2015 Procedure Code Changes. Presented by Coding Strategies / K. Morrow Webinar Format - 12/04/14

2015 Procedure Code Changes Presented by Coding Strategies / K. Morrow Webinar Format - 12/04/14

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4 Changes to 2015 code set Additions >267 Deletions > 125 Revisions > 125 Don t Forget the Guidelines 4 Copyright 2014, Coding Strategies

5 Not All Changes Are Equal Code 33215 33216 33217 33218 Description Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator 2014 or pacing cardioverter-defibrillator - Implantable defibrillator has replaced this phrase throughout the entire code set 5 Copyright 2014, Coding Strategies

6 Approach Clarified 2014 Code Description Code 93642 Description Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters) 2015 Code Description 6 Code 93642 Description Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters) Copyright 2014, Coding Strategies

7 Changes Reflect Trends Codes for application of turnbuckle jacket (29020, 29025, 29715) have been deleted. This was an old remedy for scoliosis. 7 Copyright 2014, Coding Strategies

8 Codes for new services New codes for cystourethroscopy with insertion of permanent adjustable transprostatic implants 8 Code 52441 52442 Description Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant ; each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure) Copyright 2014, Coding Strategies

9 Changes Recognize Work New code includes: - Review of CT, CTA, MRI, utilization of 3D software for iterative modeling of the aorta and device - Does not include time spent on the day before or the day of the repair procedure Code 34839 Description Physician planning of a patient-specific fenestrated visceral aortic endograft requiring a minimum of 90 minutes of physician time 9 Copyright 2014, Coding Strategies

10 Specific Unspecified Codes Code Description 44799 Unlisted, procedure, small intestine 45399 Unlisted procedure, colon Code Description 67399 Unlisted procedure, extraocular muscle Previously one UPC unlisted procedure, intestine Previously unlisted procedure ocular muscle 10 Copyright 2014, Coding Strategies

11 CPT Errata 11 Copyright 2014, Coding Strategies

12 HCPCS Modifiers Added May or may not be required for non-cms Modifier PO XE XP XS XU Description Services, procedures and/or surgeries provided at off-campus provider-based outpatient departments Separate encounter, a service that is distinct because it occurred during a separate encounter Separate practitioner, a service that is distinct because it was performed by a different practitioner Separate structure, a service that is distinct because it was performed on a separate organ/structure Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service Copyright 2014, Coding Strategies

13 Provider Based OP Dept. UB = modifier PO 1500 = new POS 13 Copyright 2014, Coding Strategies

14 Correct Coding Initiative 14 CHAPTER 5 3xxxx SERIES CODES This is an important change for vascular surgery (and contrary to CPT guidelines): When an open or percutaneous vascular procedure (e.g., thromboendarterectomy) is performed, the repair and closure are included components of the vascular procedure. CPT codes 35201-35286 (repair of blood vessel including extensive repair) are not separately reportable in addition to the primary vascular procedure unless the CPT code descriptor states that repair or closure is separately reportable.

15 NCCI Edits for All 15 UHC uses the "Column One/Column Two" and Mutually Exclusive National Correct Coding Initiative (NCCI) edits to determine whether CPT and/or HCPCS codes reported together by the same physician for the same member on the same date of service are eligible for separate reimbursement. UHC will not separately reimburse unless the codes are appropriately reported with one of the NCCI designated modifiers recognized under this policy.

16 Vendor Edits Based on NCCI The ClaimsManager Knowledgebase is comprised of the Ingenix Claims Edit System (CES) and the CMS Correct Coding Policy (CCI). Both CES and CCI form the basis of information exchange and claims analysis in ClaimsManager. The CCI, which contains industry-standard Medicare data and bundling/unbundling data, is published quarterly by AdminiStar Federal Inc. 16

17 Pharmaceuticals 17 Copyright 2014, Coding Strategies

18 Review charge masters carefully J0153 2015 Codes Deleted 2014 Codes Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) J0150 J0151 Injection, adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use a9270) Injection, adenosine for diagnostic use, 1 mg (not to be used to report any adenosine phosphate compounds, instead use A9270) 2015 Codes Deleted 2014 Codes J0887 Injection, epoetin beta, 1 microgram, (for esrd on dialysis) Q9972 Injection, epoetin beta, 1 microgram, (for esrd on dialysis) J0888 Injection, epoetin beta, 1 microgram, (for non esrd use) Q9973 Injection, epoetin beta, 1 microgram, (non-esrd use) 18 Copyright 2014, Coding Strategies

