2013 procedure coding updates

Complete 2013 Procedure Coding Updates

AAPC2480 South 3850 West, Suite BSalt Lake City, Utah 84120800-626-CODE (2633), Fax 801-236-2258www.aapc.com

2012

Complete 2013Procedure

Coding Updates

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Introduction

DisclaimerThis course was current when it was published. Every reasonable effort has been made to assure the accuracy of the infor-mation within these pages. Readers are responsible to ensure they are using the codes, and following applicable guidelines, correctly. AAPC employees, agents, and staff make no representation, warranty, or guarantee that this compilation of information is error-free, and will bear no responsibility or liability for the results or consequences of the use of this course. This guide is a general summary that explains guidelines and principles in profitable, efficient health care organizations.

USGovernmentRightsThis product includes CPT®, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995), as applicable, for U.S. Depart¬ment of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provision of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommendation their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not con¬tained herein.

CPT® is a registered trademark of the American Medical Association.

Anatomical Illustrations are provided by OptumInsight and are copyright © 2012, OptumInsight, Inc.

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

© 2012 AAPC2480 South 3850 West, Suite B, Salt Lake City, Utah 84120800-626-CODE (2633), Fax 801-236-2258, www.aapc.com

ISBN 978-1-937348-47-2

All rights reserved.

Complete2013ProcedureUpdates1=FDAApprovalPending=Add-on

CPT®for2013RevisionsSectionGuidelinesNew section guidelines occur throughout CPT® 2013. New guidelines in the codebook are printed in green ink to allow easy identification.

ModifiersCPT® 2013 contains no new modifiers; however, complete descriptors for 16 modifiers in Appendix B have undergone revisions to include “other qualified health care profes-sional” language, to specify that these modifiers may be appended to non-physician services.

All genetic testing code modifiers, previously listed in CPT® Appendix I, have been deleted. Genetic testing codes 83890-83914, to which the modifiers were applied, have been deleted and replaced by new molecular pathology codes 81200-81479.

EvaluationandManagementServicesCPT® 2013 revises 82 evaluation and management codes within the range 99201-99467 to specify that these E/M services may be provided by a physician or “other qualified health care professional.” Language suggesting that only a physician may legitimately report such services has been removed from the code descriptors.

For example, the revised descriptor for a level I, new patient visit in the outpatient setting (99201) now specifies:

Introduction

IntroductionAs technology and clinical knowledge evolve, so does the practice of medicine. Health care also operates within a complex, ever-changing regulatory environment. To keep pace, the code sets we use to report medical services, proce-dures, devices, and drugs must be updated regularly.

Each October, the American Medical Association releases a revised CPT® code set for implementation the following January 1. At AAPC, our goal is to provide you with vital information to make the implementation process easier. This workbook summarizes significant CPT® 2013 code changes available at press time. Additional changes released

subsequently, as addenda or errata, will be posted on the AAPC website (www.aapc.com).

CPT® 2013 contains revised section guidelines, parentheti-cal references, and appendices. This guide summarizes primarily revisions to the codes and code descriptors. Minor changes in grammar or spelling that do not affect code use may be omitted. This guide does not review in full all revi-sions within CPT®, and is not meant as a replacement for the complete 2013 CPT® codebook. Always use the most current version of CPT®, and carefully follow all CPT® sec-tion guidelines, parenthetical references, and other instruc-tion when assigning codes.

ChecklistforUpdatingYourCodes Begin reviewing 2013 CPT® code changes, using this guide

Order 2013 code books

Review all changes to guidelines, notes, and instructions in your book

Highlight changes in the book’s index pertinent to your specialty, and review those changes

Highlight changes in the book’s tabular (numeric) section pertinent to your specialty, and review those changes

Create a documentation “cheat sheet” of 2013 updates that must be documented differently for coders to cap-ture the information needed and distribute it to clinicians

Review and update superbills, chargemasters, etc.

Run utilization report of the deleted and revised codes using your practice management systems.

Upload software change

Train coding and billing staff on changes

Check regularly for addenda or errata to the 2013 code set; if addenda are issued, communicate the contents to coding and clinical staff

Review physician quality reporting system (PQRS) changes, if you are participating in PQRS, and educate providers/make adjustments in processes to accommo-date the new reporting measures

Communicate with payer/provider reps regarding reimbursement and coverage issues

Archive last year’s books within three months of the new code implementation dates

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Critical care during interfacility transport, critically ill or critically injured patient, 24 months of age or younger: 99466–99467.

E/M section guidelines also have been modified to allow non-physician providers to report services. For example, the descriptors for critical care services (99291–99292, 99468–99469, and 99471–99476) have not been revised, but section guidelines now stipulate, “Critical care is the direct delivery by a physician(s) or other qualified health care professional of medical care for a critically ill or criti-cally injured patient.”

Revisions to include “other qualified health care provid-ers” were made so that the type of provider (eg, physician, nurse practitioners, physician assistants, outpatient hospital facilities) does not dictate which codes may be reported. CPT® codes describe the services performed, not the provider who performs the service. Each state’s scope-of-practice laws determine the services an individual provider is qualified to perform. Providers typically considered to be “other qualified health care professionals” are advanced registered nurse practitioners (ARNP)s, physician assistants (PA)s, midwives, etc.

CPT® 2013 also adds seven new codes in three new E/M categories: Supervision by a control physician of interfacil-ity transport care of the critically ill or critically injured pediatric patient; Complex chronic care coordination ser-vices, and; Transitional care management services.

E/M:PediatricCriticalCarePatientTransportSubsection GuidanceNew, time-based codes report the non face-to-face work of a control physician directing care during interfacility transport. The patient’s age and medical condition (criti-cal illness or critical injury), and the total time, must be documented. When determining time, do not include pre-transport communication with the referring or accepting facility. Only the time spent directly by the transport team may be used to determine reportable time.

The controlling provider cannot code for any of the proce-dures performed by the team performing the transport. Do not report 99485 or 99486 with 99466 or 99467 for the same patient.

Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components:

• A problem focused history;

• A problem focused examination;

• Straightforward medical decision making.

Counseling and/or coordination of care with other physicians, other providers qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self-limited or minor. Physicians typically spend Typically, 10 minutes are spent face-to- face with the patient and/or family.

New text (underlined) clarifies that counseling and/or coordination of care may be provided with other physi-cians or “other qualified health care professionals.” Deleted text (stricken) eliminates the reference to “physician” time, thereby allowing, per AMA guidelines, that other, non-physician providers may provide the service.

Descriptor changes throughout the E/M chapter are con-sistent with this example. A summary of the affected codes includes:

Outpatient visits: 99201–99215

Observation: 99217–99226

Inpatient care (initial and subsequent): 99221–99233

Observation or initial hospital care: 99234–99236

Office consultations: 99241–99245

Inpatient consultations: 99251–99255

Emergency department visits: 99281–99285

Direction of emergency medical services: 99288

Nursing facility care (initial and subsequent): 99304–99310

Annual nursing facility assessment: 99318

Domiciliary or rest home visits: 99324–99337

Home visits: 99341–99350

Standby services: 99360

Supervision of patient care: 99374-99380

Telephone E/M services: 99441-99443

Online E/M services: 99444-99464



99489. The provider must determine which service type required the most time, and report those codes. A paren-thetical note following 99489 lists the services that cannot be reported during the same month as 99487–99489.

99487Complexchroniccarecoordinationservices;firsthourofclinicalstafftimedirectedbyaphysicianorotherqualifiedhealthcareprofessionalwithnoface-to-facevisit,percalendarmonth

AAPC Rationale Code 99487 describes the first hour of clinical staff time for performing complex chronic care coordination, when there has been no face-to-face visit with the patient. The code is reported per calendar month. The patient’s medical condition must meet the requirements stated in the coding guidelines preceding 99487–99489.

99488Complexchroniccarecoordinationservices;firsthourofclinicalstafftimedirectedbyaphysicianorotherquali-fiedhealthcareprofessionalwithoneface-to-facevisit,percalendarmonth

AAPC Rationale Code 99488 describes the first hour of clinical staff time for performing complex chronic care coordination. The patient’s medical condition must meet the requirements stated in the coding guidelines preceding 99487–99489.

This service includes one face-to-face encounter not sepa-rately reported. Additional, medically necessary encounters may be reported separately.

99489Complexchroniccarecoordinationservices;eachadditional30minutesofclinicalstafftimedirectedbyaphysicianorotherqualifiedhealthcareprofessional,percalendarmonth(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Add-on code 99489 reports each additional 30 minutes of complex chronic care coordination beyond the first hour, to be reported in addition to 99487 or 99488.

E/M:TransitionalCareManagementServicesSubsection GuidanceA new E/M subsection reports transitional care manage-ment for patients discharged from an inpatient hospital, observation, or a skilled nursing facility. The goal of tran-sitional care is to provide services needed to transition the

E/M:ComplexChronicCareCoordinationServicesSubsection GuidanceA new E/M category reports coordination of care for patients with chronic illnesses. Effective coordination of services among providers to manage complex conditions requires significant staff and provider time.

Patients with one or more chronic illnesses expected to last at least 12 months, acute exacerbation of an illness, or functional decline qualify for the use of these codes. The coordination activities are detailed in the coding guidelines preceding 99487–99489.

Codes are reported per calendar month. At least one hour must be documented to claim the services. Documenta-tion templates to record the date, time spent on chronic care coordination, and the care coordinated will facilitate proper documentation to support the services.

Other CPT® codes describe specific coordination or moni-toring of care services not reported with 99487–99489. For example, end-stage renal disease services (90951–90970) cannot be reported during the same month as 99487–

#99485Supervisionbyacontrolphysicianofinterfacilitytransportcareofthecriticallyillorcriticallyinjuredpediatricpatient,24monthsofageoryounger,includestwo-waycommunicationwithtransportteambeforetransport,atthereferringfacilityandduringthetransport,includingdatainterpretationandreport;first30minutes

AAPC Rationale Code 99485 describes the first 30 minutes of care. Do not report 99485 for fewer than 15 minutes of care.

# 99486Supervisionbyacontrolphysicianofinter-facilitytransportcareofthecriticallyillorcriticallyinjuredpediatricpatient,24monthsofageoryounger,includestwo-waycommunicationwithtransportteambeforetransport,atthereferringfacilityandduringthetransport,includingdatainterpretationandreport;eachadditional30minutes(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report one unit of add-on code 99486 for each addi-tional 30 minutes of supervision of transport care, beyond the initial 30 minutes as reported with 99485.



AnesthesiaOtherProcedures

01991Anesthesiafordiagnosticortherapeuticnerveblocksandinjections(whenblockorinjectionisperformedbyadifferentproviderphysicianorotherqualifiedhealthcarepro-fessional);otherthantheproneposition

AAPC Rationale The code is revised to allow reporting by “other qualified health care professional” (eg, certified registered nurse anesthetist (CRNA)).

01992Anesthesiafordiagnosticortherapeuticnerveblocksandinjections(whenblockorinjectionisperformedbyadifferentproviderphysicianorotherqualifiedhealthcarepro-fessional);proneposition

AAPC Rationale The code is revised to allow reporting by “other qualified health care professional” (eg, certified registered nurse anesthetist (CRNA)).

SurgeryIntegumentarySystem/Repair(Closure):OtherFlapsandGrafts

15740Flap;islandpediclerequiringidentificationanddis-sectionofananatomicallynamedaxialvessel

AAPC Rationale Code 15740 is revised to clarify the proper use of the island pedicle flap. When performing flap procedures, small blood vessels may be included as the tissue is trans-posed. An anatomically named axial vessel must be identi-fied and dissected as part of the pedicle flap procedure. See image on next page.

patient from a facility to his or her home, domiciliary, rest home, or assisted living. Such care helps to prevent read-missions and lowers the cost of health care (outpatient care is less expensive then inpatient care).

To qualify for these codes, the medical decision-making must be of moderate to high complexity. The services include one face-to-face visit and non face-to-face services (eg, arranging home health agencies for patient care). Coding guidelines preceding this subsection list the ser-vices performed for transitional care. Codes are selected based on medical decision-making associated with the patient’s condition, when the communication is initiated with the patient, and when the face-to-face encounter occurs following discharge. The first face-to-face encounter is included. The codes may be reported only once per 30 calendar days.

99495Transitionalcaremanagementserviceswiththefollowingrequiredelements:communication(directcontact,telephone,electronic)withthepatientand/orcaregiverwithin2businessdaysofdischargemedicaldecisionmakingofatleastmoderatecomplexityduringtheserviceperiodface-to-facevisit,within14calendardaysofdischarge

AAPC Rationale Report 99495 for transitional care management that includes initial communication within two business days of discharge, and a face-to-face encounter with 14 calendar days of discharge. Moderate or high complexity medical decision-making is required.

99496Transitionalcaremanagementserviceswiththefollowingrequiredelements:communication(directcontact,telephone,electronic)withthepatientand/orcaregiverwithin2businessdaysofdischargemedicaldecisionmakingofhighcomplexityduringtheserviceperiodface-to-facevisit,within7calendardaysofdischarge

AAPC Rationale Code 99496 is reported for transitional care management that includes initial communication within two business days of discharge, and a face-to-face encounter with seven calendar days of discharge. High complexity medical deci-sion-making is required. Because the patient’s condition is more severe, the face-to-face encounter is expected to happen sooner when reporting 99496 than with 99495.



MusculoskeletalSystem/Spine(VertebralColumn):Arthrodesis

22586Arthrodesis,pre-sacralinterbodytechnique,includingdiscspacepreparation,discectomy,withposteriorinstrumen-tation,withimageguidance,includesbonegraftwhenper-formed,L5-S1interspace

AAPC Rationale The new code has been created to report pre-sacral inter-body technique arthrodesis with posterior instrumentation. Code 22586 includes disc preparation, discectomy, poste-rior instrumentation, imaging guidance, and bone graft. Per CPT® instructions, do not report 22586 with 20930-20938, 22840, 22848, 72275, 77002, 77003, 77011, and 77012.

For pre-sacral interbody technique arthrodesis without instrumentation, turn to Category III codes 0195T and 0196T.

22586

Anatomical Illustrations © 2012, OptumInsight, Inc.

15740


MusculoskeletalSystem/General:IntroductionorRemoval

20665Removaloftongsorhaloappliedbyanotherphysicianindividual

AAPC Rationale The term “individual” replaces “physician” in the code descriptor, to allow a qualified health care provider other than a physician to report the service.

MusculoskeletalSystem/Spine(VertebralColumn):VertebralBody,EmbolizationorInjection

22522Percutaneousvertebroplasty(bonebiopsyincludedwhenperformed),1vertebralbody,unilateralorbilat-eralinjection;eachadditionalthoracicorlumbarvertebralbody(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Add-on code 22522 now includes conscious sedation, when performed.



24371Revisionoftotalelbowarthroplasty,includingallograftwhenperformed;humeralandulnarcomponent

AAPC Rationale Code 24371 has been added to report the revision of a total elbow arthroplasty, which involves removal of the artificial joint and replacement with a new joint. Previ-ously, this procedure was reported using two codes: 24363 for the total elbow arthroplasty and 24160 for artificial joint removal. The new code reports both services.

Report 24371 when the procedure involves both a humeral and ulnar component.

MusculoskeletalSystem/FootandToes:OtherProcedures

28890Extracorporealshockwave,highenergy,performedbyaphysicianorotherqualifiedhealthcareprofessional,requiringanesthesiaotherthanlocal,includingultrasoundguid-ance,involvingtheplantarfascia

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 28890 has been amended to allow this ser-vice to be performed by a physician or “other qualified health care professional.”

MusculoskeletalSystem/ApplicationofCastsandStrapping:Strapping—AnyAge

29590Denis-Brownesplintstrapping

AAPC Rationale This procedure is no longer performed.

RespiratorySystem/TracheaandBronchi:EndoscopySubsection GuidanceNew Category I codes replace deleted Category III codes 0250T–0252T to report procedures performed for the insertion and removal for bronchial valves. Bronchial valves are inserted to treat patients with emphysema or lung damage. Valves are inserted to limit airflow to the damaged part of the lung to promote healing. There are a total of five lobes in the lungs (two in the left lung, three in the right).

MusculoskeletalSystem/Shoulder:Repair,Revision,and/orReconstruction

23473Revisionoftotalshoulderarthroplasty,includingallograftwhenperformed;humeralorglenoidcomponent

AAPC Rationale Code 23473 has been added to report the revision of a total shoulder arthroplasty with removal and replacement of the artificial joint. Previously, two codes were reported for this procedure: 23472 for the arthroplasty and either 23331 or 23332 for removal of the implant. The new code includes the removal of the artificial joint and replacement with a new joint.

Report 23473 when the procedure involves either a humeral or glenoid component.

23474Revisionoftotalshoulderarthroplasty,includingallograftwhenperformed;humeralandglenoidcomponent

AAPC Rationale Code 23474 has been added to report the revision of a total shoulder arthroplasty with removal and replacement of the artificial joint. Previously, two codes were reported for this procedure: 23472 for the arthroplasty and either 23331 or 23332 for removal of the implant. The new code includes the removal of the artificial joint and replacement with a new joint.

Report 23474 when the procedure involves both a humeral and glenoid component.

MusculoskeletalSystem/Humerus(UpperArm)andElbow:Repair,Revision,and/orReconstruction

24370Revisionoftotalelbowarthroplasty,includingallograftwhenperformed;humeralorulnarcomponent

AAPC Rationale New code 24370 describes the revision of a total elbow arthroplasty, which involves removal of the artificial joint and replacement with a new joint. Previously, this proce-dure was reported using two codes: 24363 for the total elbow arthroplasty and 24160 for artificial joint removal. The new code reports both services.

Report 24370 when the procedure involves either the humeral or ulnar component.



add-on code 31649 for each additional lobe. Fluoroscopic guidance is included and may not be separately reported.

31651Bronchoscopy,rigidorflexible,includingfluoro-scopicguidance,whenperformed;withballoonocclusion,whenperformed,assessmentofairleak,airwaysizing,andinsertionofbronchialvalve(s),eachadditionallobe(listseparatelyinadditiontocodeforprimaryprocedure[s])

AAPC Rationale Report 31647 (above) is reported for the insertion of bron-chial valve(s) in an initial lobe. If performed in more than one lobe, report add-on code 31651 for each additional lobe. Fluoroscopic guidance is included and may not be separately reported.

31656Bronchoscopy,rigidorflexible,includingfluoroscopicguidance,whenperformed;withinjectionofcontrastmaterialforsegmentalbronchography(fiberscopeonly)

AAPC Rationale Bronchography is no longer performed. Computed Tomog-raphy (CT) is the standard of care replacing bronchography.

RespiratorySystem/TracheaandBronchi:BronchialThermoplastySubsection GuidanceCategory III codes 0276T–0277T have been deleted and replaced with new codes to report bronchial thermoplasty. The procedure involves radiofrequency ablation to treat asthmatic patients by reducing the muscle associated with airway constriction.

31660Bronchoscopy,rigidorflexible,includingfluoro-scopicguidance,whenperformed;withbronchialthermoplasty,1lobe

AAPC Rationale Report 31660 for bronchial thermoplasty performed on one lobe. The procedure includes fluoroscopic guidance.

31661Bronchoscopy,rigidorflexible,includingfluoro-scopicguidance,whenperformed;withbronchialthermoplasty,2ormorelobes

AAPC Rationale Report 31661 for bronchial thermoplasty performed on two or more lobes. The procedure includes fluoroscopic guidance.

31647Bronchoscopy,rigidorflexible,includingfluoro-scopicguidance,whenperformed;withballoonocclusion,whenperformed,assessmentofairleak,airwaysizing,andinsertionofbronchialvalve(s),initiallobe

AAPC Rationale Report 31647 for insertion of bronchial valve(s) in an initial lobe. If performed in more than one lobe, report 31651 (below) for each additional lobe. Fluoroscopic guidance is included and may not be separately reported.

31647


31648Bronchoscopy,rigidorflexible,includingfluoro-scopicguidance,whenperformed;withremovalofbronchialvalve(s),initiallobe

AAPC Rationale Report 31648 for removal of bronchial valve(s) in an initial lobe. If performed in more than one lobe, report 31649 (below) for each additional lobe. Fluoroscopic guidance is included and may not be separately reported.

31649Bronchoscopy,rigidorflexible,includingfluoro-scopicguidance,whenperformed;withremovalofbronchialvalve(s),eachadditionallobe(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report 31648 (above) for removal of bronchial valve(s) in an initial lobe. If performed in more than one lobe, report



32554Thoracentesis,needleorcatheter,aspirationofthepleuralspace;withoutimagingguidance

AAPC Rationale New codes replace 32421 and 32422 to more accurately describe procedures performed to aspirate fluid from the pleural space. A needle or catheter is used to puncture the pleural space and withdraw fluid. The new codes are selected based on whether imaging guidance is performed. When imaging guidance is not performed, report 32554.

32554


32555Thoracentesis,needleorcatheter,aspirationofthepleuralspace;withimagingguidance

AAPC Rationale New codes replace 32421 and 32422 to more accurately describe procedures performed to aspirate fluid from the pleural space. A needle or catheter is used to puncture the pleural space and withdraw fluid. The new codes are selected based on whether imaging guidance is performed.

Note that 31661 is not an add-on code: Select 31660 if the procedure is performed on one lobe or 31661 if performed on two or more lobes. Do not select 31660 and 31661 for the same surgical session.

RespiratorySystem/TracheaandBronchi:Introduction

31715Transtrachealinjectionforbronchography

AAPC Rationale Bronchography is no longer performed. Computed tomogra-phy (CT) is the standard of care replacing bronchography.

RespiratorySystem/LungsandPleura:Removal

32420Pneumocentesis,punctureoflungforaspiration

AAPC Rationale This procedure is no longer performed. See instead 32405.

32421Thoracentesis,punctureofpleuralcavityforaspiration,initialorsubsequent

AAPC Rationale Code 32421 has been deleted and replaced with new codes 32554 and 32555.

32422Thoracentesiswithinsertionoftube,includeswaterseal(eg,forpneumothorax),whenperformed(separateproce-dure)

AAPC Rationale Code 32422 has been deleted and replaced with new codes 32554 and 32555.

RespiratorySystem/LungsandPleura:IntroductionandRemoval

32551Tubethoracostomy,includeswatersealconnec-tiontodrainagesystem(eg,forabscess,hemothorax,empy-emawaterseal),whenperformed,open(separateprocedure)

AAPC Rationale The description for 32551 was revised to clarify proper use. This is an open procedure. The conditions (“abscess, hemothorax,” etc.) were removed to describe the procedure performed rather than the conditions treated.



CardiovascularSystem/HeartandPericardium:PacemakerorPacingCardioverter-Defibrillator

33225Insertionofpacingelectrode,cardiacvenoussystem,forleftventricularpacing,attimeofinsertionofpacingcardioverter-defibrillatororpacemakerpulsegenerator(includ-ingeg,forupgradetodualchambersystemandpocketrevi-sion)(Listseparatelyinadditiontocodeforprimaryprocedure)

AAPC RationaleThe code descriptor was revised to remove “pocket revi-sion” as a requirement, and parenthetical notes have been added to instruct when it is appropriate to report 33225 with other procedures. When reporting with 33322 or 33323, claim 33225 only when pocket relocation is per-formed.

The table for pacemaker and cardioverter-defibrillator ser-vices also has been revised to indentify the proper codes for the conversion of an existing bi-ventricular system and removal and replacement of the pulse generator. When the procedure is performed for a pacemaker, report 33225 with 33228 (dual lead system) or 33229 (multiple lead system). When the procedure is performed for a cardioverter-defibrillator, report 33225 with 33263 (dual lead system) or 33264 (multiple lead system).

CardiovascularSystem/HeartandPericardium:Heart(IncludingValves)andGreatVesselsSubsection GuidanceCategory III codes 0256T, 0258T, and 0259T have been deleted and replaced with Category I codes 33361–33369 to report transcatheter aortic valve replacement. TAVR is a non-invasive procedure to replace the aortic valve for patients with aortic stenosis (narrowing of the aortic valve).

New subsection guidelines provide instruction for proper use of the new codes, and identify the services included: Gaining access, deployment, and repositioning of the valve, temporary pacemaker insertion for rapid pacing, closure of arteriotomy, angiography, and radiologic supervision and interpretation. A team of providers is required for this pro-cedure (eg, cardiologist, interventional radiologists). When two surgeons work together to perform these procedures, append modifier 62.

Diagnostic coronary angiography may be reported sepa-rately when a prior coronary angiography was not per-

When imaging guidance is performed, report 32555. CPT® includes a parenthetical note instructing you not to report imaging guidance separately.

32556Pleuraldrainage,percutaneous,withinsertionofindwellingcatheter;withoutimagingguidance

AAPC Rationale New codes have been created to report the percutaneous drainage of pleural fluid. Unlike thoracocentesis, a tube or catheter is left in place to allow for drainage. Code selection is based on whether imaging guidance is used. If imaging guidance is not used, report 32556.

32557Pleuraldrainage,percutaneous,withinsertionofindwellingcatheter;withimagingguidance

AAPC Rationale New codes have been created to report the percutaneous drainage of pleural fluid. Unlike thoracocentesis, a tube or catheter is left in place to allow for drainage. Code selec-tion is based on whether imaging guidance is used. When imaging guidance is used, report 32557. Do not report imaging guidance separately.

RespiratorySystem/LungsandPleura:StereotacticRadiationTherapy

32701Thoracictarget(s)delineationforstereotacticbodyradiationtherapy(SRS/SBRT),(photonorparticlebeam),entirecourseoftreatment

AAPC Rationale Stereotactic radiation therapy is a new subsection in CPT® that includes new guidelines for proper use. Thoracic target delineation is performed to identify tumor bor-ders, tumor volume, and tumor relationship to adjacent anatomic structures. Delineation of the tumor allows the radiation oncologist to properly plan and deliver radiation treatments.

Code 32701 is not reported with the radiation treatment codes (77427–77499). According to the coding guidelines, 32701 may be reported only once per course of treatment, not per session.



33367Transcatheteraorticvalvereplacement(TAVR/TAVI)withprostheticvalve;cardiopulmonarybypasssupportwithpercutaneousperipheralarterialandvenouscannulation(eg,femoralvessels)(listseparatelyinadditiontocodeforpri-maryprocedure)

AAPC Rationale Add-on codes have been created to report cardiopulmonary bypass support when performed during a transcatheter aortic valve replacement. The add-on codes are selected based on whether the cannulation is performed percutane-ously, open, or centrally.

Report 33367 when peripheral arterial and venous cannu-lation is performed percutaneously.

33368Transcatheteraorticvalvereplacement(TAVR/TAVI)withprostheticvalve;cardiopulmonarybypasssupportwithopenperipheralarterialandvenouscannulation(eg,femo-ral,iliac,axillaryvessels)(listseparatelyinadditiontocodeforprimaryprocedure)


Report 33368 when peripheral arterial and venous cannu-lation is performed as an open procedure.

33369Transcatheteraorticvalvereplacement(TAVR/TAVI)withprostheticvalve;cardiopulmonarybypasssupportwithcentralarterialandvenouscannulation(eg,aorta,rightatrium,pulmonaryartery)(listseparatelyinadditiontocodeforprimaryprocedure)


Report 33369 when peripheral arterial and venous can-nulation is performed centrally through the aorta, right atrium, or pulmonary artery.

formed or, if a prior coronary angiography was performed, the test is not adequate (eg, patient’s condition has changed since the original angiography, the initial study is inad-equate visualization of anatomy).

The new codes are selected based on whether the approach is open or percutaneous and the vessel the surgeon uses for the approach. Cardiopulmonary bypass is reported with the appropriate add-on code (33367–33369), depending on the type of access performed.

33361Transcatheteraorticvalvereplacement(TAVR/TAVI)withprostheticvalve;percutaneousfemoralarteryapproach

AAPC Rationale Report 33361 for transcatheter aortic valve replacement using a percutaneous approach through the femoral artery.

