cpt code updates 2016 - north carolina health information ... · non-selective and/or selective...

4/25/2016

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NCHIMA 66th Annual Meeting

CPT Code Updates 2016

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Changes for 2016 • Integumentary• Respiratory• Cardiovascular• Biliary• Digestive• Abdomen, Peritoneum, and omentum• Urinary• Male Genital System• Nervous• Auditory

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4/25/2016

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Imaging Guidance Guideline

When imaging guidance or imaging supervision and interpretation is included in a surgical procedure, guidelines for image documentation and report included in the guidelines for radiology (including nuclear medicine and diagnostic ultrasound) will apply.

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Integumentary System• CPT code 10035

– For localization devices placed in soft tissue

– First lesion only– Used only once per target

regardless of how many are placed

• CPT code 10036– Is an add on code and

should only be reported with 10035

– Is reported for each additional lesion that is localized

– This code is used to report an additional localization device whether on the same side or contralateral side but for a different lesion

Soft tissue is a‐generic term for muscle, fat, fibrous tissue, blood vessels, or other supporting tissue matrix

• Localization of wire options are:Breast intra-abdominal, intra-pelvic, retroperitoneum Intra-thoracicProstateSoft tissue

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Use of CPT codes 10035 and 10036

When inserted into soft tissue you will get code 10035 and 10036 for any additional lesions unless there is a more specific site descriptor for example: breast, intra-abd, intra-pelvic, retroperitoneum, intra-thoracic, or prostate.

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Patient had localization 2 wires placed in 1st lesion on the right and 1 wire placed in 2 different lesions on the left in the soft tissue of the groin with . What are your CPT codes?10035-RT10036-LT10036-LT

This example is based on the number of lesions localized rather than the number of markers placed in one target area. Do not forget these codes include image guidance when performed. Codes 76942, 77002, 77012, or 77021 are not reported with 10035 and 10036.

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Use of CPT codes 10035 and 10036 continued

Respiratory System Lymph node statio

ns

EBUS with biopsy or aspiration of the lymph nodes is based on how many different Lymph node stations are biopsied: for 1 or 2, code 31652; and for 3 or more use 31653 .

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EBUS guided trans‐tracheal and /or trans‐bronchial sampling (eg; aspiration(s) biopsy(ies) one or two mediastinal and /or hilar lymph nodes stations or adjacent structuresReported only once per session

EBUS guided trans‐tracheal and /or trans‐bronchial sampling (eg; aspiration(s) biopsy(ies) one or two mediastinal and /or hilar lymph nodes stations or adjacent structuresReported only once per session

31652

EBUS guided trans‐tracheal and/or trans‐bronchial sample (eg. Aspirations(s)/biopsy(ies) 3 or more and/or hilar lymph nodes stations or structures.Reported only once per session

EBUS guided trans‐tracheal and/or trans‐bronchial sample (eg. Aspirations(s)/biopsy(ies) 3 or more and/or hilar lymph nodes stations or structures.Reported only once per session

Add on codeEBUS during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s)Use with 31622‐31629, 31643, 31645‐ 31646

Add on codeEBUS during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s)Use with 31622‐31629, 31643, 31645‐ 31646

31653 31654

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Bronchoscopy• Patient had lesion on left lung on CT

scan. Bronchoscopy with (EBUS) with biopsies of the para-tracheal lymph nodes and trans-bronchial biopsies of left upper lung lobe were done.

• What are you CPT codes?– 31652– 31628

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Cardiovascular SystemNew guideline for

cardiovascular system for pulmonary valve implantCode 33477

trans-catheter pulmonary valve implant

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Cont’d

New CPT guideline for 33477 Pulmonary Valve implant

33477 is used to report trans-catheter pulmonary valve implantation (TPVI).

