CPT Changes for 2005

1. CPT Changes for 2005 Julie A. Leu, CPC December 16, 2004 9:30 – 11:30 a.m.

2. Overview of Changes for 2005 • One new symbol: • Indicates a code which typically includes conscious sedation • Category I code changes: • 130 codes added • 26 codes deleted • 60 code descriptors revised

3. Overview of Changes for 2005 • Category II code changes: • 11 codes deleted • 14 codes added • Category III Codes: • 27 codes added • 9 codes deleted • 1 code descriptor revised

4. Overview of Changes for 2005 • No modifiers deleted or revised • Four new appendices: • Appendix F - Summary of CPT Codes Exempt from Modifier 63 • Appendix G - Summary of CPT Codes which Include Conscious Sedation • Appendix H - Alphabetic Index of Performance Measures by Clinical Condition or Topic • Appendix I - Genetic Testing Code Modifiers • Apply to pathology/laboratory codes only

5. Evaluation and Management • Critical Care Services • Change in guidelines for the section with reference to the age of the patient • Neonate = 28 days of age or less • Infant = 29 days through 24 months of age • Formerly CPT utilized 30 days of age or less, and 31 days through 24 months • 99293, 99294 revised to include “29 days through 24 months of age” • 99295, 99296 revised to include “28 days of age or less”

6. Anesthesia • Guidelines revised in conjunction with creation of Appendix G • If sedation is provided by the surgeon, CPT codes 99141, 99142 are to be reported. • If sedation/anesthesia is provided by another physician (or under their supervision), the anesthesia codes are to be reported. • CPT codes listed in Appendix G include the provision of sedation by the operating physician.

7. Anesthesia • One new code: • 00561 Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, under one year of age.

8. Surgery – Integumentary System • Four new codes in the Skin, Subcutaneous and Accessory Structures Codes: • 11004 Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum • 11005 abdominal wall, with or w/o fascial closure • 11006 external genitalia, perineum and abdominal wall, with or w/o fascial closure • +11008 Removal of prosthetic material or mesh, abdominal wall for necrotizing soft tissue infection

9. Surgery – Integumentary System • One revised, three new Breast codes: • 19160 Mastectomy,partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); • 19296 Placement of radiotherapy afterloading balloon catheter into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy • +19297 concurrent with partial mastectomy

10. Surgery – Integumentary System • One revised, three new Breast codes: • 19298 Placement of radiotherapy afterloading brachytherapy catheters . . . into the breast for interstitial radioelement application following (at the time of or subsequent to) partial mastectomy, includes imaging guidance • New guidelines at the beginning of Breast Excision subsection

11. Surgery – Musculoskeletal System • Five new codes • Two new codes in the Femur subsection: • 27412 Autologous chondrocyte implantation, knee • 27415 Osteochondral allograft, knee, open

12. Surgery – Musculoskeletal System • Three new codes in the Arthroscopy subsection: • 29866 Arthroscopy, knee, surgical; osteochondral autografts (eg, mosaicplasty) (includes harvesting of the autograft) • 29867 osteochondral allograft • 29868 meniscal transplantation, (includes arthrotomy for meniscal insertion), medial or lateral

13. Surgery – Respiratory System • Two new codes in the Larynx/Endoscopy subsection: • 31545 Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s) • 31546 reconstruction with graft(s) (includes obtaining autograft)

14. Surgery – Respiratory System • Four new codes, two revised codes in the Trachea and Bronchi/Endoscopy subsection: • +31620 Endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) • 31630 Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with tracheal/bronchial dilation or closed reduction of fracture • 31631 with placement of tracheal stent(s)

15. Surgery – Respiratory System • Trachea and Bronchi/Endoscopy subsection: • 31636 Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with placement of bronchial stent(s) (includes tracheal/bronchial dilation as required), initial bronchus • +31637 each additional major bronchus stented • 31638 with revision of tracheal or bronchial stent inserted at previous session

16. Surgery – Respiratory System • Lungs and Pleura • One new code in the Incision subsection: • 32019 Insertion of indwelling tunneled pleural catheter with cuff

17. Surgery – Respiratory System • Lungs and Pleura, con’t. • One revised and two new codes in the Lung Transplantation subsection: • 32850 Donor pneumonectomy (including cold preservation), from cadaver donor • 32855 Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; unilateral • 32856 bilateral