33362Transcatheteraorticvalvereplacement(TAVR/TAVI)withprostheticvalve;openfemoralarteryapproach

AAPC Rationale Report 33362 for transcatheter aortic valve replacement using an open approach through the femoral artery.

33363Transcatheteraorticvalvereplacement(TAVR/TAVI)withprostheticvalve;openaxillaryarteryapproach

AAPC Rationale Report 33363 for transcatheter aortic valve replacement using an open approach through the axillary artery.

33364Transcatheteraorticvalvereplacement(TAVR/TAVI)withprostheticvalve;openiliacarteryapproach

AAPC Rationale Report 33364 for transcatheter aortic valve replacement using an open approach through the iliac artery.

33365Transcatheteraorticvalvereplacement(TAVR/TAVI)withprostheticvalve;transaorticapproach(eg,medianster-notomy,mediastinotomy)

AAPC Rationale Report 33365 for transcatheter aortic valve replacement using a transaortic approach. This is an open procedure done via median sternotomy or mediastinotomy.



33993Repositioningofpercutaneousventricularassistdevicewithimagingguidanceatseparateanddistinctsessionfrominsertion

AAPC Rationale Report 33993 when the percutaneous ventricular assist device (pVAD) is repositioned during a separate session. Repositioning during the same session as the insertion is not reported separately.

Imaging guidance is required to report this code.

CardiovascularSystem/HeartandPericardium:VascularInjectionProcedures

36010Introductionofcatheter,superiororinferiorvenacava

AAPC Rationale Introduction of catheter, to the superior or inferior vena cava now includes conscious sedation, when performed.

36140Introductionofneedleorintracatheter;extremityartery

AAPC Rationale Introduction of a needle or intracatheter into an extremity artery now includes conscious sedation, when performed.

CardiovascularSystem/ArteriesandVeins:VascularInjectionProceduresSubsection GuidanceThe AMA/Specialty Society RVS Update Committee (RUC) reviewed codes for carotid catheter procedures because the codes were reported together more than 75 percent of the time. New codes have been created to pre-vent duplicated services. The new codes report selective and non-selective arterial catheter placement and angiog-raphy in the aortic arch, and carotid and vertebral arteries. They include vessel access, placement of catheter(s), con-trast injection(s), fluoroscopy, radiological supervision and interpretation, and closure of the arteriotomy.

The codes are unilateral; therefore, modifier 50 is appro-priate if the service is performed bilaterally. CPT® provides specific instruction on appending modifier 59 for these services.

New guidelines provide instruction for proper use of 36221–36228. The codes are built on a hierarchy of ser-

CardiovascularSystem/HeartandPericardium:CardiacAssistSubsection GuidanceCategory III codes 0048T and 0050T have been deleted and replaced with new Category I codes 33990–33993 for insertion, removal, and repositioning of percutaenous ventricle assist devices. Ventricle assist devices assist the patient’s heart to pump blood. The devices are used during high-risk procedures or for critically ill patients. Ventricle assist devices can be inserted percutaneously (33990–33991) or transthoracically (33975, 33976, 33979).

Coding guidelines have been added to the categories of Heart (Including Valves) and Great Vessels, Cardiac Valves, and Coronary Bypass procedures to direct you to the correct codes when ventricular assist devices are inserted.

33990Insertionofventricularassistdevice,percutaneousincludingradiologicalsupervisionandinterpretation;arterialaccessonly

AAPC Rationale Report 33990 when the percutaneous ventricular assist device (pVAD) involves arterial access only.

33991Insertionofventricularassistdevice,percutaneousincludingradiologicalsupervisionandinterpretation;botharte-rialandvenousaccess,withtransseptalpuncture

AAPC Rationale Report 33991 when the percutaneous ventricular assist device (pVAD) involves arterial and venous access and transseptal puncture.

33992Removalofpercutaneousventricularassistdeviceatseparateanddistinctsessionfrominsertion

AAPC Rationale Report 33992 when the percutaneous ventricular assist device (pVAD) is removed during a separate session. Removal during the same session as the insertion is not reported separately.



phyoftheextracranialcarotidandcervicocerebralarch,whenperformed

AAPC Rationale Report 36223 for selective catheter placement in the common carotid or innominate artery, including angiog-raphy of ipsilateral (same side) intracranial carotid circula-tion, the extracranial carotid, and the cervicocerebral arch.

36224Selectivecatheterplacement,internalcarotidartery,unilateral,withangiographyoftheipsilateralintracranialcarotidcirculationandallassociatedradiologicalsupervisionandinterpretation,includesangiographyoftheextracranialcarotidandcervicocerebralarch,whenperformed

AAPC Rationale Report 36224 for selective catheter placement in the inter-nal carotid artery, including angiography of ipsilateral (same side) intracranial carotid circulation, the extracranial carotid, and the cervicocerebral arch.

36224


36225Selectivecatheterplacement,subclavianorinnomi-nateartery,unilateral,withangiographyoftheipsilateralverte-bralcirculationandallassociatedradiologicalsupervisionandinterpretation,includesangiographyofthecervicocerebralarch,whenperformed

vices. When more than one procedure is performed on the ipsilateral (same side) vessel, report only the most complex procedure.

For example, a selective catheterization of the left common carotid, including an angiography of the ipsilateral extra-cranial circulation, is performed with a selective catheter-ization of the right internal carotid artery. This would be reported 36224, 36222-59. If both procedures were performed on the left (same) side (left common carotid and left internal carotid), you would report 36224 only.

Radiological supervision and interpretation is included in codes 36221–36228; however, if a 3D rendering is performed, coding guidelines allow separate reporting of 76376 or 76377. Likewise, if ultrasound guidance is required to access the vessel, report 76937; and, 75774 may be reported if the angiography is not performed for the extracranial and intracranial cervicocerebral vessels (eg, upper extremities).

36221Non-selectivecatheterplacement,thoracicaorta,withangiographyoftheextracranialcarotid,vertebral,and/orintracranialvessels,unilateralorbilateral,andallassociatedradiologicalsupervisionandinterpretation,includesangiogra-phyofthecervicocerebralarch,whenperformed

AAPC Rationale Report 36221 for non-selective thoracic aorta catheter placement. This procedure includes angiography of the cervicocerebral arch. Do not report 36221 with 36222–36226.

36222Selectivecatheterplacement,commoncarotidorinnominateartery,unilateral,anyapproach,withangiographyoftheipsilateralextracranialcarotidcirculationandallassociatedradiologicalsupervisionandinterpretation,includesangiogra-phyofthecervicocerebralarch,whenperformed

AAPC Rationale Report 36222 for selective catheter placement in the common carotid or innominate artery, including angiogra-phy of ipsilateral (same side) extracranial carotid circulation.

36223Selectivecatheterplacement,commoncarotidorinnominateartery,unilateral,anyapproach,withangiographyoftheipsilateralintracranialcarotidcirculationandallassociatedradiologicalsupervisionandinterpretation,includesangiogra-



AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 36400 has been amended to allow that this service may be performed by a physician or “other quali-fied health care professional.”

36405Venipuncture,youngerthanage3years,necessitat-ingphysician’stheskillofaphysicianorotherqualifiedhealthcareprofessional,nottobeusedforroutinevenipuncture;scalpvein


36406Venipuncture,youngerthanage3years,necessitat-ingphysician’stheskillofaphysicianorotherqualifiedhealthcareprofessional,nottobeusedforroutinevenipuncture;othervein


36410Venipuncture,age3yearsorolder,necessitatingphysician’stheskillofaphysicianorotherqualifiedhealthcareprofessional,fordiagnosticortherapeuticpurposes(nottobeusedforroutinevenipuncture)


CardiovascularSystem/ArteriesandVeins:TranscatheterProcedures

37197Transcatheterretrieval,percutaneous,ofintravascularforeignbody(eg,fracturedvenousorarterialcatheter),includesradiologicalsupervisionandinterpretation,andimagingguid-ance(ultrasoundorfluoroscopy),whenperformed

AAPC Rationale Report 36225 for selective catheter placement in the sub-clavian artery. The procedure includes angiography of ipsilateral (same side) vertebral circulation and of the cervi-cocerebral arch.

36226Selectivecatheterplacement,vertebralartery,uni-lateral,withangiographyoftheipsilateralvertebralcirculationandallassociatedradiologicalsupervisionandinterpretation,includesangiographyofthecervicocerebralarch,whenper-formed

AAPC Rationale Report 36226 for selective catheter placement in the vertebral artery. The procedure includes angiography of ipsilateral (same side) vertebral circulation and of the cervi-cocerebral arch.

36227Selectivecatheterplacement,externalcarotidartery,unilateral,withangiographyoftheipsilateralexternalcarotidcirculationandallassociatedradiologicalsupervisionandinterpretation(listseparatelyinadditiontocodeforpri-maryprocedure)

AAPC Rationale Report add-on code 36227 in addition to 36222, 36223, or 36224 for selective catheter placement in the external carotid artery.

36228Selectivecatheterplacement,eachintracranialbranchoftheinternalcarotidorvertebralarteries,unilateral,withangiographyoftheselectedvesselcirculationandallasso-ciatedradiologicalsupervisionandinterpretation(eg,middlecerebralartery,posteriorinferiorcerebellarartery)(listsepa-ratelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report add-on code 36228 in addition 36224 or 36226 for selective catheter placement in each intracranial branch of the internal carotid or vertebral arteries. Do not report 36228 more than twice, per side.

36400Venipuncture,youngerthanage3years,necessitat-ingphysician’stheskillofaphysicianorotherqualifiedhealthcareprofessional,nottobeusedforroutinevenipuncture;femoralorjugularvein



AAPC Rationale Report 37211 for infusion thrombolysis of an artery other than coronary, once per day for the initial service.

37212Transcathetertherapy,venousinfusionforthromboly-sis,anymethod,includingradiologicalsupervisionandinterpre-tation,initialtreatmentday

AAPC Rationale Report 37212 for infusion thrombolysis of a vein, once per day for the initial service.

37213Transcathetertherapy,arterialorvenousinfusionforthrombolysisotherthancoronary,anymethod,includingradio-logicalsupervisionandinterpretation,continuedtreatmentonsubsequentdayduringcourseofthrombolytictherapy,includ-ingfollow-upcathetercontrastinjection,positionchange,orexchange,whenperformed;

AAPC Rationale Report 37213 for infusion thrombolysis of an artery (other than coronary) or vein on a subsequent day of therapy. You would report this service only if the infusion thrombolysis was initiated on a previous date of service. Position change or exchange is included with the subsequent code.

AAPC Rationale Code 37197 has been created to bundle radiological super-vision and interpretation to percutaneous transcatheter retrieval of a foreign body. The creation of the bundled code resulted in the deletion of 37203. Report retrieval of the vena cava filter with 37193.

37201Transcathetertherapy,infusionforthrombolysisotherthancoronary

AAPC Rationale CPT® 2013 deletes 37201 and adds new codes 37211–37214 that bundle the surgical and radiological supervision and interpretation services. Radiology code 75896 has been revised to remove mention of thrombolysis.

37203Transcatheterretrieval,percutaneous,ofintravascularforeignbody(eg,fracturedvenousorarterialcatheter)

AAPC Rationale Code 37203 has been deleted and replaced by 37197, which bundles surgical and radiological supervision and interpretation to percutaneous transcatheter retrieval of a foreign body.

37209Exchangeofapreviouslyplacedintravascularcatheterduringthrombolytictherapy

AAPC Rationale Codes 37209 and 75900 have been deleted and replaced by new codes 37211–37214 that bundle surgical and radio-logical supervision and interpretation services with infusion thrombolysis.

Subsection GuidanceNew codes bundle surgical and radiological supervision and interpretation services with infusion thrombolysis when performed in arterial and venous vessels. During the procedure, chemicals are infused to break down clots. Codes are selected for the initial treatment day. If the treat-ment extends over more than one date of service, you may use separate codes to report the subsequent treatment day and the cessation or last treatment day.

37211Transcathetertherapy,arterialinfusionforthrom-bolysisotherthancoronary,anymethod,includingradiologicalsupervisionandinterpretation,initialtreatmentday

# 37214Transcathetertherapy,arterialorvenousinfu-sionforthrombolysisotherthancoronary,anymethod,includingradiologicalsupervisionandinterpretation,contin-uedtreatmentonsubsequentdayduringcourseofthrombo-lytictherapy,includingfollow-upcathetercontrastinjection,positionchange,orexchange,whenperformed;cessationofthrombolysisincludingremovalofcatheterandvesselclosurebyanymethod

AAPC Rationale Report 37214 for the cessation of infusion thrombolysis of an artery (other than coronary), including removal of the catheter and closure of the vessel. Claim 37214 only if the infusion thrombolysis was initiated on a previous date of service. If the initiation and cessation are per-formed on the same date of service, report either 37211 or 37212 only, depending on the type of vessel.



DigestiveSystem/Esophagus:EndoscopyHemicandLymphaticSystems:TransplantationandPost-TransplantationCellularInfusions

38240Bonemarroworblood-derivedperipheralstemHematopoieticprogenitorcelltransplantation(HPC);allogeneictransplantationperdonor

AAPC Rationale Codes for HPC transplantation have been revised to assist with code selection. Allogenic transplantation means the recipient is not the donor. Because the procedure can involve cells from more than one donor, the procedure is reported per donor. The procedure includes the physician monitoring physiological parameters, verification of cell processing, patient evaluation, and direct supervision of the infusion.

38241Bonemarroworblood-derivedperipheralstemHematopoieticprogenitorcelltransplantation(HPC);autologoustransplantation

AAPC Rationale Codes for HPC transplantation have been revised to assist with code selection. Autologous transplantation means the recipient and donor are the same person. The procedure includes the physician monitoring physiological param-eters, verification of cell processing, patient evaluation, and direct supervision of the infusion.

# 38243Hematopoieticprogenitorcell(HPC);HPCboost

AAPC Rationale A new code has been created to report HPC boost—which may occur days, months, or years from the origi-nal HPC transplantation. The boost comes from the original HPC donor from the initial transplantation. This procedure is performed to treat a relapse or post-transplant cytopenia (deficiency or lack of cellular ele-ments in the circulating blood).

# 43206Esophagoscopy,rigidorflexible;withopticalendomicroscopy

AAPC Rationale Code 43206 has been created to describe esophagos-copy performed with optical endomicroscopy. Opti-cal endomicroscopy allows the provider to eliminate random sampling and perform targeted biopsies through real-time cellular observation of mucosal tissue. The procedure is performed when the provider suspects preneoplastic diseases. Code 43026 includes moderate sedation.

43206


38242allogenicAllogenicdonorlymphocyteinfusions

AAPC Rationale With revisions to 38240 and 38241, 38242 is no longer a “child” of parent code 38240. Report 38242 for lympho-cyte infusions in patients who have had a previous bone marrow transplant.



UrinarySystem/Bladder:TransurethralSurgery

52287Cystourethroscopy,withinjection(s)forchemodener-vationofthebladder

AAPC Rationale Code 52287 has been created to report injections for che-modenervation of the bladder (eg, for neurogenic incon-tinence).

MaternityCareandDelivery:Repair

59300Episiotomyorvaginalrepair,byotherthanattendingphysician

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 59300 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation also may be reported by other (non-physi-cian), qualified attending health care professionals.

NervousSystem/SpineandSpinalCord:Reservoir/PumpImplantation

62370Electronicanalysisofprogrammable,implantedpumpforintrathecalorepiduraldruginfusion(includesevalua-tionofreservoirstatus,alarmstatus,drugprescriptionstatus);withreprogrammingandrefill(requiringskillphysician’sofaphysicianorotherqualifiedhealthcareprofessional)


NervousSystem/ExtracranialNerves,Periph-eralNerves,andAutonomicNervousSystem:Neurostimulators(PeripheralNerve)

64561Percutaneousimplantationofneurostimulatorelec-trodearray;sacralnerve(transforaminalplacement)includingimageguidance,ifperformed

AAPC Rationale Percutaneous implantation of neurostimulator electrode array to the sacral nerve now includes image guidance, when performed.

43234Uppergastrointestinalendoscopy,simpleprimaryexamination(eg,withsmalldiameterflexibleendoscope)(sepa-rateprocedure)

AAPC Rationale Upper gastrointestinal endoscopy with a small diameter endoscope (43234) is now rarely performed. The most common gastrointestinal endoscopy is 43235.

43252Uppergastrointestinalendoscopyincludingesopha-gus,stomach,andeithertheduodenumand/orjejunumasappropriate;withopticalendomicroscopy

AAPC Rationale Code 43252 has been created to report upper gastrointes-tinal endoscopy performed with optical endomicroscopy. Optical endomicroscopy allows the provider to eliminate random sampling and perform targeted biopsies through real-time cellular observation of mucosal tissue. The proce-dure is performed when the provider suspects preneoplastic diseases. Code 43252 includes moderate sedation.

DigestiveSystem/Intestines(ExceptRectum):OtherProcedures

44705Preparationoffecalmicrobiotaforinstillation,includ-ingassessmentofdonorspecimen

AAPC Rationale Code 44705 has been created to report the preparation of fecal microbiota for instillation in a patient with Clostrid-ium difficile infection. Clostridium difficile (C. difficile) is a bacterium commonly found in the intestines that can grow out of control from use of antibiotics, which kill “good” bacteria in the gut. The procedure includes collecting fecal material from a donor, preparing the fecal material in a slurry, and evaluating the material prior to instillation.

This service includes only the preparation prior to instilla-tion, not the work to instill the fecal microbiota. A separate code is reported for the instillation either through colo-noscopy or sigmoidoscopy. A parenthetical note following 44705 instructs you to report 44799 for oro-nasogastric tube or enema.



NervousSystem/ExtracranialNerves,Periph-eralNerves,andAutonomicNervousSystem:DestructionbyNeurolyticAgent,Chemode-nervation

64612Chemodenervationofmuscle(s);muscle(s)inner-vatedbyfacialnerve,unilateral(eg,forblepharospasm,hemifa-cialspasm)

AAPC RationaleThe descriptor of 64612 was revised to add “unilateral” to clarify proper code application. If the procedure is per-formed bilaterally, append modifier 50.

64614Chemodenervationofmuscle(s);extremity(s)and/ortrunkmuscle(s)(eg,fordystonia,cerebralpalsy,multiplesclerosis)

AAPC Rationale Code 64614 was revised to specify “extremity” (singular). Because the procedure includes chemodenervation of mul-tiple muscles, it is reported once per session for extremity or trunk muscles. Do not report 64614 with modifier 50.

64615Chemodenervationofmuscle(s);muscle(s)innervatedbyfacial,trigeminal,cervicalspinalandaccessorynerves,bilat-eral(eg,forchronicmigraine)

AAPC Rationale Code 64615 has been created to report bilateral chemode-nervation of muscles innervated by facial, trigeminal, cervi-cal spine, and accessory nerves. This procedure typically includes 31 injection sites to treat migraine headaches. The procedure must be performed bilaterally and is valued as such: Do not append modifier 50 to 64615. Do not report 64615 with 64612, 64613, or 64614.

EyeandOcularAdnexa:AnteriorSegmentIncision

65800Paracentesisofanteriorchamberofeye(separateprocedure);withdiagnosticaspirationremovalofaqueous

AAPC Rationale To simplify code selection, 65805 (below) has been deleted and 65800 was revised to report removal of aqueous for either diagnostic or therapeutic purposes.

65805Paracentesisofanteriorchamberofeye(separatepro-cedure);withtherapeuticreleaseofaqueous

AAPC Rationale To simplify code selection, 65805 has been deleted and 65800 (above) was revised to report removal of aqueous for either diagnostic or therapeutic purposes.

# 67810BiopsyIncisionalbiopsyofeyelidskinincludinglidmargin

AAPC Rationale Code 67810 was revised to include the anatomic site of the eyelid and the depth of tissue removed. This code is sometimes used in error when the proper integumen-tary biopsy code should be reported. To report 67810, the biopsy must be of the lid margin. Because this is an incisional procedure, it was resequenced under the “inci-sional” subsection instead of the “excisional” heading, where it previously appeared.

Report 11100, 11101, or 11310-11313 for biopsy of the skin of the eyelid.



67810

Lesion tobe biopsied

A portion of a lesion or suspecttissue is removed for analysis

The incision may be repaired with sutures


RadiologyDiagnosticRadiology:Chest

71040Bronchography,unilateral,radiologicalsupervisionandinterpretation

AAPC Rationale Bronchography is no longer performed. Computed tomog-raphy (CT) is now the standard of care replacing bron-chography.

71060Bronchography,bilateral,radiologicalsupervisionandinterpretation

AAPC Rationale Bronchography is no longer performed. Computed tomog-raphy (CT) is now the standard of care replacing bron-chography.

DiagnosticRadiology:SpineandPelvis

72040Radiologicexamination,spine,cervical;23viewsorless

AAPC Rationale Codes for radiology examination of the cervical spine have been revised to include the number of views to accurately capture the work performed. When three or fewer views are performed, report 72040.

72050Radiologicexamination,spine,cervical;4minimumor5views

AAPC Rationale Codes for radiology examination of the cervical spine have been revised to include the number of views to accurately capture the work performed. When four or five views are performed, report 72050.

72052Radiologicexamination,spine,cervical;complete,includingobliqueandflexionand/6orextensionstudiesmoreviews

AAPC Rationale Codes for radiology examination of the cervical spine have been revised to include the number of views to accurately capture the work performed. When six or more views are performed, report 72052.

DiagnosticRadiology/Vascular:AortaandArteries

75650Angiography,cervicocerebral,catheter,includingvesselorigin,radiologicalsupervisionandinterpretation

AAPC Rationale Code 75650 has been deleted. Refer to 36221–36226.

75660Angiography,externalcarotid,unilateral,selective,radiologicalsupervisionandinterpretation


75662Angiography,externalcarotid,bilateral,selective,radio-logicalsupervisionandinterpretation

AAPC Rationale Code 75662 has been deleted. Refer to 36227.



75665Angiography,carotid,cerebral,unilateral,radiologicalsupervisionandinterpretation

AAPC Rationale Code 75665 has been deleted. Refer to 36223 and 36224.

75671Angiography,carotid,cerebral,bilateral,radiologicalsupervisionandinterpretation

AAPC Rationale Code 75671 has been deleted. Refer to 36223 and 36224.

75676Angiography,carotid,cervical,unilateral,radiologicalsupervisionandinterpretation


75680Angiography,carotid,cervical,bilateral,radiologicalsupervisionandinterpretation


75685Angiography,vertebral,cervical,and/orintracranial,radiologicalsupervisionandinterpretation


DiagnosticRadiology,Vascular:TranscatheterProcedures

75896Transcathetertherapy,infusion,anymethod(eg,thrombolysisotherthanforthrombolysis,radiologicalsupervi-sionandinterpretation

AAPC Rationale New codes (37211–37214) have been created for infusion thrombolysis. The new codes include radiological supervi-sion and interpretation; therefore, 75896 was revised to exclude thrombolysis.

75898Angiographythroughexistingcatheterforfollow-upstudyfortranscathetertherapy,embolizationorinfusion,otherthanforthrombolysis

AAPC Rationale New codes (37211–37214) have been created for infusion thrombolysis. The new codes include radiological supervi-sion and interpretation; therefore, 75898 was revised to exclude thrombolysis.

75900Exchangeofapreviouslyplacedintravascularcatheterduringthrombolytictherapywithcontrastmonitoring,radiologi-calsupervisionandinterpretation

AAPC Rationale New codes (37211–37214) have been created for infusion thrombolysis. The new codes include radiological supervi-sion and interpretation; therefore, 75900 has been deleted.

75961Transcatheterretrieval,percutaneous,ofintravascularforeignbody(eg,fracturedvenousorarterialcatheter),radio-logicalsupervisionandinterpretation

AAPC Rationale Code 75961 has been deleted and replaced by 37197.

DiagnosticRadiology:OtherProcedures

76000Fluoroscopy(separateprocedure),upto1hourphysicianorotherqualifiedhealthcareprofessionaltime,otherthan71023or71034(eg,cardiacfluoroscopy)


76001Fluoroscopy,physicianorotherqualifiedhealthcareprofessionaltimemorethan1hour,assistinganonradiologicphysicianorotherqualifiedhealthcareprofessional(eg,neph-rostolithotomy,ERCP,bronchoscopy,transbronchialbiopsy)


763763Drenderingwithinterpretationandreportingofcomputedtomography,magneticresonanceimaging,ultra-sound,orothertomographicmodalitywithimagepostpro-



cessingunderconcurrentsupervision;notrequiringimagepost-processingonanindependentworkstation

AAPC Rationale Code 76376 was revised to include image postprocessing under concurrent supervision. The parenthetical note was revised to list procedures not reported with 76376.

763773Drenderingwithinterpretationandreportingofcomputedtomography,magneticresonanceimaging,ultrasound,orothertomographicmodalitywithimagepost-processingunderconcurrentsupervision;requiringimagepost-processingonanindependentworkstation

AAPC Rationale Code 76377 was revised to include image postprocessing under concurrent supervision. The parenthetical note was revised to list procedures not reported with 76377.

DiagnosticUltrasound:Extremities

76885Ultrasound,infanthips,realtimewithimagingdocumentation;dynamic(requiringphysicianorotherqualifiedhealthcareprofessionalmanipulation)


76886Ultrasound,infanthips,realtimewithimagingdocu-mentation;limited,static(notrequiringphysicianorotherquali-fiedhealthcareprofessionalmanipulation)


Breast,Mammography

+77051Computer-aideddetection(computeralgorithmanalysisofdigitalimagedataforlesiondetection)withfurtherphysicianreviewforinterpretation,withorwithoutdigitizationoffilmradiographicimages;diagnosticmammography(listsepa-ratelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 77051 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation also may be reported by other (non-physi-cian) health care professionals.

77052Computer-aideddetection(computeralgorithmanalysisofdigitalimagedataforlesiondetection)withfurtherphysicianreviewforinterpretation,withorwithoutdigitizationoffilmradiographicimages;screeningmammography(listsepa-ratelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 77052 has been amended to allow that, per AMA guidelines, this service may be performed by a “qual-ified health care professional” other than a physician.

BoneandJointStudies

77071Manualapplicationofstressperformedbyphysicianorotherqualifiedhealthcareprofessionalforjointradiography,includingcontralateraljointifindicated


NuclearMedicine/Diagnostic:EndocrineSystem

78000Thyroiduptake;singledetermination

AAPC Rationale Codes 78000–78011 have been deleted. See 78012–78014.

78001Thyroiduptake;multipledeterminations


78003Thyroiduptake;stimulation,suppressionordischarge(notincludinginitialuptakestudies)




78006Thyroidimaging,withuptake;singledetermination


78007Thyroidimaging,withuptake;multipledeterminations


78010Thyroidimaging;only


78011Thyroidimaging;withvascularflow


78012Thyroiduptake,singleormultiplequantitativemeasurement(s)(includingstimulation,suppression,ordis-charge,whenperformed)

AAPC Rationale Codes 78000–78011 have been deleted and new codes have been created to consolidate services and more accu-rately describe the types of thyroid nuclear medicine scans performed. Code 78012 is performed to evaluate the func-tion of the gland.

78013Thyroidimaging(includingvascularflow,whenperformed);

AAPC Rationale Codes 78000–78011 have been deleted and new codes have been created to consolidate services and more accu-rately describe the types of thyroid nuclear medicine scans performed. Code 78013 is performed to determine the size, shape, and position of the thyroid gland.

78014Thyroidimaging(includingvascularflow,whenperformed);withsingleormultipleuptake(s)quantitativemeasurement(s)(includingstimulation,suppression,ordischarge,whenperformed)

AAPC Rationale Codes 78000–78011 have been deleted and new codes have been created to consolidate services and more accu-rately describe the types of thyroid nuclear medicine scans

performed. Use 78014 when the services identified in 78012 and 78013 are performed during the same session.

78070Parathyroidplanarimaging(includingsubtraction,whenperformed)

AAPC Rationale Revisions were made to 78070 to more accurately describe the procedure performed. New codes 78071–78072 have been added to report Single Photon Emission Computed Tomography (SPECT) and SPECT/CT performed for parathyroid planar imaging.

