2006 CPT Coding Update

1. 2006 CPT Coding Update Steven A. Adams, CPC, CPC-H, COA http://www.coderscentral.com/beauty.htm

2. 2006 Coding Changes • * 277 Additions • * 110 Deletion • * 71 Revisions Congress expected to pass bill in February that would return CMS fee schedule back to 2005 fee schedule. CMS has told carriers to convert within 48 hours of passing of bill - no claims to refile

3. Modifier -25 • The description of modifier -25 has been expanded to further describe significant, separately identifiable services. It now explains: "A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see E/M services guidelines for instructions on determining level of E/M service)."

4. Evaluation & Management • Delete: 99261-99263: in fact the new CPT manual directs the providers to subsequent hospital visit codes. • Delete: 99271-99275; code to appropriate categories per patient presentation • Nursing facility codes have changed with an annual assessment code of 99318 being added as well as the new codes (99304-99310) themselves • Domiciliary, rest home or custodial care services: In addition to room and board on a long term basis but assisted living facility. Also the guideline states that the facility’s services do not include a medical component. So we have new codes in this category, and some of them will be listed by time. (99324-99337) • 99298 - 99300 (codes for low-birth weight) have been changed to follow-up on non-critically ill low-birth weight infants.

5. Integumentary • Skin graft codes have been reorganized with new headings; 37 new codes; 5 revision codes and 15342-15351 being deleted. Again, this means that physician documentation will have to be specific as to the type of graft, anatomical site and size of body area. • Dressing code changes (16010, 16015 have been deleted) • 16020 dressings and/or debridement of partial-thickness burns, small • 16025 medium • 16030 large

6. Musculoskeletal • New codes for I&D of abscess of spine • 22010 I&D, open, of deep abscess, posterior spine; cervical, thoracic, or cervicothoracic • 22015 lumbar, sacral, or lumbosacral • New codes for vertebral body, embolization or injection in the thoracic and lumbar area with a new add on code. • 22523 percutaneous vertebral augmentation, including cavity creation using mechanical device, one vertebral body, unilateral or bilateral cannulation; thoracic • 22524 lumbar • + 22525 each additional thoracic or lumbar vertebral body • New category III codes for total disk arthroplasty, to include removal and revision: 0090T-0098T.

7. Respiratory • Several codes will now include the use of the operating microscope or telescope. 31515 - 31571 - (Laryngoscopy, direct codes). • New resection of lung tumor codes • 32503 resection of apical lung tumor, including chest wall resection, rib(s) resection(s) neurovascular dissection, when performed; without chest wall reconstruction(s) • 32504 with chest wall reconstruction

8. Cardiovascular • Endovascular repair of descending thoracic aorta: Category III codes have been converted to new CPT codes 33880-33891 • New codes with new headings for transcatheter procedures (arterial and venous mechanical thrombectomy) • 37184 Primary percutaneous transluminal mechanical thrombectomy, initial vessel • 37185 second and all subsequent vessel(s) • + 37186 secondary percutaneous transluminal thrombectomy • 37187 percutaneous transluminal mechanical thrombectomy, veins • 37188 percutaneous transluminal mechanical thrombectomy, vein(s), repeat treatment on subsequent day during course of thrombolytic therapy

9. Vein Ligation • New codes for vein ligations: • 37700 ligation and division of long saphenous vein at saphenofemoral junction, or distal interruptions • 37718 ligation, division, and stripping, short saphenous vein • 37722 ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below • (can use -50 modifier when done bilaterally)

10. Digestive/Intestine • New heading and codes for laparoscopic bariatric surgery • 43770 - 43774 • New codes for open bariatric surgery • 43848 - 43888 • New subheadings and codes for laparoscopy procedures intestines (except rectum) • 44180 laparoscopy, surgical, enterolysis (internal adhesion) (separate procedure) • 44186 laparoscopy, surgical; jejunostomy • 44187 ileostomy or jejunostomy, non-tube • 44188 laparoscopy, surgical, colostomy or skin level cecostomy • 45400 laparoscopy; proctopexy (for prolapse) • 45402 proctopexy (for prolapse) with sigmoid resection • 44123 laparoscopy mobilization of splenic flexure • 44227 laparoscopy, closure of enterostomy

