CPT® 2015: Sizable Changes for Drug Testing Codes and Others

Get the skinny on updates to weigh your best coding options in the new year.

by Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC and G.J. Verhovshek, MA, CPC

CPT® 2015 introduces more than 250 new Category I and III codes, and almost as many revised and deleted codes. We’ll evaluate many of the 540 changes that go into effect January 1, 2015, in the months to come. In anticipation, here’s a summary of changes to plan for in the new year.

Evaluation and Management – CEMC

Evaluation and Management

A new subcategory with guidelines is added for chronic care management to describe services for a defined subset of patients, “… when medical and/or psychosocial needs of the patient require establishing, implementing, revising, or monitoring the care plan.” Services are billed per month, using 99490 Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar 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; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored.

A new subcategory and guidelines define complex chronic care management, as reported with revised codes 99487, +99489. These per month codes include the services described by 99490, “… as well as establishment or substantial revision of a comprehensive care plan; medical, functional, and/or psychosocial problems requiring medical decision making of moderate or high complexity and clinical staff care management services for at least 60 minutes, under the direction a physician or other qualified health care professional.”

Time-based codes 99497, +99498 are added, complete with new guidelines, to describe face-to-face advance care planning services. These services include, “counseling and discussing advance directives … 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.” You may report advance care planning separately when performed on the same day as another E/M service.

Anesthesia

Three anesthesia codes are deleted: 00452, 00622, and 00634. There are no other changes in this section.

Musculoskeletal System

Several arthrocentesis codes are revised, and others added, to differentiate procedures occurring with or without guidance.

For example:

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

New codes 21811–21813 describe unilateral, open treatment of rib fracture(s) with internal fixation.

Codes 22510–22515 replace 22520–22525 (percutaneous vertebroplasty and percutaneous vertebral augmentation). The new codes describe the same procedures, but include bone biopsy, when performed, plus all imaging guidance.

Cardiovascular System

Codes 33215–33264 are revised to replace references to “pacing cardioverter-defibrillator” with “implantable defibrillator,” while new codes 33270–33273 describe insertion and repositioning of “permanent subcutaneous implantable defibrillator” components. The guidelines for the Pacemaker or Implantable Defibrillator subsection are substantially revised, with nearly two full pages of added text.

A new subsection, guidelines, and codes 33946–33989 are added for extracorporeal membrane oxygenation and extracorporeal life support services (cardiac and/or respiratory support to the heart and /or lungs). These systems provide cardiac and respiratory support for patients whose heart and lungs are diseased or damaged beyond function.

Digestive System

Several codes in the Esophagoscopy and Esophagogastroduodenoscopy subsections (43180–43259) saw minor descriptor revisions. For example, the descriptor for 43194 Esophagoscopy, rigid, transoral; with removal of foreign body(s) now specifies plural “body(s)” (rather than singular “body”) to clarify that this code may be used for removal of one or more foreign bodies. More significantly, CPT® 2015 includes dozens of new parenthetical instructions in these sections to help resolve bundling issues and to explain proper code application.

The new Endoscopy, Stomal subsection includes guidelines encompassing new, revised, and existing codes 44380-44408, which include proctosigmoidoscopy, sigmoidoscopy, colonoscopy, and colonoscopy through stoma. The new guidelines specify, “When bleeding occurs as a result of an endoscopic procedure, control of bleeding is not reported separately during the same operative session.”

Urinary System

Two new codes in the Vesical Neck and Prostate subsection describe Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant (52441) and each additional implant (+52442).

Nervous System

Four new codes (62302-62305) describe myelography (radiographic exam with contrast to detect pathology of the spinal cord) by spinal region (e.g., cervical, thoracic).

New codes also describe unilateral (64486-64487) and bilateral (64488-64489) transversus abdominis plane (TAP) block. Also known as abdominal plane block or rectus sheath block, a TAP block is a peripheral nerve block designed to anesthetize the nerves supplying the anterior abdominal wall.

Eye and Ocular Adnexa

New and revised codes in this section describe various procedures pertaining to aqueous shunt, with or without graft:

66179 Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft

66180 with graft

66184 Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft

66185 with graft

Auditory System

Codes 69400-69401 and 69405 are deleted. CPT® 2015 instructs us to use 69799 in place of 69400 and 69405. Transnasal eustachian tube inflation without catheterization is now inclusive of outpatient E/M codes 99201-99205 and 99211-99215.

Radiology

Codes 72291 and 72292 are deleted. Radiological supervision and interpretation for percutaneous vertebroplasty is now an inclusive component of 22510, 22511, 22513, 22514, and 22515, as well as 0200T and 0201T (percutaneous sacral augmentation (sacroplasty)).

New codes 77061-77063 describe unilateral, bilateral, and screening digital breast tomosynthesis (3-D mammography). Tomosynthesis provides a clearer, more accurate view compared to digital mammography alone.

Code 77082 is deleted and replaced by two codes describing dual-energy X-ray absorptiometry (DXA) bone density study: 77085 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment, reported when the bone density study is performed with vertebral fracture assessment, and 77086 Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA), reported when vertebral assessment alone is performed via DXA.

Teletherapy isodose planning codes are simplified with the introduction of 77306 (simple) and 77307 (complex). Brachytherapy isodose planning codes are also replaced: The new codes are 77316 (simple), 77317 (intermediate), and 77318 (complex).