78071Parathyroidplanarimaging(includingsubtraction,whenperformed);withtomographic(SPECT)

AAPC Rationale Prior to the creation of 78071, no CPT® code properly described SPECT performed during parathyroid planar imaging.

78072Parathyroidplanarimaging(includingsubtraction,whenperformed);withtomographic(SPECT),andconcurrentlyacquiredcomputedtomography(CT)foranatomicallocalization

AAPC Rationale Prior to the creation of code 78072, no CPT® code prop-erly described SPECT/CT performed during parathyroid planar imaging.

PathologyandLaboratoryMolecularPathologyLast year, CPT® added a new subsection and 101 new codes (81200–81408) to the Pathology and Laboratory chapter to describe molecular pathology procedures. Molecular pathology is the study and diagnosis of disease through the examination of nucleic acid (including DNA and RNA), for the purposes of: detecting and monitoring infectious agents; establishing clonality (cells descended from and genetically identical to a single common ances-tor), particularly for lymphoid diseases; assessing the pres-ence of minimal residual disease for certain malignancies following therapy; determining prognosis and/or predicting response to therapy, and; testing for inherited diseases.

For 2013, CPT® adds 13 new Tier 1 molecular pathology procedure codes, as well as an unlisted molecular pathol-ogy procedure code (81479), and revises the descriptors for



all nine Tier 2 (81400–81408) procedures. Because molec-ular pathology procedures are highly specialized and infre-quently reported, we will not cover these code revisions and additions individually as part of this course. Consult your 2013 CPT® codebook for complete instructions and parenthetical guidelines, definitions, and descriptors for molecular pathology codes.

Molecular pathology instructions have been added to the beginning of the CPT® codebook. The information pro-vides a history for the creation of the molecular pathology codes, instructions for use, and frequently asked questions to assist with proper code selection.

MultianalyteAssayswithAlgorithmicAnalysis(MAAA)A new category, including coding guidelines, has been cre-ated to report MAAA. MAAAs are algorithmic analysis using the results of assays (molecular pathology assays, fluorescent in situ hybridization assays, and nonnucleic acid-based assays) and patient information, when appropri-ate, to report a numeric score(s) or probability of develop-ing specific conditions.

The code descriptions include the disease type, material analyzed, number of markers, specimen type, algorithm, and report.

81500Oncology(ovarian),biochemicalassaysoftwopro-teins(CA-125andHE4),utilizingserum,withmenopausalstatus,algorithmreportedasariskscore

AAPC Rationale This new MAAA procedure is used to determine risk score for ovarian cancer. Report 81500 when biochemical assays of two proteins and menopausal status are used for the algorithm.

81503Oncology(ovarian),biochemicalassaysoffivepro-teins(CA-125,apoliproproteinA1,beta-2microglobulin,trans-ferrin,andpre-albumin),utilizingserum,algorithmreportedasariskscore

AAPC Rationale This new MAAA procedure is used to determine risk score for ovarian cancer. Report 81503 for biochemical assays of five proteins.

81506Endocrinology(type2diabetes),biochemicalassaysofsevenanalytes(glucose,HBA1C,insulin,HS-CRP,adopo-nectin,ferritin,interleukin2-receptoralpha),utilizingserumorplasma,algorithmreportingariskscore

AAPC Rationale This new MAAA procedure is used to determine risk score for type 2 diabetes via assays of the seven analytes listed (glucose, HBA1C, insulin, HS-CRP, adoponectin, ferritin, interleukin 2-receptor alpha).

81508Fetalcongenitalabnormalities,biochemicalassaysoftwoproteins(PAPP-A,HCG[anyform]),utilizingmaternalserum,algorithmreportedasariskscore

AAPC Rationale This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of two proteins.

81509Fetalcongenitalabnormalities,biochemicalassaysofthreeproteins(PAPP-A,HCG[anyform],DIA),utilizingmaternalserum,algorithmreportedasariskscore

AAPC Rationale This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of three proteins.

81510Fetalcongenitalabnormalities,biochemicalassaysofthreeanalytes(AFP,UE3,HCG[anyform]),utilizingmaternalserum,algorithmreportedasariskscore

AAPC Rationale This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of three analytes.

81511Fetalcongenitalabnormalities,biochemicalassaysoffouranalytes(AFP,UE3,HCG[anyform],DIA)utilizingmater-nalserum,algorithmreportedasariskscore(mayincludeadditionalresultsfrompreviousbiochemicaltesting)

AAPC Rationale This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of four analytes.



81512Fetalcongenitalabnormalities,biochemicalassaysoffiveanalytes(AFP,UE3,totalHCG,hyperglycosylatedHCG,DIA)utilizingmaternalserum,algorithmreportedasariskscore

AAPC Rationale This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of five analytes.

81599Unlistedmultianalyteassaywithalgorithmicanalysis

AAPC Rationale An unlisted code has been created for MAAA tests when a Category I code does not exist and there is no appropri-ate code in Appendix O. Appendix O lists alphanumeric codes that include four numeric digits followed by “M.” Report codes in Appendix O by the proprietary name and clinical lab or manufacturer. These codes are in an Appen-dix because Category I codes report the service work and cannot include proprietary names.

Chemistry

82009AcetoneorotherketonebodiesKetonebody(s)(eg,acetone,acetoaceticacid,serumbeta-hydroxybutyrate);qualitative

AAPC Rationale Code 82009 was revised to reflect current clinical practice.

82010AcetoneorotherketonebodiesKetonebody(s)(eg,acetone,acetoaceticacid,serumbeta-hydroxybutyrate);quan-titative

AAPC Rationale Code 82010 was revised to reflect current clinical practice.

82777Galectin-3

AAPC Rationale Code 82777 has been created to report measuring of galec-tin-3, which can be used to assess the prognosis of heart failure patients.

83890Moleculardiagnostics;molecularisolationorextraction,eachnucleicacidtype(ie,DNAorRNA)

AAPC Rationale Codes 83890–83914 have been deleted; refer to molecular pathology codes 81200-81479.

83891Moleculardiagnostics;isolationorextractionofhighlypurifiednucleicacid,eachnucleicacidtype(ie,DNAorRNA)

AAPC Rationale Codes 83890–83914 have been deleted; refer to molecular pathology codes 81200–81479.

83892Moleculardiagnostics;enzymaticdigestion,eachenzymetreatment

AAPC Rationale Codes 83890–83914 have been deleted. To report, refer to molecular pathology codes 81200–81479.

83893Moleculardiagnostics;dot/slotblotproduction,eachnucleicacidpreparation


83894Moleculardiagnostics;separationbygelelectrophoresis(eg,agarose,polyacrylamide),eachnucleicacidpreparation


83896Moleculardiagnostics;nucleicacidprobe,each


83897Moleculardiagnostics;nucleicacidtransfer(eg,South-ern,Northern),eachnucleicacidpreparation


83898Moleculardiagnostics;amplification,target,eachnucleicacidsequence




83900Moleculardiagnostics;amplification,target,multiplex,first2nucleicacidsequences


83901Moleculardiagnostics;amplification,target,multiplex,eachadditionalnucleicacidsequencebeyond2(Listseparatelyinadditiontocodeforprimaryprocedure)


83902Moleculardiagnostics;reversetranscription


83903Moleculardiagnostics;mutationscanning,byphysicalproperties(eg,singlestrandconformationalpolymorphisms[SSCP],heteroduplex,denaturinggradientgelelectrophoresis[DGGE],RNA’aseA),singlesegment,each


83904Moleculardiagnostics;mutationidentificationbysequencing,singlesegment,eachsegment


83905Moleculardiagnostics;mutationidentificationbyallelespecifictranscription,singlesegment,eachsegment


83906Moleculardiagnostics;mutationidentificationbyallelespecifictranslation,singlesegment,eachsegment


83907Moleculardiagnostics;lysisofcellspriortonucleicacidextraction(eg,stoolspecimens,paraffinembeddedtissue),eachspecimen


83908Moleculardiagnostics;amplification,signal,eachnucleicacidsequence


83909Moleculardiagnostics;separationandidentificationbyhighresolutiontechnique(eg,capillaryelectrophoresis),eachnucleicacidpreparation


83912Moleculardiagnostics;interpretationandreport


83913Moleculardiagnostics;RNAstabilization


83914Mutationidentificationbyenzymaticligationorprimerextension,singlesegment,eachsegment(eg,oligonucleotideligationassay[OLA],singlebasechainextension[SBCE],orallele-specificprimerextension[ASPE])




86711Antibody;JC(JohnCunningham)virus

AAPC Rationale Code 86711 has been created to report the testing to detect the John Cunningham virus, which causes progressive multifocal leukoencephalopathy (PML), a rare but often fatal condition that destroys myelin, a protective covering of nerve cells in the brain.

Immunology:TissueTypingSubsection GuidanceNew codes 86828–86835 report testing for antibodies to human leukocyte antigens (HLA). HLA typing identifies the unique HLA antigens for an individual. Tests of HLA-class I (A, B, C) and class II (DR, DQ, DP) are performed for solid organ and bone marrow transplants.

86828Antibodytohumanleukocyteantigens(HLA),solidphaseassays(eg,microspheresorbeads,ELISA,flowcytom-

etry);qualitativeassessmentofthepresenceorabsenceofantibody(ies)toHLAclassIandclassIIHLAantigens

AAPC Rationale Report 86828 for qualitative assessment for the presence or absence of HLA class I and class II. A qualitative test tells you if a particular substance (analyte) is present in the specimen.

86829Antibodytohumanleukocyteantigens(HLA),solidphaseassays(eg,microspheresorbeads,ELISA,flowcytom-etry);qualitativeassessmentofthepresenceorabsenceofantibody(ies)toHLAclassIorclassIIHLAantigens

AAPC Rationale Report 86829 for qualitative assessment for the presence or absence of HLA class I or class II. A qualitative test tells you if a particular substance (analyte) is present in the specimen.

86830Antibodytohumanleukocyteantigens(HLA),solidphaseassays(eg,microspheresorbeads,ELISA,flowcytom-etry);antibodyidentificationbyqualitativepanelusingcompleteHLAphenotypes,HLAclassI

AAPC Rationale Report 86830 for qualitative panel using HLA class I. A qualitative test tells you if a particular substance (analyte) is present in the specimen.

86831Antibodytohumanleukocyteantigens(HLA),solidphaseassays(eg,microspheresorbeads,ELISA,flowcytom-etry);antibodyidentificationbyqualitativepanelusingcompleteHLAphenotypes,HLAclassII

AAPC Rationale Report 86831 for qualitative panel using HLA class II. A qualitative test tells you if a particular substance (analyte) is present in the specimen.

86832Antibodytohumanleukocyteantigens(HLA),solidphaseassays(eg,microspheresorbeads,ELISA,flowcytom-etry);highdefinitionqualitativepanelforidentificationofantibodyspecificities(eg,individualantigenperbeadmethodol-ogy),HLAclassI

AAPC Rationale Report 86832 for qualitative panel for identification of antibody specificities for HLA class I. A qualitative test tells you if a particular substance (analyte) is present in the specimen.

Codes 0279T and 0280T have been deleted and replaced with Category I codes to report testing for tumor cells circulating in the blood. The test is used to determine the prognosis for cancer patients.

# 86152Cellenumerationusingimmunologicselectionandidentificationinfluidspecimen(eg,circulatingtumorcellsinblood);

AAPC Rationale Code 86152 has been created to report the technical component; the interpretation and report are reported using 86153 (below). When the same provider performs the test and interpretation and report, report both 86152 and 86153.

# 86153Cellenumerationusingimmunologicselectionandidentificationinfluidspecimen(eg,circulatingtumorcellsinblood);physicianinterpretationandreport,whenrequired

AAPC Rationale Code 86152 (above) has been created to report the technical component; the interpretation and report are reported using 86153. When the same provider performs the test and interpretation and report, report both 86152 and 86153.

Immunology



86833Antibodytohumanleukocyteantigens(HLA),solidphaseassays(eg,microspheresorbeads,ELISA,flowcytom-etry);highdefinitionqualitativepanelforidentificationofantibodyspecificities(eg,individualantigenperbeadmethodol-ogy),HLAclassII

AAPC Rationale Report 86833 for qualitative panel for identification of antibody specificities for HLA class II.

86834Antibodytohumanleukocyteantigens(HLA),solidphaseassays(eg,microspheresorbeads,ELISA,flowcytom-etry);semi-quantitativepanel(eg,titer),HLAclassI

AAPC Rationale Report 86834 for semi-quantitative panel for HLA class I.

86835Antibodytohumanleukocyteantigens(HLA),solidphaseassays(eg,microspheresorbeads,ELISA,flowcytom-etry);semi-quantitativepanel(eg,titer),HLAclassII

AAPC Rationale Report 86835 for semi-quantitative panel for HLA class II.

Microbiology

87498Infectiousagentdetectionbynucleicacid(DNAorRNA);enterovirus,reversetranscriptionandamplifiedprobetechnique

AAPC Rationale Codes 87498–87539 have been revised to include “reverse transcription,” which more accurately reports the proce-dure performed.

87521Infectiousagentdetectionbynucleicacid(DNAorRNA);hepatitisC,reversetranscriptionandamplifiedprobetechnique


87522Infectiousagentdetectionbynucleicacid(DNAorRNA);hepatitisC,reversetranscriptionandquantification


87535Infectiousagentdetectionbynucleicacid(DNAorRNA);HIV-1,reversetranscriptionandamplifiedprobetechnique


87536Infectiousagentdetectionbynucleicacid(DNAorRNA);HIV-1,reversetranscriptionandquantification


87538Infectiousagentdetectionbynucleicacid(DNAorRNA);HIV-2,reversetranscriptionandamplifiedprobetechnique


87539Infectiousagentdetectionbynucleicacid(DNAorRNA);HIV-2,reversetranscriptionandquantification


87631Infectiousagentdetectionbynucleicacid(DNAorRNA);respiratoryvirus(eg,adenovirus,influenzavirus,coro-navirus,metapneumovirus,parainfluenzavirus,respiratorysyncytialvirus,rhinovirus),multiplexreversetranscriptionandamplifiedprobetechnique,multipletypesorsubtypes,3-5targets

AAPC Rationale New codes 87631–87633 have been created for the nucleic acid tests performed to detect respiratory viruses. The codes are selected based on the number of targets for the test. Report 87631 for three to five targets.




AAPC Rationale New codes 87631–87633 have been created for the nucleic acid tests performed to detect respiratory viruses. The codes are selected based on the number of targets for the test. Report 87632 for six to 11 targets.


AAPC Rationale New codes 87631-87633 have been created for the nucleic acid tests performed to detect respiratory viruses. The codes are selected based on the number of targets for the test. Report 87633 for 12 to 25 targets.

SurgicalPathology

88375Opticalendomicroscopicimage(s),interpretationandreport,real-timeorreferred,eachendoscopicsession

AAPC Rationale Code 88375 describes interpretation and report of opti-mal endomicroscopic images obtained. The use of optical endomicroscopic imaging allows for more precise biopsies. Report this code only when performed by a provider (eg, pathologist) other than the provider performing the endo-scopic procedure. Do not report 88375 with 43206 or 43252.

88384Array-basedevaluationofmultiplemolecularprobes;11through50probes

AAPC Rationale Codes 88384–88386 have been deleted. See molecular pathology codes 81200–81479.


AAPC Rationale Codes 88384–88386 have been deleted. See molecular pathology codes 81200-81479.


AAPC Rationale Codes 88384–88386 have been deleted. See molecular pathology codes 81200–81479.

MedicineMany codes in the Medicine section of CPT® 2013 have seen descriptor revisions similar to those found in E/M chapter (and less frequently, throughout the Surgery and Radiology chapters), which now specifically allow the reporting of services by “other, qualified non-physician practitioners.”

Other significant changes include new (replacement) codes for psychotherapy; percutaneous angioplasty, atherectomy, and stent placement; nerve conduction studies, and; intra-operative monitoring.

87910Infectiousagentgenotypeanalysisbynucleicacid(DNAorRNA);cytomegalovirus

AAPC Rationale Code 87910 has been created to report genotype analysis by nucleic acid for cytomegalovirus, which are herpes viruses (eg, herpes simplex viruses, varicella-zoster virus, Epstein-Barr virus)

87912Infectiousagentgenotypeanalysisbynucleicacid(DNAorRNA);hepatitisBvirus

AAPC Rationale New code 87912 describes genotype analysis by nucleic acid for the hepatitis B virus.

87901Infectiousagentgenotypeanalysisbynucleicacid(DNAorRNA);HIV-1,reversetranscriptaseandproteaseregions

AAPC Rationale Code 87901 has become a “child” code indexed to new “parent” code of 87910. Code application is not affected by this change.



ImmunizationAdministrationforVaccines/Toxoids

90653Influenzavaccine,inactivated,subunit,adjuvanted,forintramuscularuse

AAPC Rationale Code 90653 has been created to report the supply of adju-vanted seasonal trivalent influenza vaccine. The product is currently pending FDA approval.

90655Influenzavirusvaccine,trivalent,splitvirus,preser-vativefree,whenadministeredtochildren6-35monthsofage,forintramuscularuse

AAPC Rationale Codes 90655–90660 have been revised to include “tri-valent.” Trivalent means the vaccine includes three viral strains.

90656Influenzavirusvaccine,trivalent,splitvirus,preser-vativefree,whenadministeredtoindividuals3yearsandolder,forintramuscularuse


90657Influenzavirusvaccine,trivalent,splitvirus,whenadministeredtochildren6-35monthsofage,forintramuscu-laruse


90658Influenzavirusvaccine,trivalent,splitvirus,whenadministeredtoindividuals3yearsofageandolder,forintra-muscularuse


90660Influenzavirusvaccine,trivalent,live,forintranasaluse


90665Lymediseasevaccine,adultdosage,forintramuscularuse

AAPC Rationale Code 90665 has been deleted: The indicated vaccine is no longer available.

# 90672Influenzavirusvaccine,quadrivalent,live,forintranasaluse

AAPC Rationale Code 90672 has been created to report quadrivalent (four viral strains) influenza vaccine for intranasal use.

90701Diphtheria,tetanustoxoids,andwholecellpertussisvaccine(DTP),forintramuscularuse

AAPC Rationale Code 90701 has been deleted: The vaccine was removed from the market due to safety concerns.

90718Tetanusanddiphtheriatoxoids(Td)adsorbedwhenadministeredtoindividuals7yearsorolder,forintramuscularuse

AAPC Rationale Code 90718 has been deleted to prevent confusion for Td vaccine. All Td vaccines are preservative free (see 90714).

90739HepatitisBvaccine,adultdosage(2dosesched-ule),forintramuscularuse

AAPC Rationale Code 90739 has been created to report two dose schedule for Hepatitis B vaccine. The vaccine is currently pending FDA approval.



90746HepatitisBvaccine,adultdosage(3doseschedule),forintramuscularuse

AAPC Rationale Code 90746 was revised to specify three does schedule, which distinguishes it from new two-dose schedule code 90739.

PsychiatryThe psychiatry category received a major overhaul with creation of new codes and guidelines, as well as substantial code deletions. The revised code set more accurately report the services behavioral health providers now perform.

Psychiatry/InteractiveComplexity

90785Interactivecomplexity(listseparatelyinadditiontothecodeforprimaryprocedure)

AAPC Rationale This is an add-on code reported for patients whose com-munication factors complicate the delivery of psychiatric services (eg, the patient is verbally underdeveloped, or an emotional caregiver complicates the session with the patient).

CPT® includes a list of codes with which you may report 90785. Do not report 90785 with E/M services.

Psychiatry/PsychiatricDiagnosticProcedures

90791Psychiatricdiagnosticevaluation

AAPC Rationale New codes 90791 and 90792 (below) replace deleted codes 90801 and 90802. Psychiatric diagnostic evaluation is an assessment that includes obtaining a history, mental status, and recommendations. The service may require speaking with the family or other sources. Report 90791/90792 once per day, but not on the same day as E/M services. If the psychiatric diagnostic evaluation is performed without a medical service, report 90791.

90792Psychiatricdiagnosticevaluationwithmedicalservices

AAPC Rationale New codes 90791 (above) and 90792 replace deleted codes 90801 and 90802. Psychiatric diagnostic evaluation is an assessment that includes obtaining a history, mental status, and recommendations. The service may require speaking with the family or other sources. Report 90791/90792 once

per day, but not on the same day as E/M services. If the psychiatric diagnostic evaluation is performed on the same date as a medical service, report 90792.

90801Psychiatricdiagnosticinterviewexamination

AAPCRationaleCodes 90801 and 90802 have been deleted and replaced with 90791 and 90792.

90802Interactivepsychiatricdiagnosticinterviewexaminationusingplayequipment,physicaldevices,languageinterpreter,orothermechanismsofcommunication

AAPC Rationale Codes 90801 and 90802 have been deleted and replaced with 90791 and 90792.

90804Individualpsychotherapy,insightoriented,behaviormodifyingand/orsupportive,inanofficeoroutpatientfacility,approximately20to30minutesface-to-facewiththepatient

AAPC Rationale Codes 90804, 90805, 90806, 90808, and 90809 have been deleted. See new codes 90832–90838.

90805Individualpsychotherapy,insightoriented,behaviormodifyingand/orsupportive,inanofficeoroutpatientfacility,approximately20to30minutesface-to-facewiththepatient;withmedicalevaluationandmanagementservices












90810Individualpsychotherapy,interactive,usingplayequip-ment,physicaldevices,languageinterpreter,orothermecha-nismsofnon-verbalcommunication,inanofficeoroutpatientfacility,approximately20to30minutesface-to-facewiththepatient

AAPC Rationale Codes 90810, 90811, 90812, 90813, 90814, and 90815 have been deleted. See 90832–90838.

90811Individualpsychotherapy,interactive,usingplayequip-ment,physicaldevices,languageinterpreter,orothermecha-nismsofnon-verbalcommunication,inanofficeoroutpatientfacility,approximately20to30minutesface-to-facewiththepatient;withmedicalevaluationandmanagementservices










90816Individualpsychotherapy,insightoriented,behaviormodifyingand/orsupportive,inaninpatienthospital,partialhospitalorresidentialcaresetting,approximately20to30min-utesface-to-facewiththepatient




90817Individualpsychotherapy,insightoriented,behaviormodifyingand/orsupportive,inaninpatienthospital,partialhospitalorresidentialcaresetting,approximately20to30min-utesface-to-facewiththepatient;withmedicalevaluationandmanagementservices










90823Individualpsychotherapy,interactive,usingplayequip-ment,physicaldevices,languageinterpreter,orothermecha-nismsofnon-verbalcommunication,inaninpatienthospital,partialhospitalorresidentialcaresetting,approximately20to30minutesface-to-facewiththepatient

AAPC Rationale Codes 90823, 90824, 90826, 90827, 90828, and 90829 have been deleted. Refer to 90832–90838.

90824Individualpsychotherapy,interactive,usingplayequip-ment,physicaldevices,languageinterpreter,orothermecha-nismsofnon-verbalcommunication,inaninpatienthospital,partialhospitalorresidentialcaresetting,approximately20to30minutesface-to-facewiththepatient;withmedicalevalua-tionandmanagementservices












Psychiatry/PsychiatricDiagnosticProcedures:PsychotherapySubsection GuidancePsychotherapy is the treatment of mental illness and behav-ioral disturbances, including therapeutic communication to help the patient with emotional disturbances, adjust behaviors, and encourage personal growth. New, time-based codes simplify psychotherapy services reporting.

Add-on codes have been created to report psychotherapy with an appropriate E/M code if a significant and sepa-rately identifiable evaluation and management is per-formed. Do not include time spent performing the E/M service as part of the psychotherapy service.

90832Psychotherapy,30minuteswithpatientand/orfamilymember

AAPC Rationale Report 90832 for 16-37 minutes of psychotherapy. The time must be face-to-face with the patient and/or family.

90833Psychotherapy,30minuteswithpatientand/orfamilymemberwhenperformedwithanevaluationandmanagementservice(listseparatelyinadditiontothecodeforprimaryprocedure)

AAPC Rationale Report 90833 when 16-37 minutes of psychotherapy is provided on the same date as an E/M service. The time must be face-to-face with the patient and/or family. Do not include time spent performing the E/M service as part of the psychotherapy service. Select the appropriate E/M code based on the documentation.


AAPC Rationale Report 90834 for 38-52 minutes of psychotherapy. The time must be face-to-face with the patient and/or family.


AAPC Rationale Report 90836 when 38-52 minutes of psychotherapy is provided on the same date as an E/M service. The time must be face-to-face with the patient and/or family. Do not include time spent performing the E/M service as part of the psychotherapy service. Select the appropriate E/M code based on the documentation.


AAPC Rationale Report 90837 for 53 or more minutes of psychotherapy. The time must be face-to-face with the patient and/or family.


AAPC Rationale Report 90838 when 53 or more minutes of psychotherapy are provided on the same date as an E/M service. The time must be face-to-face with the patient and/or family. Do not



include time spent performing the E/M service as part of the psychotherapy service. Select the appropriate E/M code based on the documentation.

Psychiatry/PsychiatricDiagnosticProcedures:PsychotherapyforCrisesNew, time-based crisis codes have been established to report treatment for urgent assessment and treatment for a patient in a crisis state. The patient’s condition is typically life threatening or complex.

90839Psychotherapyforcrisis;first60minutes

AAPC Rationale Report 90839 for the first 60 minutes and 90840 (below) for each additional 30 minutes. Time must be face-to-face but is not required to be continuous.

90840Psychotherapyforcrisis;eachadditional30min-utes(listseparatelyinadditiontocodeforprimaryservice)

AAPC Rationale Report 90839 (above) for the first 60 minutes and add-on 90840 for each additional 30 minutes. Time must be face-to-face but is not required to be continuous.

90857Interactivegrouppsychotherapy

AAPC Rationale Code 90857 has been deleted. Refer to 90785 with 90853.

90862Pharmacologicmanagement,includingprescription,use,andreviewofmedicationwithnomorethanminimalmedi-calpsychotherapy

AAPC Rationale Code 90862 has been deleted. A parenthetical note directs you to 90863, or the appropriate E/M level if the provider’s scope of practice allows reporting E/M service.

Psychiatry/PsychiatricDiagnosticProcedures:OtherServicesorProcedures

90863Pharmacologicmanagement,includingprescriptionandreviewofmedication,whenperformedwithpsychotherapyservices(listseparatelyinadditiontothecodeforprimarypro-cedure)

AAPC Rationale Code 90863 has been created to report pharmacologic management when performed with psychotherapy services. If the provider’s scope of practice allows for reporting E/M codes, report the appropriate E/M instead of 90863.

A parenthetical note instructs you to report 90863 with 90832, 90834, or 90837.

90875Individualpsychophysiologicaltherapyincorporat-ingbiofeedbacktrainingbyanymodality(face-to-facewiththepatient),withpsychotherapy(eg,insightoriented,behaviormodifyingorsupportivepsychotherapy);approximately20-30minutes

AAPC Rationale To be consistent with the other codes in the psychiatry cat-egory, 90875 has been revised to specify “30 minutes.”

90876Individualpsychophysiologicaltherapyincorporat-ingbiofeedbacktrainingbyanymodality(face-to-facewiththepatient),withpsychotherapy(eg,insightoriented,behaviormodifyingorsupportivepsychotherapy);approximately45-50minutes

AAPC Rationale To be consistent with the other codes in the psychiatry cat-egory, 90876 has been revised to specify “45 minutes.”

90889Preparationofreportofpatient’spsychiatricstatus,history,treatment,orprogress(otherthanforlegalorconsulta-tivepurposes)forotherphysiciansindividuals,agencies,orinsurancecarriers

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 90889 has been amended to allow that this service may be provided by providers other than a physi-cian, to report preparation of a patient’s psychiatric status, history, treatment, or progress for other qualified individu-als, physicians, agencies, or insurance carriers.



