Lots of New Code Picks: 2009 HCPCS

By G. John Verhovshek, MA, CPC
HCPCS Level II codes have seen many hundreds of changes for 2009, but you’ll find that the most substantial revisions affect durable medical and drug equipment supply codes.

New DME Codes

Among the most interesting additions to durable medical equipment (DME) codes are E0656 Segmental pneumatic appliance for use with pneumatic compressor, trunk and E0657 Segmental pneumatic appliance for use with pneumatic compressor, chest, which describe the Flexitouch® chest and trunk appliances. These devices, which are adjustable to the individual patient, supply pneumatic pressure to the trunk or chest to move excess fluid from a damaged lymph area into a healthy lymph area.
Another new code, E0770 Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified now reports the WalkAide, a neural or smart prosthesis intended to address the lack of ankle dorsi-flexion in patients who have sustained damage to upper motor neurons or pathways to the spinal cord.
Codes E1356 Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each and E1357 Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each pertain to the batteries that power portable oxygen concentrators (also known as oxygen generating portable equipment (OGPE)), available under the brand name Eclipse. Eclipse battery packs are similar to those used in laptop computers, and provide a power source to run the systems for several hours per charge.
Three new codes describe added accessories for a manual wheelchair. A standing feature in a wheelchair (E2230 Manual wheelchair accessory, manual standing system) allows its user to assume a standing position without transferring from the chair. Code E2231 Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware reports the supply when a firm seat replaces a flexible sling seat in a wheelchair. A dynamic seating frame, now reported with E2295 Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features. This, in turn, allows for greater range of motion and functional mobility in patients because it strengthens their muscles and joints.
HCPCS Level II 2009 also adds two new medical equipment codes describing spirometer, E0487 Spirometer, electronic, includes all accessories and A9284 Spirometer, non-electronic, includes all accessories. Code E0487 is redundant to existing code S8190 Electronic spirometer (or microspirometer) for an electronic device. You should not report S codes for Medicare, however, so E0487 is the correct code for Medicare claims. Consult with other payers to determine which code to use for supply of an electronic spirometer, and watch for a change in the status of S8190 in the future.
Added code K0672 Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each describes any removable soft interface (the surface of the device in contact with the individual’s skin) for a single knee brace replacement. Prior to 2009, no code reported these removable components properly, although L2820 or L2830 were often used for this purpose.

New Drug Codes

A number of new codes report drugs for which there previously was no code (usually because the drugs themselves are so new), as indicated in the chart below.

Code Drug Use Trade Name
A9580 Sodium fluoride F-18 radio-
C9245 romiplostim autoimmune disease n/a
C9246 gadoxetate disodium contrast agent EOVIST
C9247 Iobenguane radio-
C9248 clevidipine butyrate antihypertensive Cleviprex
J0641 levoleucovorin calcium osteosarcoma and methotrexate overdose n/a
J1267 doripenem antibiotic DORIBAX
J1453 fosaprepitant (injected) nausea
J1930 lanreotide mitigate
Samatuline Depot
J2785 regadenoson raises heart rate Lexiscan for stressed EKG
J8705 Topotecan (capsule or inject) anti-cancer Hycamtin

Other new codes include A6545 Gradient compression wrap, non-elastic, below knee, 30-50 mm hg, each for the supply of CircAid® Medical Products T-3 M™; L0113 Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment for a custom-made cranial cervical orthosis for patients with congenital torticollis, and; L8604 Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies to describe Deflux® injectable gel, a dextranomer/hyaluronic acid copolymer implant material used as a bulking agent in the treatment of vesicoureteral reflux (VUR).