19 Clotting Factors C9136 J7181 J7182 J7200 J7201 2015 Codes Deleted 2014 Codes Injection, factor viii, fc fusion protein, (recombinant), per i.u. Injection, factor xiii a-subunit, (recombinant), per iu Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per i.u. Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per C9133 Factor ix (antihemophilic factor, i.u. recombinant), rixubis, per i.u. Injection, factor ix, fc fusion protein (recombinant), per i.u. C9134 Factor xiii (antihemophilic factor, recombinant), tretten, per 10 i.u. C9135 Factor ix (antihemophilic factor, recombinant), alprolix, per i.u. 19 Copyright 2014, Coding Strategies

20 Testosterone J1071 J3121 J3145 2015 Codes Deleted 2014 Codes Injection, testosterone Injection, testosterone cypionate, up to 100 J1070 cypionate, 1mg mg J1080 Injection, testosterone cypionate, 1 cc, 200 mg J1060 Injection, testosterone cypionate and estradiol cypionate, up to 1 ml Injection, testosterone Injection, testosterone enanthate, up to 100 J3120 enanthate, 1mg mg J3130 Injection, testosterone enanthate, up to 200 mg J0900 Injection, testosterone enanthate and estradiol valerate, up to 1 cc Injection, testosterone undecanoate, 1 mg C9023 Injection, testosterone undecanoate, 1 mg J3140 Injection, testosterone suspension, up to 50 mg J3150 Injection, testosterone propionate, up to 100 mg 20 Copyright 2014, Coding Strategies

21 EVALUATION & MANAGEMENT 21 Copyright 2014, Coding Strategies

22 Social History Age appropriate review of past and current activities that includes significant information about: - Marital status and/or living arrangements - Current employment - Occupational history - Military history - Use of drugs, alcohol, and tobacco - Level of education - Sexual history - Other relevant social factors 22 Copyright 2014, Coding Strategies

23 Neonatal/Pediatric Critical Care Same definitions of critical care exist for all ages (adult, child, neonate) Neonatal codes (< 28 days) - If readmitted to NCCU during the same day, or stay o 1 st day of readmission during same stay = 99469 o Subsequent day(s) = 99469 23 Copyright 2014, Coding Strategies

24 Care management Code 99487 99489 99490 Description Complex chronic care management services, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; establishment or substantial revision of a comprehensive care plan; moderate or high complexity medical decision making; 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.;... each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure) Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored. 24 Copyright 2014, Coding Strategies

25 Care Management Do not count time spent by clinical staff on a day the provider reported an EM service. Revisions remove face/face references (and deleted 99488). - Face/Face encounters should be an EM Must provide (and document) the established elements 25 Copyright 2014, Coding Strategies

26 Care Management Guideline Revision Provide 24/7 access to physicians or other QHC professional/clinical staff including providing patients/caregivers with a means to make contact with health care professionals in the practice to address urgent needs regardless of the time of day or day of week. 26

27 Clinical Example 75 yr. old male with diabetes, claudication, and mild CHF, s/p MI with mild dementia. Six weeks ago had peripheral arterial stent placed during hospitalization for treatment of a foot ulcer. Patient lives with his daughter, participates in remote monitoring, treated by 2 specialists in addition to PCP 27

28 Qualifying patients Complex Chronic Care Management - Coordination of a # of specialties and services - Inability to perform ADL and/or cognitive impairment resulting in poor adherence to the treatment plan w/o substantial assistance - Psychiatric or other medical comorbities that complicate care and/or - Social support requirements difficulty w/access to care - Minimum time spent (<60 min not reported) 28

29 Qualifying patients Chronic Care Management - 2+ chronic conditions expected to last at least 12 months, or until the death of the patient - Chronic conditions w/significant risk of death, acute exacerbation/decompensation, or functional decline - Comprehensive care plan - Minimum time spent (<20 min not reported) 29

30 Care management Reported once per calendar month by a single provider - Who owns the care management role - Codes are intended to be primary care incentive Do not count time spent by clinical staff on a day the provider reported an EM service. - But EM services can be reported within the calendar month Revisions remove face/face references (and deleted 99488). - Face/Face encounters should be an EM Must provide (and document) the established elements 30

31 Care management 31 Don t double-dip - Postoperative services for reported surgery - Post discharge care within 30 days of discharge if reporting transitional mgmnt (99495, 99496) Consider all services for which there is a separate code: Care plan oversight Medical team conferences On-line medical evaluation Analysis of data Telephone services Transitional care mgmt. ESRD services Anticoagulant mgmt.