Hemodialysis

90935Hemodialysisprocedurewithsingleevaluationbyaphysicianevaluationorotherqualifiedhealthcareprofessional


MiscellaneousDialysisProcedures

90945Dialysisprocedureotherthanhemodialysis(eg,peritonealdialysis,hemofiltration,orothercontinuousrenalreplacementtherapies),withsingleevaluationbyaphysicianevaluationorotherqualifiedhealthcareprofessional


90947Dialysisprocedureotherthanhemodialysis(eg,peritonealdialysis,hemofiltration,orothercontinuousrenalreplacementtherapies)requiringrepeatedevaluationbyaphysicianevaluationorotherqualifiedhealthcareprofessional,withorwithoutsubstantialrevisionofdialysisprescription


End-StageRenalDiseaseServices

90951End-stagerenaldisease(ESRD)relatedservicesmonthly,forpatientsyoungerthan2yearsofagetoincludemonitoringfortheadequacyofnutrition,assessmentofgrowthanddevelopment,andcounselingofparents;with4ormoreface-to-facevisitsbyaphysicianvisitsorotherqualifiedhealthcareprofessionalpermonth

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptors for 90951 has been amended to allow that this service may be performed by a physician or “other quali-fied health care professional.”

90952End-stagerenaldisease(ESRD)relatedservicesmonthly,forpatientsyoungerthan2yearsofagetoincludemonitoringfortheadequacyofnutrition,assessmentofgrowthanddevelopment,andcounselingofparents;with2-3face-to-facevisitsbyaphysicianvisitsorotherqualifiedhealthcareprofessionalpermonth


90953End-stagerenaldisease(ESRD)relatedservicesmonthly,forpatientsyoungerthan2yearsofagetoincludemonitoringfortheadequacyofnutrition,assessmentofgrowthanddevelopment,andcounselingofparents;with1face-to-facevisitsbyaphysicianvisitsorotherqualifiedhealthcareprofessionalpermonth


90954End-stagerenaldisease(ESRD)relatedservicesmonthly,forpatients2-11yearsofagetoincludemonitoringfortheadequacyofnutrition,assessmentofgrowthanddevelop-ment,andcounselingofparents;with4ormoreface-to-facevisitsbyaphysicianvisitsorotherqualifiedhealthcareprofes-sionalpermonth


90955end-stagerenaldisease(ESRD)relatedservicesmonthly,forpatients2-11yearsofagetoincludemonitoringfortheadequacyofnutrition,assessmentofgrowthanddevelop-ment,andcounselingofparents;with2-3face-to-facevisitsbyaphysicianvisitsorotherqualifiedhealthcareprofessionalpermonth

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 90955 has been amended to allow that this



service may be performed by a physician or “other quali-fied health care professional.”

90956End-stagerenaldisease(ESRD)relatedservicesmonthly,forpatients2-11yearsofagetoincludemonitoringfortheadequacyofnutrition,assessmentofgrowthanddevelop-ment,andcounselingofparents;with1face-to-facevisitsbyaphysicianvisitsorotherqualifiedhealthcareprofessionalpermonth


90957End-stagerenaldisease(ESRD)relatedservicesmonthly,forpatients12-19yearsofagetoincludemonitoringfortheadequacyofnutrition,assessmentofgrowthanddevel-opment,andcounselingofparents;with4ormoreface-to-facevisitsbyaphysicianvisitsorotherqualifiedhealthcareprofes-sionalpermonth


90958End-stagerenaldisease(ESRD)relatedservicesmonthly,forpatients12-19yearsofagetoincludemonitoringfortheadequacyofnutrition,assessmentofgrowthanddevel-opment,andcounselingofparents;with2-3face-to-facevisitsbyaphysicianvisitsorotherqualifiedhealthcareprofessionalpermonth


90959End-stagerenaldisease(ESRD)relatedservicesmonthly,forpatients12-19yearsofagetoincludemonitoringfortheadequacyofnutrition,assessmentofgrowthanddevel-opment,andcounselingofparents;with1face-to-facevisitsbyaphysicianvisitsorotherqualifiedhealthcareprofessionalpermonth


90960End-stagerenaldisease(ESRD)relatedservicesmonthly,forpatients20yearsofageandolder;with4ormoreface-to-facevisitsbyaphysicianvisitsorotherqualifiedhealthcareprofessionalpermonth


90961End-stagerenaldisease(ESRD)relatedservicesmonthly,forpatients20yearsofageandolder;with2-3face-to-facevisitsbyaphysicianvisitsorotherqualifiedhealthcareprofessionalpermonth


90962End-stagerenaldisease(ESRD)relatedservicesmonthly,forpatients20yearsofageandolder;with1face-to-facevisitsbyaphysicianvisitsorotherqualifiedhealthcareprofessionalpermonth


Gastroenterology

91110Gastrointestinaltractimaging,intraluminal(eg,capsuleendoscopy),esophagusthroughileum,withphysicianinterpretationandreport

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 91110 has been amended to allow that this service is not limited to physician reporting, and per AMA



recommendation may be reported by other (non-physi-cian), qualified attending health care professionals.

91111Gastrointestinaltractimaging,intraluminal(eg,cap-suleendoscopy),esophaguswithphysicianinterpretationandreport

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 91111 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physi-cian), qualified attending health care professionals.

91112Gastrointestinaltransitandpressuremeasurement,stomachthroughcolon,wirelesscapsule,withinterpretationandreport

AAPC Rationale Code 91112 replaces Category III code 0242T. The proce-dure involves pressure measurements from the stomach to the colon.

SpecialOphthalmologicalServices:Other

92286SpecialanteriorAnteriorsegmentphotographyimag-ingwithinterpretationandreport;withspecularendothelialmicroscopyandendothelialcellcountanalysis

AAPC Rationale Because films have been replaced by digital images, the code descriptor has been revised to more accurately report the work done.

92287SpecialanteriorAnteriorsegmentphotographyimag-ingwithinterpretationandreport;withfluoresceinangiography

AAPC Rationale Because films have been replaced by digital images, the code descriptor has been revised to more accurately report the work done.

SpecialOtorhinolaryngologicServices:EvaluativeandTherapeuticServices

92613Flexiblefiberopticendoscopicevaluationofswal-lowingbycineorvideorecording;physicianinterpretationandreportonly

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 92613 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals.

92615Flexiblefiberopticendoscopicevaluation,laryngealsensorytestingbycineorvideorecording;physicianinterpreta-tionandreportonly


92617Flexiblefiberopticendoscopicevaluationofswallow-ingandlaryngealsensorytestingbycineorvideorecording;physicianinterpretationandreportonly


Cardiovascular:CoronaryTherapeuticServicesandProcedures

92980Transcatheterplacementofanintracoronarystent(s),percutaneous,withorwithoutothertherapeuticintervention,anymethod;singlevessel

AAPC Rationale Codes 92980, 92981, 92982, and 92984 have been deleted. See 92920–92944.

92981Transcatheterplacementofanintracoronarystent(s),percutaneous,withorwithoutothertherapeuticintervention,anymethod;eachadditionalvessel(Listseparatelyinadditiontocodeforprimaryprocedure)




92982Percutaneoustransluminalcoronaryballoonangio-plasty;singlevessel


92984Percutaneoustransluminalcoronaryballoonangio-plasty;eachadditionalvessel(Listseparatelyinadditiontocodeforprimaryprocedure)


92995Percutaneoustransluminalcoronaryatherectomy,bymechanicalorothermethod,withorwithoutballoonangio-plasty;singlevessel

AAPC Rationale Codes 92995, 92996 have been deleted. See new codes 92924, 92925, and 92933–92944.

92996Percutaneoustransluminalcoronaryatherectomy,bymechanicalorothermethod,withorwithoutballoonangio-plasty;eachadditionalvessel(Listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Codes 92995, 92996 have been deleted. See new codes 92924, 92925, and 92933–92944.

Cardiovascular/TherapeuticServicesandProcedures:CoronarySubsection GuidanceA new subsection has been added to CPT® for coronary therapeutic services and procedures, which includes guidelines to define services and provide instruction for code use.

To properly code percutaneous coronary interventions (PCI), you must know the type of procedure(s) performed (angioplasty, stent, and/or atherectomy). During angio-plasty, a balloon-tipped catheter is inserted and inflated to open an occluded vessel. Stent(s) may be required to prop open the vessel. During atherectomy, a catheter with a sharp blade is used to cut away the occlusion.

Combination codes are used when the same vessel requires angioplasty, stent, and atherectomy. You should report only the most extensive procedure performed in each vessel.

During PCI, multiple procedures may be performed in multiple vessels. You may report codes for the major coro-nary arteries, as well as well as for branches of the coronary arteries. The coronary arteries are left main, left anterior descending, left circumflex, right main, and ramus inter-medius. All segments (proximal, mid, distal) are included in the major coronary artery procedure, unless one of the segments requires access through a bypass graft, in which case the bypass graft may be reported separately.

For coding purposes, the recognized branches of the major coronary arteries are the diagonals of the left anterior descending, marginals of left circumflex, and posterior descending posterolaterals of the right. You may code no more than two branches for a major coronary artery.

Base codes (92920, 92924, 92928, 92933, 92937, 92941, and 92943) are reported for the most extensive procedure in a major coronary artery. If PCI is performed during the same session in additional major coronary arteries or bypass graft, report the appropriate base code. If PCI is performed in additional coronary branches, report the applicable add-on code (92921, 92925, 92929, 92934, 92938, or 92944).

PCI includes access, selective catheterization, radiologic supervision and interpretation, closure of arteriotomy, and imaging to document completion of the procedure.

Diagnostic coronary angiography is usually included, but may be separately reported under the circumstances explained in the guidelines preceding the PCI codes.



92920


# 92920Percutaneoustransluminalcoronaryangio-plasty;singlemajorcoronaryarteryorbranch

AAPC Rationale Report angioplasty when no other invention (stent or atherectomy) is performed in the major coronary artery. Claim one unit of 92990 for each major coronary vessel.

# 92921Percutaneoustransluminalcoronaryangio-plasty;eachadditionalbranchofamajorcoronaryartery(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report 92921 for each additional branch of a major artery. A parenthetical note describes which primary codes 92921 may be reported with. Claim 92921 when angioplasty is the only intervention performed in the vessel.

# 92924Percutaneoustransluminalcoronaryatherec-tomy,withcoronaryangioplastywhenperformed;singlemajorcoronaryarteryorbranch

AAPC Rationale Report 92924 for atherectomy in a major coronary artery or branch. Angioplasty performed in the same vessel is included.

# 92925Percutaneoustransluminalcoronaryather-ectomy,withcoronaryangioplastywhenperformed;eachadditionalbranchofamajorcoronaryartery(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report 92925 for each additional branch of a major coronary artery. A parenthetical note lists which primary codes 92925 may be reported with. Angioplasty per-formed in the same vessel is included.

# 92928Percutaneoustranscatheterplacementofintra-coronarystent(s),withcoronaryangioplastywhenperformed;singlemajorcoronaryarteryorbranch

AAPC Rationale Report 92928 when one or more stents are placed in a major coronary artery. The procedure is coded per major coronary artery—not per stent placed. Angioplasty per-formed in the same vessel is included.

# 92929Percutaneoustranscatheterplacementofintracoronarystent(s),withcoronaryangioplastywhenper-formed;eachadditionalbranchofamajorcoronaryartery(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report 92929 when one or more stents are placed in an additional branch of a major coronary artery. The proce-dure is coded per major coronary artery branch—not per stent placed. Angioplasty performed in the same vessel is included.



# 92933Percutaneoustransluminalcoronaryatherec-tomy,withintracoronarystent,withcoronaryangioplastywhenperformed;singlemajorcoronaryarteryorbranch

AAPC Rationale Report combination code 92933 for angioplasty, stent(s), and atherectomy performed in the same major coronary artery or branch.

# 92934Percutaneoustransluminalcoronaryatherec-tomy,withintracoronarystent,withcoronaryangioplastywhenperformed;eachadditionalbranchofamajorcoronaryartery(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report combination code 92934 for angioplasty, stent(s), and atherectomy performed in each additional branch of a major coronary artery.

# 92937Percutaneoustransluminalrevascularizationoforthroughcoronaryarterybypassgraft(internalmammary,freearterial,venous),anycombinationofintracoronarystent,atherectomyandangioplasty,includingdistalprotectionwhenperformed;singlevessel

AAPC Rationale New codes have been created to report any interven-tion (angioplasty, stent, and/or atherectomy) performed through a coronary bypass graft. When multiple inter-ventions are performed on native vessels in addition to bypass grafts, select a base code for the intervention for the native vessels, as well as the bypass graft.

# 92938Percutaneoustransluminalrevascularizationoforthroughcoronaryarterybypassgraft(internalmammary,freearterial,venous),anycombinationofintracoronarystent,atherectomyandangioplasty,includingdistalprotectionwhenperformed;eachadditionalbranchsubtendedbythebypassgraft(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report add-on code 92938 for any intervention (angio-plasty, stent, atherectomy) performed in each additional branch subtended by the bypass graft.

# 92941Percutaneoustransluminalrevascularizationofacutetotal/subtotalocclusionduringacutemyocardialinfarc-tion,coronaryarteryorcoronaryarterybypassgraft,anycombinationofintracoronarystent,atherectomyandangio-plasty,includingaspirationthrombectomywhenperformed,singlevessel

AAPC Rationale Report 92941 for any combination of services (angi-ography, stent, atherectomy) for a patient having an acute myocardial infarction causing an acute, subtotal occlusion. Mechanical thrombectomy (92973) may be reported separately, if performed.

# 92943Percutaneoustransluminalrevascularizationofchronictotalocclusion,coronaryartery,coronaryarterybranch,orcoronaryarterybypassgraft,anycombinationofintracoronarystent,atherectomyandangioplasty;singlevessel

AAPC Rationale Report 92943 for any combination of services (angi-ography, stent, atherectomy) for a patient with chronic total occlusion. CPT® defines chronic occlusion as “no antegrade flow through the true lumen, accompanied by suggestive angiographic and clinical criteria.” The clini-cal criterion is included in the coding guidelines preced-ing the PCI codes.

# 92944Percutaneoustransluminalrevascularizationofchronictotalocclusion,coronaryartery,coronaryarterybranch,orcoronaryarterybypassgraft,anycombinationofintracoronarystent,atherectomyandangioplasty;eachaddi-tionalcoronaryartery,coronaryarterybranch,orbypassgraft(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report 92944 for each additional coronary artery, branch, or bypass graft for any combination of services (angiography, stent, atherectomy) for a patient with chronic total occlusion. CPT® defines chronic occlusion as “no antegrade flow through the true lumen, accom-panied by suggestive angiographic and clinical criteria.” The clinical criterion is included in the coding guide-lines preceding the PCI codes.



Cardiography

93015Cardiovascularstresstestusingmaximalorsub-maximaltreadmillorbicycleexercise,continuouselectrocar-diographicmonitoring,and/orpharmacologicalstress;withphysiciansupervision,withinterpretationandreport


93016Cardiovascularstresstestusingmaximalorsub-maximaltreadmillorbicycleexercise,continuouselectrocardio-graphicmonitoring,and/orpharmacologicalstress;physiciansupervisiononly,withoutinterpretationandreport


CardiovascularMonitoringServices

93224Externalelectrocardiographicrecordingupto48hoursbycontinuousrhythmrecordingandstorage;includesrecording,scanninganalysiswithreport,physicianreviewandinterpretationbyaphysicianorotherqualifiedhealthcarepro-fessional


93227Externalelectrocardiographicrecordingupto48hoursbycontinuousrhythmrecordingandstorage;physicianreviewandinterpretationbyaphysicianorotherqualifiedhealthcareprofessional


93228Externalmobilecardiovasculartelemetrywithelec-trocardiographicrecording,concurrentcomputerizedrealtimedataanalysisandgreaterthan24hoursofaccessibleECGdatastorage(retrievablewithquery)withECGtriggeredandpatientselectedeventstransmittedtoaremoteattendedsurveillancecenterforupto30days;physicianreviewandinterpretationbyaphysicianorotherqualifiedhealthcareprofessional


93229Externalmobilecardiovasculartelemetrywithelec-trocardiographicrecording,concurrentcomputerizedrealtimedataanalysisandgreaterthan24hoursofaccessibleECGdatastorage(retrievablewithquery)withECGtriggeredandpatientselectedeventstransmittedtoaremoteattendedsurveillancecenterforupto30days;technicalsupportforconnectionandpatientinstructionsforuse,attendedsurveillance,analysisandphysicianprescribedtransmissionofdailyandemergentdatareportsasprescribedbyaphysicianorotherqualifiedhealthcareprofessional


# 92973Percutaneoustransluminalcoronarythrom-bectomymechanical(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale 92973 was revised to add “mechanical” to promote proper coding. This code is not reported for chemical thrombectomy.



93268Externalpatientand,whenperformed,autoacti-vatedelectrocardiographicrhythmderivedeventrecordingwithsymptom-relatedmemoryloopwithremotedownloadcapabilityupto30days,24-hourattendedmonitoring;includestransmis-sion,physicianreviewandinterpretationbyaphysicianorotherqualifiedhealthcareprofessional


93272Externalpatientand,whenperformed,autoacti-vatedelectrocardiographicrhythmderivedeventrecordingwithsymptom-relatedmemoryloopwithremotedownloadcapabilityupto30days,24-hourattendedmonitoring;physicianreviewandinterpretationbyaphysicianorotherqualifiedhealthcareprofessional


ImplantableandWearableCardiacDeviceEvaluations

93279Programmingdeviceevaluation(inperson)withiterativeadjustmentoftheimplantabledevicetotestthefunc-tionofthedeviceandselectoptimalpermanentprogrammedvalueswithphysiciananalysis,reviewandreportbyaphysicianorotherqualifiedhealthcareprofessional;singleleadpace-makersystem


93280Programmingdeviceevaluation(inperson)withiterativeadjustmentoftheimplantabledevicetotestthefunc-tionofthedeviceandselectoptimalpermanentprogrammedvaluesphysiciananalysis,reviewandreportbyaphysicianorotherqualifiedhealthcareprofessional;dualleadpacemakersystem


93281Programmingdeviceevaluation(inperson)withiterativeadjustmentoftheimplantabledevicetotestthefunc-tionofthedeviceandselectoptimalpermanentprogrammedvalueswithphysiciananalysis,reviewandreportbyaphysicianorotherqualifiedhealthcareprofessional;multipleleadpace-makersystem


93282Programmingdeviceevaluation(inperson)withiterativeadjustmentoftheimplantabledevicetotestthefunc-tionofthedeviceandselectoptimalpermanentprogrammedvalueswithphysiciananalysis,reviewandreportbyaphysicianorotherqualifiedhealthcareprofessional;singleleadimplant-ablecardioverter-defibrillatorsystem


93283Programmingdeviceevaluation(inperson)withiterativeadjustmentoftheimplantabledevicetotestthefunc-tionofthedeviceandselectoptimalpermanentprogrammedvalueswithphysiciananalysis,reviewandreportbyaphysicianorotherqualifiedhealthcareprofessional;dualleadimplant-ablecardioverter-defibrillatorsystem




93284Programmingdeviceevaluation(inperson)withiterativeadjustmentoftheimplantabledevicetotestthefunc-tionofthedeviceandselectoptimalpermanentprogrammedvalueswithphysiciananalysis,reviewandreportbyaphysi-cianorotherqualifiedhealthcareprofessional;multipleleadimplantablecardioverter-defibrillatorsystem


93285Programmingdeviceevaluation(inperson)withiterativeadjustmentoftheimplantabledevicetotestthefunc-tionofthedeviceandselectoptimalpermanentprogrammedvalueswithphysiciananalysis,reviewandreportbyaphysicianorotherqualifiedhealthcareprofessional;implantablelooprecordersystem


93286Peri-proceduraldeviceevaluation(inperson)andprogrammingofdevicesystemparametersbeforeorafterasurgery,procedure,ortestwithphysiciananalysis,reviewandreportbyaphysicianorotherqualifiedhealthcareprofessional;single,dual,ormultipleleadpacemakersystem


93287Peri-proceduraldeviceevaluation(inperson)andprogrammingofdevicesystemparametersbeforeorafterasurgery,procedure,ortestwithphysiciananalysis,reviewandreportbyaphysicianorotherqualifiedhealthcareprofes-sional;single,dual,ormultipleleadimplantablecardioverter-defibrillatorsystem


93288Interrogationdeviceevaluation(inperson)withphysiciananalysis,reviewandreportbyaphysicianorotherqualifiedhealthcareprofessional,includesconnection,record-inganddisconnectionperpatientencounter;single,dual,ormultipleleadpacemakersystem


93289Interrogationdeviceevaluation(inperson)withphy-siciananalysis,reviewandreportbyaphysicianorotherquali-fiedhealthcareprofessional,includesconnection,recordinganddisconnectionperpatientencounter;single,dual,ormul-tipleleadimplantablecardioverter-defibrillatorsystem,includinganalysisofheartrhythmderiveddataelements


93290Interrogationdeviceevaluation(inperson)withphysiciananalysis,reviewandreportbyaphysicianorotherqualifiedhealthcareprofessional,includesconnection,record-inganddisconnectionperpatientencounter;implantablecardiovascularmonitorsystem,includinganalysisof1ormorerecordedphysiologiccardiovasculardataelementsfromallinternalandexternalsensors


93291Interrogationdeviceevaluation(inperson)withphysiciananalysis,reviewandreportbyaphysicianorotherqualifiedhealthcareprofessional,includesconnection,record-inganddisconnectionperpatientencounter;implantablelooprecordersystem,includingheartrhythmderiveddataanalysis




93292Interrogationdeviceevaluation(inperson)withphy-siciananalysis,reviewandreportbyaphysicianorotherquali-fiedhealthcareprofessional,includesconnection,recordinganddisconnectionperpatientencounter;wearabledefibrillatorsystem


93293Transtelephonicrhythmstrippacemakerevaluation(s)single,dual,ormultipleleadpacemakersystem,includesrecordingwithandwithoutmagnetapplicationwithphysiciananalysis,reviewandreport(s)byaphysicianorotherqualifiedhealthcareprofessional,upto90days


93294Interrogationdeviceevaluation(s)(remote),upto90days;single,dual,ormultipleleadpacemakersystemwithinterimphysiciananalysis,reviewandreport(s)byaphysicianorotherqualifiedhealthcareprofessional


93295Interrogationdeviceevaluation(s)(remote),upto90days;single,dual,ormultipleleadimplantablecardioverter-defibrillatorsystemwithinterimphysiciananalysis,reviewandreport(s)byaphysicianorotherqualifiedhealthcareprofessional


93297Interrogationdeviceevaluation(s),(remote)upto30days;implantablecardiovascularmonitorsystem,includ-inganalysisof1ormorerecordedphysiologiccardiovasculardataelementsfromallinternalandexternalsensors,physiciananalysis,reviewandreport(s)byaphysicianorotherqualifiedhealthcareprofessional


93298Interrogationdeviceevaluation(s),(remote)upto30days;implantablelooprecordersystem,includinganalysisofrecordedheartrhythmdata,physiciananalysis,reviewandreport(s)byaphysicianorotherqualifiedhealthcareprofessional


Echocardiography

93351Echocardiography,transthoracic,real-timewithimagedocumentation(2d),includesM-moderecording,whenperformed,duringrestandcardiovascularstresstestusingtreadmill,bicycleexerciseand/orpharmacologicallyinducedstress,withinterpretationandreport;includingperformanceofcontinuouselectrocardiographicmonitoring,withsupervi-sionbyaphysiciansupervisionorotherqualifiedhealthcareprofessional

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 93351 has been amended to allow that the supervision service may be performed by a physician or “other qualified health care professional.”

IntracardiacElectrophysiologicalProcedure/StudiesSubsection GuidanceTo combine comprehensive electrophysiologic evaluation with intracardiac catheter ablation of arrhythmogenic focus services, codes 93651 and 93652 have been deleted and replaced by new codes 93653–93657.



93651Intracardiaccatheterablationofarrhythmogenicfocus;fortreatmentofsupraventriculartachycardiabyablationoffastorslowatrioventricularpathways,accessoryatrioventricularconnectionsorotheratrialfoci,singlyorincombination

AAPC Rationale Codes 93651 and 93562 have been deleted. See new codes 93653–93657.

93652Intracardiaccatheterablationofarrhythmogenicfocus;fortreatmentofventriculartachycardia

AAPC Rationale Codes 93651 and 93562 have been deleted. See new codes 93653–93657.

93653Comprehensiveelectrophysiologicevaluationinclud-inginsertionandrepositioningofmultipleelectrodecatheterswithinductionorattemptedinductionofanarrhythmiawithrightatrialpacingandrecording,rightventricularpacingandrecording,HISrecordingwithintracardiaccatheterablationofarrhythmogenicfocus;withtreatmentofsupraventriculartachycardiabyablationoffastorslowatrioventricularpathway,accessoryatrioventricularconnection,cavo-tricuspidisthmusorothersingleatrialfocusorsourceofatrialre-entry

AAPC Rationale Report 93653 when comprehensive electrophysiologic evaluation is performed in addition to ablation of supra-ventricular tachycardia. Ablation is the destruction of tissue in the heart to correct arrhythmia. Supraventricular tachycardia (SVT) is rapid heart rhythm originating above the ventricular tissue.

93654Comprehensiveelectrophysiologicevaluationinclud-inginsertionandrepositioningofmultipleelectrodecatheterswithinductionorattemptedinductionofanarrhythmiawithrightatrialpacingandrecording,rightventricularpacingandrecording,HISrecordingwithintracardiaccatheterablationofarrhythmogenicfocus;withtreatmentofventriculartachycardiaorfocusofventricularectopyincludingintracardiacelectro-physiologic3dmapping,whenperformed,andleftventricularpacingandrecording,whenperformed

AAPC Rationale Report 93654 when comprehensive electrophysiologic evaluation is performed in addition to ablation of ventricu-lar tachycardia or focus of ventricular ectopy. Ablation is the destruction of tissue in the heart to correct arrhythmia. Ventricular tachycardia is rapid heartbeat that starts in the ventricles.

93655Intracardiaccatheterablationofadiscretemech-anismofarrhythmiawhichisdistinctfromtheprimaryablatedmechanism,includingrepeatdiagnosticmaneuvers,totreataspontaneousorinducedarrhythmia(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report 93655 with 93653, 93654, or 93656 when an addi-tional mechanism of arrhythmia requires ablation in addi-tion to the primary site.

93656Comprehensiveelectrophysiologicevaluationinclud-ingtransseptalcatheterizations,insertionandrepositioningofmultipleelectrodecatheterswithinductionorattemptedinduc-tionofanarrhythmiawithatrialrecordingandpacing,whenpossible,rightventricularpacingandrecording,hisbundlerecordingwithintracardiaccatheterablationofarrhythmogenicfocus,withtreatmentofatrialfibrillationbyablationbypulmo-naryveinisolation

AAPC Rationale Report 93656 when comprehensive electrophysiologic evaluation is performed in addition to ablation of atrial fibrillation. Atrial fibrillation is an abnormal heart rhythm where the upper chambers of the heart (atria) beat irregu-larly and rapidly.

93657Additionallinearorfocalintracardiaccatheterablationoftheleftorrightatriumfortreatmentofatrialfibrilla-tionremainingaftercompletionofpulmonaryveinisolation(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report 93657 with 93657 if ablation of the left or right atrium is required for atrial fibrillation remaining after pulmonary vein isolation.