Should be reported only once per session Includes the work when performed

• percutaneous access• placing the access sheath• advancing the repair device delivery system into position • or repositioning the device as needed • and deploying the device(s). • Angiography• radiological supervision, and interpretation performed to

guide TPVI (ex: guiding device placement and documenting completion of the intervention)

All are included in the code.cont’d

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New CPT guideline for 33477 Pulmonary Valve implant continued

When done to complete the Pulmonary valve implant the following are also included: Includes all cardiac catheterizations intra-procedural contrast injection fluoroscopic guidance radiological S&I Imaging guidance performed to complete

the pulmonary valve procedure

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New CPT guideline for 33477 Pulmonary Valve implant continuedIncludes when donepercutaneous balloon angioplasty of the

conduit/treatment zonevalvuloplasty of the pulmonary valve

conduitstent deployment with in the pulmonary

conduit or an existing bio-prosthetic pulmonary valve, when performed.

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• Do not report 33477 in conjunction with 76000, 76001, 93451, 93453-93461, 93530-

93533, 93563, 93566-93568 for angiography intrinsic to the procedures

• Do not report 33477 in conjunction with 37236, 37237, 92997, 92998 if done for

pulmonary angioplasty/valvuloplasty or stenting within the prosthetic valve delivery site

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If pulmonary angioplasty is performed at a site separate from the prosthetic valve delivery site then 92997, 92998 can be reported separately

If pulmonary artery stenting is performed at a site separate from the prosthetic valve delivery site 37236, 37237 can be reported separately

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New CPT guideline for 33477 Pulmonary Valve implant continuedDiagnostic right heart catheterization and diagnostic coronary angiography codes should not be used with 33477 to report. Contrast injections, angiography, road-mapping,

and/or fluroscopic guidance for the TPVI. Pulmonary conduit angiography for guidance of TPVI

or Right heart catheterization for hemodynamic

measurements before, during, and after TPVI for guidance of TPVI.

These codes include: 93451, 93453-93461, 93530-93533, 93563, 93566-93568

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New CPT guideline for 33477 Pulmonary Valve implant continuedFor separate and distinct services from TPVI the following can be reported with 33477: Diagnostic right and left heart catheterization

codes (93451-93453, 93456-93461, 93530-93533)

Diagnostic coronary angiography codes (93454-93464)

Diagnostic pulmonary angiography code (93568) may be reported with 33477 for separate and distinct services from TPVI if

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New CPT guideline for 33477 Pulmonary Valve implant continuedItems representing separate and distinct procedures are as follows: No prior study is available and full diagnostic

study is performed A prior study is available, but as documented

in the medical record• There is inadequate visualization of the anatomy

and/or pathology• The patient’s condition with respect to the clinical

indication has changed since the prior study • There is clinical change during the procedure that

requires new evaluation

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Other items that can be reported separately are: Other cardiac cath services when

performed for diagnostic purposes not intrinsic to TPVI

Same session/same day diagnostic cardiac cath services report the appropriate cardiac cath codes appended with modifier 59 or X subset to indicate separate and distinct procedural services TPVI.

Diagnostic coronary angiography performed at a separate session from an interventional procedure may be separately reportable, when performed

Percutaneous coronary interventional procedures may be reported separately

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New CPT guideline for 33477 Pulmonary Valve implant continued Percutaneous pulmonary artery branch interventions

may be reported separately when performed. When trans-catheter ventricular support is required in

conjunction with TPVI the appropriate code may be reported with the appropriate percutaneous ventricular assist device (VAD) procedure codes (33990-33993)

Extracorporeal life support services (ECLS) procedure codes (33946-33989) or balloon pump insertion codes (33967, 3390, 33973)

When cardiopulmonary bypass is performed in conjunction with TPVI code 33477 may be reported with the appropriate add-on code for percutaneous peripheral bypass (33367) open peripheral bypass (33368) or central bypass (33369).

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Two New Add-On Codes for Intravascular US Services

37252 – IV US (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention including S&I initial non-coronary vessel (list separately in addition to code for primary procedure.)

