

• Added to report the insertion of an anterior segment drainage device for the management of glaucoma using an external surgical approach.

• Placed to relieve intraocular pressure associated w/glaucoma that is not responding to medical therapy or surgical interventions (eg, laser trabeculoplasty).

Otolaryngology

Code revision – 69210 removal of impacted cerumen

– “Removal impacted cerumen requiring instrumentation, unilateral”

– Requires use of instrumentation and generally magnification (eg, otoscope, operating microscope) to physically remove the cerumen

Radiology

Code 72040

– Revised to include the exact number of views to eliminate overlap in the coding structure

• 72040 Radiologic examination, spine, cervical; 2 or 3 views

• 72050 4 or 5 views• 72052 6 or more views

Radiology

• Radiation Oncology

– Description of Simulation is now included in the guidelines– Definitions for the three categories of Simulation are now included in

the guidelines– Code 77295 is now listed under “Medical Radiation Physics, Dosimetry,

Treatment Devices, and Special Services”– New add-on code 77293 is now listed under “Clinical Treatment

Planning (External and Internal Sources)”

Pathology & Laboratory

Therapeutic Drug Assays

– Ten new codes added to identify drug assay procedures– As stated in the existing Therapeutic Drug Assay guidelines, the

material tested may be from any source and are quantitative in nature– Anticipated major changes in drug testing codes for 2015


Molecular Pathology

– Tier 1• Now contains 107 codes

– Tier 2 – Code revisions (analyte additions to each level):• 81400 – 81408• Editorial revisions to existing codes to include additional analytes

determined to fall under Tier 2 reporting


81400 9 additions

81401 24 additions

81402 1 additions

81403 19 additions

81304 52 additions

81405 84 additions

81406 91 additions

81407 24 additions

81408 14 additions

Medicine

• Vaccine, Toxoids– New code 90673 – established for a trivalent recombinant DNA

influenza vaccine (FDA approval 1/2013)

• Four new quadrivalent influenza virus vaccine codes• 90685 – 90688• Quadrivalent; two type A strains and two type B strains• Codes distinguish between infants and young children and

individuals 3 years of age an older, as well as with and without preservatives

Medicine

GastroenterologyCode 91065 was revised

– Includes methane testing• Used to measure end-expiratory breath specimens

– Parenthetical instruction added instructing the user to report this code once for each test administered

Medicine

Special Otorhinolaryngologic ServicesCode 92506 was deleted (lacked specificity)• Four new codes

– 92521 – 92524– Directly relate to the evaluation of speech fluency, speech sound

production, language comprehension, and expression, and analysis of voice and resonance

Medicine

CardiovascularRepair of Structural Heart Defect

– New code 93582 was established to report percutaneoustranscatheter closure of a patent ductus arteriosus (PDA)• Congenital disorder• Failure of the ductus arteriosus connecting the aorta to the

pulmonary artery fails to close normally after birth• Causes excess blood flow through the lungs resulting in undue

strain on the heart• Large PDA openings left untreated can lead to heart failure and

death

Medicine

New code 93583 – established to reporttranscatheter septal reduction therapy

– (eg, alcohol septal ablation)– Minimally invasive procedure to reduce septal thickness to improve

left ventricular outflow tract obstruction• Patients with hypertrophic cardiomyopathies

Medicine

Intracardiac Electrophysiological Procedures/Studies

– Codes revisions for 93653 and 93656• “when possible” changed to “when necessary”• “bundle” was added to His, i.e. His bundle (His bundle was

included in 93656)• Updated parentheticals

– 93654 only parenthetical revisions

Medicine

Active Wound Care Management– Cat III code 0183T was deleted and replaced with new code 97610

• Low frequency, non-contact, non-thermal ultrasound• Modality used to promote the healing of wounds (such as pressure

ulcers) using acoustic or sound energy to atomize saline and deliver ultrasound energy by way of a continuous mist to the wound bed and surrounding tissue.

• Includes topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day

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