NoninvasivePhysiologicStudiesandProcedures

93745Initialset-upandprogrammingbyaphysicianorotherqualifiedhealthcareprofessionalofwearablecardio-verter-defibrillatorincludesinitialprogrammingofsystem,establishingbaselineelectronicECG,transmissionofdatatodatarepository,patientinstructioninwearingsystemandpatientreportingofproblemsorevents




93750Interrogationofventricularassistdevice(VAD),inperson,withphysicianorotherqualifiedhealthcareprofes-sionalanalysisofdeviceparameters(eg,drivelines,alarms,powersurges),reviewofdevicefunction(eg,flowandvolumestatus,septumstatus,recovery),withprogramming,ifper-formed,andreport


93790Ambulatorybloodpressuremonitoring,utilizingasystemsuchasmagnetictapeand/orcomputerdisk,for24hoursorlonger;physicianreviewwithinterpretationandreport


Cardiovascular:OtherProcedures

93797Physicianorotherqualifiedhealthcareprofessionalservicesforoutpatientcardiacrehabilitation;withoutcontinuousECGmonitoring(persession)


93798Physicianorotherqualifiedhealthcareprofessionalservicesforoutpatientcardiacrehabilitation;withcontinuousECGmonitoring(persession)


Pulmonary:DiagnosticTestingandTherapies

94014Patient-initiatedspirometricrecordingper30-dayperiodoftime;includesreinforcededucation,transmissionofspirometrictracing,datacapture,analysisoftransmitteddata,periodicrecalibrationandphysicianreviewandinterpretationbyaphysicianorotherqualifiedhealthcareprofessional

AAPCRationaleConsistent with revisions throughout CPT® 2013, the descriptor for 94014 has been amended to allow that this service may be performed by a physician or “other quali-fied health care professional.”

94016Patient-initiatedspirometricrecordingper30-dayperiodoftime;physicianreviewandinterpretationbyaphysi-cianorotherqualifiedhealthcareprofessional


94452Highaltitudesimulationtest(HAST),withphysi-cianinterpretationandreportbyaphysicianorotherqualifiedhealthcareprofessional


94453Highaltitudesimulationtest(hast),withphysicianinterpretationandreportbyaphysicianorotherqualifiedhealthcareprofessional;withsupplementaloxygentitration




94610Intrapulmonarysurfactantadministrationbyaphysi-cianorotherqualifiedhealthcareprofessionalthroughendotra-chealtube


Code 94610 is Modifier 51 exempt.

94774Pediatrichomeapneamonitoringeventrecordingincludingrespiratoryrate,patternandheartrateper30-dayperiodoftime;includesmonitorattachment,downloadofdata,physicianreview,interpretation,andpreparationofareportbyaphysicianorotherqualifiedhealthcareprofessional


94777Pediatrichomeapneamonitoringeventrecordingincludingrespiratoryrate,patternandheartrateper30-dayperiodoftime;physicianreview,interpretation,andprepara-tionofareportbyaphysicianorotherqualifiedhealthcareprofessional


AllergyandClinicalImmunology:AllergyTesting

95004Percutaneoustests(scratch,puncture,prick)withallergenicextracts,immediatetypereaction,includingtestinter-pretationandreportbyaphysician,specifynumberoftests


95010Percutaneoustests(scratch,puncture,prick)sequentialandincremental,withdrugs,biologicalsorvenoms,immediatetypereaction,includingtestinterpretationandreportbyaphy-sician,specifynumberoftests

AAPC Rationale Codes 95010 and 95015 have been deleted and replaced by 95017 and 95018.

95015Intracutaneous(intradermal)tests,sequentialandincremental,withdrugs,biologicals,orvenoms,immediatetypereaction,includingtestinterpretationandreportbyaphysician,specifynumberoftests

AAPC Rationale Codes 95010 and 95015 have been deleted and replaced by 95017 and 95018.

95017Allergytesting,anycombinationofpercutaneous(scratch,puncture,prick)andintracutaneous(intradermal),sequentialandincremental,withvenoms,immediatetypereaction,includingtestinterpretationandreport,specifynumberoftests

AAPC Rationale Codes 95010 and 95015 have been deleted. New codes describe percutaneous and/or intracutaneous allergy test-ing. The codes are selected based on whether the testing is with venoms or drugs and biological.

Report 95017 for allergy testing with venoms.

95018Allergytesting,anycombinationofpercutaneous(scratch,puncture,prick)andintracutaneous(intradermal),sequentialandincremental,withdrugsorbiologicals,imme-diatetypereaction,includingtestinterpretationandreport,specifynumberoftests

AAPC Rationale Codes 95010 and 95015 have been deleted. New codes describe percutaneous and/or intracutaneous allergy test-ing. The codes are selected based on whether the testing is with venoms or drugs and biological.

Report 95017 when performing allergy testing with drugs or biologicals.



95024Intracutaneous(intradermal)testswithallergenicextracts,immediatetypereaction,includingtestinterpretationandreportbyaphysician,specifynumberoftests


95027Intracutaneous(intradermal)tests,sequentialandincremental,withallergenicextractsforairborneallergens,immediatetypereaction,includingtestinterpretationandreportbyaphysician,specifynumberoftests


AllergyandClinicalImmunology:IngestingChallengeTesting

95075Ingestionchallengetest(sequentialandincrementalingestionoftestitems,eg,food,drugorothersubstancesuchasmetabisulfite)

AAPC Rationale Code 95075 has been deleted and replaced with time-based codes 95076 and 95079.

95076Ingestionchallengetest(sequentialandincrementalingestionoftestitems,eg,food,drugorothersubstance);ini-tial120minutesoftesting

AAPC Rationale Report 95076 for the first 120 minutes of testing to con-firm an allergy by ingestion challenge test. Time-based codes 95076 and 95079 replace deleted code 95075.

95079Ingestionchallengetest(sequentialandincremen-talingestionoftestitems,eg,food,drugorothersubstance);eachadditional60minutesoftesting(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report add-on code 95079 for each additional 60 min-utes, beyond the initial 120 minutes of testing (95076), to confirm an allergy by ingestion challenge test. Time-based codes 95076 and 95079 replace deleted code 95075.

AllergyandClinicalImmunology:AllergenImmunotherapy

95120Professionalservicesforallergenimmunotherapyinprescribingphysicianstheofficeorinstitutionoftheprescribingphysicianorotherqualifiedhealthcareprofessional,includingprovisionofallergenicextract;singleinjection


95125Professionalservicesforallergenimmunotherapyinprescribingphysicianstheofficeorinstitutionoftheprescribingphysicianorotherqualifiedhealthcareprofessional,includingprovisionofallergenicextract;2ormoreinjections


95130Professionalservicesforallergenimmunotherapyinprescribingphysicianstheofficeorinstitutionoftheprescribingphysicianorotherqualifiedhealthcareprofessional,includingprovisionofallergenicextract;singlestinginginsectvenom


95131Professionalservicesforallergenimmunotherapyinprescribingphysicianstheofficeorinstitutionoftheprescribingphysicianorotherqualifiedhealthcareprofessional,includingprovisionofallergenicextract;2stinginginsectvenoms



NeurologyandNeuromuscularProcedures:SleepMedicineTesting

95808Polysomnography;anyage,sleepstagingwith1-3additionalparametersofsleep,attendedbyatechnologist

AAPC Rationale New polysomnography codes specify patient age, as well as type of study performed: 95808 has been revised to indi-cate the code may be reported for any age.

95810Polysomnography;age6yearsorolder,sleepstag-ingwith4ormoreadditionalparametersofsleep,attendedbyatechnologist

AAPC Rationale New polysomnography codes specify patient age, as well as type of study performed: 95810 has been revised to indi-cate the code can be reported for patients six years of age, or older.

95811Polysomnography;age6yearsorolder,sleepstag-ingwith4ormoreadditionalparametersofsleep,withinitia-tionofcontinuouspositiveairwaypressuretherapyorbilevelventilation,attendedbyatechnologist

AAPC Rationale New polysomnography codes specify patient age, as well as type of study performed: 95811 was revised to indicate the code may be reported for patients six years old, or older.

This code differs from 95810 in that it includes initiation of continuous positive airway pressure (CPAP) therapy or bilevel ventilation. CPAP is performed by a machine that uses mild air pressure to keep the airways open. If obstruc-tive sleep apnea is identified during a polysomnography, CPAP titration is performed to determine the pressure needed to resolve the sleep apnea, and to determine the appropriate settings if the patient needs a positive airway pressure device for treatment.










NeurologyandNeuromuscularProcedures:RoutineElectroencephalography

95830Insertionbyphysicianorotherqualifiedhealthcareprofessionalofsphenoidalelectrodesforelectroencephalo-graphic(EEG)recording

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 95830 has been amended to allow that this service may be performed by a physician “or other quali-fied health care professional.”

NeurologyandNeuromuscularProcedures:NerveConductionTestsSubsection GuidanceNew coding guidelines define services performed for motor and nerve conduction studies. Motor nerve conduc-tion studies require electrodes to be placed over the motor points of the muscle being tested. Nerve conduction stud-ies require electrodes to be placed over the specific nerve to be tested.

Codes are selected based on the number of studies per-formed. A study is defined as sensory conduction test, a motor conduction test with or without an F-wave test, or an H-reflex test.

Nerve conduction studies are reported only once when the test includes multiple sites on the same nerve. To assist with coding, Appendix J includes a list of nerves and a table indicating the reasonable maximum number of stud-ies performed for common diagnosis.

When electromyography is performed with nerve conduc-tion studies, use 95885–95887.

95900Nerveconduction,amplitudeandlatency/velocitystudy,eachnerve;motor,withoutF-wavestudy

AAPC Rationale Codes 95000–95004 have been deleted. See new codes 95907–95913.

95903Nerveconduction,amplitudeandlatency/velocitystudy,eachnerve;motor,withF-wavestudy


# 95782Polysomnography;youngerthan6years,sleepstagingwith4ormoreadditionalparametersofsleep,attendedbyatechnologist

AAPC Rationale Code 95782 describes polysomnography in patients younger than 6 years of age. The study includes sleep staging and four or more additional sleep parameters. The additional parameters are defined in the coding guidelines preceding the polysomnography codes.

If fewer than seven hours of reporting are performed, append modifier 52.

# 95783Polysomnography;youngerthan6years,sleepstagingwith4ormoreadditionalparametersofsleep,withinitiationofcontinuouspositiveairwaypressuretherapyorbi-levelventilation,attendedbyatechnologist

AAPC Rationale Code 95783 describes polysomnography in patients younger than 6 years of age. The study includes sleep staging and four or more additional sleep parameters. The additional parameters are defined in the coding guidelines preceding the polysomnography codes.

This study also includes the initiation of continuous positive airway pressure (CPAP) or bi-level ventilation. CPAP is performed by a machine that uses mild air pres-sure to keep the airways open. If obstructive sleep apnea is identified during a polysomnography, CPAP titra-tion is performed to determine the pressure needed to resolve the sleep apnea, and to determine the appropriate settings if the patient needs a positive airway pressure device for treatment.

If fewer than seven hours of reporting are performed, append modifier 52.



95904Nerveconduction,amplitudeandlatency/velocitystudy,eachnerve;sensory


95907Nerveconductionstudies;1-2studies

AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95907 for one or two studies.


AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95908 for three to four studies.


AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95909 for five to six studies.


AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95910 for seven to eight studies.


AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95911 for nine to 10 studies.


AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95912 for 11 to 12 studies.

95913Nerveconductionstudies;13ormorestudies

AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95913 for 13 or more studies.

NeurologyandNeuromuscularProcedures:AutonomicFunctionTests

95920Intraoperativeneurophysiologytesting,perhour(Listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Code 95920 has been deleted. For intraoperative neuro-physiology monitoring, see new add-on codes 95940 and 95941.

Subsection GuidanceContinuous intraoperative neurophysiology monitoring can be performed either in or outside of the operating room. These add-on codes are reported for monitoring time, in addition to the codes for the baseline studies (a parenthetical note lists the appropriate baseline study codes).

Intraoperative monitoring performed by the surgeon or anesthesiologist is not reported separately.

# 95940Continuousintraoperativeneurophysiologymonitoringintheoperatingroom,oneononemonitoringrequiringpersonalattendance,each15minutes(listsepa-ratelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report 95940 for intraoperative neurophysiology moni-toring, for each 15 minutes of monitoring time per-formed in the operating room. Do not count the time performing baseline tests in the time for monitoring. No other cases can be monitored when reporting 95940.

# 95941Continuousintraoperativeneurophysiologymonitoring,fromoutsidetheoperatingroom(remoteornearby)orformonitoringofmorethanonecasewhileintheoperatingroom,perhour(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Report 95941 for intraoperative neurophysiology moni-toring, per hour, for monitoring outside of the operat-ing room, or when monitoring more than one case in the operating room. Do not count the time performing baseline tests in the time for monitoring. Do not report if monitoring lasts 30 minutes or less.



95934H-reflex,amplitudeandlatencystudy;recordgastrocne-mius/soleusmuscle

AAPC Rationale Codes 95934, 95936 have been deleted. Refer to 95907–95913.

95936H-reflex,amplitudeandlatencystudy;recordmuscleotherthangastrocnemius/soleusmuscle

AAPC Rationale Codes 95934, 95936 have been deleted. Refer to 95907–95913.

NeurologyandNeuromuscularProcedures:SpecialEEGTests

95954PharmacologicalorphysicalactivationrequiringphysicianorotherqualifiedhealthcareprofessionalattendanceduringEEGrecordingofactivationphase(eg,thiopentalactiva-tiontest)

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 95954 has been amended to allow that this

service may be performed by a physician “or other quali-fied health care professional.”

95961Functionalcorticalandsubcorticalmappingbystimulationand/orrecordingofelectrodesonbrainsurface,orofdepthelectrodes,toprovokeseizuresoridentifyvitalbrainstructures;initialhourofattendancebyaphysicianattendanceorotherqualifiedhealthcareprofessional


95962Functionalcorticalandsubcorticalmappingbystimulationand/orrecordingofelectrodesonbrainsurface,orofdepthelectrodes,toprovokeseizuresoridentifyvitalbrainstructures;eachadditionalhourofattendancebyaphysicianattendanceorotherqualifiedhealthcareprofessional(listsepa-ratelyinadditiontocodeforprimaryprocedure)


NeurologyandNeuromuscularProcedures:Other

95991Refillingandmaintenanceofimplantablepumporreservoirfordrugdelivery,spinal(intrathecal,epidural)orbrain(intraventricular),includeselectronicanalysisofpump,whenperformed;requiringskillofaphysician’sskillorotherqualifiedhealthcareprofessional


NeurologyandNeuromuscularProcedures:MotionAnalysis

96004PhysicianreviewReviewandinterpretationbyphysi-cianorotherqualifiedhealthcareprofessionalofcomprehen-sivecomputer-basedmotionanalysis,dynamicplantarpressure

# 95924Testingofautonomicnervoussystemfunction;combinedparasympatheticandsympatheticadrenergicfunc-tiontestingwithatleast5minutesofpassivetilt

AAPC Rationale Code 95924 describes combined parasympathetic and sympathetic adrenergic function tests. The tests are per-formed to determine the presence and site of autonomic dysfunction, and the autonomic subsystems that may be disordered. Report 95924 if the service described by 95921 and 95922 are performed during the same session.

# 95943Simultaneous,independent,quantitativemea-suresofbothparasympatheticfunctionandsympatheticfunction,basedontime-frequencyanalysisofheartratevari-abilityconcurrentwithtime-frequencyanalysisofcontinuousrespiratoryactivity,withmeanheartrateandbloodpressuremeasures,duringrest,paced(deep)breathing,Valsalvamaneuvers,andhead-upposturalchange

AAPC Rationale Report 95943 if a tilt table is not used during autonomic function tests: 95921–95924 require the use of a tilt table.



measurements,dynamicsurfaceelectromyographyduringwalk-ingorotherfunctionalactivities,anddynamicfinewireelectro-myography,withwrittenreport


NeurologyandNeuromuscularProcedures:FunctionalBrainMapping

96020Neurofunctionaltestingselectionandadministrationduringnoninvasiveimagingfunctionalbrainmapping,withtestadministeredentirelybyaphysicianorotherqualifiedhealthcareprofessional(ie,psychologist),withreviewoftestresultsandreport


PhysicalMedicineandRehabilitation:TherapeuticProcedures

97530Therapeuticactivities,direct(one-on-one)patientcontactbytheprovider(useofdynamicactivitiestoimprovefunctionalperformance),each15minutes

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 97530 has been amended to allow greater flexibility in who may report this service.

97532Developmentofcognitiveskillstoimproveattention,memory,problemsolving(includescompensatorytraining),direct(one-on-one)patientcontactbytheprovider,each15minutes


97533Sensoryintegrativetechniquestoenhancesensoryprocessingandpromoteadaptiveresponsestoenvironmentaldemands,direct(one-on-one)patientcontact,bytheprovidereach15minutes


97535Self-care/homemanagementtraining(eg,activitiesofdailyliving(ADL)andcompensatorytraining,mealprepara-tion,safetyprocedures,andinstructionsinuseofassistivetechnologydevices/adaptiveequipment)directone-on-onecon-tact,bytheprovidereach15minutes


97537Community/workreintegrationtraining(eg,shop-ping,transportation,moneymanagement,avocationalactivitiesand/orworkenvironment/modificationanalysis,worktaskanal-ysis,useofassistivetechnologydevice/adaptiveequipment),directone-on-onecontactbyprovider,each15minutes


PhysicalMedicineandRehabilitation:TestsandMeasurements

97755Assistivetechnologyassessment(eg,torestore,augmentorcompensateforexistingfunction,optimizefunc-tionaltasksand/ormaximizeenvironmentalaccessibility),directone-on-onecontactbyprovider,withwrittenreport,each15minutes




Non-Face-to-FaceNonphysicianServices:On-lineMedicalEvaluation

98969Onlineassessmentandmanagementservicepro-videdbyaqualifiednonphysicianhealthcareprofessionaltoanestablishedpatient,orguardian,orhealthcareprovider,notoriginatingfromarelatedassessmentandmanagementserviceprovidedwithintheprevious7days,usingtheinternetorsimi-larelectroniccommunicationsnetwork

AAPC Rationale This code was revised to remove "other qualified health care professional" because a health care provider would not provide an assessment on another health care provider. The code was revised to correct an error made in the code description.

SpecialServices,ProceduresandReports:Miscellaneous

99000Handlingand/orconveyanceofspecimenfortrans-ferfromthephysician’sofficetoalaboratory


99001Handlingand/orconveyanceofspecimenfortrans-ferfromthepatientinotherthanaphysician’sanofficetoalaboratory(distancemaybeindicated)


99002Handling,conveyance,and/oranyotherserviceinconnectionwiththeimplementationofanorderinvolvingdevices(eg,designing,fitting,packaging,handling,deliveryormailing)whendevicessuchasorthotics,protectives,prostheticsarefabricatedbyanoutsidelaboratoryorshopbutwhichitemshavebeendesigned,andaretobefittedandadjustedbytheattend-ingphysicianorotherqualifiedhealthcareprofessional


99070Suppliesandmaterials(exceptspectacles),providedbythephysicianorotherqualifiedhealthcareprofessionaloverandabovethoseusuallyincludedwiththeofficevisitorotherservicesrendered(listdrugs,trays,supplies,ormaterialspro-vided)


99071Educationalsupplies,suchasbooks,tapes,andpam-phlets,providedbythephysicianforthepatient’seducationatcosttophysicianorotherqualifiedhealthcareprofessional


99078Physicianorotherqualifiedhealthcareprofessionalqualifiedbyeducation,training,licensure/regulation(whenapplicable)educationalservicesrenderedtopatientsinagroupsetting(eg,prenatal,obesity,ordiabeticinstructions)

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 99078 has been amended to allow that this service may be performed by a physician “or other quali-fied health care professional qualified by education, train-ing, licensure/regulation.”

99091Collectionandinterpretationofphysiologicdata(eg,ECG,bloodpressure,glucosemonitoring)digitallystoredand/ortransmittedbythepatientand/orcaregivertothephysicianorotherqualifiedhealthcareprofessional,qualifiedbyeduca-tion,training,licensure/regulation(whenapplicable)requiringaminimumof30minutesoftime

AAPC Rationale Consistent with revisions throughout CPT® 2013, the descriptor for 99091 has been amended to allow that this service may be performed by a physician “or other quali-fied health care professional qualified by education, train-ing, licensure/regulation.”



Moderate(Conscious)Sedation

99143Moderatesedationservices(otherthanthoseser-vicesdescribedbycodes00100-01999)providedbythesamephysicianorotherqualifiedhealthcareprofessionalperform-ingthediagnosticortherapeuticservicethatthesedationsupports,requiringthepresenceofanindependenttrainedobservertoassistinthemonitoringofthepatient’slevelofcon-sciousnessandphysiologicalstatus;youngerthan5yearsofage,first30minutesintra-servicetime


Code 99143 is modifier 51 exempt.

99144Moderatesedationservices(otherthanthoseser-vicesdescribedbycodes00100-01999)providedbythesamephysicianorotherqualifiedhealthcareprofessionalperform-ingthediagnosticortherapeuticservicethatthesedationsupports,requiringthepresenceofanindependenttrainedobservertoassistinthemonitoringofthepatient’slevelofcon-sciousnessandphysiologicalstatus;age5yearsorolder,first30minutesintra-servicetime


Code 99144 is modifier 51 exempt.

99145Moderatesedationservices(otherthanthoseservicesdescribedbycodes00100-01999)providedbythesamephysicianorotherqualifiedhealthcareprofessionalper-formingthediagnosticortherapeuticservicethatthesedationsupports,requiringthepresenceofanindependenttrainedobservertoassistinthemonitoringofthepatient’slevelofconsciousnessandphysiologicalstatus;eachadditional15minutesintra-servicetime(listseparatelyinadditiontocodeforprimaryservice)


99148Moderatesedationservices(otherthanthoseser-vicesdescribedbycodes00100-01999),providedbyaphysi-cianorotherqualifiedhealthcareprofessionalotherthanthehealthcareprofessionalperformingthediagnosticortherapeu-ticservicethatthesedationsupports;youngerthan5yearsofage,first30minutesintra-servicetime


99149Moderatesedationservices(otherthanthoseser-vicesdescribedbycodes00100-01999),providedbyaphysi-cianorotherqualifiedhealthcareprofessionalotherthanthehealthcareprofessionalperformingthediagnosticortherapeu-ticservicethatthesedationsupports;age5yearsorolder,first30minutesintra-servicetime


99150Moderatesedationservices(otherthanthoseservicesdescribedbycodes00100-01999),providedbyaphysicianorotherqualifiedhealthcareprofessionalotherthanthehealthcareprofessionalperformingthediagnosticorthera-peuticservicethatthesedationsupports;eachadditional15minutesintra-servicetime(listseparatelyinadditiontocodeforprimaryservice)


Medicine:OtherServicesandProcedures

99174OcularphotoscreeningwithinterpretationandreportInstrument-basedocularscreening(eg,photoscreening,auto-mated-refraction),bilateral

AAPC Rationale Code 99174 has been revised to more accurately describe the procedure performed. Photoscreening and automated refraction instruments are used when performing this screening test.



99183Physicianorotherqualifiedhealthcareprofessionalattendanceandsupervisionofhyperbaricoxygentherapy,persession


CategoryIICodesCategory II codes are supplemental tracking codes to report “performance measures,” which are specific services and test results that have been shown through evidence-based medicine to support and contribute to quality patient care.

Reporting of Category II codes is optional, at this time. Category II codes have no relative value associated with them because they describe clinical components included in E/M or other clinical services. Category II codes should not be used in place of Category I or Category III codes.

For 2013, CPT® has added seven new Category II codes, revised six codes, and deleted one code. For additional information on these codes, consult your CPT® codebook or the AMA website at: www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/category-ii-codes.page?.

CategoryIIICodesCategory III codes describe emerging technologies and, unlike Category I “unlisted procedure” codes, allow for tracking and collection of specific data. If a Category III code is available, it must be reported instead of a Category I unlisted procedure code. Category III codes have a five-year life span: Per CPT® guidelines, if a Category III code is not replaced by a Category I code (or otherwise revised) within five years, the Category III code will “sunset” (i.e., be archived), “unless it is demonstrated that a temporary code is still needed.”

CategoryIIICode

0030TAntiprothrombin(phospholipidcofactor)antibody,eachIgclass

AAPC Rationale Code 0030T has been deleted. Use 86849 for antipro-thrombin antibody.

0048TImplantationofaventricularassistdevice,extracorporeal,percutaneoustransseptalaccess,singleordualcannulation

AAPC Rationale Code 00487 has been deleted. Refer to new code 33991.

0050TRemovalofaventricularassistdevice,extracorporeal,percutaneoustransseptalaccess,singleordualcannulation

AAPC Rationale Code 0050T has been deleted. Refer to new codes 33990-33993.

0173TMonitoringofintraocularpressureduringvitrectomysur-gery(Listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Code 0173T has been deleted.

0195TArthrodesis,pre-sacralinterbodytechnique,discspacepreparation,discectomy,includingwithoutinstrumenta-tion,imaging(whenperformed)withimageguidance,anddiscectomytoprepareinterspace,lumbarincludesbonegraftwhenperformed;singleL5-S1interspace

AAPC Rationale Code 0195T was revised to include bundled services and to indicate the procedure is performed without instrumenta-tion, to distinguish it from 22586.

0196TArthrodesis,pre-sacralinterbodytechnique,discspacepreparation,discectomy,includingwithoutinstrumenta-tion,imaging(whenperformed)withimageguidance,anddiscectomytoprepareinterspace,lumbarincludesbonegraftwhenperformed;eachadditionalL4-L5interspace(listsepa-ratelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Code 0196T was revised to include bundled services and to indicate the procedure is performed without instrumenta-tion, to distinguish it from 22586.



0206TAlgorithmicComputerizeddatabaseanalysisofmultiplecyclesofdigitizedcardiacelectricaldatafromtwoormoreECGleads,includingtransmissiontoaremotecenter,applicationofelectrocardiographic-deriveddatamultiplenon-linearmathematicaltransformations,withcomputerprobabilityassessment,includingreportcoronaryarteryobstructionsever-ityassessment

AAPC Rationale Code 0206T has been revised to more accurately describe the procedure. This code is used to identify coronary artery obstruction, and is not intended for cardiac ischemia.

0242TGastrointestinaltracttransitandpressuremeasure-ment,stomachthroughcolon,wirelesscapsule,withinterpreta-tionandreport

AAPC Rationale Code 0242T has been deleted. Refer to new code 91112.

0250TAirwaysizingandinsertionofbronchialvalve(s),eachlobe(Listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Code 0250T has been deleted. Refer to new codes 31647-31649.

0251TBronchoscopy,rigidorflexible,includingfluoroscopicguidance,whenperformed;withremovalofbronchialvalve(s),initiallobe

AAPC Rationale Code 0251T has been deleted. Refer to new codes 31647–31649.

0252TBronchoscopy,rigidorflexible,includingfluoroscopicguidance,whenperformed;withremovalofbronchialvalve(s),eachadditionallobe(Listseparatelyinadditiontocodeforpri-maryprocedure)


0256TImplantationofcatheter-deliveredprostheticaorticheartvalve;endovascularapproach


0257TImplantationofcatheter-deliveredprostheticaorticheartvalve;openthoracicapproach(eg,transapical,transventricular)

AAPC Rationale Code 0257T has been deleted. Refer to new codes 33365 and 0318T.

0258TTransthoraciccardiacexposure(eg,sternotomy,thora-cotomy,subxiphoid)forcatheter-deliveredaorticvalvereplace-ment;withoutcardiopulmonarybypass

AAPC Rationale Code 0258T has been deleted. Refer to new codes 33365 and 33366.

0259TTransthoraciccardiacexposure(eg,sternotomy,thora-cotomy,subxiphoid)forcatheter-deliveredaorticvalvereplace-ment;withcardiopulmonarybypass


0276TBronchoscopy,rigidorflexible,includingfluoroscopicguidance,whenperformed;withbronchialthermoplasty,1lobe

AAPC Rationale Codes 0276T and 0277T have been deleted. Refer to new codes 31660 and 31661.