New Procedure Codes

Three new procedure codes—G0398, G0399, and G0400—now describe home sleep studies. These codes are more precise than CPT® code 95086, which describes an unattended study, but does not describe specifically a home sleep study.
Another group of added procedure G codes (G0416-G0149) now apply for prostate saturation biopsy. This technique, performed under general anesthesia using a transrectal ultrasound probe to image the prostate, uses a grid or template to identify the precise location of each biopsy core.
For Medicare patients only, codes G0412-G0415 describe pelvic bone fracture care similar to that described by CPT® codes 27215-27218. Unlike the category I codes, however, the new HCPCS Level II codes apply to either unilateral or bilateral fractures.
A new temporary code, S2118 Metal-on-metal total hip resurfacing, including acetabular and femoral components, now applies for total hip resurfacing/arthroplasty. For those payers who accept S codes, you no longer have to report 27299 Unlisted procedure, pelvis or hip joint for this service. In contrast to total hip replacement/arthroplasty, total hip resurfacing/arthroplasty does not include femoral head and neck removal, or bone removal from the femur. Instead, an artificial shell is placed over the top of the femur, and another shell is inserted in the acetabulum (the cup-shaped cavity on the hip bone where the femur fits into). Several metal-on-metal systems, including the Birmingham Hip Resurfacing Device (BHR) and the Cormet Hip Resurfacing system, have garnered FDA approval. The Buechel-Pappas Integrated Total Hip Replacement, which includes a metal femoral component and a polyethylene acetabular component, has also been approved by the FDA. The Conserve® Plus device, another metal-on-metal system, is in the FDA approval process.

Deleted, Replaced by New HCPCS Level II Codes

Many new-for-2009 HCPCS Level II codes simply take the place of now-deleted codes. For example, codes L7611-L7622, which described terminal hook device prosthetics, were deleted and replaced directly with new codes L6711-

Deleted Replacement Drug Trade Name
C9237 J1930 lanreotide acetate Samatuline Depot
C9238 J1953 levetiracetam Keppra
C9239 J9330 temsirolimus Torisel
C9240 J9207 ixabepilone Ixempra
C9241 J1276 doripenem DORIBAX
C9242 J1453 fosaprepitant EMEND
C9243 J9033 bendamustine HCl Ribomustin and TREANDA
C9244 J2785 regadenoson Lexiscan
J3100 (50 mg) J3101 (1 mg) tenecteplase TNKase
J9182 J9181 etoposid Eposin, Etopophos, Vepesid, and VP-16
Q4096 J7186 ristocetin cofactor Alphanate
Q4097 J1459 immune globulin Privigen
Q4098, J1751, J1752 J1750 iron dextran DexFerrum and Infed
Q4099 J7606 Formoterol fumarate Foradil

L6722. The codes were re-numbered to allow for consolidation and inclusion of terminal hook device supply codes into a single code category, L6703-L6810.
Skin substitute codes J7340-J7349 were deleted and replaced with new codes Q4100-Q4114. The language within the codes was simplified, so code choice can be made according to the brand of the item used as a skin substitute; for example, Q4103 Skin substitute, Oasis burn matrix, per square centimeter.
Codes reporting “Welcome to Medicare” services have also undergone revision. New code G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment replaces G0344 for an initial visit. The eligibility period for a new Medicare beneficiary to receive an initial preventive physician exam was extended to 12 months, up from the previous six months under G0344. Screening electrocardiogram during a “Welcome to Medicare” visit, previously reported with G0366-G0368, should now be reported with G0403-G0405, as appropriate to the specific service.
Several codes for drug reporting were upgraded from temporary status to full-fledged J codes. Two J codes were also replaced to report identical drugs, but with slight changes, as indicated in chart.
Codes J7602 and J7603 to report Albuterol, an inhalation solution administered for the treatment of asthma, have been replaced with four new codes, J7611-J7614, to accommodate changes the packaging and use of albertol and levalbuterol administered through DME.