37253- each additional non-coronary vessel (list separately in addition to code for primary procedure.)

Instructional notes: i. 37253 can be use in conjunction with

37252ii. Do not report 37252, 37253 in

conjunction with 37191-37192, or 37197.22

New Add-On Codes for Intravascular US Services continued

• IVUS Services Include all transducer manipulations and/or repositioning

within the specific vessel being examined during a diagnostic procedure or before, during, and/or after therapeutic intervention

37191-37192, 37197 include the work of the IVUS and should not be separately reported with those procedures.

If a lesion extends across the margins of one vessel into another, this should be reported with a single code despite imaging more than one vessel.

Non-selective and/or selective vascular cauterizations may be separately reportable such as 36005-36248.

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New Endoscopy CodesMediastinoscopy report with:

39401- includes biopsy(ies) of mediastinal mass when performed

39402- with lymph node biopsy(ies)

39400 has been deleted and 39401 and 39402 have replaced it

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Patient diagnosed with a mass of the mediastinal area with enlarged lymph nodes. Patient taken to the OR for mediastinoscopy with biopsy of the mediastinal mass and biopsy of mediastinal lymph nodes. What are the CPT codes that should be assigned.

39402 is the only CPT code you need

39401 and 39402 39401 is code 2 of column 1/ column 2 edit and not allowed to be coded together even with a modifier.

This is because 39402 includes all components of 39401 in addition to the lymph node biopsy(ies) that it includes.

Digestive System

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43210 Esophageal Fundoplasty•Esophagus, Endoscopy, Esophagogastroduodenoscopy

•43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when, performed (separate procedure)

•# 43210 with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed

Should not be reported with: 43810, 43191, 43197, 43200, 43235

Biliary Tract

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New Codes Biliary System

Biliary Tract 47531‐47534

Percutaneous Biliary Stent(s)

and Drain Placement

47535‐47544

Biliary catheters 47533= external

47534= internal

47538‐47540 = multiple stents

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Biliary TractNew codes: 47351 and 47352

47531‐ describes cholangiography percutaneous existing access:

• includes complete diagnostic procedure

• Injection of contrast material

• includes the radiologic S&I

• includes procedural image guidance (fluro, US)

47352 new access

In addition to all the above 47532 also Includes accessing the biliary system with needle or catheter

(ex: given in CPT book is percutaneous trans‐hepatic cholangiogram)29

Biliary Tract continuedNew Codes 47533 and 47534New Codes 47533 and 47534

• 47533 Placement of biliary drainage catheter percutaneous EXTERNAL

• includes diagnostic cholangiography when performed

• Includes imaging guidance (US or Fluro)

• Includes all radiological S&I

• 47534 is all the above the only difference is internal‐external

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Biliary Tract continued

47533 ‐ 47540

describe percutaneous therapeutic biliary procedures that include

• catheter or stent placement

• catheter removal and replacement (exchange)

• and/or catheter removal

•As well as elements of access

•Drainage catheter manipulation

•Diagnostic cholangiography

• Imaging and guidance

•Radiological Supervision and Interpretation

47533, 47534, 47538, 47539, 47540

• In addition to all the previous block these can be reported once for each catheter or stent placed Example: is bilobar placement, multi‐segmental placement

47535, 47536, 47537 in addition to the first block these

• May be reported once for each catheter

conversion, exchange, or removal (bilobar and bisegmental are

examples)

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47538, 47539, 47540 in addition to the first block these on previous slide

• May be reported may be reported only once per session to describe one or more overlapping or serial stent(s) placed in a single bile duct or bridging more than one ductal segment (hepatic duct and common bile duct for example) through a single percutaneous site

• May be reported more than once for additional procedure under these circumstances

• Placement of side‐by‐side (double barrel) stents within a single bile duct

• Placement of two or more stents into separate bile ducts through a single percutaneous access