0277TBronchoscopy,rigidorflexible,includingfluoroscopicguidance,whenperformed;withbronchialthermoplasty,2ormorelobes


0279TCellenumerationusingimmunologicselectionandiden-tificationinfluidspecimen(eg,circulatingtumorcellsinblood)




0280TCellenumerationusingimmunologicselectionandiden-tificationinfluidspecimen(eg,circulatingtumorcellsinblood);interpretationandreport


0291Tintravascularopticalcoherencetomography(coro-narynativevesselorgraft)duringdiagnosticevaluationand/ortherapeuticintervention,includingimagingsupervision,inter-pretation,andreport;initialvessel(listseparatelyinadditiontoprimaryprocedure)

AAPC Rationale Intravascular optical coherence tomography provides microstructural information on atherosclerotic plaques. Report 0291T in addition to cardiac catheterization (92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975, 93454–93461, 93563, 93564) for the initial vessel.

0292TIntravascularopticalcoherencetomography(coronarynativevesselorgraft)duringdiagnosticevaluationand/ortherapeuticintervention,includingimagingsupervision,interpretation,andreport;eachadditionalvessel(listseparatelyinadditiontoprimaryprocedure)

AAPC Rationale Intravascular optical coherence tomography provides microstructural information on atherosclerotic plaques. Report 0292 for each additional vessel, as an add-on with 0291T and primary cardiac catheterization (92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975, 93454-93461, 93563, 93564).

0293TInsertionofleftatrialhemodynamicmonitor;completesystem,includesimplantedcommunicationmoduleandpressuresensorleadinleftatriumincludingtransseptalaccess,radiologicalsupervisionandinterpretation,andassoci-atedinjectionprocedures,whenperformed

AAPC Rationale Code 0293T describes insertion of a device to monitor left atrial pressure, to identify pressure changes in patients with heart failure. Do not report 0293T with 93462 or 93662.

0294TInsertionofleftatrialhemodynamicmonitor;pressuresensorleadattimeofinsertionofpacingcardioverter-defibrillatorpulsegeneratorincludingradiologicalsupervision

andinterpretationandassociatedinjectionprocedures,whenperformed(listseparatelyinadditiontocodeforprimarypro-cedure)

AAPC Rationale Report 0294T for insertion of a device to monitor left atrial pressure, when performed during insertion of a pacing cardioverter-defibrillator. The device is used to identify pressure changes in patients with heart failure. Claim 0294T in addition to 33230, 33231, 33240, 33262–33264, or 33249. Do not report with 93462 or 93662.

0295TExternalelectrocardiographicrecordingformorethan48hoursupto21daysbycontinuousrhythmrecordingandstorage;includesrecording,scanninganalysiswithreport,reviewandinterpretation

AAPC Rationale New codes describe external electrocardiographic record-ing for more than 48 hours, up to 21 days. Current codes (93224–92337) report similar recording when performed up to 48 hours.

Combination code 0295T describes all the components (recording, scanning analysis with report, review and inter-pretation). Codes 0296T–0298T report the component services separately, in case the services are performed by different providers.

0296TExternalelectrocardiographicrecordingformorethan48hoursupto21daysbycontinuousrhythmrecordingandstorage;recording(includesconnectionandinitialrecording)


Report 0296T for recording only. If the same provider per-forms recording, scanning analysis with report, review and interpretation, report 0295T.

0297TExternalelectrocardiographicrecordingformorethan48hoursupto21daysbycontinuousrhythmrecordingandstorage;scanninganalysiswithreport

AAPC Rationale New codes describe external electrocardiographic record-ing for more than 48 hours, up to 21 days. Current codes



(93224–92337) report similar recording when performed up to 48 hours.

Report 0297T for scanning analysis with report only. If the same provider performs recording, scanning analysis with report, review and interpretation, report 0295T.

0298TExternalelectrocardiographicrecordingformorethan48hoursupto21daysbycontinuousrhythmrecordingandstorage;reviewandinterpretation


Report 0298T for review and interpretation only. If the same provider performs recording, scanning analysis with report, review and interpretation, report 0295T.

0299TExtracorporealshockwaveforintegumentarywoundhealing,highenergy,includingtopicalapplicationanddressingcare;initialwound

AAPC Rationale Extracorporeal shock wave treatment (ESWT) has been shown in the clinical setting to promote the healing of burns and other difficult-to-heal wounds. Codes for ESWT for wound healing are reported per wound. Claim 0299T for the initial wound.

0300TExtracorporealshockwaveforintegumentarywoundhealing,highenergy,includingtopicalapplicationanddressingcare;eachadditionalwound(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale Codes for ESWT for wound healing are reported for each wound. Report +0300T for each additional wound, in addition to 0299T for the initial wound.

0301TDestruction/reductionofmalignantbreasttumorwithexternallyappliedfocusedmicrowave,includinginterstitialplacementofdisposablecatheterwithcombinedtemperaturemonitoringprobeandmicrowavefocusingsensocatheterunderultrasoundthermotherapyguidance

AAPC Rationale Code 0301T describes focused microwave thermotherapy of the breast. Microwave applicators are placed on either side of the compressed breast. A probe is placed within the breast to monitor the interstitial temperature. The tech-nique is based on the preferential microwave heating that occurs in high-water content breast carcinoma, compared to the surrounding lower water content healthy breast tis-sues. The procedure includes imaging guidance.

Do not report 0301T with 76645, 76942, 76998, or 77600–77615.

0302TInsertionorremovalandreplacementofintracar-diacischemiamonitoringsystemincludingimagingsupervisionandinterpretationwhenperformedandintra-operativeinter-rogationandprogrammingwhenperformed;completesystem(includesdeviceandelectrode)

AAPC Rationale An intracardiac ischemic monitoring device system includes a generator, adaptor, and transvenous lead. The system detects and warns patients during a major ischemic coronary event (eg, coronary plaque rupture). New codes report insertion of the system, insertion of individual com-ponents when the entire system is not inserted, removal of the system, programming, and interrogation.

Report 0302T when the entire system is inserted or replaced. The procedure includes interrogation and pro-gramming.

0303TInsertionorremovalandreplacementofintracar-diacischemiamonitoringsystemincludingimagingsupervisionandinterpretationwhenperformedandintra-operativeinterro-gationandprogrammingwhenperformed;electrodeonly


Report 0303T when the electrode is inserted or replaced. The procedure includes interrogation and programming.



0304TInsertionorremovalandreplacementofintracar-diacischemiamonitoringsystemincludingimagingsupervisionandinterpretationwhenperformedandintra-operativeinterro-gationandprogrammingwhenperformed;deviceonly


Report 0304T when the device is inserted or replaced. The procedure includes interrogation and programming.

0305TProgrammingdeviceevaluation(inperson)ofintra-cardiacischemiamonitoringsystemwithiterativeadjustmentofprogrammedvalues,withanalysis,review,andreport


Report 0305T for programming and adjustments of the system, including analysis, review, and report. The service must be performed in person.

0306TInterrogationdeviceevaluation(inperson)ofintra-cardiacischemiamonitoringsystemwithanalysis,review,andreport


Report 0306T for interrogation of the system, including analysis, review, and report. The service must be per-formed in person.

0307TRemovalofintracardiacischemiamonitoringdevice


Report 0307T when the device is removed without replacement.

0308TInsertionofoculartelescopeprosthesisincludingremovalofcrystallinelens

AAPC Rationale Code 0308T describes insertion and implantation of a telescope into the lens capsule. The procedure is performed on patients with central vision loss caused by end-stage, age-related macular degeneration. Code 0308T is modifier 51 exempt.

0309TArthrodesis,pre-sacralinterbodytechnique,includ-ingdiscspacepreparation,discectomy,withposteriorinstru-mentation,withimageguidance,includesbonegraft,whenperformed,lumbar,L4-L5interspace(listseparatelyinadditiontocodeforprimaryprocedure)

AAPC Rationale The new code has been created to report pre-sacral inter-body technique arthrodesis with posterior instrumentation. Code 0309T includes the disc preparation, discectomy, posterior instrumentation, imaging guidance, and bone graft. Report 0309T when the procedure is performed at the L4-L5 interspace.

This code is used with 22586. Do not report with 20930-20938, 22840, 22848, 72275, 77002, 77003, 77011, or 77012.

0310TMotorfunctionmappingusingnon-invasivenavigatedtranscranialmagneticstimulation(nTMS)fortherapeutictreat-mentplanning,upperandlowerextremity

AAPC Rationale Report 0310T for motor function mapping accomplished by combining transcranial magnetic stimulation (TMS) and electromyography (EMG) with guidance, with mag-netic resonance. The test is performed to identify func-tional motor cortex prior to brain surgery.



0311TNon-invasivecalculationandanalysisofcentralarte-rialpressurewaveformswithinterpretationandreport

AAPC Rationale Code 0311T describes central arterial pressure waveforms to evaluate patients with difficult-to-treat hypertension (eg not responding to medication).

0312TVagusnerveblockingtherapy(morbidobesity);laparoscopicimplantationofneurostimulatorelectrodearray,anteriorandposteriorvagaltrunksadjacenttoesophagogastricjunction(EGJ),withimplantationofpulsegenerator,includesprogramming

AAPC Rationale Vagal blocking employs a device to block hunger and satiety signals from the vagus nerve. The procedure is per-formed laparoscopically and does not alter the anatomy of the stomach. A total of six Category III codes were created to report the insertion of the system, revision or replace-ment of the components of the system, removal of compo-nents, and analysis and reprogramming.

Report 0312T for laparoscopic implantation of the neuro-stimulator electrode array, pulse generator, and program-ming.

0313TVagusnerveblockingtherapy(morbidobesity);lapa-roscopicrevisionorreplacementofvagaltrunkneurostimulatorelectrodearray,includingconnectiontoexistingpulsegenerator


Report 0313T for laparoscopic revision or replacement of the electrode array, and connection to the existing pulse generator.

0314TVagusnerveblockingtherapy(morbidobesity);lapa-roscopicremovalofvagaltrunkneurostimulatorelectrodearrayandpulsegenerator


Report 0314T for laparoscopic removal of the electrode array and pulse generator only.

0315TVagusnerveblockingtherapy(morbidobesity);removalofpulsegenerator


Report 0315T for removal of the pulse generator only.

0316TVagusnerveblockingtherapy(morbidobesity);replacementofpulsegenerator


Report 0316T for replacement of the pulse generator only.



0317TVagusnerveblockingtherapy(morbidobesity);neuro-stimulatorpulsegeneratorelectronicanalysis,includesrepro-grammingwhenperformed


Report 0317T for electronic analysis and reprogramming of the pulse generator.

0318TImplantationofcatheter-deliveredprostheticaorticheartvalve,openthoracicapproach,(eg,transapical,otherthantransaortic)

AAPC Rationale Procedures for the implantation of a prosthetic aortic heart valve are reported based on approach. Report 0318T when the procedure is performed using an open thoracic approach. A parenthetical note directs you to 33361-33365 for other approaches.



Complete2013ProcedureUpdates63

Practical Activity

PracticalActivityDuring this portion of the workshop, you will be coding five cases. These cases were selected to test new codes or coding concepts for 2013. You will be given time to code the cases on your own. After you complete the cases, your presenter will review the answers and rationales with you. For each case, select the appropriate CPT® codes, and modifiers if applicable.

Case 1DATE OF PROCEDURE: January 31, 2013

PROCEDURE PERFORMED:

1. Cervical cerebral arch angiography

2. Selective catheter placement, bilateral common carotid artery

3. Selective innominate and bilateral carotid, cervical, and intracervical angiography

BRIEF HISTORY OF PRESENT ILLNESS: This is a 67-year-old Caucasian female who presented with abnormal Doppler study with outpatient carotid bruit. She underwent cardiac vascular consultation, and elected to proceed with carotid angi-ography to accurately assess disease severity and plan for management. Carotid velocities were 317/132 cm per second with a ratio of 4.88. Left internal carotid velocities were 166/67 cm per second with a ratio of 1.58. Bilateral vertebral artery flow direction with antegrade and normal.

Informed consent was obtained. The risk/benefit ratio of the procedure was explained. On arrival to the lab, the patient was in pain-free, hemodynamically stable condition. A 5-French sheath was placed in right common femoral artery over a J-wire. A pigtail catheter was advanced and was parked in the ascending aorta and 25 mL of contrast was injected at 20 mL per second and a cerebral arch angiography was performed.

Subsequently, a Bernstein-2 catheter was advanced and sequentially placed with the help of a Glidewire in the innominate, right common, and left common carotid artery, selective innominate, bilateral cervical carotid, and intracerebral carotid angiography was performed using diluted Visipaque dye injection. Complications were none immediate.

FINDINGS: This is a type 2 (B) arch with a slight downward displacement of innominate artery and left common carotid artery. Innominate artery is widely patent and bifurcates normally into the subclavian and common carotid artery. Subcla-vian artery has mild, non-obstructive plaque and gives rise to dominant vertebral and internal mammary artery, which are unremarkable.

The right common carotid artery is free of significant disease.

The right internal carotid artery at its origin has complex hazy 90 percent grade stenosis. There is a faint contrast line, and it appears there is significant calcification on the back wall of this vessel. The remainder of the cervical internal carotid artery is unremarkable. Right external carotid artery has mild non-obstructed plaque at its origin.

Intracerebral right angiography reveals unremarkable intracerebral internal carotid artery sub-segments and normal cere-bral artery and middle cerebral artery. No intracerebral aneurysms are identified. Capillary phases and venous phases are unremarkable.

The left common carotid artery has non-obstructing plaque at its origin.

The left carotid bulb has out-pouching and a small contained ulcerated area. The left internal carotid artery at its origin has 60 percent smooth excentric stenosis. The remainder of the left cervical and intracerebral internal carotid artery are unremarkable.


Complete 2013 Procedure Coding UpdatesPractical Activity

The left middle cerebral and internal carotid arteries are unremarkable.

Vertebral artery angiography was not performed due to lack of any posterior fossa symptoms.

Subclavian artery was unremarkable.

All the equipment was removed and access site hemostasis was achieved with manual compression.

IMPRESSION: Critical right internal carotid artery and moderate-grade left internal carotid artery stenosis.

CPT® code(s): ___________________________________________________________

Case 2CARDIOPULMONARY SERVICES/CATHETERIZATION LABORATORY REPORT

DATE OF PROCEDURE: 7/10/13

PROCEDURES PERFORMED:

1. Rotational atherectomy of the mid left anterior descending utilizing a 1.5- mm bur.

2 Cutting balloon atherectomy of the mid left anterior descending,

3. Intracoronary stent placement utilizing a 3.5 x 23 Promus stent in the mid left anterior descending.

4. Percutaneous transluminal coronary angioplasty of the first diagonal branch.

5. Intravascular ultrasound-guided percutaneous coronary intervention of the left anterior descending.

CLINICAL PROFILE: This is an 87-year-old man with a history of angina and complex two-vessel coronary artery disease, referred for intervention.

PROCEDURAL DETAILS: Pre-procedure informed consent was obtained. The patient was brought to the cardiac catheter-ization laboratory and sedated with low doses of Versed and Fentanyl, as detailed in the event log. Using standard sterile percutaneous technique and local administration of 2 percent lidocaine, the right femoral artery was entered with an #8Fr. short sheath. IV Angiomax was begun. We then advanced an #8Fr. XB 3.5 guiding catheter but this would not engage the left main trunk, which arose low off a very long and dilated ascending aorta. A total of nine different guides were then attempted in a series without successfully cannulating the left main trunk. Ultimately, we switched out the short sheath for a long #8Fr. sheath, as it appeared that tortuosity in the iliacs was in part impeding our ability to manipulate guide and cannulate the vessel. After this and utilizing a #7Fr. XB-5 guide, we were successfully able to cannulate the left main trunk, although guide support was mediocre. Please see the event log for a detailed list of the guide catheters. Altogether, it took 38 minutes to cannulate the left main trunk. We then advanced a short Runthrough wire into the apex of the LAD. There was an obvious, complex, calcified lesion in the mid vessel. We attempted to pre dilate this with a cutting balloon, but this balloon would not cross the lesion. We then pre dilated the mid LAD with a 2.5 Voyager balloon. Following this, we again tried to advance the cutting balloon across the lesion but this was not successful. We therefore advanced a Rotab-lator GoldWire into the distal LAD and removed the Runthrough wire. The mid LAD was rotablated with a 1.5-mm burr. Following this, we successfully advanced the Cutting balloon. This was a 3.0 X 10 Cutting balloon. We then performed baseline IVUS with an Eagle Eye ultrasound catheter. A 3.5 x 23 Pronmus stent was then advanced across the lesion and deployed successfully. The first diagonal branch was subtotally occluded after stenting the LAD and was noted to be 90 percent at baseline. A Whisper ES wire was then advanced into the first diagonal branch. We then attempted to pass a 2.0 x 12 Sprinter balloon in the first diagonal branch and it would not cross. A 1.5 x 12 Maverick Fire Star balloon, crossed with difficulty and multiple balloon inflations were obtained. We then advanced a 2.0 x 12 Quantum balloon and per-formed additional balloon dilations with an excellent result. We then performed post procedure IVUS of the LAD and this showed adequate stent expansion. Final angiograms were then performed with all devices removed, and the patient




Practical Activity

returned to the holding area in stable condition. Total fluoroscopic time was 30 minutes. He was loaded with Plavix post procedure. He will be observed overnight. Sheath management will be per protocol on the floor.

ANGIOGRAPHIC FINDINGS: Left Selective Coronary Angiography: Left selective coronary angiograms demonstrate a supe-riorly-directed left main trunk which arises low in the aortic root. The LAD shows moderate ostial disease of 50 percent or less severity. A 90 percent stenosis is present in the mid LAD. This is complex calcified lesion arising between the first and second diagonal branches. The first diagonal branch shows 90 percent baseline stenosis. Following intervention, there is zero percent residual stenosis in the LAD, and a 20 percent or less residual stenosis in the first diagonal branch. A 60 per-cent stenosis in the LAD beyond the stent is to be treated medically. There is TIMI grade-III flow post procedure.

FINAL SUMMARY: Successful but technically difficult interventional procedure to the mid left anterior descending, involv-ing the combination of Rotablator, cutting balloon atherectomy, and stenting.

CPT® code(s): __________________________________________________________________________

Case 3I discussed the procedure, risks, benefits, and alternatives regarding placement of a chest tube with the patient prior to the procedure. Patient understood and consented to the procedure.

SHORT HISTORY INDICATIONS FOR OPERATION: Female had a horseback riding accident yesterday and over the last day has acquired a pneumothorax, which has been enlarging. It became very large, at least a 50 percent, maybe more, pneu-mothorax later this morning. Because it was enlarging and getting to the point of being dangerous, I felt that a small chest tube would be indicated to expand the lungs and to decrease the chance of a complete collapse of her lung.

ANESTHESIA: Of note; also 1 gram of Ancef was given preprocedure for coverage.

DESCRIPTION OF PROCEDURE: The patient was placed in the right lateral decubitus position and the area was prepped and draped. Under sterile conditions a #12 French chest tube was placed in the left lateral chest wall as high as could be and the chest tube going over the rib, approximately the 3” to 4” rib that the chest tube went over. It was placed into posi-tion. I felt with my finger and felt no lung material, only the fluid that I pushed through and the chest tube was placed easily in the proper position. If was sewn in place using 2-0 silk suture. Chest tube was placed on suction and in the recov-ery room, a post chest tube chest x-ray was taken and it shows that the lung has expanded to near completion and the chest tube is in proper position. The patient was brought to the recovery room in stable condition.

CPT® code(s): __________________________________________________________________________

Case 4PROGRESS NOTE: Pharmacologic Management

SUBJECTIVE/OBJECTIVE: The patient brought in lab results he recently had done at the hospital from his physician, show-ing he had CBC, kidney function test, blood sugar, liver function test, and thyroid function test that were within normal limits, and his total cholesterol was 188. His HDL was 53. His LDL was 119 and his triglycerides were 78. The patient says he is feeling well. He has good focus and is working well. The only thing he is requesting is to go back to the immediate release Ritalin because of the cost. He says he is a bit short of money, although he knows that the Ritalin IR does not work as well for him, he wants to try that again. His energy is good. His sleep is good.

MENTAL STATUS EXAMINATION: Shows a gentleman who looks his stated age. He is cooperative and pleasant. Has good eye contact. His mood is euthymic. His affect is congruent. He denies auditory or visual hallucinations, suicidal or homi-cidal ideations. He denies delusions. He is alert and oriented x 4.


Complete 2013 Procedure Coding UpdatesPractical Activity

PLAN: As per patient’s request, we will switch over to Ritalin Immediate Release 40 mg bid because of cost, #60. I gave him a prescription with today’s date, not to be filled until September 24 and I noted that on the prescription, because the patient had his last prescription called on August 24, 2013.

Prescription: Ritalin IR 40 mg bid #60, no refills, to be filled only on September 24, 2013.

Follow Up: The patient is to follow up in the office in six weeks.

M Smith, MD

CPT® code(s): __________________________________________________________________________

Case 5PREOPERATIVE DIAGNOSIS:

1. Right Shoulder Failed Hemiarthroplasty for Superior Proximal Humerus Fracture

2. Right Shoulder Chronic Anterior Inferior Dislocation

POSTOPERATIVE DIAGNOSIS:

1. Right Shoulder Failed Hemiarthroplasty for Superior Proximal Humerus Fracture

2. Right Shoulder Chronic Anterior Inferior Dislocation

NAME OF PROCEDURE:

1. Right Shoulder Arthroplasty Revision

2. Right Shoulder Anterior Capsular Shift

ANESTHESIA: General

PREOPERATIVE PREAMBLE: This patient is a delightful female who has a right shoulder anterior inferior dislocation with loosening of the soft tissue anteriorly. This is a chronic condition. I have counseled this patient at length regarding the natural history of this problem, as well as potential risks, complications, and benefits of surgical versus nonsurgical man-agement. The patient and the patient’s family state they understand the risks include, but are not limited to, infection, component loosening, dislocation, injury to myotendinous units, injury to neurovascular bundles, deep venous thrombosis, pulmonary embolus, anesthesia problems, and even death. She has been given no warranties, no guarantees, no promises. Full informed consent has been obtained.

The patient was taken to the operating room and in the supine position successfully induced with a general anesthesia using endotracheal intubation. After adequate analgesia was obtained, the right shoulder was prepped and draped in the usual sterile fashion, standard deltopectoral interval approach was used to incise the epidermis, dermis, and subcutaneous tissue with a #10 blade. The dissection was carried down through the deltopectoral interval, then the clavipectoral interval was then entered, gaining access to the joint. The patient had a large redundant anterior joint capsule, thick and fibrotic material. The patient was also found to have a component, which had subsided some and loosened some. Therefore, it was removed, as well as a portion of the proximal cement mantle in the proximal humerus.

I then debrided the intraarticular aspect of the joint, removing any obstructive fibrious tissue and obstructive debris, gain-ing access to the glenoid, which was found to have some minimal degenerative change but no significant arthritis. The labrum was also somewhat atrophied anteriorly but was largely intact.

I removed the existing humeral component and I resized the component for a smaller diameter component, which would allow cementing into the preexisting cement mantle. I also over retroverted the components to try to prevent further ante-rior interior dislocation. I gained length through the soft tissue envelope, approximately 2 cm, which should also keep




Practical Activity

the component from moving inferiorly, therefore by retroversion and lengthening I was able to create significant stability. The final component was opened, which was 2 mm smaller in diameter than the original component, giving an adequate cement mantle. I cemented into the original cement mantle with more retroversion and more length. When the cement dried, the shoulder was reduced and found to be stable.

I then performed an anterior capsulorrhaphy, capsular tightening, capsular shift by bringing up the anterior interior cap-sule material and taking away the redundancy anteriorly and inferiorly. This was done with multiple interrupted sutures. The wound was then copiously irrigated and closed in standard fashion. Sterile dressing was placed over the wounds. At the end of this procedure, the sponge, needle, and instrument counts were correct. This procedure was completed without event. Patient is now convalescing without event in the recovery room.

CPT® code(s): __________________________________________________________________________


Complete 2013 Procedure Coding UpdatesPractical Activity–Answers and Rationales

PracticalExerciseAnswerKeyandRationalesCase1CPT® code(s): 36223-50

Rationale: Look in the CPT® index for Angiography/Common Carotid/Selective Catheterization (36222, 36223). Selec-tive catheterization of the right common carotid was followed by angiography and interpretation of the right common carotid, right external carotid, right internal carotid and the right intracerebral arteries (36223). Selective catheterization of the left common carotid was followed with angiography and interpretation of the left common carotid, the left inter-nal carotid, and left intracerebral arteries, which again is code 36223. The left and right external carotid angiography was not performed; however, the descriptor indicates it is included when performed. Arch angiography is also included in this code. Modifier 50 is appended to indicate a bilateral procedure. The documentation notes that the right subcla-vian has mild non-obstructive plaque and right internal mammary is normal. The left subclavian artery was unremark-able. This is included in the arch angiography, which is bundled. Do not report 36215-59, 75716-26. The final code selection is 36223-50.

Case2CPT® code(s): 92933-LD, 92921-LD, 92978

Rationale: Angioplasty, followed by atherectomy, then stent placement in the LD was performed. Report only the most intensive procedure, which is the atherectomy. New combination codes were created to report atherectomy, stent, and angioplasty performed in the same major coronary artery. See 92933–92934. This was a single major coronary artery reported with 92933. Modifier LD is appended for the left anterior descending artery. Next report the angioplasty of the first diagonal branch of the LD. Look in the CPT® index for Angioplasty/Coronary Artery/Percutaneous Transluminal 92920–92921. This is an additional branch of the left anterior descending; therefore, add-on code 92921-LD is correct. Next, report the IVUS. Look in the CPT® index for Vascular Procedures/Intravascular Ultrasound/Coronary Vessels 92978–92979. Although IVUS was used pre- and post-procedure, it is only reported once per vessel. You might have con-sidered adding modifier 22 Increased procedural service because it took 38 minutes to cannulate the left main trunk and the case was difficult; however, the documentation does not substantiate that the case took much longer and was more difficult than usual. Do not report moderate sedation. The bullseye next the codes indicate it is included (further, no time is listed for moderate sedation).

Case3CPT®: 32556-LT

Rationale: This is the placement of a chest tube. Look in the CPT® index for Insertion/Catheter/Pleural Cavity 32550, 32556. Image guidance was not performed to place the tube. The correct code is 32556 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance.


Complete 2013 Procedure Coding UpdatesPractical Activity–Answers and Rationales

Case4CPT® code(s): 99212

Rationale: The new pharmacologic management code (90863) is an add-on code that may be reported only with psycho-therapy services; psychotherapy services were not provided. According to the coding guidelines, providers who are permit-ted should report the service with E/M codes. The provider rendering the service is an MD; therefore, you would select the appropriate E/M code using the three key components (history, exam, and medical decision making).

The provider documented:Problem focused history: brief HPI, problem focused ROS

Expanded problem focused exam: limited exam of 2-7 body areas and/or organ systems (1995) or a problem focused exam for 1997 Psychiatric Exam (4 elements)

Straightforward MDM: One established stable diagnosis, one data point (review of labs), moderate risk (prescription drug management). Only 2 of the 3 key components are needed; however, this will not change the assignment of 99212.

Case5CPT® code(s): 23473-RT

Rationale: The procedure preformed is the revision of an arthroplasty of the shoulder. From the CPT® index, look up Revi-sion/Shoulder. You are referred to Arthroplasty/Shoulder Joint, which directs you to 23470, 23472–23474. The code is selected based on whether the procedure involves the humeral and/or glenoid component. The description of the procedure states the humeral component was removed and replaced (23473). Debris was removed from the glenoid but the compo-nent did not require revision. According to the NCCI edits an anterior capsulorrhaphy is bundled with shoulder arthro-plasty; therefore, it is not reported separately. The notes for 23473 instruct not to report 23331 Removal of foreign body, shoulder; deep with 23473


Complete 2013 Procedure Coding UpdatesSlide Presentation

SlidePresentation

2013 CPT® Coding Updates

Presented by: Raemarie Jimenez, CPC, CPMA, CPC‐I, CANPC, CRHCDirector of Education

Co written by John Verhovshek, CPC

1

CPT® DisclaimerCPT® copyright 2012 American Medical Association. All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT® is a registered trademark of the American Medical Association.



