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Sneak a Peek at CPT® 2016 Changes

Sneak a Peek at CPT® 2016 Changes

See what procedural coding changes will affect you most.

The release of the 2016 CPT® codebook brings us approximately 350 new, revised, or deleted codes, as well as many new guidelines, coding tips, and parenthetical instructions. Here are some highlights.
What’s New for Prolonged Clinical Staff Services
New for 2016 are two, time-based, add-on evaluation and management (E/M) codes to describe prolonged clinical staff services provided with direct patient contact:
+99415 Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)
+99416  each additional 30 minutes (List separately in addition to code for prolonged service)
Services must be directly supervised by the physician or qualified healthcare professional. As defined at 42 CFR 413.65, “direct supervision” means that the physician or nonphysician practitioner must be present on the same campus where the services are being furnished.
Time counted toward +99415 and +99416 does not have to be continuous; however, time spent by clinical staff performing other, separately reported services does not count toward prolonged services time.
Note that facilities may not report +99415 and +99416.
Endobronchial Ultrasound Gains Codes
Endobronchial ultrasound (EBUS) combines ultrasound with bronchoscope to visualize the airway wall and adjacent structures. The technique allows surgeons to obtain sample tissue from the lungs and nearby lymph nodes; for example, to diagnose and stage lung cancer, detect infections, and identify other lung conditions.
Code 31620 (which previously reported EBUS) is deleted and replaced by three new codes:
31652 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures
31653 with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures
31654 with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s) (List separately in addition to code for primary procedure[s])
Intravascular Ultrasound
Now Includes Radiological S&I

Over the past several years, radiological supervision and interpretation (S&I) increasingly has become an included component of many procedures. The trend continues in 2016.
For example, non-coronary intravascular ultrasound codes 37250 and 37251 (which did NOT include radiological S&I) are deleted, to be replaced by two new add-on codes that describe identical procedures, but now include radiological S&I. The codes are:
37252 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure)
37253 each additional noncoronary vessel (List separately in addition to code for primary
Cholangiography-related Codes Get an Overhaul 
Cholangiography is visualization of the bile ducts using an injected contrast medium to locate obstruction(s). Cholangiography codes 47531–47541 are deleted and replaced by a new set of codes describing injection of the contrast medium (47531, existing access and 47532, new access), placement/revision/removal of biliary drainage catheter (47533-47537), stent placement (47538-47540), access for rendezvous procedure (47541), removal of stones from the biliary ducts (+47544), and more.
New Urinary Imaging Procedures
CPT® 2016 introduces 50430 and 50431 for antegrade nephrostogram and ureterogram (imaging procedures for diagnostic assessment of the urinary system), and designates revised and replacement codes for urinary catheter procedures.
For example, 50433 Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access describes percutaneous nephrostomy to place a nephroureteral catheter that drains internally and/or externally (via new access). Report a single unit of 50433 for each renal collecting system/ureter accessed (e.g., 50433 x 2, if both renal collecting systems/ureters are accessed.). The procedure includes diagnostic nephrostogram and/or ureterogram (when performed), as well as imaging guidance and all associated radiological S&I.
Additional codes are added to describe percutaneous conversion of a nephrostomy catheter to nephroureteral catheter (50434), and removal and replacement of an existing nephrostomy catheter (50435).
Intracranial Thrombolysis Gains a Code
Thrombolysis is the breakdown of blood clots. For 2016, you’ll report this service with CPT® 61645 Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s) for thrombolysis for intracranial arteries using mechanical thrombectomy (clot removal) or infusion.
Diagnostic angiography, fluoroscopic guidance, selective catheterization and thrombolytic injection(s) are included, although you may separately report diagnostic angiography of a non-treated vascular territory. Also included are neurologic and hemodynamic monitoring of the patient, and closure by manual pressure, arterial closure device, or suture. You may report 61645 once per intracranial territory treated. The intracranial territories include right carotid circulation, left carotid circulation, and vertebro-basilar circulation.
There are also new codes for prolonged administration of pharmacologic agent(s) in any intracranial artery, for any reason other than thrombolysis:
61650 Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory
+61651 each additional vascular territory (List separately in addition to code for primary procedure).
Three New Codes for Paravertebral Block
A paraspinous block completely desensitizes the affected spinal segment (generally for pain relief). CPT® 2016 adds three codes to report thoracic paravertebral block (PVB) by injection (single and additional) or continuous infusion:
64461 Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)
+64462 second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary procedure)
64463 continuous infusion by catheter (includes imaging guidance, when performed)
Radiologic Exam Codes Get More Precise
New codes describing radiologic exam of the spine now provide greater specificity as to the number of views. For example:
72081 Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view
72082 2 or 3 views
72083 4 or 5 views
72084 minimum of 6 views
The new codes replace several now-deleted codes, such as 72069 and 72090.
Similar changes affect codes describing radiologic exam of the hip(s) and pelvis. Two examples include:
73502 Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views
73523 Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views
Clinical Brachytherapy Revised
Many codes describing services related to clinical brachytherapy are deleted and replaced, while several other codes are revised. For example, deleted codes 77785 and 77786 are replaced by the following:
77770 Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel
77771 2-12 channels
77772 over 12 channels
Also added are new codes for skin surface brachytherapy, 77767-77768.
Pathology and Laboratory:
Refining Test Methods and More

