Long Island Health Information Management Association

Long Island Health Information Management Association 2015 CPT and Medicare OPPS Changes January 14, 2015 John W. Ruth, MBA, RHIA Director, Revenue Integrity Stony Brook University Hospital 1

Objectives of Today s Session Discuss regulatory changes to the APC system for 2015 Provide an overview of the off campus hospital-based facilities rule Examine the impact of the code additions/changes on the APC system Discuss bundling process initiated by CMS utilizing C-APCs Introduce physician Inpatient 20 day certification requirements Identify major additions, deletions and revisions to the CPT code set for 2015 Discuss new X{ESPU} Modifiers 2

OPPS Regulatory Updates 3

Payment Update Conversion factor 2.2% increase for 2015-1.7% in 2014 - $74.144 for hospitals that meet quality reporting standards - 2.0% reduction in payment update factor if hospital does not meet quality reporting standards ($72.661) CMS did not propose and is not adopting any major changes to the wage index for OPPS. It will use FFY2015 wage indexes including all reclassifications and add-ons as published in the IPPS Final Rule Copayments continue to be no less than 20% of charges 4

Off-campus Provider-based Facilities CMS requested input from provider community for preference on how to collect info (claims-based approach v. cost report), and obtained no consensus Finalized new policy on data collection no payment change Optional for January 1, 2015, REQUIRED for January 1, 2016: Hospitals: Use HCPCS modifier PO with every code for outpatient hospital services furnished in off-campus provider-based department, reported on UB- 04 (CMS Form 1450) Physicians: Use 2 new POS codes on form CMS-1500 to identify on-or offcampus service Will delete POS 22 (outpatient hospital depts) New codes not available yet (Anticipated 7/1/2015); mandatory when available 5

Items and Services to be Packaged CMS added two new categories of supporting items and services to the packaged services (total number of categories is now = 7). For certain cases, a separate payment will be made if the item or service is furnished on a different date of service as the primary service. The 2 new categories are: (1) Ancillary Services (but only for APCs with proposed geometric mean cost <$100) (2) Prosthetic Supplies Does not include APC 0634 (clinic visit), because geometric mean cost = $119.87 Acknowledged policy may disproportionately affect teaching hospitals but this did not persuade CMS to change policy Per CMS: once packaged, always packaged 6

Items and Services to be Packaged (Cont.) Exclusions: Preventive services Certain psychiatry and counseling-related services Certain low cost drug administration services Status Indicators: Deleting SI X Most will now go to SI Q1 (STV-Packaged Codes) Remaining, not conditionally packaged, go to SI S (Procedure or Service, Not Discounted When Multiple) 7

Final CY 2015 Comprehensive APCs Established 25 comprehensive APCs to prospectively pay for the most costly hospital outpatient device-dependent services CMS has defined a comprehensive APC as a classification for the provision of a primary service and all adjunct services provided to support the delivery of the primary service. The comprehensive APC treats all individually reported codes on the claim as representing components of the comprehensive service A single prospective payment based on the cost of all individually reported codes on the claim. Modified the methodology to make larger payments for many complex and costly multiple device procedures. Beneficiaries will pay a single copayment, reducing their liability 8

Final CY 2015 Comprehensive APCs (Cont.) NOT bundled into C-APCs: Ambulance services Brachytherapy Cancer screenings (mammography, colonoscopy, prostate, etc.) PT, speech-language pathology, occupational therapy services Pass-through drugs, biologicals, and devices Preventive services (e.g., annual wellness visits) Self-administered drugs SI F (certain CRNA services, Hep B vaccines, corneal tissue acquisition) SI L (influenza and pneumococcal pneumonia vaccines) Certain Part B inpatient services 9

Final CY 2015 Comprehensive APCs (Cont) 10

Final CY 2015 Comprehensive APCs-Table 7 (Cont) 11

Skin Substitutes Revised methodology to establish the high cost/low cost threshold: Based on the weighted average Mean Unit Cost (MUC) for all skin substitute products from claims data Final MUC threshold is $25 per cm2 (compared to the proposed $27 threshold) MUC above $25 per cm2 in high cost group MUC at/below $25 per cm2 in low cost group If no claims data to calculate a MUC, CMS will use ASP + 6% payment rate If that s not available, Wholesale Acquisition Cost (WAC) + 6%, or 95% of Average Wholesale Price (AWP). 12