Two new codes (77385, simple and 77386, complex) report intensity modulated radiation treatment delivery (IMRT) including guidance and tracking, when performed. IMRT allows the radiation oncologist to adjust the intensity of radiation beams across the treatment area, allowing higher radiation doses than traditional radiation therapy methods, while minimizing exposure to healthy tissues.

Codes describing radiation treatment delivery have been simplified, and include a “per day” code for superficial and/or ortho voltage (77401), as well as codes for simple (77402), intermediate (77407), and complex (77412) delivery. All treatment delivery codes are reported once per treatment session. New guidelines further instruct coders and providers on how to apply the codes.

Pathology and Laboratory

Among the most noteworthy changes for 2015, the CPT® codebook completely overhauls drug screening codes. Tests are now divided into two classes. Per CPT®:

“Presumptive drug class procedures are used to identify possible use or non-use of a drug or drug class. A presumptive test may be followed by a definitive test … to specifically identify drugs or metabolites.

Definitive drug class procedures are qualitative or quantitative test to identify possible use or non-use of a drug. These tests identify specific drugs. Tables are provided to assist with proper code selection.”

Five codes (80300-80304) describe presumptive drug class screening, according to whether the drug falls into “drug class A” or “drug class B” (as defined by CPT®). Extensive guidelines and coding examples accompany the new codes to educate coders on proper use.

Dozens of new codes describe definitive drug testing. The codes are assigned according to the specific substance tested. For example:

80324 Amphetamines; 1 or 2

80325 3 or 4

80326 5 or more

80359 Methylenedioxyamphetamines (MDA, MDEA, MDMA)

80373 Tramadol

Also included are “not otherwise specified” codes:

80375 Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 1-3

80376 4-6

80377 7 or more

CPT® 2015 adds 24 new codes and revises five codes for molecular pathology procedures. A molecular pathology table appears at the beginning of the Pathology and Laboratory section. You can identify the appropriate molecular pathology code by the abbreviated gene name of the test.

Three new codes (87505-87507) describe infectious agent detection of gastrointestinal pathogen by nucleic acid (deoxyribonucleic acid (DNA) or ribonucleic acid (RNA)). Codes are assigned according to the number of types/subtypes for which testing is performed. New codes similarly describe detection by nucleic acid (DNA or RNA) for Human Papillomavirus (HPV) (e.g., 87623 Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44).

Medicine

New vaccine codes report Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use (90630) and Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (HPV), 3 dose schedule, for intramuscular use (90651).

New procedures include 91200 Liver elastography, mechanically induced shear wave (eg, vibration), without imaging, with interpretation and report and 92145 Corneal hysteresis determination, by air impulse stimulation, unilateral or bilateral, with interpretation and report. Also new are codes for transesophageal echocardiography (TEE) for guidance during structural interventions of the transcatheter intracardiac or great vessels (93355); and for brief emotional/behavioral assessment, with scoring and documentation using standardized instrument (96127).

Negative pressure wound therapy codes 97605 (area 50 square centimeters or less) and 97606 (area greater than 50 square centimeters) are massaged to describe vacuum assisted drainage collection using durable medical equipment. New codes 97607 and 97608 describe the same procedure using disposable equipment.

New hypothermia initiation code 99184 (initiation of selective head or total body hypothermia in the critically ill neonate) replaces 99481 and 99482, which are deleted from the E/M section for 2015.

Category III

The majority of CPT® Category III codes deleted for 2015 are replaced by new Category I codes. For example, 0247T is deleted and replaced by 21812 Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 4-6 ribs, and 21813 Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 7 or more ribs.

Significant additions include new codes for radiostereometric analysis (RSA) of the spine (0348T) and upper (0349T) and lower (0350T) extremities; optical coherence tomography (0351T–0354T); various behavioral assessments (0359T–0363T); adaptive behavior treatment by protocol (0364T–0374T); and visual field assessment (0378T–0379T).

Modifiers

Revisions to CPT® 2015 Appendix A: Modifiers include the introduction of four new HCPCS Level II modifiers, collectively referred to as -X{EPSU} modifier, as well as new text — related to the introduction of the -X{EPSU} modifiers — in the long descriptor for modifier 59 Distinct procedural service.

CPT® 2015 defines the -X{EPSU} modifiers as, “HCPCS modifiers for selective identification of subsets of Distinct Procedural Services [-59 modifier]).” The Centers for Medicare & Medicaid Services (CMS) similarly defined the -X{EPSU} modifiers, announced in CMS Transmittal 1422, Change Request 8863, as “subsets of distinct procedural services (-59 modifier).”

XE Separate encounter

XS Separate structure

XP Separate practitioner

XU Unusual non-overlapping service

The intent of the -X{EPSU} modifiers is to require providers to specify the circumstances that call for separate reimbursement of the reported services, which generally would not be reported together. For example, excision of skin lesions include simple repair at the same location; however, if a repair occurs at a separate location from the lesion excision, you may report the procedures independently by appending an appropriate modifier. Beginning January 1, 2015, for Medicare claims, append modifier XS to the repair code (rather than modifier 59) to indicate “separate structure.” There are specific codes sets for which CMS will require the X{EPSU} when clarity is required. The X{EPSU} will not replace modifier 59 in all instances of reporting.


 

Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, is AAPC’s vice president of member and certification development and a member of the Weston, Florida, local chapter.

G.J. Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Henderson, North Carolina, local chapter.

2017-code-book-bundles-728x90-01

Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

Latest posts by Renee Dustman (see all)

About Has 428 Posts

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

Leave a Reply

Your email address will not be published. Required fields are marked *