11. Urinary • One new code under Kidney heading • 50250 ablation, open, one or more renal mass lesion(s), cryosurgical, including intraoperative ultrasound, if performed • Renal pelvis catheter procedures. It was also stated that these procedures DO include the radiology S& I codes and one cannot bill separately for those after Jan. 1, 2006. • 50382 removal and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological S&I • 50384 removal of internally dwelling ureteral stent via percutaneous approach including radiological S&I • 50387 removal and replacement of externally accessible transnephric ureteral stent requiring fluoroscopic guidance, including radiological S&I • 50389 removal of nephrostomy tube, requiring fluoroscopic guidance - if no fluoroscopic guidance, use E&M code • 50592 Ablation, one or more renal tumor(s), percutaneous, unilateral, radiofrequency (unilateral procedure)

12. GYN • Female GU • 57295 revision of prosthetic vaginal graft, vaginal approach • 57420 colposcopy of the entire vagina, with cervix if present • 57421 with biopsy(s) of vagina/cervix • + 58110 endometrial sampling (biopsy) performed in conjunction with colposcopy • use with 57420, 57421, 57421-57461 - colpo codes

13. Intracranial Services • New endovascular therapy codes: 61630, 61635, 61640 and new add on codes 61641 and 61642. The new notes in this section indicate that additional radiology codes that were coded in the past are now included in the definition of these procedures. • 61630 balloon angioplasty, intracranial (atherosclerotic stenosis) • 61635 transcatheter placement of intravascular stent, intracranial • 61640 balloon dilatation of intracranial vasospasm, percutaneous • + 61641 each additional vessel in same vascular family • + 61642 each additional vessel in different vascular family

14. Chemodenervation • Codes 64650 and 64653 have been added to report chemodenervation of the endocrine glands and other areas. • Code 64613, used to report chemodenervation, has been revised to no longer limit its usage for treatment of cervical spinal muscles. It can now be used to report chemodenervation of any neck muscle(s). • 64613: Chemodenervation of muscle(s); neck muscle(s) (e.g., for spasmodic torticollis, spasmodic dysphonia) • 64650: Chemodenervation of endocrine glands; both axillae • 64653: Chemodenervation of endocrine glands: other area(s) (e.g., scalp, face, neck), per day

15. Ophthalmology • Codes 67901 and 67902 now reflect the current practice for use of banked facial strips • for transciliary body sclera fistulization, use 0123T • 67901 Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia • 67902 frontalis muscle technique with autologous fascial sling

16. Operating Microscope • 69990 now includes codes 31545, 31546

17. Radiology • New notes that direct many coders to: • 76376 3D rendering with interpretation and reporting of CT, MRI, ultrasound • 76377 requiring image postprocessing on an independent workstation • Other changes • 75900 exchange of a previously placed intravascular catheter during thrombolytic therapy - (for procedure see 37209) • 76012 radiological S&I, percutaneous vertebroplasty or vertebral augmentation including cavity creation • 77412 radiation treatment delivery, three or more treatment areas

18. Endovascular Repair • Several changes in the Endovascular Repair section • 75956 endovascular repair of descending thoracic aorta involving coverage of left subclavian artery origin • 75957 not involving coverage of left subclavian artery origin • 75958 placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta • 75959 placement of distal extension prosthesis after endovasulcar repair

19. Pathology • Other CPT 2006 changes include the following revision: of glycated hemoglobin code • 83036 to refer to "glycosylated (A1C)" • 83037, for reporting glycosylated (A1C) testing by a device cleared by the FDA for home use. 83037 will allow physicians to provide and report the new self-contained system used in a patient encounter to have real-time A1C results for use in face-to-face patient interaction. • Fecal occult blood test codes • 82270 should be used to report three specimens collected by the patient. • 82271 is used to report a specimen collected by other sources (previously reported with 82273) • 82272 is used to report a single specimen, such as that collected from a digital rectal examination.