Skin Substitutes (cont.) HCPCS Codes: Q4121, Q4122, Q4127, Q4131, Q4132, and Q4133 APC 2015 APC title 0328 Level III Skin Repair. 0329 Level IV Skin Repair. 13

Inpatient Only List Removed CPT codes: 63043, each additional cervical interspace; and 63044, each additional lumbar interspace, from the 2015 inpatient list These add-on codes are being assigned status indicator N for CY 2015 Added CPT code: 22222, Osteotomy of the spine, including discectomy, anterior approach, single vertebral segment; thoracic Complete list of Inpatient Only codes is available in Addendum E on CMS website 14

Part B Drugs in the Outpatient Department CMS continues paying at ASP +6% for non-pass-through drugs and biologicals that are payable separately under OPPS for CY 2015. CMS continuing pass-through status for 26 drugs and granted passthrough status for additional 9 drugs effective 1/1/15 (Table 29, Page 66877 of the Final Rule) CMS terminated pass-through payment status for 9 drugs/biologicals effective 1/1/15 (Table 28, Page 66875) 15

Part B Drugs in the Outpatient Department (Cont.) CY 2015 packaging threshold = $95 (originally proposed packaging threshold of $90) If a drug s average cost per day exceeds $95, it is separately payable, if not, it is packaged. CMS utilized an estimated payment rate of Average Sales Price (ASP) + 6% ASP based payment rates for both OPPS and physician office settings will continue to be updated quarterly using quarterly reported ASP data ( subject to a two-quarter lag). Only HCPCS codes identified as separately payable in the Final Rule are subject to quarterly updates. 16

Partial Hospitalization Program Rates Payment rates for the 4 partial hospitalization (PHP) APCs will be calculated using geometric mean per diem costs. Final 2015 per diem costs: Hospital-based PHPs: Level I: Decreased by approx. 2.6% as compared to 2014 costs Level II: Decreased by approx. 5.3% as compared to 2014 costs Community Mental Health Center (CMHC) PHPs: Level I: Increased by approx. 0.76% as compared to 2014 costs Level II: Increased by approx. 5.7% as compared to 2014 costs 17

Hospital Outpatient Quality Reporting Program New Measure, effective 1/1/2018: OP-32: Facility Seven Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy CMS will perform a dry-run in 2015. Hospitals will have an opportunity to review confidential performance results, which will not be publically reported Measures timed out (to be removed in CY 2017): OP-6: Timing of Antibiotic OP-7: Prophylactic Antibiotic Selection for Surgical Patients Voluntary Measure for CY 2016: OP-31: Cataracts Improvement in Patient s Visual Function within 90 Days Following Cataract Surgery will be a voluntary measure starting CY 2017. Removed from reporting for CY 2016 18

Hospital Outpatient Quality Reporting Requirements Chart Abstracted Measures Data calculations based on a 12-month period from 7/1/14 through 6/30/15 6 mandatory measures for CY 2017 (public reporting of OP-15 continues to be deferred) 1 additional measure starting CY 2018 Claims Based Measures Data submitted between July 1, 2016 and November 1, 2016 with respect to performance on measures for CY 2015 4 mandatory measures for CY 2017 Web-based Measures Data reported via the CDC NHSN by 5/15/16 for the period 10/1/15 through 3/31/16 1 mandatory measure for CY 2017 (healthcare worker vaccination measure) (combined inpatient-outpatient measure) 19

Inpatient Physician Certification Physician certification by a treating physician is required for Part A payment for inpatient hospital services for cases that are 20 days or more or are outlier cases Physician must certify or recertify no later than 20 days into the hospital stay: 1. Continued hospital stay is required for either: - i. medical treatment or medically required diagnostic study; or - ii. special or unusual services for cost outlier cases 2. The estimated time the patient will need to remain in the hospital must be stated 3. The plans for post-hospital care, if appropriate Separate certification form not required. Information can be contained within a progress note Will be monitored by the Medicare Administrative Contractor 20

CPT Changes for 2015 Approximate Number of Codes Added/Revised: New codes: 215 Revised codes: 129 Deleted codes: 147 Category New Revised E&M 3 2 Surgery 86 61 Radiology 15 4 Pathology 109 25 Medicine 16 15 21

Evaluation & Maintenance Services 22

Evaluation and Management Services A revised section title, 2 new subsections, guidelines, 1 new code, 1 deleted codes and 2 revised codes have been added for reporting chronic care management and complex chronic care management services Revised inpatient neonatal and pediatric critical care guidelines Deleted 2 intensive care services codes and added 1 new code to combine the services Added military history as a social history element 23