• Placement of stents through two or more percutaneous access site

• Placement of side‐by‐side (double‐barrel stent) in a single

47538

• Should not be reported with 47536 if a biliary drainage catheter (external or internal‐external is replaced after the biliary stent is placed

47540

• describes biliary stent placement with the additional service of placing a biliary drainage catheter external or internal‐external

• Should not be reported with 47533, 47534, for the same ductal system



47541

•Assist with Endoscopic procedures performed in conjunction with other physician specialists

•Access placed may include wire and/or catheter

•May not be reported if wire is placed through existing percutaneous access

47542, 47543, 74544

•Procedures that may be performed in conjunction with other codes in this family are add on codes and do not include

• access, catheter placement, or diagnostic imaging

• 47542 should not be reported with 47538, 47539, and 47540.

Code 47544 should not be reported with 47531‐47543 for

removal of incidental sludge and/or debris.

47542 should not be reported with 47544 if a balloon is used

for removal of calculi, debris, and/or sludge

rather than for dilation

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Abdomen, Peritoneum, Omentum

Excision, Destruction

• 49185‐ sclerotherapy includes

• Percutaneous

• Includes contrast injection

• Sclerosant injection(s)

• Diagnostic study

• Image guidance

• Radiological S&I

How to use

• For one lesion or multiple lesion interconnected single access report once

• For multiple lesions separate access with modifier 59

• not for sclerotherapy of lymphatic or vascular malformation

• Do not report with 49424, 76080

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Urinary System

35New Codes for Urinary 50430‐50435 50693‐50696 50705‐50706

Urinary System Guidelines continued

Other introduction (injection/change/removal) procedures

•50430 and 50431

•Diagnostic procedures

•Include injection of contrast

•Radiological S&I

•Procedural imaging

•50430 also includes accessing the collecting system and/or associated ureter with a needle and/or catheter

•50430 and 50431 should not be reported with 50432—50435, 50693‐50695

50432‐50435

•Therapeutic procedures describing catheter placement or exchange

•include the elements of access

•Drainage Catheter manipulations

•Image guidance

•Diagnostic imaging

•Radiological S&I when performed

•Do not report 50432 in conjunction with 50430‐50433, 50694, 50695, 74425 for the same renal collecting systems and/or associated ureter

•Do not report 50432 in conjunction with 50395 for dilation of the nephrostomy tube tract

50433

•Percutaneous nephrostomy with additional accessing of the ureter/bladder to ultimately place a nephro‐ureteral catheter (a single transnephric catheter with nephrostomy and ureteral components that allows drainage internally, externally, or both

•Do not report 50433 with 50430‐50432, 50693‐50695, 74427 for the same renal collecting system and/or associated ureter

•Do not report 50433 with 50395 for dilation in the nephro‐ureteral catheter tract

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Urinary System Guidelines continued and Individual Code Descriptors

Codes 50430‐50435, 50606, 50693‐50695, 50705 and 50706

The renal pelvis and its associated ureter are considered a single entity for reporting purposes

May be reported once for each renal collecting system/ureter

accessed (eg, two separate codes would be reported for bilateral nephrostomy tube placement or for unilateral duplicated collecting

system/ureter requiring two separate procedures

50430

• Inject procedures for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure includes radiological S&I and image guidance for new access

•50431 includes above but is for existing access

50432

• Placement of nephrostomy percutaneous includes

• Diagnostic nephrostogram and/or ureterogram

• Image guidance

• Radiological S&I

• Do not report 50432 in conjunction with 50430‐50433, 50964, 74425 for the same renal collecting system and/or associated ureter

• Do not report 50432 in conjunction with 50395 for dilation of the nephrostomy tube tract

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50433 Placement of nephroureteral catheter, percutaneous for new access includes:

• diagnostic nephrostogram and/or ureterogram

• image guidance

• radiological S&I

• Do not report 50433 with 50430‐50432, 50693, 50694, 50695, 74425 for the same renal collecting system and/or associated ureter

• Do not report 50433 with 50395 for dilation of the nephroureteral catheter tract