Objective

Overview of the New, Revised and Deleted CPT® codes for 2013

Review documentation requirements for the new codes

Hands‐on exercises to practice using the new and revised codes

Code Changes‐Now What?

• Review 2013 CPT® code changes, using this guide

• Order 2013 codebooks• Review all changes to guidelines, notes and instructions in your book

• Highlight changes in the book’s index pertinent to your specialty and review those changes

4




• Highlight changes in the tabular section pertinent to your specialty

• Create a documentation “cheat sheet” of 2013 updates that must be documented differently for coders to capture the information needed and distribute it to clinicians

• Review and update superbills, chargemasters, etc.• Run utilization report of the deleted and revised codes.

5


• Upload software change• Train coding and billing staff on changes• Check for addenda or errata (www.ama‐

assn.org/resources/doc/cpt/cpt‐corrections‐errata.pdf)

• Review PQRS changes• Communicate with payer/provider reps regarding reimbursement and coverage issues

• Archive last year’s books

6



Time Defined“Time” defined in the Introduction – Use the following criteria unless section or subsection guidelines instruct otherwise

– Time is met when the midpoint is passed• Codes reporting an hour require a minimum of 31 minutes to report the code

– Do not report time performing a concurrent service

• Example: deduct the time spent performing billable services (eg, CPR) from critical care time

7

E/M Changes

• 82 E/M codes revised to include “other qualified health care professionals”

Example: Descriptor revisions for 99201

Counseling and/or coordination of care with other physicians, other providers qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self‐limited or minor. Physicians typically spend Typically, 10 minutes are spent face‐to‐ face with the patient and/or family.

8



E/M Changes

• Other Qualified Health Care Professionals– CPT® code description changed to describe the service, not the provider performing the service

– CPT® codes are used by other providers—not just physicians

– Examples:• Outpatient hospitals/ASC• Nurse practitioners/Physician Assistants• Physical Therapist/Occupational Therapist

9

E/M Changes

• Other Qualified Health Care Professional– State Scope of Practice– Facility Requirements– Payer Policies– Medicare Claims Processing Manual

10



Pediatric Critical Care Transport

• New codes report services provided by the control physician during an interfacility transport– 99485 and 99486– Based on time– Patients 24 months of age or younger– Must be critically ill or critically injured

11


• Services include: – Two way communication with transport team

• Time – Begins when the control physician first contacts the transport team

– Ends when patient care is taken over by the receiving facility

12




• Do not report:– Services performed by the transport team– Pretransport communication time with receiving facility

– Direct face‐to‐face transport (99466, 99467) with 99485, 99486

13

Complex Chronic Care Coordination Services

• For clinical staff time directed by a physician or other qualified health care provider

• Reported for coordination of services (medical and psychosocial)

• Time based – Reported per calendar month

• Based on whether patient has face‐to‐face encounter during the month

14




Clinical indications that qualify:– One or more chronic illnesses expected to last at least 12 months

– Acute exacerbation or decompensation– Functional decline– Medical Decision Making must be moderate or high

15


Documentation must include:– Condition of the patient– Total time spent performing coordination services for complex chronic care

– Based on clinical staff time• If physician performs coordination services, the time is added to the clinical staff time to support the code

16




Fact to face encounter (during calendar month)

Yes

99488 (first hour)

99489 (each additional 30 minutes)

No

99487 (first hour)

99489 (each additional 30 minutes)

17


Patient Diagnosis: Multiple Sclerosis and COPD exacerbation

Date Time Services Coordinated

1/10/13 20 minutes Contacted Home Health to arrange for oxygen in the patients home. Patient is scheduled to receive the oxygen this afternoon. The CMN was completed and sent to the home health agency. Discussed the arrangements and proper use of oxygen with the patient’s daughter. Patient and daughter understand

1/15/13 15 minutes Patient’s daughter called stating the patient is depressed due to the limitations she is experiencing due to the MS. Arranged for the patient to see psychologist and evaluation from PT to see if there can be any improvement in mobility.

18




Do not report with– Care plan oversight (99339, 99340, 99374‐99380)– Prolonged services without direct contact (99358, 99359)

– Anticoagulant management (99363, 99364)– Medical conference team (99366‐99368)– Education and training (98960‐98962, 99071, 99078)

– Telephone services (98966‐98968, 99441‐99443)

19


Do not report with– Online medical evaluation services (98969‐99444)– Preparation of special reports (99080)– Analysis of data (99090, 99091)– Transitional care management (99495, 99496)– Medication therapy management services (99605‐99607)

– ESRD services (90951‐90970)

20



Transitional Care Management Services

• Reported for transitional care for patients discharged from the hospital, SNF, rehab hospital, partial hospital or observation to home, domiciliary, rest home or assisted living

• Proper transitional care is important to prevent repeat admissions

• Reported by physician or other qualified health care provider. Can be reported by the same individual who discharged the

21


Documentation must include:– Contact with the patient (telephone or electronic) within two business days of discharge

– Documentation to support MDM• 99495 requires at least moderate MDM• 99496 requires high MDM

– Face‐to‐face visit• 99495 within 14 business days• 99496 within 7 business days

22




MDM Face‐to‐face visit within 7 days

Face‐to‐face visit in 8 to 14 days

Moderate 99495 99495High 99496 99495

23


Documentation should include:– Date of the patient’s discharge– Initial patient contact within 2 days (phone or email)

– MDM must be documented• Refer to the MDM criteria using the CPT® coding guidelines or 1995/1997 CMS Documentation Guidelines

– Documented face‐to‐face encounter• Do not report a separate code for the E/M

24




• Do not report with– Care plan oversight (99339, 99340, 99374‐99380)– Prolonged services without direct contact (99358, 99359)

– Anticoagulant management (99363, 99364)– Medical conference team (99366‐99368)– Education and training (98960‐98962, 99071, 99078)

– Telephone services (98966‐98968, 99441‐99443)

25


• Do not report with– ESRD services (90951‐90970)– Online medical evaluation services (98969‐99444)– Preparation of special reports (99080)– Analysis of data (99090, 99091)– Complex chronic care coordination (99487‐99489)– Medication therapy management services (99605‐99607)

26



Anesthesia

▲ 01991 Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider physician or other qualified health care professional); other than the prone position

• Same change is made to 01992• Revision to include “other qualified health care professionals”

27

Integumentary

▲ 15740 Flap; island pedicle requiring identification and dissection of an anatomically named axial vessel

• Revision made to clarify proper code use because reason to believe code is misused

• Most commonly reported with skin malignancy diagnosis

28



Integumentary

• Documentation for island pedicle flap– Island of skin is detached from its epidermal and dermal attachments while retaining its vascular supply (anatomically named axial vessel)

– Most commonly used on the lip and nose

29

Musculoskeletal

▲ 20665 Removal of tongs or halo applied by another physician individual– Revision to remove physician as the only provider

▲ +22522 Percutaneous vertebroplasty– Includes moderate sedation– 22520 and 22521 already included moderate sedation

30



Musculoskeletal

● 22586 Arthrodesis, pre‐sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5‐S1 interspace

31

Musculoskeletal

• Documentation for 22586– Unlike other spine codes, this code is specific to the interspace (L5‐S1)

– Posterior instrumentation required – Imaging guidance cannot be reported separately

32



Musculoskeletal

● 23473 Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component

● 23474 Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component

33

Musculoskeletal

Documentation for 23473– Revision of a previous shoulder arthroplasty– Includes the removal of previous placed components – Humeral or glenoid component

Documentation for 23474– Revision of a previous shoulder arthroplasty– Includes the removal of previous placed components – Humeral and glenoid component

34



Musculoskeletal

● 24370 Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component

● 24371 Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar component

35

Musculoskeletal

Documentation for 24370– Revision of a previous elbow arthroplasty– Includes the removal of previous placed components – Humeral or ulnar component

Documentation for 24371– Revision of a previous elbow arthroplasty– Includes the removal of previous placed components – Humeral and ulnar component

36



Musculoskeletal

▲ 28890 Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia– Revision to remove physician as the only provider

37

Musculoskeletal

29590 Denis‐Browne splint strapping– No longer performed

38



Respiratory New codes 31647‐31651 replace Category III codes 0250T‐0252T for insertion/removal for bronchial valves – Bronchial valves are inserted to treat patients with emphysema or lung damage

• Valves limit airflow to the damaged part of the lung to promote healing

– There are a total of five lobes in the lungs• Two lobes in the left lung• Three lobes in the right lung

– Procedures include conscious sedation

39

Respiratory

● 31647 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), initial lobe

● 31648 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe

40



Respiratory ● +31649 Bronchoscopy, rigid or flexible, including fluoroscopic

guidance, when performed; with removal of bronchial valve(s), each additional lobe (list separately in addition to code for primary procedure)

● +31651 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), each additional lobe (list separately in addition to code for primary procedure[s])

41

Respiratory

Documentation Requirements 31647‐31651– Insertion of valves

• How many lobes–Removal of valves

• How many lobes

42



RespiratoryBronchography is no longer performed• Deleted codes include:

• 31656 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with injection of contrast material for segmental bronchography (fiberscope only)

• 31715 Transtracheal injection for bronchography

• Computed Tomography (CT) is the current standard of care

43

Respiratory

Category III codes 0276T‐0277T have been deleted and replaced with new codes (31660‐31661) for bronchial thermoplasty – Uses radiofrequency ablation to treat asthmatic patients

– Reduces the muscle associated with airway constriction

– Procedures include conscious sedation

44



Respiratory

● 31660 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe● 31661 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes

45

Respiratory

Documentation for 31660, 31661– Thermoplasty: therapeutic radiofrequency energy used to heat and reduce the tissue of smooth muscle present in the airway wall

– If performed on one lobe, report 31660– If performed on two or more lobes, report 31661– The codes include fluoroscopic guidance and conscious sedation

46



Respiratory

32420 Pneumocentesis, puncture of lung for aspiration– No longer performed– Directed to use 32405 Biopsy, lung or mediastinum, percutaneous needle

47

Respiratory

32421 Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent– Deleted– See 32554/3255532422 Thoracentesis with insertion of tube, includes water seal (eg, for pneumothorax), when performed (separate procedure)– Deleted– See 32554/32555

48



Respiratory

▲ 32551 Tube thoracostomy, includes water seal connection to drainage system (eg, for abscess, hemothorax, empyema water seal), when performed, open (separate procedure)– Clarify access

• Open procedure

– Conditions removed so as not to limit use to only abscess, hemothorax, empyema

– Includes conscious sedation

49

Respiratory● 32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance● 32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance– A needle or catheter is used to puncture the pleural space and withdraw fluid

– Replace 32420/32422– Select codes based on whether imaging guidance is performed

50



Respiratory

Documentation requirements 32554, 32555– Surgical puncture and drainage of the pleural space

– The catheter or needle is not left in over time• The puncture is performed and the fluid is aspirated

– Code selection based on whether imaging guidance is performed

• Do not report a separate code for the imaging

51

Respiratory

● 32556 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance● 32557 Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance

52



Respiratory

Documentation requirements 32556, 32557– Reports percutaneous drainage of pleural fluid

• If performed as an open procedure‐report 32551

– Tube or catheter is left in place (unlike thoracocentesis)

– Code selection is based on whether imaging guidance is used

• Do not report a separate code for the imaging

53

Respiratory

● 32701 Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment– New subsection and guidelines

• Performed to identify tumor borders, volume and relationship to adjacent anatomic structures

– Do not report with 77427‐77499– Report only once per course of treatment

54



Cardiovascular

▲ +33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter‐ defibrillator or pacemaker pulse generator (including eg, forupgrade to dual chamber system and pocket revision) (List separately in addition to code for primary procedure)– revised to remove “pocket revision” as a requirement– parenthetical notes have been added to instruct when it is appropriate to report 33225 with other procedures

55

Cardiovascular

Category III codes 0256T, 0258T and 0259T deleted and replaced by 33361‐33367 for TAVR– non‐invasive procedure to replace the aortic valve for patients with aortic stenosis (narrowing of the aortic valve)

– Services include: • Gaining access• Deployment and repositioning of the valve• Temporary pacemaker insertion for rapid pacing• Closure of arteriotomy• Angiography• Radiologic supervision and interpretation

56



Cardiovascular

33361‐33367, cont…– Two providers are required for this procedure (eg, cardiologist, interventional radiologists)

• When two surgeons work together to perform these procedures, append modifier 62

– Diagnostic coronary angiography may be reported separately when:

• a prior coronary angiography was not performed • if a prior coronary angiography was performed, the test is not adequate (eg, patient’s condition has changed since the original angiography, the initial study is inadequate visualization of anatomy)

57

Cardiovascular

33361‐33367, cont…• Codes selection is based on

– whether the approach is open or percutaneous– the vessel the surgeon uses for the approach

• Cardiopulmonary bypass may be reported with the appropriate add‐on code (33367‐33369), depending on the type of access performed

58



Cardiovascular

● 33361 – percutaneous approach – femoral artery

● 33362– open approach – femoral artery

● 33363– open approach – axillary artery

59

Cardiovascular

● 33364– open approach – iliac artery

● 33365 – transaortic approach– open procedure via median sternotomy or mediastinotomy

60



Cardiovascular

Add‐ons 33367‐33369 report cardiopulmonary bypass during a TAVR– Select codes based on whether the cannulation is performed percutaneously, open or centrally

● +33367 …percutaneous peripheral arterial and venous cannulation

● +33368 …open peripheral arterial and venous cannulation

● +33369 …central arterial and venous cannulation

61

Cardiovascular

• New codes 33990‐33993 describe insertion, removal and repositioning of percutaenous ventricle assist devices (pVAD)– Replace category III codes 0048T and 0050T

• Ventricle assist devices assist the patient’s heart to pump blood during high‐risk procedures or for critically ill patients

• Coding guidelines have been added to Heart (Including Valves) and Great Vessels, Cardiac Valves and Coronary Bypass subcategories

62



Cardiovascular● 33990 – arterial access only

● 33991 – arterial and venous access and transseptal puncture

● 33992 – Removal during a separate session

• Removal during the same session as insertion included

● 33993 – repositioning during a separate session

• Repositioning during the same session as insertion is included

63

Cardiovascular

Documentation for 33990‐33993– Include conscious sedation – Type of access

• arterial or arterial and venous, which requires transseptal puncture

– Removal is coded if performed at a separate session

– Repositioning is coded if performed at a separate session

64



Cardiovascular

Conscious sedation now included:▲ 36010 Introduction of catheter, superior or inferior vena cava

▲ 36140 Introduction of needle or intracatheter; extremity artery

65

Cardiovascular

New codes 36221‐36225 describe selective and non‐selective arterial catheter placement and angiography in the aortic arch, and carotid and vertebral arteries

• Included:– vessel access– placement of catheter(s)– contrast injection(s)– fluoroscopy– radiological supervision and interpretation– closure of the arteriotomy

• New guidelines provide instruction for proper use

66



Cardiovascular

36221‐36225, cont…• Codes are unilateral

– Modifier 50 is for bilateral service

• CPT® provides specific instruction on appending modifier 59 for these services

• Codes are built on a hierarchy of services– When more than one procedure is performed on the ipsilateral (same side) vessel, report only the most complex procedure

67

Cardiovascular36221‐36225, cont…• Radiological supervision and interpretation is included; however– if a 3D rendering is performed, you may separately report 76376 or 76377

– if ultrasound guidance is required to access the vessel, report 76937

– 75774 may be reported if the angiography is not performed for the extracranial and intracranial cervicocerebral vessels (eg, upper extremities)

• Conscious sedation is included

68



Cardiovascular

● 36221 – Non‐selective thoracic aorta catheter placement– Includes angiography of the cervicocerebral arch– Do not report with 36222‐36226

● 36222 – Selective catheter placement in common carotid or innominate artery– includes angiography of ipsilateral extracranial carotid circulation

● 36223 – Selective catheter placement in common carotid or innominate artery– Includes angiography of ipsilateral (same side) intracranial carotid

circulation, extracranial carotid and cervicocerebral arch

69

Cardiovascular

● 36224– Selective catheter placement in internal carotid artery– Includes angiography of ipsilateral intracranial carotid circulation,

extracranial carotid and cervicocerebral arch

● 36225 – Selective catheter placement in the subclavian artery – Includes angiography of ipsilateral vertebral circulation and

cervicocerebral arch

● 36226 – Selective catheter placement in the vertebral artery – Includes angiography of ipsilateral vertebral circulation and

cervicocerebral arch

70



Cardiovascular

● +36227 – Report in addition to 36222, 36223, or 36224 for selective catheter placement in the external carotid artery

● +36228– Report in addition 36224 or 36226 for selective catheter placement in each intracranial branch of the internal carotid or vertebral arteries

– Do not report 36228 more than twice, per side

71

Cardiovascular

Venipuncture code descriptors are revised to allow reporting by “other qualified health care professional”– 36400– 36405– 36406– 36410

72



Cardiovascular

● 37197 Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), includes radiological supervision and interpretation, and imaging guidance (ultrasound or fluoroscopy), when performed– Bundles radiological S&I to percutaneous transcatheter retrieval of a foreign body

– 37203 deleted– Report retrieval of the vena cava filter with 37193

73

CardiovascularNew codes 37211‐37214 bundle infusion thrombolysis with radiological S&I when performed in arterial and venous vessels– 37201 deleted– 75896 revised – 37203 deleted– 75900 deleted

• During the procedures, chemicals are infused to break down clots

74



Cardiovascular37211‐37214, cont…• Codes are selected per day

– If the treatment extends over more than one date of service, you may use separate codes to report the subsequent treatment day and the cessation or last treatment day

● 37211 – For infusion thrombolysis of artery other than coronary– Once per day for the initial service

● 37212– For infusion thrombolysis of a vein– Once per day for the initial service

75

Cardiovascular

37211‐37214, cont…● 37213– Infusion thrombolysis of an artery (other than coronary) or vein

– Subsequent day of therapy

● 37214– Cessation of infusion thrombolysis of an artery (other than coronary

– Includes removal of the catheter and closure of the vessel

76



Hemic and Lymphatic Systems

Codes for hematopoietic progenitor cell (HPC) transplantation (38240, 38241) have been revised to assist with code selection – Allogenic transplantation = the recipient is not the donor

• Because the procedure can involve cells from more than one donor, the procedure is reported per donor

• Includes the physician monitoring physiological parameters, verification of cell processing, patient evaluation and direct supervision of the infusion

77


– Autologous transplantation = the recipient is the donor


78




Codes for hematopoietic progenitor cell (HPC) transplantation (38240, 38241) have been revised to assist with code selection – Allogenic transplantation = the recipient is not the donor

• Because the procedure can involve cells from more than one donor, the procedure is reported per donor


77


– Autologous transplantation = the recipient is the donor


78




● 38243 Hematopoietic progenitor cell (HPC) boost – May occur days, months or years from the original HPC transplantation

– Comes from the original HPC donor from the initial transplantation

– To treat a relapse or post‐transplant cytopenia (deficiency or lack of cellular elements in the circulating blood)

▲ 38242– No longer a “child” of 38240– For patients with previous bone marrow transplant

79

Digestive System

● 43206 Esophagoscopy, rigid or flexible; with optical endomicroscopy● 43252 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with optical endomicroscopy– Eliminates random sampling and allows targeted biopsy through real‐time cellular observation of mucosal tissue

– Performed for suspected preneoplastic diseases– Includes moderate sedation

80



Digestive System

43234 Upper gastrointestinal endoscopy, simple primary examination (eg, with small diameter flexible endoscope) (separate procedure)– Deleted/rarely performed– Most common GI endoscope is 43235

81

Digestive System

● 44705 Preparation of fecal microbiota for instillation, including assessment of donor specimen– for Clostridium difficile instillation

• Bacterium can grow out of control from use of antibiotics

– Includes collecting fecal material from a donor, preparing the fecal material in a slurry and evaluating the material prior to instillation

– Includes only the preparation prior to instillation, not the work to instill the fecal microbiota

• Report instillation through colonoscopy or sigmoidoscopy separately

82



Urinary System

● 52287 Cystourethroscopy, with injection(s) for chemodenervation of the bladder

• For chemodenervation of the bladder– eg, neurogenic incontinence

83

Maternity Care and Delivery: Repair

▲ 59300 Episiotomy or vaginal repair, by other than attending physician

– Revised to allow reporting by attending provider other than physician

• Midwife

84



Nervous System▲ 62370 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion … (requiring skill physician’s of a physician or other qualified health care professional)– No longer limited to physician reporting

▲ 64561 Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed– Now includes imaging guidance

85

Nervous System

▲ 64612 – Revised to add “unilateral” – If performed bilaterally, append modifier 50

▲ 64614– Revised to specify “extremity” (singular)– Report once per session for extremity and/or trunk muscles

– Do not report with modifier 50

86



Nervous System

● 64615 – Describes bilateral chemodenervation of muscles innervated by facial, trigeminal, cervical spine and accessory nerves

– Inherently bilateral• Do not append modifier 50

– Do not report with 64612, 64613 or 64614

87

Eye and Ocular Adnexa

▲ 65800 Paracentesis of anterior chamber of eye (separate procedure); with diagnostic aspirationremoval of aqueous65805 Paracentesis of anterior chamber of eye (separate procedure); with therapeutic release of aqueous– 65805 deleted– 65800 now report either diagnostic or therapeutic removal of aqueous

88



Eye and Ocular Adnexa

▲ 67810 Biopsy Incisional biopsy of eyelid skin including lid margin– Biopsy must be of the lid margin – Report 11100, 11101 or 11310‐11313 for biopsy of the skin of the eyelid

89

Radiology

• 71040 Bronchography, unilateral, radiological supervision and interpretation

• 71060 Bronchography, bilateral, radiological supervision and interpretation– Bronchography is no longer performed– Computed tomography (CT) is now the standard of care replacing bronchography

90



Radiology

Codes for radiology examination of the cervical spine have been revised to include the number of views

▲ 72040 Radiologic examination, spine, cervical; 3 views or less▲ 72050 …4 or 5 views▲ 72052 …6 or more views

91

Radiology

Angiography codes 75650‐75685 have been deleted–Replaced by “combination codes” that bundle surgical and radiological services

– See 36221‐36227

92



Radiology▲ 75896 Transcatheter therapy, infusion, any method (eg, thrombolysis other than for thrombolysis, radiological supervision and interpretation▲ 75898 Angiography through existing catheter for follow‐up study for transcatheter therapy, embolization or infusion, other than for thrombolysis75900 Exchange of a previously placed intravascular catheter during thrombolytic therapy with contrast monitoring, radiological supervision and interpretation– New codes infusion thrombolysis codes 37211‐37214 include radiological supervision and interpretation

•93

Radiology

75961 Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), radiological supervision and interpretation– Replaced by 37197

94



Radiology

Revised to include “other qualified health care professional”

– 76000/76001 Fluoroscopy – 76885/76886 Ultrasound– +77051/+77052 Computer‐aided mammography– 77071 Joint radiography

95

Radiology

▲ 76376 3D rendering … with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation▲ 76377 3D rendering … with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation– Revised to include image postprocessing under concurrent supervision

– Parenthetical note lists procedures not reported with 76376/76377

96



Radiology

New codes 78012‐78014 replace 78000‐78011 for thyroid imaging ● 78012 to evaluate the function of the gland● 78013 to determine the size, shape and position of the thyroid gland● 78014 when the services identified in 78012 and 78013 are performed during the same session

97

Radiology

▲ 78070 Parathyroid planar imaging (including subtraction, when performed)● 78071 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT)● 78072 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired computed tomography (CT) for anatomical localization

98



Pathology and Laboratory

Molecular Pathology• 13 New Tier 1 molecular pathology procedure codes

• An unlisted molecular pathology procedure code added (81479)

• Revised the descriptors for all nine Tier 2 (81400‐81408) procedures

99

Pathology and LaboratoryMultianalyte Assays with Algorithmic Analysis (MAAA)

– New subsection with guidelines for proper use– 9 new codes (81500‐81599)– Algorithmic analysis using the results of assays (molecular pathology assays, fluorescent in situ hybridization assays, and nonnucleic acid‐based assays) and patient information, when appropriate, to report a numeric score(s) or probability of developing specific conditions

100




Multianalyte Assays with Algorithmic Analysis (MAAA)

Example:● 81503 Oncology (ovarian), biochemical assays of five proteins (CA‐125, apoliproprotein A1, beta‐2 microglobulin, transferrin, and pre‐albumin), utilizing serum, algorithm reported as a risk score

101


Chemistry▲ 82009 Acetone or other ketone bodiesKetone body(s) (eg, acetone, acetoacetic acid,serum beta‐hydroxybutyrate); qualitative▲ 82010 Acetone or other ketone bodies Ketone body(s) (eg, acetone, acetoacetic acid, serum beta‐hydroxybutyrate); quantitative

• Changes made to reflect current clinical practice

102




Chemistry ● 82777 Galectin‐3

• Used to assess the prognosis of patient with heart failure

103


Chemistry• 83890‐83914 have been deleted

• Refer to molecular pathology codes 81200‐81479

104



Pathology and LaboratoryImmunology#● 86152 Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood);

#● 86153 Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required

105


Immunology● 86711 Antibody; JC (John Cunningham) virus

106




Tissue Typing• New codes 86828‐86835 were created to report tissue typing for solid organ and bone marrow transplants

107

Pathology and LaboratoryMicrobiology▲ 87498 Infectious agent detection by nucleic acid (DNA or RNA); enterovirus, reverse transcription andamplified probe technique▲ 87521 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, reverse transcription andamplified probe technique▲ 87522 Hepatitis C, reverse transcription andquantification

108



Pathology and LaboratoryMicrobiology▲ 87535 Infectious agent detection by nucleic acid (DNA or RNA); HIV‐1, reverse transcription andamplified probe technique

▲ 87536 …HIV‐1, reverse transcription andquantification

▲ 87538 …HIV‐2, reverse transcription and amplified probe technique

▲ 87539 …HIV‐2, reverse transcription andquantification

109


New codes 87631‐87633 describe nucleic acid tests performed to detect respiratory viruses– Codes are selected based on the number of targets for the test

• Parenthetical – For assays that are used to type and subtype influenza viruses only, see 87501‐87503

– For assays that include influenza viruses with additional respiratory viruses, see 87631‐87633

110



Pathology and LaboratoryMicrobiology● 87910 Infectious agent genotype analysis by nucleic acid (DNA or RNA); cytomegalovirus▲ 87901 Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV‐1, reverse transcriptase and protease regions● 87912 Infectious agent genotype analysis by nucleic acid (DNA or RNA); hepatitis B virus

111

Pathology and LaboratorySurgical Pathology● 88375 Optical endomicroscopic image(s), interpretation and report, real‐time or referred, each endoscopic session

• Used to report interpretation and report when 43206 or 43252 are performed

• Not reported by the surgeon, only when performed by another physician (eg, pathologist)

112




Codes 88384‐88386 have been deleted• See molecular pathology codes 81200‐81479

113

MedicineMany codes revised to include “other qualified health care professional,” or to remove “physician” from the code description

• Hemodialysis (90935, 90945, 90947)• End‐Stage Renal Disease Services (90951‐90962)• Gastroenterology (91110, 91111) • Evaluative and Therapeutic Services (92613, 92615, 92617)

114



Medicine“Other qualified providers,” cont…• Cardiography (93015, 93016)• Cardiovascular Monitoring Services (93224, 93227, 93228, 93229, 93268, 93272)

• Implantable and Wearable Cardiac Device Evaluations (93279‐93298)

• Echocardiography (93351)

115

Medicine“Other qualified providers,” cont…• Noninvasive Physiologic Studies and Procedures (93745, 93750, 93790)

• Other Procedures (93797, 93798)• Pulmonary Diagnostic Testing and Therapies (94014, 94016, 94452, 94453, 94610, 94774)

• Allergy Testing (95004, 95024, 95027)• Allergen Immunotherapy (95120‐95134)

116



Medicine“Other qualified providers,” cont…• Special EEG Tests (95954, 95961, 95962)• Other Procedures (95991)• Motion Analysis (96004)• Functional Brain Mapping (96020)• Therapeutic Procedures (97530‐97537)• Tests and Measurements (97755)• Online Medical Evaluation (98969)

117

Medicine

“Other qualified providers,” cont…• Special Services, Procedures and Reports (99000‐99002, 99070, +99071, 99078, 99091)

• Moderate (Conscious) Sedation (99143‐99150)

• Other Services and Procedures (99174, 99183)

118



Medicine

Psychiatry: Significant changes to codes and guidelines

• New codes– Interactive complexity– Psychiatric diagnostic evaluation– Psychotherapy– Psychotherapy for crisis– Pharmacologic management

119

Medicine

Interactive Complexity– Add‐on code (90785) used to report communication factors that complicate psychiatric services

– Typical factors• Third parties involved with care (guardians, caregivers)• Require others to be involved with the care (interpreters)

• Require third parties (welfare agencies, schools)

120



MedicineInteractive Complexity cont…

– Must include one of the following:• Manage maladaptive communication (high reactivity) • Caregiver emotions or behavior interferes• Disclosure of sentinel events and mandated reporting (abuse to state agency)

• Use of play equipment or physical devices• Require others to be involved with the care (interpreters)

• Has not developed or lost expressive language communication skills.