32 Work flow processes 32

33 Advance Care Planning Code 99497 99498 Description Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure) Medicare will NOT pay for these services in 2015 - Status I (not valid for CMS purposes) 33 Copyright 2014, Coding Strategies

34 Primary targets: SURGERY Musculoskeletal System Cardiovascular System Digestive System Nervous System 34 Copyright 2014, Coding Strategies

35 Global Package Definition 2014 Version 2015 Version Subsequent to the decision for surgery, one related Evaluation and Management (E/M) encounter on the date immediately prior to or on the date of procedure (including history and physical) Evaluation and Management (E/M) service(s) subsequent to the decision for surgery on the day before and/or day of surgery (including history and physical) 35 Copyright 2014, Coding Strategies

36 Anticipate Further Changes CMS will transition post-op days to ZERO - Current 10 day procedures = CY 2017 - Current 90 day procedures = CY 2018 + Report EM separately - Surgical RVUs will be re evaluated 36 Copyright 2014, Coding Strategies

37 Arthrocentesis Code 20600 20604 20605 20606 20610 20611 Description Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance... with ultrasound guidance, with permanent recording and reporting Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance... with ultrasound guidance, with permanent recording and reporting Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance... with ultrasound guidance, with permanent recording and reporting 37 Copyright 2014, Coding Strategies

38 Procedure Description 20611 - Ultrasound perform a focused ultrasound evaluation. Obtain, label, and interpret images in multiple planes through specific areas of concern, focusing on best approach for the injection. Document the normal anatomic structure and any pathologic findings. Utilize imaging to direct the needle to the joint or bursa, avoiding bony prominences, blood vessels, or other vulnerable structures. 38 Copyright 2014, Coding Strategies

39 Bone Tumor Ablation New code cryoablation Revision bundles imaging guidance Code 20982 Description Ablation therapy for reduction or eradication of 1 or more bone tumors (e.g., metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency 20983... cryoablation 39 Copyright 2014, Coding Strategies

40 Rib Fractures Converted Category III to Category I Code 0245T 0248T 21811 21812 21813 Description Open treatment of rib fracture requiring internal fixation, unilateral; # ribs Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 1-3 ribs Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 4-6 ribs Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 7 or more ribs 40 Copyright 2014, Coding Strategies

41 New - Vertebral Augmentation Code Description Percutaneous vertebroplasty (bone biopsy included when performed), 22510 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic 22511... lumbosacral +22512... each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure) Code Description Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical 22513 device (e.g., kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic 22514... lumbar... each additional thoracic or lumbar vertebral body (List separately in +22515 addition to code for primary procedure) 41 Copyright 2014, Coding Strategies

42 Correct Coding Initiative Guidelines CPT codes 22510-22512 represent a family of codes describing percutaneous vertebroplasty, and CPT codes 22513-22515 represent a family of codes describing percutaneous vertebral augmentation. Within each of these families of codes, the physician may report only one primary procedure code and the add-on procedure code for each additional level(s) whether the additional level(s) are contiguous or not. - (This is contrary to the new CPT guidelines which were based on the 2014 CCI manual.) 42

43 Sacroplasty Code 0200T 0201T Description Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed Codes revised to include imaging guidance and bone biopsy (when performed) Copyright 2014, Coding Strategies

44 Total Disc Arthroplasty Code 22856 22858 0092T Description Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical ;second level, cervical (List separately in addition to code for primary procedure) Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), each additional interspace, cervical (List separately in addition to code for primary procedure) 44 Copyright 2014, Coding Strategies

45 Sacroiliac Arthrodesis Code 27279 27280 Description Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device Arthrodesis, open, sacroiliac joint, including obtaining bone graft, including instrumentation, when performed 45 Copyright 2014, Coding Strategies

46 Arthrography Code Description 27370 Injection of contrast for knee arthrography Revised to specify that it represents injection of contrast (presumably to differentiate it from the new arthrocentesis codes) 46 Copyright 2014, Coding Strategies

