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Presented by: Arlene Morrow, CPC CMM CMSCS For McVey Associates November 2, 2013

The Hunt for Coding Treasures 2014 CPT-4 Updates. Presented by: Arlene Morrow, CPC CMM CMSCS For McVey Associates November 2, 2013. Arlene Morrow CPC CMM CMSCS

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Presented by: Arlene Morrow, CPC CMM CMSCS For McVey Associates November 2, 2013

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  1. The Hunt for Coding Treasures 2014 CPT-4 Updates Presented by: Arlene Morrow, CPC CMM CMSCS For McVey Associates November 2, 2013

  2. Arlene Morrow CPC CMM CMSCS Arlene is in her 19th year as a McVey Seminar leader teaching Gastroenterology, Obstetrics & Gynecology, Orthopedics and Pulmonary / Critical Care. She has served the healthcare industry for over 38 years as a Business Office Manager, Practice Manager, Lecturer and Consultant. Her consulting firm in Tampa FL specializes in conducting individualized coding and reimbursement training programs for physician offices, medical groups and clinics. She is a Certified Professional Coder through the American Academy of Professional Coders (AAPC), a Certified Medical Manager through the Professional Association of Health Care Office Managers (PAHCOM) and a Certified Multi Specialty Coding Specialist through the Professional Association of Healthcare Coding Specialists (PAHCS) . Contact Information Email: arlene@arlenemorrow.com Note: Please list Tampa Bay AAPC in subject line of email 2

  3. Disclaimer … Welcome! It is my intent to bring you only the best coding, billing and practice management information. I hope that you will find this presentation helpful as well as educational. The purpose of this material is to accompany the presentation. The materials are only supplemental and are not intended as a substitute for authoritative information. They were prepared by the presenter, who is responsible for their content. There is no guarantee that the use of this information will prevent differences of opinion with providers or carriers in reimbursement disputes. Neither the presenter nor any third party sponsor provides any warranties, express or implied, regarding the content of this material due to constantly changing regulations, laws, policies and procedures. This material is only intended to be used as a teaching tool to accompany the oral presentation. 3

  4. Breaking News! 2014 Conversion Factor • The temporary Conversion Factor is $35.8228 through March 31, 2014 • The Pathway for SGR Reform Act of 2013, signed December 28, 2013, prevented a scheduled 20.1% cut in physician pay due to the sustainable growth rate (SGR) formula. • Members of Congress hope to pass a permanent repeal of the flawed SGR formula by the time the temporary fix expires on March 31, 2014.

  5. CPT 2014 effective January 1, 2014 Legend • 175 New Category I Codes (Note: New codes are shown withREDbullets) • 107 Revised Codes • 47 Deleted Codes 5

  6. Evaluation & Management • New Codes 99446-99449 describe Interprofessional telephonic/ internet assessment and management services These are time based E/Ms provided by consulting physician including a verbal or written report to patient’s treating /requesting physician or qualified healthcare professional. • New Add-On codes for hypothermia in critically ill neonates per day. Codes are listed in addition to 99291, 99292, 99468, 99469 99481 describes Total body systemic hypothermia 99482 describes Selective head hypothermia

  7. Surgery - Integumentary New Code 10030 Image guided fluid collection drainage by catheter (eg abscess, hematoma, seromas, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck) percutaneous (For each collection with separate catheter) 7

  8. Surgery - Integumentary 14 New codes added for breast biopsies and 7 deleted codes 19081 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance +19082 each additional lesion, including stereotactic guidance • Including ultrasound guidance +19084 each additional lesion, Including ultrasound guidance • Including magnetic resonance guidance +19086 each additional lesion, Including MR guidance 8

  9. Surgery - Integumentary 14 New codes added for breast biopsies and 7 deleted codes 19281 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance +19282 each additional lesion, including mammographic guidance 19283 Including stereotactic guidance +19284 each additional lesion, Including stereotactic guidance 19285 Including ultrasound guidance +19286 each additional lesion, Including ultrasound guidance • Including magnetic resonance guidance +19288 each additional lesion, Including MR guidance 9

  10. Surgery - Musculoskeletal 3 New Codes Distinguish removal of foreign body (23333) from removal of prosthetic device( 23334-23335) 23333Removal of foreign body, shoulder; deep (subfascial or intramuscular) • Removal of prosthesis, includes debridement and synovectomy when performed; humeral ORglenoid component • humeral ANDglenoid components ( eg, total shoulder) Revisions 24160 Removal of prosthesis, includes debridement & synovectomy when performed; humeral AND ulnar components 24164 Radial head 10