Evaluation and Management Services Care Management Services: Management and support services provided by clinical staff, under direction of physician or other qualified health care professional, to a patient residing at home (includes domiciliary or rest home or assisted living facility). Physician oversees the management and/or coordination of services Plan of care documented 1x per month Chronic Care Mgt Services = 20 Mins per month; 2+ conditions lasting 12+ months Complex Chronic Care Mgt Services = 1 hour per month + comprehensive plan CODE 99490 99487 +99489 BRIEF DESCRIPTION Chronic care management services, at least 20 minutes of clinical staff time directed by a physician/qualified h.c. professional, per calendar month, elements: 2+ chronic conditions expected to last at least 12 months or until death; significant risk to patient; comprehensive plan established, implemented, revised or monitored 60 minutes of medical staff time directed by physician Each additional 30 minutes of medical time directed by physician 24

Evaluation and Management Services 99497-99498 Advance Care Planning Used to counsel and discuss advance directives ONLY Can be discussion between physician or qualified HCP and family member or surrogate No active problem management during discussion time Report E&M services performed on same day separately CODE 99497 BRIEF DESCRIPTION Advanced care planning including explanation of advance directives, such as standard forms (including completion of forms) by physician or other HCP; first 30 minutes + 99498 Advanced care planning, each additional 30 minutes 25

Surgical Services 26

Surgical Services Numerous changes have been made to the surgery section: 86 new codes 61 revised codes Changes include: Clarified services which are included in the surgical code New codes which include imaging procedures New procedure codes for open repair of rib fractures with thoracoscopy and vertebral augmentation 27

Surgical Services Musculoskeletal: Arthrocentesis Codes 20604; 20606; 20611 have been added to describe arthrocentesis, aspiration or injection of small, intermediate or major joints with ultrasound guidance Codes 20600; 20605; 20610 revised to exclude ultrasound Ultrasound must be recorded and a report included in the patient record Do not report with 76942 Ultrasound guidance for needle placement CODE 20604 20606 20611 BRIEF DESCRIPTION Arthocentesis, aspiration, injection, small joint or bursa, with ultrasound guidance, with permanent recording and reporting Arthocentesis, aspiration, injection, intermediate joint or bursa, with ultrasound guidance, with permanent recording and reporting Arthocentesis, aspiration, injection, major joint or bursa, with ultrasound guidance, with permanent recording and reporting 28

Surgical Services Musculoskeletal System-Ablation New code to identify ablation of tumors of bone and adjacent soft tissue Includes any imaging guidance (ultrasound, fluoroscopy, CT, MRI) Moderate sedation included A new Category III code has also been created for cryoablation of pulmonary tumors CODE 20982 20983 0340T BRIEF DESCRIPTION Ablation therapy for reduction or eradication of 1 or more bone tumors, including adjacent soft tissue when involved with tumor extension, percutaneous, including imaging guidance when performed; radiofrequency Cryotherapy Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance 29

Surgery Musculoskeletal System-Rib Fractures Code 21800 Strapping with rib belt, and 21810 External rib fixation, have been deleted. Use 21899 to report external rib fixation Codes 21811, 21812 and 21813 have been converted from Category III codes to permanently identify open treatment with internal fixation of rib fractures Thoracoscopic approach is included Codes are differentiated by number of ribs treated Existing code 21805 is used for open treatment of ribs without fixation, each rib CODE 21811 21812 21813 BRIEF DESCRIPTION Open treatment of rib fracture(s) with internal fixation, excludes thoracoscopic visualization when performed, unilateral; 1-3 ribs 4 6 ribs 7 or more ribs 30

Surgery Musculoskeletal System-Vertebroplasty New percutaneous vertebroplasty comprehensive CPT codes added to replace 22520-22525 (deleted) and 72291 (deleted) Codes 22510-22515 are comprehensive and include fracture reduction, imaging guidance and any bone biopsy performed CPT 22310-22327 (closed treatment of vertebral body fractures) exclude using 22510-22515 in conjunction and conversely, 22310-22327 in conjunction with 22510-22515 Moderate sedation is inherent in the code assignment, not separately identified Sacral procedures are reported only one time per encounter Percutaneous sacral augmentation are reported with Category III codes 0200T and 0201T, which have been revised to also include imaging guidance 31