47 Subcutaneous implantable defibrillator (S-ICD) Category III (0319T 0328T) deleted New category I codes ( 33270-33273) - Additional new codes for associated services (93260, 93261, 93644) 47 Copyright 2014, Coding Strategies

48 Mitral Valve Repair Code 33418 33419 Description Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session (List separately in addition to code for primary procedure) Angiography and RS&I performed to guide TMVR are included. - Does the report consistently document the intent 48 Copyright 2014, Coding Strategies

49 New Valve Repair code Code 0345T Description Transcatheter mitral valve repair percutaneous approach via the coronary sinus 49 Copyright 2014, Coding Strategies

50 Extensive changes to the procedures for these services (25 new codes) - Initiation - Repositioning - Removal 50 Copyright 2014, Coding Strategies

51 Carotid Stent Existing codes (37215, 37216) revised for consistency (open or percutaneous) New code added for antegrade approach Code 37218 Description Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation All three still bundle ipsilateral imaging 51 Copyright 2014, Coding Strategies

52 Arterial stent placement Description of the new code Code 37236 Description Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery Driven by location and intent - LE, occlusive disease.. See 37221 37235 - LE, any other reason... See 37236 - Intrathoracic carotid/innominate antegrade approach 37218 - Extracranial vertebral.. See 0075T, 0076T 52 Copyright 2014, Coding Strategies

53 Gastroenterology 53

54 HCPCS Bridge Gap Temporary G codes = deleted 2014 codes New 2015 codes won t have units until 2016 - For example 2014 Code HCPCS Code 2015 Code 44383 G6018 44384 44393 G6019 44401 45339 G6022 45346 45345 G6023 45347 Description Ileoscopy, through stoma; with transendoscopic stent placement (includes predilation) Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesions(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation) 54 Copyright 2014, Coding Strategies

55 Which Codes for Which Payer Medicare (original, Medicare Advantage) - Code has not changed 2014 2015, use CPT - Code changed 2014 2015, use G code - Code is NEW for 2015, report CPT code Commercial, Medicaid, Exchange, etc. - Report CPT code unless otherwise instructed 55

56 Cancer Screening - Cologuard Added to the physician self-referral list Code G0464 Description Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (e.g., KRAS, NDRG4 and BMP3) Reimbursed once every 3 years - Age 50 85 - Asymptomatic - At average risk for developing colorectal cancer 56

57 Cryoablation Code Description 47383 Ablation, 1 or more liver tumor(s), percutaneous, cryoablation Imaging guidance will be reported separately Ultrasound (76940) CT (77013) MR (77022) 57 Copyright 2014, Coding Strategies

58 Pain Management TAP block provides anesthesia of the abdominal wall and is used primarily for postop pain control. Code 64486 64487 64488 64489 58 Description Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)... by continuous infusion(s) (includes imaging guidance, when performed) Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)... by continuous infusions (includes imaging guidance, when performed) Copyright 2014, Coding Strategies

59 Eye and ocular adnexa Code Description Aqueous shunt to extraocular equatorial plate 66179 reservoir, external approach; without graft 66180 ; with graft Code Description Revision of aqueous shunt to extraocular equatorial 66184 plate reservoir; without graft 66185 ; with graft 59 Copyright 2014, Coding Strategies

60 RADIOLOGY 60 Copyright 2014, Coding Strategies

61 Diagnostic Changes Breast Imaging - Ultrasound - Tomosynthesis Myelography Vertebral Fracture Assessment (VFA) Arthography Copyright 2014, Coding Strategies

62 Interventional Changes Arthrocentesis Tumor Ablation Vertebral Augmentation - Vertebroplasty - Kyphoplasty - Sacroplasty FEVAR planning Copyright 2014, Coding Strategies

63 Correct Coding Initiative Changes Post-procedure mammography changes (again) - 11. If a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with mammographic or stereotactic guidance (e.g., 19081-19082, 19281, 19282), the physician should not separately report a post procedure mammography code (e.g., 77051, 77052, 77055-77057, G0202-G0206) for the same patient encounter. The radiologic guidance codes include all imaging by the defined modality required to perform the procedure. 63