18. Surgery – Cardiovascular System • Heart and Pericardium • Two new codes, two revised codes in Heart/Lung Transplantation subsection: • 33930 Donor cardiectomy-pneumonectomy (including cold preservation) • 33933 Backbench standard preparation of cadaver donor heart/lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, and trachea for implantation

19. Surgery – Cardiovascular System • Two new codes, two revised codes in Heart/Lung Transplantation subsection: • 33940 Donor cardiectomy (including cold preservation) • 33944 Backbench standard preparation of cadaver donor heart allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, pulmonary artery, and left atrium for implantation

20. Surgery – Cardiovascular System • Arteries and Veins • Eight new codes, three deleted, one revised • 34803 Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis ( two docking limbs) • Codes 35161 and 35162 have been deleted. A parenthetical note has been added to instruct that code 37799 should be reported for direct aneurysm repair of other arteries, not otherwise specified. • Code 35582 has been deleted due to a confusing redundancy of codes in the section.

21. Surgery – Cardiovascular System • Arteries and Veins, con’t. • 36475 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated • +36476 second and subsequent veins treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)

22. Surgery – Cardiovascular System • Arteries and Veins, con’t. • 36478 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated • +36479 second and subsequent veins treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)

23. Surgery – Cardiovascular System • Arteries and Veins, con’t. • 36818 Arteriovenous anastomosis, open, by upper arm cephalic vein transposition • 37205 Transcatheter placement of an intravascular stent(s), (except coronary, carotid, and vertebral vessel), percutaneous, initial vessel • 37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection • 37216 without distal embolic protection

24. Surgery – Digestive System • 18 new codes, five revised codes • 43257 Upper gastrointestinal endoscopy . . . ; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease • 43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) • 43645 with gastric bypass and small intestine reconstruction to limit absorption

25. Surgery – Digestive System • 43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) • 43846 Gastric restrictive procedure with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy

26. Surgery – Digestive System • Guidelines added to the Intestines/Excision subsectionto address intestinal allotransplantation. • 44137 Removal of transplanted intestinal allograft, complete • 44715 Backbench standard preparation of cadaver or living donor intestine allograft prior to transplantation, including mobilization and fashioning of the superior mesenteric artery and vein • 44720 Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; venous anastomosis, each • 44721 arterial anastomosis, each

27. Surgery – Digestive System • 45391 Colonoscopy, flexible, proximal to splenic flexure; with endoscopic ultrasound examination • 45392 with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s) • 46947 Hemorrhoidopexy (eg, for prolapsing internal hemorrhoids), by stapling • New Liver Transplantation subsection • 47133 and 47140 revised • Five new codes (47143 – 47147)

28. Surgery – Digestive System • 48550 Donor pancreatectomy (including cold preservation), with or without duodenal segment for transplantation • 48551 Backbench standard preparation of cadaver donor pancreas allograft prior to transplantation, . . . • 48552 Backbench reconstruction of cadaver donor pancreas allograft prior to transplantation, venous anastomosis, each

29. Surgery – Urinary System • Seven new codes, five deleted, five revised • New Renal Transplantation subsection guidelines • Codes 50300, 50320, and 50360 were revised • New codes 50323 and 50325 report “standard” backbench services performed on living or cadaver donor renal allograft prior to transplantation. • New codes 50327, 50328, and 50329 report backbench reconstruction procedures performed on living or cadaver donor renal allograft prior to transplantation.

30. Surgery – Urinary System • 50391 Instillation of therapeutic agent into renal pelvis and/or ureter through established nephrostomy, pyelostomy or ureterostomy tube (eg, anticarcinogenic or antifungal agent) • Codes 50559, 50578, 50959, and 50978 have been deleted and can be reported utilizing the radiation oncology codes (eg, 77778) • 52234 Cystourethroscopy, with fulguration . . .; SMALL bladder tumor(s) (0.5 up to 2.0 cm) • 52402 Cystourethroscopy with transurethral resection or incision of ejaculatory ducts

31. Surgery – Female Genital System • Five new codes, one revised • +57267 Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach • 57282 Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus) • 57283 intra-peritoneal approach (uterosacral, levator myorrhaphy)

32. Surgery – Female Genital System • 58356 Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when performed • 58565 Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants • 58956 Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy

33. Surgery – Nervous System • Three new codes, three revised • 63050 Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments; • 63051 with reconstruction of the posterior bony elements (including the applica-tion of bridging bone graft and non-segmental fixation devices (eg, wire, suture, mini-plates), when performed)

34. Surgery – Nervous System • +63295 Osteoplastic reconstruction of dorsal spinal elements, following primary intraspinal procedure • Codes 61685, 63685, and 64590 all were revised to include the replacement of stimulation or drug delivery devices.