20. Vaccines • New symbol of a lightening bolt. This is for vaccines and toxoids that denote FDA approval is pending. • Vaccine codes to look for in 2006 include those for a • 90649 human papilloma virus vaccine • 90680 rotavirus vaccine • 90713 poliovirus vaccine (IPV), was revised to include intramuscular administration. • 90714 preservative-free tetanus and diphtheria toxoids (Td) adsorbed • 90715 tetanus (Tdap) 7 years or older • 90718 will remain in use until manufacturers phase out the preservative-containing vaccine • 90736 zoster (shingles) vaccine

21. Chemotherapy / Hydration & Injection Information Total redo on the infusion and injection section: New heading- Hydration, Therapeutic, Prophylactic and Diagnostic Injections and Infusions (excludes chemotherapy). So this means that 90780-90799 have been deleted and we now have new codes for hydration and new codes for therapeutic. See Injection Form

22. Injection Changes • Another, related to code 90772, "Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular," could cause some confusion. The instructions say to use code 99211 rather than 90772 when the injection is given "without direct physician supervision." Because the incident-to guidelines require direct physician supervision of services billed with 99211, physicians have no means of billing a 90772-type injection given without direct physician supervision if the payer follows the incident-to guidelines.

23. Rehab Changes • There are four new procedures for reporting auditory rehabilitation. The first two, 92626 and 92627, are for reporting "Evaluation of auditory rehabilitation status; first hour" and for "each additional 15 minutes." The other two codes are 92630 "Auditory rehabilitation; pre-lingual hearing loss" and 92633 "Auditory rehabilitation; post-lingual hearing loss." • The new codes created a need for revision of the descriptors of two long-standing codes: 92506 and 92507. Reference to aural rehabilitation in both of those procedures is deleted for 2006. CPT 92506 will read, "Evaluation of speech, language, voice, communication, and/or auditory processing. "Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual" will be the new 92507.

24. Rehab Changes • Another audiology code was revised for 2006. Audiologists had reported problems with 92568, "Acoustic reflex testing," and 92569, "Acoustic reflex decay." Third party payers denied reimbursement for 92569 stating that is was bundled in 92568. The payers were not persuaded that they were incorrect when contacted by the audiologists or ASHA. The 2006 CPT should resolve the payers' misinterpretation because of the new and more specific descriptor for 92568, "Acoustic reflex testing; threshold." • There is a change of note for speech-language pathologists who evaluate and treat patients with voice disorders. CPT 92520 will more specifically describe what is involved with laryngeal function studies. The descriptor for 2006 will read "Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)." Please note the "i.e." is not an "e.g." so that 92520 is restricted to reporting either aerodynamic testing or acoustic testing.

25. EMG & Nerve Conduction • Code 95858: tensilon test for myasthenia gravis with electromyographic recording has been deleted • Two codes have been created. • 95865: Needle electromyography; larynx • 95866: Needle electromyography; hemidiaphragm • Two add-on codes have also been added • + 95873: Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure • + 95874: Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure) • These codes should not be billed in conjunction with needle EMG codes 95860-95874

26. Psychiatry • 96100 has been deleted. Use 96101, 96102 and 96103 • 96101 - Psychological testing, per hour of the psychologist’s or physician’s time, both face-to-face time with the patient and time interpreting test results and preparing the report • 96102 with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face • 96103 administered by a computer, with qualified health care professional interpretation and report • 96116 Neurobehavioral status exam per hour of psychologist’s or physician's time • 96118 Neuropsychological testing, per hour psychologist's or physician’s time • 96119 qualified health care professional • 96120 administered by a computer