50434 Convert nephrostomy catheter to nephroureteral catheter percutaneous pre‐existing nephrostomy tract includes

•Diagnostic nephrostogram and/or ureterogram

• Image guidance

•Radiological S&I

•Do not report 50434 in conjunction with 50430, 50431, 50435, 50684, 50693, 74425 for the same renal collecting system

50435 Exchange nephrostomy catheter, percutaneous,

•Diagnostic nephrostogram and/or ureterogram

• Image guidance

•Radiological S&I

•Do not report 50435 with 50430, 50431, 50434, 50693, 74425 for the same renal collecting system and/or associated ureter

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Other Introduction (injection/Change/Removal) Procedures

50693 Placement of ureteral stent, percutaneous pre‐existing nephrostomy tract

•Nephrostogram and/or ureterogram

• Image guidance

•Radiological S&I

50694 includes all the above but for new access without separate nephrostomy catheter

50695 includes all the above but for new access with separate nephrostomy catheter

Do not report 50693, 50694, 50695 in conjunction with 50430‐50435, 50684, 74425 for the same renal collecting system and/or associated ureter

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Repair 50705

•Ureteral embolization or occlusion, including imaging guidance and radiological S&I list separately from the primary procedure

•Can be used with 50382, 50384‐50389, 50430‐50435, 50684, 50688, 50690, 50694, 50695, 51610

Repair 50706

• Balloon dilation, ureteral stricture, including imaging guidance, radiological S&I,

• Use with 50382, 50384‐50389, 50430‐50435, 50684, 50688, 50690, 50693‐50695, 51610

• Do not report with 50553, 50572, 50953,50972, 52341, 52344, 52345, 74485

Guidelines for 50705 and 50706

•These two procedures may be performed through de novo transrenal access, and existing, renal/ureteral access, transurethral access, an ileal conduit or ureterostomy the service of gaining access can be reported separately

•Diagnostic pyelography/ ureterography is not included and can be reported separately

•Other interventions or catheter placements performed at the same setting as the embolization/dilation may be reported separately

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Male Genital SystemRepair

• 54437

• Repair of traumatic corporeal tear(s)

• For repair of the urethra see 53410, 53415

• 54438

• Replantation penis complete amputation including urethral repair

• If incomplete penile amputation see 54437 for repair of corporeal tear(s) and 53410, 53415 for repair of the urethra

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Nervous System61645

•Percutaneous arterial transluminal mechanical trombectomy and/or infusion for thrombolysis intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intra procedural pharmacological thrombolytic injection(s)

•Do not report 61645 in conjunction with 36221‐36226, 37184, 61630, 61635, 61650, 61651 for the same vascular territory

61650

•Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography and imaging guidance initial vascular territory

61651

•Each additional vascular territory (list separately in addition to code for primary procedure

•Use 61651 in conjunction with 61650

•Do not report 61650 or 61651in conjunction with 36221‐36226, 61640‐61642 61645 for the same vascular territory

•Do not report 61650 or 61651 in conjunction with 96420, 96422, 96423, 96425 for the same vascular territory

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Nervous system guidelines

61645, 61650, and 61651

• Cerebral endovascular therapeutic intervention in any intracranial artery

• Includes selective catheterizations

• Diagnostic angiography

• Subsequent angiography

• Radiological S&I within the treated vascular territory

• Fluoroscopic guidance

• Neurologic and hemodynamic monitoring of the patient

• Closure of the arteriotomy by manual pressure

• An arterial closure device or suture

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Nervous System Guidelines

61645, 61650, 61651 continued

To report these services the

intracranial arteries are divided into three vascular territories

1) Right carotid circulation

2) Left carotid circulation

3) vertebro‐basilar circulation

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Nervous System Guidelines continued

61650 is reported once

for

the first intracranial vascular territory treated with intra‐arterial prolonged administration of pharmacologic

agent(s) during the same session

61651 is reported for

the additional territory(ies) and but can only be reported for a maximum of twice per day