  11. Surgery - Cardiovascular 8 New Codes for Fenestrated Endovascular Aorta Repair (FEVAR) 34841 Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological S&I including target zone angioplasty, when performed; including one visceral artery endoprosthesis (superior mesenteric, celiac or renal artery) 34842 including two visceral artery endoprostheses ( superior mesenteric, celiac and/or renal artery(s) 34843 including three visceral artery endoprostheses ( superior mesenteric, celiac and/or renal artery(s) 34844 including four or more visceral artery endoprostheses ( superior mesenteric, celiac and/or renal artery(s) 11

  12. Surgery - Cardiovascular 8 New Codes for Fenestrated Endovascular Aorta Repair (FEVAR) 34845 Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological S&I including target zone angioplasty, when performed; including one visceral artery endoprosthesis (superior mesenteric, celiac or renal artery) 34846 including two visceral artery endoprostheses ( superior mesenteric, celiac and/or renal artery(s) 34847 including three visceral artery endoprostheses ( superior mesenteric, celiac and/or renal artery(s) 34848 including four or more visceral artery endoprostheses ( superior mesenteric, celiac and/or renal artery(s) 12

  13. Surgery - Cardiovascular 5 New Codes for Peripheral Stenting 37217 Transcatheter placement of an intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, via open ipsilateral cervical carotid artery exposure including angioplasty, when performed, and radiological S&I 37236 Transcatheter placement of an intravascular stent(s) (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological S&I, and including all angioplasty within the same vessel, when performed; initial artery +37237 each additional artery 13

  14. Surgery - Cardiovascular 5 New Codes for Peripheral Stenting 37238 Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological S&I, and including angioplasty within the same vessel, when performed; initial vein +37239 each additional vein 14

  15. Surgery - Cardiovascular 4 New Codes for Vascular Embolization or Occlusion 37241 Vascular embolization or occlusion, inclusive of all radiological S&I, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) 37242 arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial and arteriovenous malformations, AV fistulas, aneurysms, pseudoaneurysms 37243 for tumors, organ ischemia, or infarction 37244 for arterial or venous hemorrhage or lymphatic extravasation 15

  16. Surgery – Digestive System • CPT has added 26 New CPT codes for GI endoscopies (Esophagoscopy, EGD, ERCP and enteroscopy • There are 41 revisions and 17 deletions mostly to GI endoscopy codes • You will now choose esophagoscopy codes based on whether the scope is rigid or flexible and whether the approach is transoral or transnasal • Code 91065 revised to describe Breath hydrogen or methane test 16

  17. Surgery – Digestive System New Flexible TransnasalEsophagoscopy Codes 43197 Diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure) 43198 With biopsy, single or multiple 17

  18. Surgery – Digestive System New Rigid TransoralEsophagoscopy Codes 43191 Rigid, transoral, diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure) 43192 with directed submucosal injection(s), any substance 43193 with biopsy, single or multiple 43194 with removal of foreign body 43195 with balloon dilation (less than 30 mm diameter) 43196 with insertion of guide wire followed by dilation over guide wire 18

  19. Surgery – Digestive System New Flexible TransoralEsophagoscopy Codes 43211 with endoscopic mucosal resection 43212 with placement of endoscopic stent (includes pre & post-dilation & guide wire passage, when performed 43213 with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed 43214 With dilation of esophagus with balloon ( 30 mm diameter or larger) (includes fluoroscopic guidance, when performed) 43229 With ablation of tumor(s), polyp(s), or other lesion(s) (includes pre + post-dilation and guide wire passage when performed) 19

  20. Surgery – Digestive System Revised Flexible TransoralEsophagoscopy Codes 43200 Flexible transoral, diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure) 43201 with directed submucosal injection(s), any substance 43202 with biopsy, single or multiple 43215 with removal of foreign body 43220 With transendoscopic balloon dilation (less than 30 mm diameter) 43226 with insertion of guide wire followed by passage of dilators over guide wire 43227 with control of bleeding, any method 20

  21. Surgery – Digestive System New EGD Flexible Transoral Codes 43233 With dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) 43253 With transendoscopic U/S guided transmural injection of diagnostic or therapeutic substance(s) (eg, anesthetic, neurolytic agent) or fiducial marker(s) (includes EUS exam of esophagus, stomach, and either duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) 43254 With endoscopic mucosal resection 21

  22. Surgery – Digestive System New EGD Flexible Transoral Codes 43266 With placement of endoscopic stent (includes pre and post dilation and guide wire passage when performed 43270 With ablation of tumor(s), polyp(s), or other lesion(s) (includes pre and post dilation and guide wire passage, when performed) 22