121

Medicine

Interactive Complexity cont…– Can be used with the following codes:

• Diagnostic psychiatric evaluation (90791, 90792)• Psychotherapy (90832, 90834, 90837)• Psychotherapy with E/M (90833, 90836, 90838, 99201‐99255, 99304‐99337, 99341‐99350)

• Group psychotherapy (90853)

122



Medicine

Interactive Complexity, cont…– Do not report with:

• Psychotherapy for crisis (90839, 90840)• E/M performed without psychotherapy

123

MedicinePsychiatric Diagnostic Evaluation (90791, 90792)• 90801, 90802 deleted• Biophysical assessment including history, mental status and recommendations

• Do not report on the same date as E/M• If medical service is performed on same DOS as psychiatric diagnostic evaluation, report 90792

• For interactive complexity, report 90785 with 90791 or 90792

• Do not report 90791 and 90792 on the same DOS

124



Medicine Psychotherapy (90832‐90838)• 90804‐90809, 90810‐90815, 90816‐90822 and 90823‐90829

deleted• New codes are based on time • Add‐on codes used when psychotherapy is performed on the

same DOS as E/M• Do not include time performing the E/M service as

psychotherapy time• For interactive psychotherapy, report 90785 with the

psychotherapy code

125

Time (min)

Psycho‐therapy

Psych andE/M

Psych and Interactive Psych

Psych, Interactive Psych and E/M

16‐37 90832 E/M, 90833 90832, 90785 E/M, 90833, 90785

38‐52 90834 E/M, 90836 90834, 90785 E/M, 90836, 90785

53 > 90837 E/M, 90838 90837. 90785 E/M, 90838, 90785

126



Medicine

Psychotherapy in Crisis (90839, 90840)• Urgent assessment of a patient with a life threatening or complex condition

• Reported based on time• If performed 30 minutes or less, report with 90832 or 90833

• Do not report with psychiatric diagnostic evaluation (90791, 90792), psychotherapy codes (90832‐90838) or other psychiatric services (90785‐90899)

127

Medicine

Pharmacologic management (90863)• 90862 was deleted• New code is an add‐on code that can only be reported with psychotherapy codes

• Do not use time spent performing pharmacologic management to determine psychotherapy codes

• If the provider is permitted to bill with E/M codes (eg, psychiatrist), report the service as an E/M

• Do not report 90863 with an E/M code

128



Medicine

Gastroenterology0242T was deleted and replaced with 91112

● 91112 Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report

129

Medicine

Ophthalmoscopy▲ 92286 Special anterior Anterior segment photography imaging with interpretation and report; with specular endothelial microscopy and endothelial cell count analysis

▲ 92287 Special anterior Anterior segment photography imaging with interpretation and report; with fluorescein angiography

130



Medicine

Coronary Therapeutic Services and Procedures• Codes 92980, 92981, 92982, 92984, 92995, 92996 were deleted

• Services in this subsection include: atherectomy, stent and angioplasty on coronary arteries

• Services include: access, selective catheterization, radiologic supervision and interpretation, closure of arteriotomy, and imaging to document completion of the procedure

131

Medicine

Coronary Therapeutic Services and Procedures, cont…• Coronary arteries: left main, left anterior descending, left circumflex, right main and ramus intermedius

• Coronary branches: diagonals of the left anterior descending, marginals of left circumflex and posterior descending posterolaterals of the right

132



Medicine

• Documentation must include:– Major coronary arteries and branches involved in the procedure(s)

– Procedures being performed• More than one intervention can be performed on multiple vessels

– Patient’s condition: acute myocardial infarction or chronic total occlusion

• There are specific codes for this

– Is the procedure being performed on a bypass graft?

133

Medicine

PCI code selection:• Report one base code for the most complex procedure for each major coronary artery involved in the case • Atherectomy > stent > angioplasty

• Can report up to two branches• Conscious sedation included

134



Medicine

● 92920 Percutaneous transluminal coronary angioplasty; single major coronary artery or branch

● +92921 Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)

135

Medicine

● 92924 Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch

● +92925 Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)

136



Medicine

● 92928 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch

● +92929 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)

137

Medicine

● 92933 Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch

● +92934 Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)

138



Medicine

● 92937 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel

● 92938 …each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure)

139

Medicine

● 92941 Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel

140



Medicine

● 92943 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel

● +92944 …each additional coronary artery, coronary artery branch, or bypass graft (list separately in addition to code for primary procedure)

141

Medicine

PCI example: Stent placed and angioplasty performed on LAD, stent placed in D1, angioplasty in D2

142



Medicine

143

Correct Codes: 92928-LD,92929-LD,92921-LD

Picture Source: Radiology Assistant http://www.radiologyassistant.nl/en/p48275120e2ed5

Medicine

▲ +92973 Percutaneous transluminal coronary thrombectomy mechanical (list separately in addition to code for primary procedure)

Code revised because this code is not used for chemical thrombectomy‐only mechanical

144



Medicine

Intracardiac Electrophysiological Procedures• 93651 and 93562 have been deleted• New codes 93653‐93657 reported for comprehensive electrophysciologic evaluation and ablation of arrhythmia– Code is selected based on the arrhythmia treated

145

Medicine

Allergy Testing Codes 95010 and 95015 were deleted Report with 95017 or 95018 based on whether venom or drugs and biologicals are used in the testing

146



Medicine

Code 95075 has been deleted and replaced with time‐based codes 95076 and 95079

● 95076 Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); initial 120 minutes of testing

● +95079 each additional 60 minutes of testing (list separately in addition to code for primary procedure)

147

Medicine

Sleep Medicine Testing• Codes revised to include the age of the patient

• 95808 reported for any age• 95810, 95811 for ages 6 years and older

• New codes 95782, 95783 for patients younger than 6 years

148



Medicine

Nerve Conduction Studies• Codes 95000‐95004 were deleted• New codes 95907‐95913 reported based on the number of studies performed

• Motor nerve conduction studies: electrodes placed over the motor points of the muscle being tested

• Nerve conduction studies: electrodes placed over the specific nerve to be tested

149

Medicine

Nerve Conduction Studies, cont…• A study is defined as sensory conduction test, a motor conduction test with or without an F‐wave test, or an H‐reflex test

• Use Appendix J to assist with coding

150



MedicineIntraoperative Neurophysiology• 95920 is deleted• Codes reported based on whether the monitoring is one on one in the operating room (95940) or remote (95941)

• Report add‐ons with the baseline studies• If more than one patient is monitored in the operating room, report 95941

• Can not be reported by the surgeon or anesthesiologist

151

Category II

• Supplemental codes for tracking performance measures

• More information on the AMA sitewww.ama‐assn.org/ama/pub/physician‐resources/solutions‐managing‐your‐practice/coding‐billing‐insurance/cpt/about‐cpt/category‐ii‐codes.page

• More information on the CMS sitehttp://www.cms.gov/Medicare/Quality‐Initiatives‐Patient‐Assessment‐Instruments/PQRS/MeasuresCodes.html

152



Category III

Deleted Cat. Code

• 0030T• 0048T• 0050T• 0173T• 0242T• 0250T‐0252T

Replacement Code

• 86849• 33991• 33990‐33993• N/A• 91112• 31647‐31649

153

Category III Codes

Deleted Cat. III Code

• 0256T• 0257T• 0258T• 0259T• 0276T, 0277T• 0279T, 0280T

Replacement Code

• 33361‐33364• 33365 + 0318T• 33365 + 33366• 33365‐33369• 31660, 31661• 86152, 86153

154



Category III Codes

▲ 0195T Arthrodesis, pre‐sacral interbody technique … without instrumentation … L5‐S1 interspace▲ +0196T …L4‐L5 interspace– Codes revised to indicate “without instrumentation”

–Distinguish from 22586 (with instrumentation)

155

Category III Codes

▲ 0206T Algorithmic Computerized databaseanalysis of multiple cycles of digitized cardiac electrical data from two or more ECG leads, including transmission to a remote center, application of electrocardiographic‐derived data multiple nonlinear mathematical transformations, with computer probability assessment, including report coronary artery obstruction severity assessment– Revised to describe coronary artery obstruction– Not intended for cardiac ischemia

156



Category III Codes

● +0291T intravascular optical coherence tomography … initial vessel (list separately in addition to primary procedure)– Provides micro‐structural information on atherosclerotic plaques

– Report with 92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975, 93454‐93461, 93563, 93564 for the initial vessel


157

Category III Codes

● +0292T Intravascular optical coherence tomography … each additional vessel (list separately in addition to primary procedure)– Add‐on with 0291T– Report with 92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975, 93454‐93461, 93563, 93564 for the initial vessel


158



Category III Codes

● 0293T Insertion of left atrial hemodynamic monitor; complete system, includes implanted communication module and pressure sensor lead in left atrium including transseptal access, radiological supervision and interpretation, and associated injection procedures, when performed– Insertion to monitor left atrial pressure– Do not report with 93462 or 93662– Includes conscious sedation

159

Category III Codes

● +0294T Insertion of left atrial hemodynamic monitor; pressure sensor lead at time of insertion of pacing cardioverter‐defibrillator pulse generator including radiological supervision and interpretation and associated injection procedures…– Device to monitor left atrial pressure during insertion of a pacing cardioverter‐defibrillator

– Claim with 33230, 33231, 33240, 33262‐33264 or 33249– Do not report with 93462 or 93662– Includes conscious sedation

160



Category III CodesNew codes describe external electrocardiographic recording for more than 48 hours, up to 21 days.– Current codes (93224‐92337) report similar recording when performed up to 48 hours.

● 0295T …recording, scanning analysis with report, review and interpretation● 0296T …recording (includes connection and initial recording)● 0297T …scanning analysis with report● 0298T …review and interpretation

161

Category III Codes● 0299T Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound● +0300T …each additional wound (list separately in addition to code for primary procedure)– Promotes healing of burn wounds– Report per wound

•162



Category III Codes

● 0301T Destruction/reduction of malignant breast tumor with externally applied focused microwave, including interstitial placement of disposable catheter with combined temperature monitoring probe and microwave focusing sensocatheter under ultrasound thermotherapy guidance– Focused microwave thermotherapy of the breast– Includes imaging guidance– Includes conscious sedation– Do not report with 76645, 76942, 76998 or 77600‐77615

163

Category III Codes

Intracardiac ischemic monitoring system detects/warns patients of major ischemic coronary event – eg, coronary plaque rupture– Includes a generator, adaptor and transvenous lead

● 0302T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra‐operative interrogation and programming when performed; complete system (includes device and electrode)– Includes conscious sedation– Insert or remove complete system

164



Category III CodesIntracardiac ischemic monitoring, cont…● 0303T Insertion or removal and replacement … electrode only– Electrode only insertion/replacement– Includes interrogation and programming– Includes conscious sedation

● 0304T … device only– Device only insertion/replacement– Includes interrogation and programming– Includes conscious sedation

165

Category III CodesIntracardiac ischemic monitoring, cont…● 0305T Programming device evaluation (in person) of intracardiac ischemia monitoring system with iterative adjustment of programmed values, with analysis, review, and report– Programming and adjustments– Must be performed in person

● 0306T Interrogation device evaluation (in person) of intracardiac ischemia monitoring system with analysis, review, and report– System interogation, including analysis, review and report– Must be performed in person

166



Category III Codes

Intracardiac ischemic monitoring, cont…

● 0307T Removal of intracardiac ischemia monitoring device– Device removal without replacement – Includes conscious sedation

167

Category III Codes

● 0308T Insertion of ocular telescope prosthesis including removal of crystalline lens– Insertion/implantation of a telescope– For patients with central vision loss caused by end‐stage, age‐related macular degeneration

– Modifier 51 exempt– Includes conscious sedation

168



Category III Codes● +0309T Arthrodesis, pre‐sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft, when performed, lumbar, L4‐L5 interspace (list separately in addition to code for primary procedure)– Pre‐sacral interbody technique arthrodesis with posterior instrumentation

– Includes disc preparation, discectomy, posterior instrumentation, imaging guidance and bone graft

– Performed at L4‐L5 interspace

169

Category III Codes

● 0310T Motor function mapping using non‐invasive navigated transcranial magnetic stimulation (nTMS) for therapeutic treatment planning, upper and lower extremity– Motor function mapping combining transcranial magnetic stimulation (TMS) and electromyography (EMG) with guidance, with magnetic resonance

– Performed to identify functional motor cortex prior to brain surgery

•170



Category III Codes

● 0311T Non‐invasive calculation and analysis of central arterial pressure waveforms with interpretation and report– Central arterial pressure waveforms for patients with difficult‐to‐treat hypertension

171

Category III Codes

Vagal blocking for weight loss● 0312T = laparoscopic implantation of the neurostimulator electrode array, pulse generator and programming● 0313T = laparoscopic revision or replacement of the electrode array, and connection to the existing pulse generator ● 0314T = laparoscopic removal of the electrode array and pulse generator only

172



Category III Codes

Vagal blocking for weight loss, cont…● 0315T = removal of the pulse generator only● 0316T = replacement of the pulse generator only ● 0317T = electronic analysis and reprogramming of the pulse generator

173

Category III Codes

● 0318T Implantation of catheter‐delivered prosthetic aortic heart valve, open thoracic approach, (eg, transapical, other than transaortic)

• Implantation of a prosthetic aortic heart valve• Reported based on approach

– 0318T = open thoracic approach– 33361‐33365 for other approaches

174

The OfficialAmerican Medical Association

CPT® Errata

Revised: 10/19/2012 - 9:49:26 AM 1 Copyright 1995-2012 American Medical Association – All Rights Reserved

CORRECTIONS DOCUMENT—CPT® 2013

Introduction

Current Procedural Terminology (CPT®), Fourth Edition, is a set of… Inclusion of a descriptor and its associated five-digit code number in …

Add new text symbols to denote revision of the text in the Introduction to the CPT code set.

Evaluation and Management (E/M) Services Guidelines CounselingCounseling is a discussion with a patient and/or family concerning one or more of the following areas:

Diagnostic results, impressions, and/or recommended diagnostic studies Prognosis Risks and benefits of management (treatment) options Instructions for management (treatment) and/or follow-up Importance of compliance with chosen management (treatment) options Risk factor reduction Patient and family education

►(For psychotherapy, see 90832-90834, 90836-90840)◄

Add an instructional parenthetical note following the counseling guidelines to coincide with the new psychotherapy range of codes 90832-90834 and 90836-90840.

Evaluation and Management Tables Initial Neonatal Intensive Care

Remove reference to weight “1500-5000 gms” from the (E/M) Initial Neonatal Intensive Care table.


Evaluation and Management Table Continuing Neonatal and Infant Inpatient Low Birth-Weight Intensive Care

Remove reference to age “28 days of age or less” from the (E/M) Continuing Neonatal and Infant Inpatient Low Birth-Weight Intensive Care table.

Evaluation and ManagementNursing Facility Services guidelines

The following codes are used…

These codes should also be used…

Nursing facilities that provide…

Physicians and other qualified health care professionals have a central role in assuring that all residents receive thorough assessments and that medical plans of care are instituted or revised to enhance or maintain the residents’ physical and psychosocial functioning. This role includes providing input in the development of the MDS and a multi-disciplinary plan of care, as required by regulations pertaining to the care of nursing facility residents.

Two major subcategories of nursing facility services…

For definitions of key components...

Revise the Nursing Facility Services guidelines by removing reference to the terms “and other qualified health care professionals” as initial assessments in the nursing facility are only done by physicians.


Evaluation and ManagementHospital Inpatient Services Subsequent Hospital Care Hospital Discharge Services The hospital discharge day…

99238 Hospital discharge day management; 30 minutes or less

99239 more than 30 minutes

(These codes are to be utilized by the physician to report all services provided to a patient on the date of discharge, if other than the initial date of inpatient status. To report services to a patient who is admitted as an inpatient and discharged on the same date, see codes 99234-99236 for observation or inpatient hospital care including the admission and discharge of the patient on the same date. To report concurrent care services provided by a physician[s] other than the ordering physician or another qualified health care professional, use subsequent hospital care codes [99231-99233] on the day of discharge.)

Revise the parenthetical note following code 99239 to remove reference to provider

Surgery Musculoskeletal System GeneralGrafts (or Implants)

20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure)

(Use 20930 in conjunction with 22319, 22532, 22533, 22548-22558, 22590-22612, 22630, 22633, 22634, 22800-22812, 0195T, 0196T)

20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure)


20937 morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure)


Revise the parenthetical notes following 20930, 20936 and 20937 by removing reference to Category III codes 0195T and 0196T to reflect code revisions that now make these inappropriate for reporting with these graft services.


Surgery Respiratory System Trachea and Bronchi Endoscopy

For endoscopy procedures, code appropriate endoscopy of each anatomic site examined. Surgical bronchoscopy always includes diagnostic bronchoscopy when performed by the same physician. Codes 31622-3164931651, 31660, 31661 include fluoroscopic guidance, when performed.

(For tracheoscopy, see laryngoscopy codes 31515-31578)

31615 Tracheobronchoscopy through established tracheostomy incision

Revise the Endoscopy introductory guidelines to include the new range of codes 31622-31651, 31660, 31661 that include fluoroscopic guidance when performed. Surgery Respiratory System Trachea and Bronchi Endoscopy 31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when

performed; diagnostic, with cell washing, when performed (separate procedure)

31627 with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s])

(31627 includes 3D reconstruction. Do not report 31627 in conjunction with 76376, 76377)

(Use 31627 in conjunction with 31615, 31622-31631, 31622-31626. 31628-31631, 31635, 31636, 31638-31643)

Revise the second parenthetical note following 31627 by expanding the code range 31622-31631 to exclude code 31627. Surgery Respiratory System Trachea and Bronchi Endoscopy

Bronchoscopy (Illustration) 31622-31646 31651 A rigid or flexible bronchoscope is inserted through the oropharynx and vocal cords and beyond the trachea into the right or left bronchi.

Revise the range of codes included in the bronchoscopy illustration to include the entire range of bronchoscopy codes.


Surgery Cardiovascular System Heart and Pericardium Patient-Activated Event Recorder 33282 Implantation of patient-activated cardiac event recorder

(Initial implantation includes programming. For subsequent electronic analysis and/or reprogramming, use 93285, 93291, 93298, 93299)

Add code 93299 to the parenthetical note following 33282. Surgery Cardiovascular System Arteries and Veins Transcatheter Procedures Other Procedures

37205 Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity arteries), percutaneous; initial vessel

(For radiological supervision and interpretation, use 75960)

(For transcatheter placement of intravascular cervical carotid artery stent(s), see 37215, 37216)

(For transcatheter placement of intracranial stents, use 61635) (For transcatherter transcatheter coronary stent placement, see 92980, 92981)

Revise the misspelled word “transcatheter” noted in the parenthetical note following 37205. Surgery Digestive System Pharynx, Adenoids, and Tonsils Excision, Destruction

42894 Resection of pharyngeal wall requiring closure with myocutaneous or fasciocutaneous flap or free muscle, skin, or fascial flap with microvascular anastamosis anastomosis

Revise the misspelled word “anastomosis” noted in code 42894.


Pathology and Laboratory Molecular Pathology Tier 1 Molecular Pathology Procedures

#•81161 DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy) deletion analysis, and duplication analysis, if performed

Add code 81161 as an active code for 2013. Pathology and Laboratory Molecular Pathology Tier 1 Molecular Pathology Procedures

•81201 APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; full gene sequence

Revise code 81201 by italicizing the gene name “APC (adenomatous polyposis coli)”.Pathology and Laboratory Molecular Pathology Tier 1 Molecular Pathology Procedures

•81252 GJB2 (gap junction protein, beta 2, 26kDa;, connexin 26) (eg, nonsyndromic hearing loss) gene analysis; full gene sequence

Revise code 81252 by adding a comma after “26KDa,” and removing the semicolon. Pathology and Laboratory Tier 2 Molecular Pathology Procedures

▲81401 Molecular pathology procedure, Level 2 (eg, 2-10 SNPs, 1 methylated variant, or 1 somatic variant [typically using nonsequencing target variant analysis], or detection of a dynamic mutation disorder/triplet repeat)

EWSR1/ERG (t(21;22)) (eg, Ewing sarcoma/peripheral neuroectodermal tumor), translocation analysis, qualitative, and quantitative, if performed

EWSR1/FLI1 (t(11;22)) (eg, Ewing sarcoma/peripheral neuroectodermal tumor), translocation analysis, qualitative, and quantitative, if performed

EWSR1/WT1 (t(11;22)) (eg, Ewing sarcoma/peripheral neuroectodermal tumor), translocation analysis, qualitative, and quantitative, if performed

Revise 81401 to include the following missing analyte “EWSR1/WT1…”


Pathology and Laboratory Tier 2 Molecular Pathology Procedures

▲81402 Molecular pathology procedure, Level 3 (eg, >10 SNPs, 2-10 methylated variants, or 2-10 somatic variants [typically using non-sequencing target variant analysis], immunoglobulin and T-cell receptor gene rearrangements, duplication/deletion variants 1 exon)

TCD@ TRD@ (T cell antigen receptor, delta) (eg, leukemia and lymphoma), gene rearrangement analysis, evaluation to detect abnormal clonal population

Revise the analyte following 81402 by removing “[TCD@]” and replacing it with “[TRD@]”. Pathology and Laboratory Multianalyte Assays with Algorithmic Analyses

• 81503 Oncology (ovarian), biochemical assays of five proteins (CA-125, apoliproprotein apolipoprotein A1, beta-2 microglobulin, transferrin, and pre-albumin), utilizing serum, algorithm reported as a risk score

Revise the misspelled word “apolipoprotein” noted in code 81503. Pathology and Laboratory Multianalyte Assays with Algorithmic Analyses

• 81506 Endocrinology (type 2 diabetes), biochemical assays of seven analytes (glucose, HbA1c, insulin, hs-CRP, adoponectin adiponectin, ferritin, interleukin 2-receptor alpha), utilizing serum or plasma, algorithm reporting a risk score

Revise the misspelled word “adiponectin” noted in code 81506. Pathology and Laboratory Transfusion Medicine

86890 Autologous blood or component, collection processing and storage; predeposited

86891 intra- or postoperative salvage

(For physician services to autologous donors, see 99201-99204)

Delete the parenthetical note following 86891.


MedicineCardiovascularCardiography

Codes 93040-93042 are appropriate when an order for the test is triggered by an event, the rhythm strip is used to help diagnose the presence or absence of an arrhythmia, and a report is generated. There must be a specific order for an electrocardiogram or rhythm strip followed by a separate, signed, written, and retrievable report. It is not appropriate to use these codes for reviewing the telemetry monitor strips taken from a monitoring system. The need for an electrocardiogram or rhythm strip should be supported by documentation in the patient medical record. (For echocardiography, see 93303-93350) ►(For electrocardiogram, 64 leads or greater, with graphic presentation and analysis, see 0178T-0180T use 93799)◄ 93000 Electrocardiogram, routine ECG…

Delete reference to code 93799 from the parenthetical note preceding 93000 and replace with codes 0178T-0180T.

Category III

(0258T has been deleted. To report, see 33365, 33366 0318T)

Revise the instructional parenthetical note for deleted code 0258T by removing code 33366 and adding Category III code 0318T. Appendix D Summary of CPT Add-on Codes

9591595916

Delete reference to codes 95915 and 95916 from Appendix D, as these are not active CPT codes.Appendix F Summary of CPT Codes Exempt from Modifier 63

99337

Delete reference to code 99337 from Appendix F.


Appendix O Multianalyte Assays with Algorithmic Analyses

Proprietary Name and Clinical Laboratory or Manufacturer

Alpha-Numeric Code Code Descriptor

Category I Codes for Multianalyte Assays with Algorithmic Analyses (MAAA)

No proprietary name and clinical laboratory or manufacturer:

Maternal serum screening procedures are well established procedures and are performed by many labs throughout the country. The concept of prenatal screens has existed and evolved for over ten years and is not exclusive to any one facility.

●81508

●81509

●81510

●81511

●81512

●81599

Fetal congenital abnormalities, biochemical assays of two proteins (PAPP-A, hCG [any form]), utilizing maternal serum, algorithm reported as a risk score

Fetal congenital abnormalities, biochemical assays of three proteins (PAPP-A, hCG [any form], DIA), utilizing maternal serum, algorithm reported as a risk score

Fetal congenital abnormalities, biochemical assays of three analytes (AFP, uE3, hCG [any form]), utilizing maternal serum, algorithm reported as a risk score

Fetal congenital abnormalities, biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) utilizing maternal serum, algorithm reported as a risk score (may include additional results from previous biochemical testing)

Fetal congenital abnormalities, biochemical assays of five analytes (AFP, uE3, total hCG, hyperglycosylated hCG, DIA) utilizing maternal serum, algorithm reported as a risk score

Unlisted Multianalyte assay with algorithmic analysis

Add multianalyte assay reference codes 81508 and 81599 to the Appendix O table.


Medium Descriptors Short Descriptors

95907 MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB MOTOR&/SENS 1-2 NRV CNDJ TST NERVE CONDUCTION STUDIES 1-2 STUDIES NVR CNDJ TST 1-2 STUDIES

95908 MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB MOTOR&/SENS 3-4 NRV CNDJ TST NERVE CONDUCTION STUDIES 3-4 STUDIES NRV CNDJ TST 3-4 STUDIES

95909 MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB MOTOR&/SENS 5-6 NRV CNDJ TST NERVE CONDUCTION STUDIES 5-6 STUDIES NRV CNDJ TST 5-6 STUDIES

95910 MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB MOTOR&SENS 7-8 NRV CNDJ TEST

NERVE CONDUCTION STUDIES 7-8 STUDIES NRV CNDJ TEST 7-8 STUDIES 95911 MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB MOTOR&SEN 9-10 NRV CNDJ TEST

NERVE CONDUCTION STUDIES 9-10 STUDIES NRV CNDJ TEST 9-10 STUDIES 95912 MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB MOTOR&SEN 11-12 NRV CND TEST

NERVE CONDUCTION STUDIES 11-12 STUDIES NRV CNDJ TEST 11-12 STUDIES

95913 MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB MOTOR&SENS 13/> NRV CND TEST

NERVE CONDUCTION STUDIES 13/> STUDIES NRV CNDJ TEST 13/> STUDIES

Revise medium and short descriptor for codes 95907-95913.


Medium Descriptor

27499 DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&AM NRVE 75956 EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I 75957 EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I 75958 EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I 75959 PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I 88154 CYTP SLIDES C/V MNL SCR&CPTR-RESCR CELL S&I88167 CYTP SLIDES C/V MNL SCR&CPTR RESCR CELL S&I 93459 CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I

Revise medium descriptor for codes 27499, 75956, 75957, 75958, 75959, 88154, 88167, and 93459.

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2013 procedure coding updates

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