Surgery Musculoskeletal System-Vertebroplasty (Cont.) All codes include conscious sedation Imaging guidance included Kyphoplasty included CODE 22510 22511 + 22512 22513 22514 + 22515 BRIEF DESCRIPTION Percutaneous vertebroplasty (includes bone biopsy), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic lumbosacral Each additional cervicothoracic or lumbosacral body (Listed in addition to main procedure) Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included), using mechanical device (kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic lumbar Each additional cervical or lumbosacral body (Listed in addition to main procedure) 32

Surgery Musculoskeletal System-Spinal Prosthetic Devices Revised 22856 with a semicolon Second level CPT 22858 converted from Category III 0375T, which now describes levels 3+ Additional levels (beyond second level) identified with 0375T Example: Total disc arthroplasty, C4-5, C5-6, C6-7 = 22856; 22858; 0375T CODE 22856 22858 BRIEF DESCRIPTION Total disc arthroplasty (artificial disc), anterior approach.; single interspace, cervical Second level, cervical (list in addition to main procedure) 33

Surgery Musculoskeletal System-Arthrodesis CPT code 27279, Arthrodesis of sacroiliac joint, was converted from Category III code 0334T (deleted) Minimally invasive procedure Includes placement bone biopsy, image guidance, placement of transfixion device CPT 27280 revised to specify open as distinguished from new code 27279, which is percutaneous CODE 27279 BRIEF DESCRIPTION Arthrodesis, sacroiliac joint, percutaneous or minimally invasive, with image guidance, includes obtaining bone graft and placement of transfixing device 27280 Arthrodesis, open, sacroiliac joint.etc. 34

Surgery Cardiovascular: Pacemaker or Implantable Defibrillator Revised instructions to differentiate implantable cardiac defibrillators versus subcutaneous cardiac defibrillators S-ICDs do not have electrodes inserted into or on the heart, the lead is subcutaneously tunneled to the left parasternal region Defined battery to be the pulse generator itself Clarified codes for relocation of pockets, electrodes and evaluations Added new codes to identify S-ICD implant and replacement or reposition of electrode-codes converted from Category III Revised Procedure Table to assist in assigning the correct code for the procedure performed 35

Surgery Cardiovascular: Pacemaker or Implantable Defibrillator (Cont.) Instructional notes added and revised, cross-references added throughout the section S-ICD New Codes: CODE 33270 33271 33272 33273 BRIEF DESCRIPTION Insertion or replacement of S-ICD with electrode, including defibrillator threshold measurement, induction of arrhythmia, threshold testing & programming or reprogramming Insertion of S-ICD electrode Removal of subcutaneous ICD electrode Reposition of previously implanted subcutaneous ICD electrode 36

Surgery Cardiovascular: Aortic & Mitral Valves New codes 33418 & 33419 have been added for heart valve repair via transcatheter, percutaneous approach Converted from Category III code 0343T & 0344T which have been deleted Guidelines added to aortic and mitral valve sections to incorporate 33418 & 33419, when appropriate (e.g. cardiopulmonary bypass 33367-33369) CODE 33418 + 33419 BRIEF DESCRIPTION Transcatheter mitral valve repair, percutaneous, including transseptal puncture; initial prosthesis Additional prosthesis(es) during same session (List separately in addition to primary procedure) 37

Surgery Cardiovascular: ECMO & ECLSS New section Extracorporeal Membrane Oxygenation (ECMO) or Extracorporeal Life Support Services (ECLSS) has been added Prior codes for ECMO related services 33960, 33961, and 36822 have been deleted New codes 33946-33989 have been created ECMO and ECLSS are performed on inpatients only, not specifically detailed in this presentation Suggest reviewing new section in CPT code book for detailed code listings and descriptions 38

Surgery Cardiovascular: Arteries and Veins Code 34839 added for physician planning of specific manufactured fenestrated visceral aortic endograft Planning includes review of CT, computerized tomography, MRI and 3 dimensional software to model the aorta and device Several exclusion notes have been added to the Endovascular Repair of Abdominal Aortic Aneurysm section 39