Deleted, Replaced by CPT® Codes

A few HCPCS Level II codes were replaced with CPT® codes. The most prominent example may be the elimination of G0308-G0327, to describe end stage renal disease (ESRD)-related services, from HCPCS Level II. New CPT® codes 90951-90970 now describe the identical services.
G codes to describe insertion of single chamber cardioverter defibrillator pulse generator (G0297), and insertion of dual chamber cardioverter defibrillator pulse generator with insertion of repositioning of leads (G0300), are deleted this year. Hospitals should now bill CPT® codes 33240 Insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator and 33249 Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator, respectively, to report these procedures, along with the applicable device C codes, for payment under the Outpatient Prospective Payment System (OPPS).
Laparoscopic hernia repairs finally make the transition from HCPCS Level II to CPT®, as well, with the deletion of S2075-S2077. These codes are replaced with six CPT® codes: 49652 and 49653 for laparoscopic repair of ventral, umbilical, spigelian or epigastric hernia; 49654 and 49655 for initial incisional hernia repair, and; 49656 for recurrent incisional hernia repair. All laparoscopic hernia repairs 49652-49656 include mesh insertion, when required.
Code S2135, for treatment of Morton’s neuroma, has been deleted and replaced with two new CPT® codes: 64455 reports steroid injection for diagnostic or therapeutic services, while 64632 reports an alcohol dilute injection or another neurolytic agent to destroy the nerve.
S9092 was deleted for 2009 and replaced by CPT® code 95992 Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day. Canalith repositioning procedures (CRPs) are systematic and therapeutic positionings of the head designed to roll a calcium crystal within the semicircular canal’s convolutions.

Deleted, Not Replaced

Some codes were deleted without replacement for 2009. For example, Roche Pharmaceuticals discontinued the sale and distribution of its anti-HIV medication HIVID® (zalcitabine) tablets as of Dec. 31, 2006. Code S0141, which previously described the drug, has been deleted. Similarly, S0143, which described Aztreonam lysine for inhalation, was eliminated pending further clinical study and FDA approval of the drug.

Descriptor Revisions

With few exceptions, revisions of HCPCS Level II code descriptors provide clarification on proper code use, rather than changing the code meaning. For instance, the term sterile was added to several dozen dressings supply code descriptors (such as A6010 Collagen based wound filler, dry form, sterile, per gram of collagen) to confirm that the codes are reserved for surgical-grade dressings and fillers. Likewise, Injection was added to many J code descriptors to clarify route of admission. In these, and most other cases in which existing code descriptors have undergone revision for 2009, proper code application remains the same as in previous years.
Several descriptor revisions deserve special attention. Descriptors for transthoracic echocardiography codes C8921-87928 now add the phrase “or without contrast followed by contrast” to specify that a failed “without contrast” echocardiography is bundled to a follow-up echocardiography with contrast. Plus, two new C codes, C8929 and C8930, now report transthoracic echocardiography with contrast, or without contrast followed by contrast, in the hospital setting.
The inclusion of “and/or vacuum” to the descriptor for L4360 Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, includes fitting and adjustment now allows you to report this code for VACO®ped, a cast replacement system for the treatment of injuries of the lower leg and foot that can be used for the entire rehabilitation after ankle fractures and other injuries. The VACO®ped uses a self-adjusting vacuum cushion to conform to the patient’s anatomy. Along with a rigid lattice frame, the vacuum cushion provides cast-like stabilization.
Also, the term injection was removed from the descriptor for S0088 Imatinib, 100 mg to clarify that the code may also apply for Gleevec (imatinib) tablets to treat Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) in chronic phase; Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) in blast crisis, accelerated phase, or in chronic phase after failure of interferon-alpha therapy; and some patients with Kit (CD117)-positive gastrointestinal stromal tumors (GIST).
Additional changes to HCPCS Level II 2009 include new temporary (non-Medicare) S codes for genetic testing and detection of rupture of fetal membranes, expanded telehealth services (consultations, G0406-G0406) and dozens of additional G codes for reporting Physician Quality Reporting Initiative (PQRI) (pay for performance) measures, among others.

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