61650 and 61651

are for prolonged administration of non‐thrombolytic agent(s)

(spasmolytic or chemo)into an artery to treat non‐iatrogenic central

nervous system disease or sequelae

Do not use these codes to report administration of heparin,

nitroglycerin, saline they are used to report only prolonged

administrations of 10 continuous minutes or intermittent duration

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Nervous System Continued

Introduction / Injection of

Anesthetic Agent (nerve block), diagnostic or therapeutic

64461Paravertebral Block (para‐spinous block) thoracic, single injection site includes imaging guidance when performed

+64462

Second and any additional injection site(s) includes imaging list separate from the primary procedure

Report in conjunction with 64461

Do not report more than once per day

+64463 Continuous infusion by catheter includes imaging

Do not report 64461, 64462, or 64463 with 62310, 62318, 64420, 64421, 64479, 64480, 64490, 64491, 64492, 76942, 77002, 77003

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Auditory

69209

• Removal impacted cerumen using irrigation/lavage unilateral

• Do not report with 69210 when performed on the same ear

• For bilateral procedure report 69209 with modifier 50

• For removal of impacted cerumen requiring instrumentation use 69210

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• Represent therapies identified as no longer contemporary or commonly performed

– Rib fracture (21805)

– Laparoscopic cholangiography (47560, 47561)

– Basket or snare gallstone extraction (47630)

– Biliary Catheter/tube Change (47525, 47530)

– Spinal accessory nerve injection (64412)

– 32 vaccine codes

Deleted Codes No Replacements

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Works Cited1. AHA, Edition/Year: 2016, Professional Edition CPT, Publisher: American Medical Association,

Authors: American Medical Association2. https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUK

Ewi1j7LU6ZPMAhXDOCYKHZZkD8AQjRwIBw&url=http%3A%2F%2Fwww.visualdictionaryonline.com%2Fhuman-being%2Fanatomy%2Furinary-system.php&psig=AFQjCNGBmWaLhbsCRmDrTYqwD484lbstug&ust=1460919038142941

3. https://www.google.com/imgres?imgurl=https://www.mskcc.org/sites/default/files/styles/large/public/node/20233/images/biliary2a_1.png&imgrefurl=https://www.mskcc.org/cancer-care/patient-education/caring-your-biliary-drainage-catheter&h=283&w=400&tbnid=FH27ilHX62EUQM:&docid=VowVmmQG_JjaiM&ei=r3IEV579HYWZmQG_xIa4CQ&tbm=isch&ved=0ahUKEwjekNn3-fjLAhWFTCYKHT-iAZcQMwgfKAIwAg

4. https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiCv9zY-vjLAhWG8CYKHZwTD8UQjRwIBw&url=https%3A%2F%2Fgi.jhsps.org%2FGDL_Disease.aspx%3FCurrentUDV%3D31%26GDL_Cat_ID%3DAF793A59-B736-42CB-9E1F-E79D2B9FC358%26GDL_Disease_ID%3D0ADCFD83-7DE7-4D53-82F5-6F0C9BFB7F14&bvm=bv.118443451,d.eWE&psig=AFQjCNHoAFyJjiyLXLA209KQrRmk8sKWvA&ust=1459995892085639

5. http://img.medscape.com/slide/migrated/editorial/cmecircle/2008/17517/flash/chang/images/slide7.png6. http://medical-dictionary.thefreedictionary.com/soft+tissue7. http://image.slidesharecdn.com/skinsofttissueboneenglish-120118142152-phpapp02/95/skin-soft-tissue-

bone-infections-symposia-the-crudem-foundation-2-728.jpg?cb=13268965738. http://figures.boundless.com/5284/raw/e-human-heart-28cropped-29.svg9. http://www.buckscountygi.com/images/pic-

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cpt code updates 2016 - north carolina health information ... · non-selective and/or selective...

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