Surgery Cardiovascular: Transcatheter Procedures Code 37215, 37216 and 37217 have been revised to indicate they are used for both open and percutaneous procedures New code 37218 was added transcatheter placement of intravascular stent(s) in the intrathoracic common carotid or innominate artery, antegrade approach Not appropriate to use 37218 with selective cath codes 36222-36224 Codes 37215-37218 now include radiological supervision and interpretation CODE 37218 BRIEF DESCRIPTION Transcatheter placement of an intravascular stent(s), intrathoracic common carotid artery or innominate artery, via open or percutaneous carotid artery antegrade approach, including angioplasty, when performed, and radiological supervision & interpretation 40

Surgery Digestive: GI Endoscopy There are multiple changes in Endoscopy services throughout GI including: - Esophagoscopy - Colonoscopy via stoma Terms with or without have been replaced with including, when performed to provide clarity Replaced the term bowel with intestine throughout Added new codes in lower GI endoscopy for stent placement also include pre-, post-dilation and guide wire passage when performed, in order to maintain consistency New ablation procedure codes also include the pre-, post-dilation and guidewire passage Replaced any method with for control of bleeding throughout 41

Surgery Digestive: GI Endoscopy Specific instructions related to flexible sigmoidoscopy have been added. Flex sig reported when not advanced beyond splenic flexure Colonoscopy through stoma have specific CPT codes added Colonoscopy definition has been clarified to include entire colon from rectum to cecum, including terminal ileum or small intestine proximal to an anastomosis, when performed Colonoscopy decision tree has been added at endoscopy section 45300 42

Surgery Digestive: GI Endoscopy 43

Surgery Digestive System-Endoscopy CODE BRIEF DESCRIPTION 43180 Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker s diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed 44381 Ileoscopy, through stoma; with transendoscopic balloon dilation 44384 Ileoscopy, through stoma; with placement of endoscopic stent (includes pre- and postdilation and guide wire passage, when performed) 44401 Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) 44402 Colonoscopy through stoma; with endoscopic stent placement (including pre-and postdilation and guide wire passage, when performed) 44403 Colonoscopy through stoma; with endoscopic mucosal resection 44404 Colonoscopy through stoma; with directed submucosal injection(s), any substance 44405 Colonoscopy through stoma; with transendoscopic balloon dilation 44406 Colonoscopy through stoma; with endoscopic ultrasound, limited to sigmoid, descending, transverse or ascending colon and cecum 44407 Colonoscopy through stoma; with transendoscopic ultrasound guided fine needle aspiration (limited as described in 44406) 44408 Colonoscopy through stoma; for decompression (e.g. volvulus), includes decompression tube 44

Surgery Digestive System: Endoscopy CODE 45346 45347 45349 45350 45388 45389 45390 45393 45398 45399 BRIEF DESCRIPTION Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s) or other lesion(s) Sigmoidoscopy, flexible; with placement of endoscopic stent Sigmoidoscopy, flexible; with endoscopic mucosal resection Sigmoidoscopy, flexible; with band ligation (hemorrhoids) Colonoscopy, flexible, with ablation of tumor(s), polyp(s) or other lesion(s) Colonoscopy, flexible; with placement of endoscopic stent Colonoscopy, flexible; with endoscopic mucosal resection Colonoscopy, flexible; with decompression (includes placement of decompression tube) Colonoscopy, flexible; with band ligation (hemorrhoids) Unlisted procedure, colon 45

Surgery Digestive System: Endoscopy CODE 46601 46607 BRIEF DESCRIPTION Anoscopy; diagnostic, with high resolution magnification (e.g. colposcope, operating microscope), including specimen collection by brushing or washing With HRA etc., with biopsy, single or multiple 46

Surgery Digestive System: Liver CODE BRIEF DESCRIPTION 47383 Ablation, 1 or more liver tumors, percutaneous, cryoablation 47

Surgery Urinary System: Vesical Neck and Prostate New codes 52441 and 54242 have been added for cystourethroscopic insertion of adjustable transprostatic implants. Code 54221 used for initial implant and 54224 is for each additional implant CODE BRIEF DESCRIPTION 54241 54242 Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant each additional implant (report in addition to primary procedure) 48

Surgery Nervous System: Myelography CPT codes added to bundle myelography procedures Radiology procedure codes 72240, 72255, 72265 & 72270 are used if two physicians perform procedure-one physician performing the injection of contrast, and radiologist performing R&I with report CODE 62302 62303 62304 62305 BRIEF DESCRIPTION Myelography via lumbar injection, including R & I; cervical thoracic lumbosacral 2 or more regions (e.g. lumbar/thoracic, cervical) 49