27. Physical Medicine / Rehab • Code 97020 for microwave therapy has been deleted as it is a form of diathermy. Therefore, code 97024 has been revised. • 97024: Application of a modality to one or more areas; diathermy (e.g., microwave) • 97542: Wheelchair management (e.g., assessment, fitting, training); each 15 minutes

28. Negative Pressure Therapy • CPT 2005 included two new codes for Negative Pressure Wound Therapy (97605, 97606). However, under the 2005 Medicare Physician Fee Schedule, Medicare would not reimburse for those codes. • Beginning January 1, 2006, Medicare will reimburse for the negative pressure wound therapy codes. • The assigned values will be: Work Practice Liability Total non-facility 97605 .55 .34 .02 .91 97606 .60 .90 .03 1.53

29. Orthotic & Prosthetic Management • CPT 2006 has a new subsection of the 97000 series codes called "Orthotic Management and Prosthetic Management." Within that subsection are the revised orthotic management code and two previously existing codes that have been renumbered. • If a HCPCS Level II "L" code is billed for an orthotic, the "L" code includes the evaluation and fitting components of the orthotic management. Therefore, once the "L" code is billed, the 97760 code can only be utilized to represent the time spent training the patient in use of the orthotic. The documentation should support this.

30. Orthotic Management • Codes 97504 (orthotic fitting and training) and 97520 (prosthetic training) have been deleted. In their place, a new subsection for Orthotic Management and Prosthetic Management has been added. • 97760: Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s), and/or trunk, each 15 minutes • 97761: Prosthetic training, upper and/or lower extremity(s), each 15 minutes • 97762: Checkout for orthotic/prosthetic use, established patient, each 15 minutes • The new 97761 code is the replacement for the 97520 code • The new 97762 code is the replacement for the 97703 code

31. Education & Training Codes • A new group of codes have been developed to report educational and training services prescribed by a physician and provided by a qualified, nonphysician healthcare professional using a standardized curriculum to an individual or a group of patients for treatment of established illness(s)/disease(s) or to delay comorbidity. • 98960 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum (emphasis added), face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient • 98961 2-4 patients • 98962 5-8 patients

32. Special Services • Special services codes 99050-99060 have been revised to report more accurately services provided after hours or on an emergency basis. • 99050 - services provided at times other than regular schedule • 99051 - services provided during regular evening/weekend • 99053 - services between 10PM and 8AM in 24 hour facility • 99056 - services normally in office, but done out of office - patient • 99058 - services for emergency which disrupts office schedule • 99060 - services for emergency out of the office

33. Conscious Sedation • Conscious sedation and the codes 99141 and 99142 have been deleted and we now have 6 moderate (conscious) sedation codes • Moderate (conscious) sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patient airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. • Moderate sedation does not include minimal sedation (anxiolysis), deep sedation, or monitored anesthesia care (codes 00100-01999).

34. Conscious Sedation • The following services are included with moderate sedation and should not be reported separately: • Assessment of the patient (not included in intraservice time); • Establishment of IV access and fluids to maintain patency, when performed; • Administration of agent(s); • Maintenance of sedation; • Monitoring of oxygen saturation, heart rate, and blood pressure; and • Recovery (not included in intraservice time). • Intraservice time starts with the administration of the sedation agent(s), requires continuous face-to-face attendance, and ends at the conclusion of personal contact by the physician providing the sedation.

35. CS - Same Physician • 99143: Moderate sedation services provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness, and physiological status; under 5 years of age, first 30 minutes intra-service time • 99144: age 5 years or older, first 30 minutes intra-service time • + 99145: Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness, and physiological status; each additional 15 minutes intra-service time (list separately in addition to code for primary service

36. CS - Other Physician • 99148: Moderate sedation services provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; under 5 years of age, first 30 minutes intra-service time • 99149: age 5 years or older, first 30 minutes intra-service time • + 99150: Moderate sedation services (other than those services described by codes 00100-01999) provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intra-service time (list separately in addition to code for primary service)