35. Surgery – Eye and Ocular Adnexa • One new code, one revised • 66710 Ciliary body destruction; cyclophotocoagulation, transscleral • 66711 cyclophotocoagulation, endoscopic

36. Radiology Code Changes • Thirteen new codes, 14 revised, 11 deleted • Introductory guidelines for the subsections related to selective catheterization imaging • Aorta and Arteries • Veins and Lymphatics • Transcatheter Procedures • 75960 revision to the cross reference only

37. Radiology Code Changes • 76075 Dual energy x-ray absorptiometry (DXA), bone density study, one or more sites; axial skeleton (eg, hips, pelvis, spine) • 76077 vertebral fracture assessment • 76510 Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter • 76511 quantitative A-scan only • 76512 B-scan (with or without superimposed nonquantitative A-scan)

38. Radiology Code Changes • 76820 Doppler velocimetry, fetal; umbilical artery • 76821 middle cerebral artery • 76827 Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete • Guidelines added for Non-Obstetrical Ultrasounds • 77750 Infusion or instillation of radioelement solution (includes three months follow-up care) • 78267 Urea breath test, C-14 (isotopic); acquisition for analysis

39. Radiology Code Changes • Code descriptors for 78464 and 78465 were revised to include attenuation correction, when performed, for myocardial perfusion single photon emission computed tomography (SPECT). • Code 78810 has been eliminated and six new codes, 78811- 78816, added for reporting tumor imaging by positron emission tomography (PET). • Code 78990 has been deleted. HCPCS Level II codes may be used to report the diagnostic radiopharmaceuticals used.

40. Radiology Code Changes • 79005 Radiopharmaceutical therapy, by oral admninistration • 79101 Radiopharmaceutical therapy, by intravenous administration • 79200 Radiopharmaceutical therapy, by intracavitary administration • 79300 Radiopharmaceutical therapy, by interstitial radioactive colloid administration • 79440 Radiopharmaceutical therapy, by intra-articular administration • 79445 Radiopharmaceutical therapy, by intra-arterial particulate administration

41. Pathology Code Changes Chemistry Section – six new codes and three revised: • 82045 Albumin; ischemia modified • 82656 Elastase, pancreatic (EL-1), fecal, quantitative or semi-quantitative. • 83009 Helicobacter pylori, blood test analysis for urease activity, non-radioactive isotope

42. Pathology Code Changes • 83013 Helicobacter pylori, breath test analysis for urease activity, non-radioactive isotope. • 83014 Helicobacter pylori, drug administration • 83630 Lactoferrin, fecal, qualitative • 84163 Pregnancy-associated plasma protein-A (PAPP-A)

43. Pathology Code Changes • 84165Protein; electrophoretic fractionation and quantitation • 84166 Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF) • Genetic Testing Modifiers (Appendix I) for use with molecular diagnostic procedures, CPT codes 83890 through 83912.

44. Pathology Code Changes Hematology and Coagulation section one revised code: • 85046 Blood count; reticulocytes, automated, including one or more cellular parameters (eg, reticulocyte hemoglobin content, immature reticulocyte fraction, reticulocyte volume, RNA content), direct measurement

45. Pathology Code Changes Immunology section, four new codes and one revised code: • 86064 B cells, total count • 86379 Natural killer (NK) cells, total count • 86587 Stem cells (ie, CD34), total count

46. Pathology Code Changes Immunology section, four new codes and one revised code: • 86334 Immunofixation electrophoresis; serum • other fluids with concentration (eg, urine, CSF)

47. Pathology Code Changes Microbiology section, one new code and one revised code: • 87046 Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate • 87807 Infectious agent antigen detection by immunoassay with direct optical observation; repiratory syncytial virus.

48. Pathology Code Changes Cytopathology section, one deleted code (88180) and five new codes: • 88184 Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker • +88185 each additional marker • 88187 Flow cytometry, interpretation; 2 to 8 markers • 88188 9 to 15 markers • 88189 16 or more markers

49. Pathology Code Changes Cytogenetic Studies Section • Genetic Testing Modifiers (Appendix I) for use with cytogenetic studies procedures, CPT codes 88230 through 88299.

50. Pathology Code Changes Surgical pathology section, three new codes and two revised codes: • 88360 Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, each antibody; manual • 88361 using computer assisted technology Surgical Pathology section