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Medical Group Business Services

Medical Group Business Services. Brown Bag Education Series University of California, San Francisco. And Now For Another Fun-Filled Year. Coding and Regulatory Updates for 2007. UCSF Clinical Enterprise Compliance Program. CECP Education Series Wanda T. Ziemba MFA RHIT CHCC CHCO CHC CPC

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Medical Group Business Services

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  1. Medical Group Business Services Brown Bag Education Series University of California, San Francisco UCSF Clinical Enterprise Compliance Program

  2. And Now For Another Fun-Filled Year Coding and Regulatory Updates for 2007 UCSF Clinical Enterprise Compliance Program

  3. UCSF Clinical Enterprise Compliance Program CECP Education Series Wanda T. Ziemba MFA RHIT CHCC CHCO CHC CPC Associate Compliance Officer & CECP Educators UCSF Clinical Enterprise Compliance Program

  4. The New, New, New Codes UCSF Clinical Enterprise Compliance Program

  5. Overview of CPT Changes • New Technology • Interventional Procedures • Laparoscopic/Endoscopic Services • Progress Towards CPT – 5 • Multiple special instructions UCSF Clinical Enterprise Compliance Program

  6. CPT – Evaluation & Management • Clarification of services provided after an initial consultation when the consulting physician assumes care • Only one consultation per consultant per admission UCSF Clinical Enterprise Compliance Program

  7. Critical Care – Preambles highlighted but no changes noted UCSF Clinical Enterprise Compliance Program

  8. Anticoagulant Management- New Codes • 99363: Anticoagulant management for an outpatient taking Warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed) and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements • 99364: each subsequent 90 days of therapy (must include a minimum of 3 INR measurements UCSF Clinical Enterprise Compliance Program

  9. CPT – Anesthesia • Spine & Spinal Cord – • 00625: Anesthesia for procedures on the thoracic spine and cord via an anterior or transthoracic approach; not utilizing one lung ventilation • 00626: utilizing one lung ventilation UCSF Clinical Enterprise Compliance Program

  10. CPT – Integumentary • Graft Site Preparation – 4 new codes replacing 15000 and 15001. • 15002:Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children • 15003: each addition 100 sq cm or additional 1% of body are of infants and children UCSF Clinical Enterprise Compliance Program

  11. 15004: as in 15002 – face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits • 15005: each additional 100 sq cm or additional 1% of body area of infants and children UCSF Clinical Enterprise Compliance Program

  12. Lipectomy – two new codes that replace 15831 (excision excessive skin and subcutaneous tissue, including lipectomy: abdomen (abdominoplasty. UCSF Clinical Enterprise Compliance Program

  13. 15830: Excision, excision skin and subcutaneous tissue (includes lipectomy) abdomen, infraumbilical panniculectomy • 15831: Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen, eg abdominoplasty (includes umbilical transposition and fascial plication) ( list separately in addition to code for primary procedure. UCSF Clinical Enterprise Compliance Program

  14. Codes are chosen based on the complexity of the service provided. • 15830 is used to report less extensive procedures • 15831 for extensive procedures requiring closures with umbilical transposition and fascial plication UCSF Clinical Enterprise Compliance Program

  15. Breast – one new code and 8 re-numbered • 19105: new code for (ablation, cryosurgical of adenoma, including ultrasound guidance, each fibroadenoma • Replaces Category III code 0120T UCSF Clinical Enterprise Compliance Program

  16. UCSF Clinical Enterprise Compliance Program

  17. UCSF Clinical Enterprise Compliance Program

  18. CPT – Cardiovascular • Thromboendarterectomy • One revised and 5 new codes • Previously reported with CPT 35381 (thromboendartectomy with or without patch graft, femoral and/or popliteal and /or tibioperoneal) UCSF Clinical Enterprise Compliance Program

  19. 35301: Thromboendarterectomy, including patch graft if performed • 35302: Thromboendarterectomy, including patch graft if performed; superficial femoral artery • 30304: Thromboendarterectomy, including patch graft if performed; popliteal artery UCSF Clinical Enterprise Compliance Program