There have been many changes to the Pathology and Laboratory chapter for 2016, most of which are based on methods used to perform various tests. For example, a new code was created to report an obstetric panel with HIV testing: 80081 Obstetric panel (including HIV testing).
Ten new codes are added to the Multianalyte Assays with Algorithmic Analyses (MAAA) section to report risk scores for rheumatoid arthritis, coronary artery disease, heart transplant rejection, and oncology (including colon, colorectal, gynecologic, lung, and thyroid).
Cleaning Up the Vaccine Codes
There are over 60 revisions to vaccine codes for 2016, almost all of which are minor “housekeeping” changes. Many obsolete vaccines are deleted (for example, 90645 and 90646); and many vaccine descriptors are revised to provide greater clarity, with no affect on code application. For example, the abbreviation “HepA” is added after the name of the vaccine in the descriptor for 90634 Hepatitis A vaccine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramuscular use, but code use does not change.
In a few cases, revisions are more substantial. For example, the descriptor for 90647 Haemophilus influenzae type B vaccine (Hib), PRP-OMP conjugate, 3 dose schedule, for intramuscular use is revised to delete “3-dose schedule,” and to change the vaccine to “Haemophilus influenzae type” B. Also added is 90625 Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use and two codes for meningococcal recombinant protein and outer membrane vesicle vaccine (90620, 90621).
Special Otorhinolaryngologic Services
Caloric vestibular testing is used to evaluate the vestibular nerve. For 2016, the former code for caloric vestibular testing (92543) is deleted and replaced by two new codes:
92537 Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations)
92538 monothermal (ie, one irrigation in each ear for a total of two irrigations), which more precisely define the test protocol.
Special Dermatological Procedures
A new series of codes (96931-96936) now describes reflectance confocal microscopy for cellular and sub-cellular imaging of skin. The technique allows for imaging of skin lesions in vivo (no biopsy is necessary).
More information is available in AAPC’s December workshop, “New Year, New Updates,” in several cities December 2-14. Check out the Education section on AAPC’s website for more information.
Earwax Removal by Lavage Now a Distinct Service
Impacted cerumen (ear wax) can cause symptoms including pain, dizziness, and loss of hearing. In years past, removal of impacted cerumen not requiring instrumentation has been reported using an appropriate evaluation and management (E/M) code. The American Medical Association (AMA) added a parenthetical note to CPT® 2014 instructing, “For cerumen removal that is not impacted [see above] or does not require instrumentation, eg, by irrigation only, see E/M service code, which may include new or established patient office or other outpatient services ….” The AMA also revised the CPT® descriptor for 69210 to specify “requiring instrumentation.”
For 2016, the rules have changed. You may still report 69210 Removal impacted cerumen requiring instrumentation, unilateral for removal of cerumen requiring instrumentation; however, removal by lavage now has its own code, 69209 Removal impacted cerumen using irrigation/lavage, unilateral, and no longer is reported as an E/M service. CPT® 2016 now instructs, “for cerumen removal that is not impacted, see E/M service code….”
Note that both 69209 and 69210 are unilateral procedures; for removal of impacted cerumen from both ears, append modifier 50 Bilateral procedure to the appropriate code.
No Time for Electronic Analysis of Neurostimulator Pulse Generator System 
In prior years, electronic analysis of implanted neurostimulator pulse generator system was a time-based service. For 2016, that’s no longer the case. Code 95972 Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming has been revised to eliminate the time element “up to one hour,” while 95973 (previously used to report each additional 30 minutes beyond the first hour) has been deleted.

John Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Hendersonville-Asheville, N.C., local chapter.
Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, is vice president, Member and Certification Development and a member of the Weston, Fla., local chapter.

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Raemarie Jimenez, CPC, CIC, CPB, CPMA, CPPM, CPC-I, CDEO, CANPC, CRHC, CCS, is senior vice president of products at AAPC and a member of the Salt Lake City, Utah, local chapter.

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