  23. Surgery – Digestive System Revised Flexible Transoral EGD Codes 43235 EGDflexible transoral, diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure) 43236 with directed submucosal injection(s), any substance 43237 With EUS exam limited to esophagus, stomach or duodenum and adjacent structures 43238 With transendoscopic U/S guided intramural or transmural fine needle aspiration/biopsy(s), esophagus (includes EUS exam limited to esophagus, stomach or duodenum and adjacentstructures) 43239 with biopsy, single or multiple 23

  24. Surgery – Digestive System Revised Flexible Transoral EGD Codes 43240 With transmural drainage of pseudocyst (includes placement of transmural drainage catheter(s)/ stent(s), when performed, and EUS, when performed) 43241 With insertion of intraluminal tube or catheter 43242 With transendoscopic U/S guided intramural or transmural fine needle aspiration/biopsy(s), (includes EUS exam of the esophagus, stomach and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) 43243 with injection sclerosis of esophageal/gastric varices 24

  25. Surgery – Digestive System Revised Flexible Transoral EGD Codes 43244 With band ligation of esophageal/gastric varices 43245 With dilation of gastric/duodenal stricture(s) (eg, balloon, bougie) 43246 With directed placement of PEG tube 43247 With removal of foreign body 43248 With insertion of guide wire followed by passage of dilator(s) throughesophagus over guide wire 43249 With transendoscopic balloon dilation of esophagus (less than 30 mm diameter) 43250 With removal of tumor(s), polyp(s) or other lesion(s) by hot biopsy forceps or bipolar cautery 25

  26. Surgery – Digestive System Revised Flexible Transoral EGD Codes 43251 With removal of tumor(s), polyp(s) or other lesion(s) by snare technique 43252 With optical endomicroscopy 43255 With control of bleeding, any method 43257 With delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of GERD 43259 With EUS exam, including the esophagus, stomach and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis 26

  27. Surgery – Digestive System New ERCP Codes 43274 With placement of endoscopic stent into biliary or pancreatic duct, including pre and post dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent 43275 With removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s) 43276 With removal and exchange of stent(s), biliary or pancreatic duct, including pre and post dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged 27

  28. Surgery – Digestive System New ERCP Codes 43277 With trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincter- otomy, when performed, each duct 43278 With ablation of tumor(s), polyp(s), or other lesion(s), including pre and post dilation and guide wire passage when performed 28

  29. Surgery – Digestive System Revised ERCP Codes 43260 Including collection of specimen(s) by brushing or washing when performed(separate procedure) 43263 With pressure measurement of sphincter of Oddi 43264 with removal of calculi/debris from biliary/pancreatic duct(s) 43265 With destruction of calculi, any method (eg, mechanical, electrohydraulic, lithotripsy) +43273 Endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s) 29

  30. Surgery – Digestive System Revised Biliary Endoscopy Code 47552 Biliary endoscopy, percutaneous via T-tube or other tract; diagnostic, with collection of specimen(s) by brushing and/or washing, when performed (separate procedure) 30

  31. Surgery – Urinary System 52356 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent ( eg, Gibbons or double- J type) 31

  32. Surgery - Nervous System 8 New codes and 2 Deleted Codes (64613-64614) 64616Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm) neck muscle(s), excluding muscles of the larynx, unilateral (eg, cervical dystonia, spasmodic torticollis) 64617 Larynx, unilateral, percutaneous (eg, for spasmodic dysphonia), includes guidance by needle electromyography, when performed 32

  33. Surgery - Nervous System 8 New codes and 2 Deleted Codes (64613-64614) 64642Chemodenervation of one extremity; 1-4 muscle(s) +64643 each additional extremity, 1-4 muscle(s) 64644Chemodenervation of one extremity; 5 or more muscle(s) +64645 each additional extremity, 5 or more muscle(s) 64646Chemodenervation of trunk muscle(s); 1-5 muscle(s) +64647 6 or more muscle(s) 33

  34. Surgery – Eye & Ocular Adnexa New Code 66183 Insertion of anterior segment aqueous drainage device, without extraocular resrvoir, external approach 34

  35. Radiology New Add-On Code +77293 Respiratory motion management simulation (Use 77293 in conjunction with 77295, 77301) Note:77295 describes 3-D radiotherapy plan, including dose- volume histograms 77301 describes Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications 35

  36. Pathology & Laboratory New Codes for Therapeutic Drug Assays • The material for exam may be from any source. Examination is quantitative 80155 Caffeine 80159Clozapine 80169Everolimus 80171Gabapentin 80175Lamotrigine 80177Levetiracetam 80180Mycophenolate 80183Oxcarbazepine 80199Tigabine 80203Zonisamide 36