  20. 30305: Thromboendarterectomy, including patch graft if performed; tibial or peroneal artery, initial vessel • 35306: Thromboendarterectomy, including patch graft if performed; each additional tibial or peroneal artery (list separately in addition to code for primary procedure) UCSF Clinical Enterprise Compliance Program

  21. Revisions to bypass graft codes • 35501: Bypass graft with vein; common carotid - ipsilateral internal carotid artery • 35506: carotid – subclavian or subclavian – carotid • 35509: carotid – contralateral carotid • 35601: Bypass graft with other than vein; common carotid – ipsilateral internal carotid UCSF Clinical Enterprise Compliance Program

  22. CPT – Gastrointestinal • Four new codes • Two for implantation or replacement • Two for revision or removal • Differentiated by approach – laparoscopic or open UCSF Clinical Enterprise Compliance Program

  23. UCSF Clinical Enterprise Compliance Program

  24. 43647: Laparoscopy, surgical; implantation or replacement of gastric neurostimulator electrodes, antrum • 43648: revision or removal or gastric neurostimulator electrodes, antrum • 43881: Implantation or replacement of gastric neurostimulator electrodes, antrum, open • 43882: revision or removal or gastric neurostimulator electrodes, antrum, open UCSF Clinical Enterprise Compliance Program

  25. Revision of existing codes to indicate placement or revision of gastric neurostimulators in non-abdominal areas • 64590: Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling • 64595: Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver UCSF Clinical Enterprise Compliance Program

  26. 43647-43648, 43881-43882 replaced Category III codes 0155T-0158T • Did not appear in the CPT 2006 because there were implement on July 1, 2006 UCSF Clinical Enterprise Compliance Program

  27. Laparoscopic Intraperitoneal Catheter Procedures • 49324: Laparoscopy, surgical; with insertion of intraperitoneal cannula or catheter, permanent • 49325:…with revision of previously placed intraperitoneal cannula or catheter, with removal of intraluminal obstructive material if performed • 49326: …with omentopexy tacking procedure (lust separately in addition to primary procedure • 49435: Insertion of subcutaneous extension to intraperitoneal cannula or catheter with remote chest exit site (list separately in addition to code for primary procedure • 49436: Delayed creation of exit site from embedded subcutaneous segment of intraperitoneal cannula or catheter UCSF Clinical Enterprise Compliance Program

  28. Replace the unlisted 49329 (unlisted laparoscopy procedure, abdomen, peritoneum and omentum • Note that 49362, 49435 and 49436 are add-on services UCSF Clinical Enterprise Compliance Program

  29. Six renumbered digestive procedures • Slightly revised descriptions UCSF Clinical Enterprise Compliance Program

  30. UCSF Clinical Enterprise Compliance Program

  31. CPT – Male Genitourinary • One new code added • 55876: placement of interstitial device(s) for radiation therapy guidance (eg fiducial markers, dosimeter), prostate (via needle any approach), single or multiple • Radiological S&I – 76942, 77002, 77012, 77021 UCSF Clinical Enterprise Compliance Program

  32. CPT – Female Genitourinary • 56442 – Hymenotomy simple incision • 58541 – laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less • 58542 - …with removal or tube(s) and/or ovary(s) • 58543 – laparoscopy, surgical, supracervical hysterectomy for uterus greater than 250 g • 58544 - …with removal or tube(s) and/or ovary(s) UCSF Clinical Enterprise Compliance Program

  33. 58548 – Laparoscopy, surgical with radial hysterectomy with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling with removal of tube(s) and ovary(s) if performed • 58957 – Resection, tumor debulking of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal retroperitoneal tumors) with omentectomy if performed • 58958 - …with pelvic lymphadenectomy and limited para-aortic lymphadenectomy UCSF Clinical Enterprise Compliance Program