64 Breast Ultrasound Long-standing 76645.. Deleted Code 76641 Description Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete 76642... limited Complete exam includes all 4 quadrants of the breast and the retro areolar region - Limited is a focused exam limited to 1 or more elements in the complete exam Both include the axilla if performed - If axilla only assign the limited extremity code 76882 64

65 Digital Breast Tomosynthesis Code Description 77061 Digital breast tomosynthesis; unilateral 77062... bilateral +77063 Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure) G2079 Diagnostic digital breast tomosynthesis, unilateral or bilateral (List separately in addition to code for primary procedure) 65 Copyright 2014, Coding Strategies

66 Digital Breast Tomosynthesis The screening DBT code is an add-on code that will be reported together with the screening mammogram code. Cannot report diagnostic codes 77061-77062 with regular screening mammo code - How will this impact appropriate billing both screening and diagnostic study on same day? Codes do not guarantee coverage - CMS will pay for diagnostic tomo - Unclear how commercial payors will handle Copyright 2014, Coding Strategies

67 Medicare Billing Procedure Screening digital mammogram with tomosynthesis Diagnostic digital mammogram with tomosynthesis UNILATERAL Diagnostic digital mammogram with tomosynthesis BILATERAL Codes G0202 77063 G0206 G0279 G0204 G0279 Copyright 2014, Coding Strategies

68 Myelography Revised 2 injection codes 61055 & 62284 - Parenthetical RS&I = physician or OQHCP 4 new comprehensive codes for myelogram contrast injection and imaging - These codes include the lumbar injection as well as the myelogram S&I. Copyright 2014, Coding Strategies

69 Myelography Note that the existing myelogram S&I codes (72240-74470) have not been deleted. - The ACR noted previously that these codes would be retained since in some cases different physicians perform the injection and the S&I Code Description 62302 Myelography via lumbar injection, including radiological supervision and interpretation; cervical 62303... thoracic 62304... lumbosacral 62305... 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical) Copyright 2014, Coding Strategies

70 Myelography Discussed in September 2014 CPT Assistant - Not reported just for documentation of needle placement - Must have an order for an x-ray myelogram if billing for this separate from a CT Edits in place that prevent billing regular myelogram with CT - Need to append modifier 59 to myelogram (not CT) Copyright 2014, Coding Strategies

71 Vertebral Fracture Assessment 77082 - deleted Code 77085 is a combination code that includes axial DXA as well as vertebral fracture assessment, while 77086 represents a stand-alone VFA. The existing codes for axial and appendicular DXA studies (77080, 77081) are not changing and will be used whenever DXA is performed without VFA. Code 77085 77086 Description Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA) 71 Copyright 2014, Coding Strategies

72 72 Lung Cancer Screening Coverage and reimbursement is evolving Many facilities offer these as a self-pay exam Listed as a grade B exam by the US Preventative Services Task Force (USPSTF) Annual screening for adults 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years

73 Lung Cancer Screening 73 231 Under the ACA most commercial payors must provide coverage without a deductible for preventive services that have received a grade of A or B Aetna and Cigna have already implemented coverage Medicare is allowed but not required to cover USPSTF recommended services.

74 74 Lung Cancer Screening Decision memo issued in November 2014 - Beneficiary eligibility adopting recommendation - Lung cancer screening counseling exam must be ordered during counseling and shared decision making visit - Radiologist qualifications required training, certification and experience - Imaging center eligibility criteria including participation in national registry

75 Lung Cancer Screening Medicare will not pay until Final Decision Obtain ABN for Medicare patients New HCPCS code effective 10/1/14 Check payor guidelines regarding use of S code or 71250 (CT Thorax) Code Description S0832 Low-dose computed tomography for lung cancer screening 75

76 76 Lung Cancer Screening Studies should be reported with diagnosis codes V76.0 ICD-10-CM will be Z12.2 Plus secondary codes for tobacco dependence or history of smoking

77 Radiation therapy changes Significant changes to the code set for these services 77 Copyright 2014, Coding Strategies

78 LABORATORY SERVICES 78 Copyright 2014, Coding Strategies

79 Changes to 2015 code set Additions > 95 Deletions > 40 Revisions > 25 Don t Forget the Guidelines 79 Copyright 2014, Coding Strategies

80 Drug Testing No longer qualitative or quantitative Decide if the procedures are: - Presumptive oseparate drug class lists - Definitive o59 new definitive drug testing codes oarranged by drug class - Therapeutic (TDA) 80 Copyright 2014, Coding Strategies