Surgery Nervous System: Nerve Blocks New codes added to identify administration of anesthetic for postoperative pain control and analgesia of abdominal wall Transverse Abdominis Plane (TAP) block Includes any imaging guidance CPT 64486 and 64487 report unilateral TAP blocks CPT 64488 and 64489 report bilateral TAP blocks CODE 64486 64487 64488 64489 BRIEF DESCRIPTION Transversus abdominis plane (TAP) block, unilateral; by injection(s), includes imaging guidance when performed By continuous infusion(s), includes imaging guidance Transversus abdominis plane (TAP) block, bilateral; by injection(s), includes imaging guidance when performed By continuous infusion(s), includes imaging guidance 50

Surgery Eye and Ocular Adnexa Codes 66179 and 66184 were added to identify Aqueous Shunt reservoir procedures without graft. Codes 66180 and 66184 were revised to identify these procedures with graft. CODE 66179 66180 66184 66180 BRIEF DESCRIPTION Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft With graft Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft With graft 51

Surgery Auditory: Operating Microscope Instructions related to additional exclusions where the use of an operating microscope is inherent to the procedure Code 69990 Microsurgical technique requiring use of operating microscope (List separately in addition to code for primary procedure), exclusionary CPT codes have been added 52

Radiology Services 7000-7999 53

Radiology-Breast Procedures Most significant change in radiology coding for 2015 is the area of breast imaging. Changes for both breast ultrasound and tomosynthesis. The current breast ultrasound code (76645) has been deleted, and two new codes (76641-76642) have been created, one each for complete and limited exams. Procedure code 76641 represents a complete examination of all four quadrants of the breast and the retroareolar region. Limited code, 76642, is for a focused exam of the breast that is limited to one or more of the elements included in 76641. Both code definitions also include an examination of the axilla, if performed. There is a new note in the CPT Manual that directs the assignment of the limited extremity code 76882 if only the axilla is evaluated using ultrasound. Documentation must include a complete evaluation of the anatomic area, image documentation, and a final written report to ensure that it is separately reportable. 54

Radiology-Breast Procedures CODE 76641 76642 BRIEF DESCRIPTION Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited 55

Radiology-Breast Procedures Three new codes have been created for Digital Breast Tomosynthesis (DBT) to address both screening and diagnostic studies. DBT is a digital tomographic study performed using low dose x-ray exposures obtained as the imaging machine moves in an arc around the breast Computer algorithms utilized to construct thin, discrete images of the breast The screening DBT code +77063 is an add-on code that will be reported together with the screening mammogram code 77057 CODE 77061 77062 + 77063 BRIEF DESCRIPTION Digital breast tomosynthesis; unilateral Digital breast tomosynthesis; bilateral Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure) 56

Radiology Vertebral Fracture Assessment The existing code representing vertebral fracture assessment (VFA) has been deleted Two new codes have been added for 2015. CPT 77085 identifies VFA performed as part of a bone density study CPT 77086 is for VFA alone. Code Brief Description 77085 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment 77086 Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA) 57

Radiology-Non-vascular Interventional Procedures New Joint Procedure CPT codes have been previously discussed (20604, 20606, 20611) The new codes for joint aspiration and/or injection include ultrasound guidance. The existing codes were revised to state not using ultrasound guidance. These procedures are sometimes performed under fluoroscopic guidance not addressed with the new codes 58

Radiology Radiation Therapy Radiation therapy codes underwent significant changes for 2015. Teletherapy isodose planning and brachytherapy codes now include the basic dosimetry calculation Intensity Modulated Radiation Treatment (IMRT) codes now include guidance and tracking. Radiation treatment delivery codes were deleted or revised for 2015 since there is no reason to differentiate based on complexity levels 77403-04, 77306, 77308-09, 77411, 77413-14, 77416, 77418, 77421 have been deleted Guidelines added to differentiate between conventional treatments and IMRT treatments 59

Radiology Radiation Therapy (Cont.) Revised codes: 77401 Radiation treatment delivery, superficial and/or ortho voltage, per day 77402 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; greater than 1MeV, simple And: 77407 Radiation treatment delivery, greater than 1MeV; intermediate 77412 Radiation treatment delivery, greater than 1MeV; complex Radiation treatment delivery codes which were added appear in the table on the following page 60

Radiology Radiation Therapy Code Brief Description 77306 77307 77316 Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s) Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s) Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s) 77317 Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s) 77318 77385 77386 77387 Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s) Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed 61