  37. Pathology & Laboratory New Codes for Multianalyte Assays with Algorithmic Analyses 81504 Oncology (tissue of origin). Microarray gene expression profiling of >2000 genes,utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as tissue similarity scores 81507 Fetal aneuploidy ( trisomy 21,18 and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy 37

  38. Pathology & Laboratory New Code for Microbiology 87661Trichomonas vaginalis, amplified probe technique New Code for Surgical Pathology +88343 each additional separately identifiable antibody per slide 38

  39. Medicine - Vaccines / Toxoids New Codes for Vaccines 90673 Influenza virus vaccine, trivalent, derived from recombinant DNA {RIV3} , hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use 90685 Influenza virus vaccine, quadrivalent, split virus,, preservative free, when administered to children 6-35 months of age, for intramuscular use 90686 Influenza virus vaccine, quadrivalent, split virus,, preservative free, when administered to children 3 years of age and older, for intramuscular use

  40. Medicine - Vaccines / Toxoids New Codes for Vaccines – Pending FDA approval 90687 Influenza virus vaccine, quadrivalent, split virus,, preservative free, when administered to children 6-35 months of age, for intramuscular use 90688 Influenza virus vaccine, quadrivalent, split virus,, preservative free, when administered to individuals 3 years of age and older, for intramuscular use

  41. Medicine – ENT Services New Codes 92521 Evaluation of speech fluency, (eg, stuttering, cluttering) 92522 Evaluation of speech sound production ( eg, articulation, phonological process, apraxia, dysarthria) 92523 with evaluation of language comprehension and expression (eg, receptive and expressive language) 92524 Behavioral and qualitative analysis of voice and resonance

  42. Medicine - Cardiovascular New Code 93582Percutaneoustranscatheter closure of patent ductusarteriosis 93583Percutaneoustranscatheterseptal reduction therapy (eg. Alcohol septal ablation) including temproary pacemaker insertion when performed

  43. Medicine - Pulmonary 94669Mechanical chest wall oscillation to facilitate lung function, per session

  44. Medicine – Active Wound Care New Codes 97610 Low frequency, non-contact, non-thermal ultrasound including topical application(s), when performed, wound assessment and instruction(s) when performed, wound assessment, and instruction(s) for ongoing care, per day

  45. Category II • 47 New Codes for Category II • 1 Revised Codes • 0 Deleted Codes 45

  46. Category III - Cardiovascular New Codes 0319T Insertion or replacement of subcutaneous implantable defibrillator system with subcutaneous electrode 0320T Insertion of subcutaneous defibrillator electrode 0321T Insertion of subcutaneous implantable defibrillator pulse generator only with existing subcutaneous electrode 0322T Removal of subcutaneous implantable defibrillator pulse generator only 0323T Removal of subcutaneous implantable defibrillator pulse generator with replacement of subcutaneous implantable defibrillator pulse generator only 0324T Removal of subcutaneous defibrillator electrode 0325T Repositioning of subcutaneous implantable defibrillator electrode and/or pulse generator 46

  47. Category III-Cardiovascular New Codes 0326T EP evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters 0327T Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, implantable subcutaneous lead defibrillator system 0328T 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, implantable subcutaneous lead defibrillator system 47

  48. Category III-Cardiovascular New Codes 0331T Myocardial sympathetic innervation imaging, planar qualitative and quantitative assessment 0332T with tomographic SPECT (For myocardial infarct avid imaging, see 78466, 78468, 78469) 48

  49. Category III-General New Codes 0329T Monitoring of intraocular pressure for 24 hours or longer, unilateral or bilateral, with interpretation and report 0330T Tear film imaging, unilateral or bilateral , with interpretation and report 0333T Visual evoked potential, screening of visual acuity, automated 0334T Sacroiliac joint stabilization for arthrodesis, percutaneous or minimally invasive (indirect visualization), includes obtaining and applying autograft or allograft (structural or morselized), when performed, includes image guidance when performed (eg, CT or fluoroscopic ) 0335T Extra-osseous subtalar joint implant for talotarsal stabilization 49

  50. Category III-General New Codes 0336T Laparoscopy, surgical, ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring, radiofrequency 0337T Endothelial function assessment, using peripheral vascular response to reactive hyperemia, non-invasive (eg, brachial artery ultrasound, peripheral artery tonometry), unilateral or bilateral 0338T Transcatheter renal sympathetic denervation, percutaneous apprach including arterial puncture, selective catheter placement(s) renal artery(ies), fluoroscopy, contrast injection(s), intraprocedural roadmapping and radiological supervision and interpretation, including pressure gradient measurements, flush aortogram and diagnostic renal angiography when performed; unilateral 0339Tbilateral 50

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