Catch a Glimpse of CPT® 2014

Preview what’s in store for coding in the year ahead so you aren’t caught by surprise.
By Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC
It’s that time of year where surprise packages arrive at your door. Being surprised with a mailbox full of holiday cards and gifts is a treat, but also is receiving the CPT® codebook after weeks of anticipation. Every year the American Medical Association (AMA) provides us with a multitude of code changes. This year is no different, so the fact that CPT® 2014 includes changes to every chapter except one (Anesthesia was spared) comes as no surprise. The exciting part comes after you peel off the cellophane and crack open your shiny, new codebook. Let’s take a quick look, chapter by chapter, and see what 2014 will bring.

E/M: New Consult and Induced Hypothermia Codes

CPT® 2014 adds a new category and four new codes (99446-99449) to evaluation and management (E/M) services for “Interprofessional telephone/Internet consultations.” The codes describe a situation where a specialist consults with a patient’s primary physician to offer opinion or advice, but does not meet face-to-face with the patient. These time-based services “are typically provided in complex and/or urgent situations where a timely face-to-face service with the consultant may not be feasible,” and include a review of the patient’s medical records, test results, etc.
Note: The Centers for Medicare & Medicaid Services (CMS) is unlikely to recognize 99446-99449 for Medicare payment because the services are not face-to-face with the patient, and Medicare does not pay for CPT® consultation codes.
Two new add-on codes (99481, 99482) have been included in the neonate/pediatric critical category to describe total body and selective head hypothermia for critically ill neonates. Therapeutic hypothermia may be used to decrease mortality and improve neurodevelopmental outcomes for neonates with hypoxic ischemic encephalopathy, resulting from oxygen deprivation to the brain. These “per day” codes are reported in addition to primary critical care services 99291/+99292 or 99468/99469.
CPT® 2014 also introduces new explanatory text for pediatric critical care transport (99466-99486), complex chronic care coordination (99487-99489), and transitional care management (99495-99496).
New code 10030 describes percutaneous, image-guided fluid collection/drainage of a soft tissue abscess, hematoma, cyst, etc., using a catheter. Imaging (e.g., 77002, 77012) is included, and may not be separately reported.
CPT® 13150 has been deleted; complex repairs of the eyelids, nose, ears, and/or lips must now measure at least 1.1 cm. Smaller repairs (1 cm or less) may be reported using simple (12001-12021) or intermediate (12031-12057) closure codes.
A series of new, more granular breast biopsy codes (19081-+19086) replace 19102/19103. These new combination codes report both the surgical portion and imaging guidance for breast biopsies, as determined by the type of imaging guidance required. Also new, 19281-+19288 describe placement of a breast localization device without biopsy, by guidance type (e.g., stereotactic, ultrasound, magnetic resonance). New instructions for proper code use are added to the Excision guidelines preceding the breast procedure codes.
New/replacement codes now describe removal of deep, foreign body from the shoulder (23333), as well as removal of shoulder prosthesis (23334 humeral or glenoid, and 23335 humeral and glenoid).
To clarify proper code use, many code descriptors throughout the chapter now specify “sarcoma” rather than “malignant neoplasm” (e.g., 28046 Radical resection of tumor (eg, malignant neoplasm sarcoma), soft tissue of foot or toe; less than 3 cm). Guidelines at the beginning of the Musculoskeletal chapter are updated to clarify correct coding for excision of subcutaneous soft connective tissue tumors and radical resection of soft connective tissue tumors.
Code 32201 has been deleted. You’ll now select new code 49405 Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous for percutaneous image-guided drainage of an abscess or cyst of the lungs or mediastinum by catheter placement.
A new section within the Cardiovascular chapter describes fenestrated endovascular repair of the visceral and infrarenal aorta. Codes 34841-34844 describe repair of the visceral aorta only, with one, two, three, or four visceral artery endoprostheses (as specified by the individual codes). Codes 34845-34848 describe repair of the visceral and infrarenal abdominal aorta, also including placement of one, two, three, or four visceral artery endoprostheses. The grafts used during these procedures include fenestrations (holes), which allow the repaired vessel to retain the required patency/flexibility. You may separately report other interventional procedures (e.g., arterial embolization) performed at the time of these repairs.
Added codes and guidelines now describe transcatheter placement of intravascular stents(s) in arteries (37236/+37237) and veins (37238/+37239), except for those in the lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or carotid. All services include balloon angioplasty performed in the treated vessel, post-dilation following stent placement, and treatment of a lesion in the same vessel.
CPT® 2014 significantly revises vascular embolization and occlusion codes: 37204-37210 have been deleted and replaced by a new subsection, including new guidelines and codes 37241-37244. The procedures include all radiological supervision and interpretation, road mapping, and imaging guidance necessary to complete the intervention, and are classified as either venous or arterial.
Endoscopy codes—specifically, for both rigid and flexible esophagoscopy—have undergone significant changes: 13 new codes (43191-43198, 43211-43212, 43213-43214, and 43299); descriptor revisions for nearly all of the remaining codes (e.g., Esophagoscopy, rigid or flexible, transoral; diagnostic, with or without including collection of specimen(s) by brushing or washing, when performed (separate procedure)); and new parenthetical instructions. The changes promote greater precision and more granular code assignment, and also allow for deletion of manipulation codes 43456 and 43458.
Endoscopic retrograde cholangiopancreatography (ERCP) codes have also undergone significant revision, with new instructions to describe the procedures and clarify code assignments, as well as new and revised codes (for instance, to describe placement/exchange of endoscopic stent into the biliary or pancreatic duct).
New combination codes for image-guided fluid collection by catheter (49405-49407) replace several deleted codes, including 49021 and 50021.
Nervous System
Codes describing chemodenervation have been reshuffled: 64613 and 64614 have been deleted and replaced by new codes 64616 and 64617 (chemodenervation of neck muscles excluding larynx, and of the larynx, respectively) and 64642-64647, which describe chemodenervation according to the number of extremities (and/or trunk muscles) and number of muscles targeted (e.g., 64644 Chemodenervation of one extremity; 5 or more muscle(s)).
Unlike years past, there are only a handful of changes for radiology this year:

  • Radiologic exam of spine, 72040, now specifies “2 or 3 views.”
  • 75960 is deleted because radiologic supervision for transcatheter placement of stents is included in new codes 37236-+37239
  • 77031 and 77032 are deleted; stereotactic localization is now inclusive of 19081 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance and 19283 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance.
  • New add-on code 77293 describes respiratory motion management simulation, to be reported in addition to 77295 (Therapeutic radiology …) and 77301 (Intensity modulated radiotherapy plan …).

Pathology and Laboratory
New drug assay codes and their corresponding tests are:
80155 Caffeine
80159 Clozapine
80169 Everolimus
80171 Gabapentin
80175 Lamotrigine
80177 Levetiracetam
80180 Mycophenolate (mycophenolic acid)
80183 Oxcarbazepine
80199 Tiagabine
80203 Zonisamide
Approximately a dozen of the molecular pathology codes 81400-81408 (levels 1-9) have undergone minor descriptor revisions, as well.
New codes in the Medicine chapter were added to describe new influenza virus vaccines (90673, 90685-90688) and various speech/voice evaluations (92521-92524). Also in this chapter, new codes for wound care include 94669 Mechanical chest wall oscillation to facilitate lung function, per session and 97610 Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day.
Category III Codes
Category III codes describe emerging technologies. If a Category III code is available, it must be reported instead of a Category I unlisted procedure code. As in past years, Category III codes include a grab bag of changes. Many deleted Category III codes have been replaced by new Category I codes. For example: 0078T-0081T are deleted and replaced by 34841-34848 for fenestrated endovascular repair of the visceral and infrarenal aorta; 97610 replaces 0183T for low frequency ultrasound, and; 0260T/0261T are deleted in favor of +99481 and +99482 for total body and selective head hypothermia for critically-ill neonates.
Other changes include:

  • New codes 0319T-0328T describe various procedures/services related to implantable subcutaneous lead defibrillator systems. These new systems provide electric shock to the heart (defibrillation) for the treatment of an abnormally rapid heartbeat that originates from the lower chambers of the heart (ventricular tachyarrhythmias).
  • New technology eye/adnexa codes include 0329T Monitoring of intraocular pressure for 24 hours or longer, unilateral or bilateral, with interpretation and report and 0330T Tear film imaging, unilateral or bilateral, with interpretation and report.
  • New codes 0331T and 0332T describe myocardial sympathetic innervation imaging and planar qualitative and quantitative assessment (without and with single-photon emission computed tomography (SPECT), respectively).
  • Codes 0338T and 0339T describe unilateral or bilateral transcatheter renal sympathetic denervation by percutaneous approach.

Stay Tuned for Details …

I don’t know about you, but I can’t wait to use my new gift. Look for more in-depth examinations of the most significant CPT® coding and guideline changes for 2014 in AAPC Cutting Edge in the coming months.

Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, is AAPC director of product development and a member of the Weston, Fla., AAPC local chapter.

G.J. Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Fort Myers, Fla., AAPC local chapter.

Certified Pediatrics Coder CPEDC

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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