81 MEDICINE SERVICES 81 Copyright 2014, Coding Strategies

82 Vaccinations 82 Code 90630 90651 90654 90721 90723 90734 Description Influenza virus vaccine, quadrivalent (IIV4) split virus, preservative free, for intradermal use Human Papillomavirus vaccine types 6,11,16,18,31,33,45,52,58, 3 dose schedule for intramuscular use Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Hemophilus influenza B vaccine (DTaP/Hib), for intramuscular use Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV), for intramuscular use Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use Copyright 2014, Coding Strategies

83 Watch Techniques Liver elastography wo imaging Code 91200 Description Liver elastography, mechanically induced shear wave (e.g., vibration), without imaging, with interpretation and report Elastography in conjunction with ultrasound imaging will continue to be reported with Category III add-on code +0346T. 83 Copyright 2014, Coding Strategies

84 TEE Guidance During Intervention Reported once per intervention and only by the individual who is NOT performing the interventional procedure Code 93355 Description Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (eg,tavr, transcathether pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal defect closure) (peri-and intraprocedural), real-time image acquisition and documentation, guidance with quantitative measurements, probe manipulation, interpretation, and report, including diagnostic transesophageal echocardiography and, when performed, administration of ultrasound contrast, Doppler, color flow, and 3D 84 Copyright 2014, Coding Strategies

85 Bioimpedance Spectroscopy Code 93702 Description Bioimpedance spectroscopy (BIS), extracellular fluid analysis for lymphedema assessment(s) 85 Copyright 2014, Coding Strategies

86 Revision - Neurostimulator Code 95972 Description Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (i.e., peripheral nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, up to 1 hour 86 Copyright 2014, Coding Strategies

87 Cognitive Function of CNS 87 Code 96110 Code 96127 Description Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument Description Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument Copyright 2014, Coding Strategies

88 Active Wound Care Code 97605 Description Negative pressure wound therapy (e.g., vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters 97606 ; total wound(s) surface area greater than 50 square centimeters Negative pressure wound therapy, (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical 97607 application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters 97608 ; total wound(s) surface area greater than 50 square centimeters 88 Copyright 2014, Coding Strategies

89 New Hypothermia Code Code 99184 Description Initiation of selective head or total body hypothermia in the critically ill neonate, includes appropriate patient selection by review of clinical, imaging and laboratory data, confirmation of esophageal temperature probe location, evaluation of amplitude EEG, supervision of controlled hypothermia, and assessment of patient tolerance of cooling 89 Copyright 2014, Coding Strategies

90 CATEGORY III 90 Copyright 2014, Coding Strategies

91 Pulmonary tumor ablation Includes US, CT, MR guidance Code 0340T Description Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance 91 Copyright 2014, Coding Strategies

92 Elastography Code 0346T Description Ultrasound, elastography (List separately in addition to code for primary procedure) Extended list of codes to be reported in conjunction with this add-on service. 92 Copyright 2014, Coding Strategies

93 Radiosterometric Analysis Code 0347T 0348T 0349T 0350T Description Placement of interstitial device(s) in bone for radiostereometric analysis (RSA) Radiologic examination, radiostereometric analysis (RSA); spine, (includes cervical, thoracic and lumbosacral, when performed) upper extremity(ies), (includes shoulder, elbow, and wrist, when performed) lower extremity(ies), (includes hip, proximal femur, knee, and ankle, when performed) 93 Copyright 2014, Coding Strategies

94 Optical Coherence Tomography Interpretation and report of OCT images during breast surgery Code Description Optical coherence tomography of breast or axillary 0351T lymph node, excised tissue, each specimen; realtime intraoperative 0352T ; interpretation and report, real-time or referred Optical coherence tomography of breast, surgical 0353T cavity; real-time intraoperative 0354T ; interpretation and report, real-time or referred 94 Copyright 2014, Coding Strategies

95 Capsule endoscopy Imaging of the distal ileum Code 0355T Description Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), colon, with interpretation and report Capsule imaging of the esophagus and ileum (91110) Capsule imaging of the esophagus (91111) 95 Copyright 2014, Coding Strategies