  34. CPT – Nervous System • 64910 – Nerve repair with synthetic conduit or vein allograft (eg nerve tube) each nerve • 64911 - …with autogenous vein graft (includes harvest of vein graft) each nerve UCSF Clinical Enterprise Compliance Program

  35. CPT – Eye • 67346 – Biopsy of extraocular muscle UCSF Clinical Enterprise Compliance Program

  36. CPT Radiology • Significant additions • Changes in technology • Functional MRI of brain • Obstetric Ultrasound • Guidance techniques • Fluoroscopy • CT • MRI • Stereotactic UCSF Clinical Enterprise Compliance Program

  37. New mammography CPT codes • Bone and joint studies • Stereotactic delivery of radiation treatment UCSF Clinical Enterprise Compliance Program

  38. Functional MRI • Identification and mapping of stimulation of brain function • 70554 – MRI imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration • 70555 - …requiring physician or psychologist administration of entire neurofunction testing • Significant instructional notes for bundled services (see 96020) UCSF Clinical Enterprise Compliance Program

  39. Obstetric Ultrasound • 76813 – Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation • 76814 - …each additional gestation (list separately in addition to code for primary procedure) UCSF Clinical Enterprise Compliance Program

  40. Fluoroscopic Guidance • 77001 – Central venous access device placement, replacement or removal • 77002 – Needle placement, localization devices • 77003 • Spine or paraspinous diagnostic or therapeutic injections procedures UCSF Clinical Enterprise Compliance Program

  41. CT Guidance • 77011 – Stereotactic localization • 77012 – Needle placement • 77013 – guidance for and monitoring of parenchymal tissue ablation • 77014 – Placement of radiation therapy fields UCSF Clinical Enterprise Compliance Program

  42. MRI Guidance • 77021 - Needle placement • 77022 - guidance for and monitoring of parenchymal tissue ablation UCSF Clinical Enterprise Compliance Program

  43. Breast Mammography • New codes for computer-aided detection • Ductograms and galactograms • Unilateral and bilateral services for both diagnostic and screening • MRI breast with and/or without contracts, unilateral & bilateral UCSF Clinical Enterprise Compliance Program

  44. Bone and Joint Studies • 77071 – Manual application of stress performed by physician • 77072 – Bone age studies • 77073 – Bone length studies • 77074 – Radiologic examination, osseous survey, limited • 77075 – …complete axial & appendicular skeleton UCSF Clinical Enterprise Compliance Program

  45. 77076 – Radiologic examination, osseous survey, infant • 77077 – Joint survey, single view, two or more joints • 77078 =- CT bone mineral density study, 1or mo3 sites, axial • 77079 - …axial skeleton UCSF Clinical Enterprise Compliance Program

  46. 77080 – DEXA bone density study, 1 or mor3e sites, axial • 77081 …appendicular skeleton • 77082 - …vertebral fracture assessment • 77083 – Radiographic absorptiometry, 1 or more sites • 77084 – MRI bone marrow blood supply UCSF Clinical Enterprise Compliance Program

  47. Radiation Oncology • Stereotactic delivery • 77371 – Complete course consisting of 1 session; multi source Cobalt 60 based • 77372 - …linear accelerator based • 77373 – per fraction, to one or more lesions entire course not to exceed 5 fractions UCSF Clinical Enterprise Compliance Program

  48. CPT – Pathology and Laboratory • Few new codes • New bugs, new detection • 83913 – RNA stabilization • 87305 – …Aspirgillus (Microbiology) • 87498 - …enterovirus • 87640 - …staph aureus, amplified probe • 87641 - …above, methicillin resistant • 87653 - …Streptococcus, group B, direct probe technique UCSF Clinical Enterprise Compliance Program

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  50. CPT – Medicine • Pulmonary – new ventilator management codes replacing 94656 and 94657 • 94002 – Hospital, initial day • 94003 - …hospital subsequent day • 94004 - …nursing facility per day • 94005 – Home vent management care plan oversight per month, 30 minutes or more UCSF Clinical Enterprise Compliance Program

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