96 Adaptive Behavior Four new assessment codes - Behavior identification assessment (0359T) - Observational behavioral f/u (0360T/0361T) - Exposure behavioral f/u (0362T/0363T) Eleven new treatment codes 96 Copyright 2014, Coding Strategies

97 Visual Field Assessment Code 0378T 0379T Description Visual field assessment, with concurrent real time data analysis and accessible data storage with patient initiated data transmitted to a remote surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional ; technical support and patient instructions, surveillance, analysis, and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional 97 Copyright 2014, Coding Strategies

98 Pacemaker Leadless System Three new codes Code 0387T 0388T 0389T Description Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular Transcatheter removal of permanent leadless pacemaker, ventricular Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report, leadless pacemaker system 98

99 Pacemaker Leadless and Pocketless Two new codes Code 0390T 0391T Description Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure or test with analysis, review and report, leadless packermaker system Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, leadless pacemaker system 99

100 Responses to the questions submitted via CHAT during the live presentation QUESTION & ANSWERS 100

101 Q&A new modifier PO Is the modifier PO used for ED facility charges, as a hospital based outpatient department? For now, we have very little guidance on the new modifier. If you are reporting for the ED, I would accept the flexibility that the modifier is voluntary for 2015 and wait for further guidance from CMS. They anticipate guidelines by July 2015. 101

102 Q&A ED services and Global Surgery Are the ER services before surgery is scheduled outside of the packaged service. Historically, the surgical package has been linked to the provider reporting the procedure. ER services would expectedly be paid separately. If you are asking about minor procedures performed in the ED, that evaluation would (typically) be the source of the decision for the procedure, and be separately reported. 102

103 Q&A Contrast Injections On code 27370, if they are specifically saying injection of contrast, then we use this code. But if we are just doing anesthesia and steroid, then we use the 20610. That is the guideline, effective Jan 2015. 27370 will be limited to specifically contrast injections. 103

104 Q&A Cancer Screening For a person with average risk, but no prior history we will use the new code in January. But the high risk is still the same G code. Correct, the new code will allow tracking for average and high risk with separate codes. The diagnosis codes should also support the reported code. 104

105 Q&A GI definition changes Has the descriptor changed for the majority of lower GI procedures to state to the cecum instead of past the splenic flexure? Yes, and it will impact extent of exam 105

106 Q&A Post procedure mammography When we do the stereotactic biopsy, followed up with a post-mammogram that day, did you say we can longer code for that separately? Unfortunately, that is correct. For 2015 services, the post procedure mammography will be included in mammo-guided biopsies and stereotactic-guided biopsies. 106

107 Q&A Colonoscopy Decision Tree Pg 284 of the book contains colonscopy decision tree. Under the therapeutic box, 2 nd row, farthest to the right is the modifier 52 a typo? Yes, it is. The last box, farthest to the right should NOT have the modifier. This was the example of why we need to review the Errata and Technical Corrections on the AMA website. As the slide placed the incorrect behind the correct, it may not have printed correctly. 107

108 Q&A - Myelography What is the difference between the code 62284 and the new codes (62302, 62303, 62304, 62305) 62284 will be used when one provider reports the injection, and another provider reports the imaging. The codes were retained to allow for that component approach. If the same provider is doing both the injection and the imaging, then the new codes come into play. The new codes are comprehensive codes. 108

109 Q&A Care Management and SNF Can an attending physician for SNF submit the care management codes if they are following a resident after the required 30/60/90 days. Most are in the facility due to their chronic illness. The guidelines do not restrict who reports the codes. There are restrictions based upon what other management type codes are reported during the same calendar month (see manual for full list). If the guidelines are met, it may be an option. Remember the attending physician would be managing his employed, clinical support staff team not counting time of the clinical staff employed by the SNF. 109

110 Q&A Agile Patency Capsule What is the code for the Agile Patency Capsule? The capsule is the device, the CPT code will be driven by the extent of the examination. 110

111 Karna W. Morrow, CPC, RCC, CPC-S AHIMA Approved ICD-10-CM Trainer karna.morrow@codingstrategies.com THANK YOU

112 Wrap Up Thank you for attending our webinar! Please complete the survey, your feedback helps us to design training to meet your needs. You will receive an email within 3-5 days providing a link to the CE Certificate, the webinar recording and the presentation slides. Feel free to contact us: Karna Morrow karna.morrow@codingstrategies.com