Transcript 2014 Coding Changes - Richmond Association of Coders
2014 Coding Changes
AAPC RICHMOND VA. CHAPTER JANUARY 2014
Overview & Objectives
Identify coding changes for the upcoming year (HIGHLIGHTS) CPT ® HCPCS What's new for 2014- over 330 coding changes
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CPT ®
AAPC Richmond Va. Chapter - January 2014 175 NEW CODES 47 DELETED CODES 107 REVISED CODES
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Evaluation & Management
Interprofessional Telephone/Internet Consultations (99446 - 99449) four new codes Time-based!! must document a minimum of 5 minutes to report 99446 Time includes review of medical record, diagnostic test, verbal & written communication Request from treating physician to consultant for opinion and/or treatment advice to assist in the diagnosis and/or management of the patient no face to face w/ patient Complex and/or urgent situations where a timely face-to-face service with the consultant may not be feasible New patient to consultant or Established patient with new problem or exacerbation of an existing patient No face-to-face with consultant last 14 days or next 14 days Report only once in a seven day period
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Evaluation & Management (cont.)
Complex Chronic Care Coordination Services (99487 - 99489) Codes did not change Guidelines revised to detail: Typical adult patients Typical pediatric patients Requirements for care coordination offices/practices Requirements: Provide 24/7 access to clinical staff Use standardized methodology to identify CCCC patients Internal process whereby identified patients being receiving treatment in a timely manner Standardized medical record form and format Engage and educate patients and caregivers and coordinate care among all service professionals
AAPC Richmond Va. Chapter - January 2014
Evaluation & Management (cont.)
Transitional Care Management Services (99495 - 99496) Codes did not change/ just revised Can report for new or established patients Separately reported E&M cannot be reported on the same day Discharge service may not be used as required face-to-face visit 6
AAPC Richmond Va. Chapter - January 2014
Integumentary - Lund-Browder (No more “Rule of Nines” in CPT)
Area
Head Neck Trunk* Buttock* Genitalia 1 U Arm* 4
Birth-1yr
19 2 13 2.5
L Arm* Hand* Thigh* Leg* Foot* 3 2.5
2.5
5 3.5
3 2.5
6.5
5 3.5
1 4 17
1-4 Yrs
2 13 2.5
3 2.5
8 5.5
3.5
1 4 13
5-9 Yrs
2 13 2.5
3 2.5
8.5
6 3.5
1 4
10-14 Yrs
11 2 13 2.5
1 4 3 2.5
9 6.5
3.5
15 Yrs
9 2 13 2.5
AAPC Richmond Va. Chapter - January 2014
1 4 3 2.5
9.5
7 3.5
7 2 13 2.5
Adult
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Integumentary - Breast Procedures
New biopsy with localization codes: Include localization devices, when performed Include imaging of the biopsy specimen, when performed Differ based on type of guidance Stereotactic (19081, +19082) Ultrasound MRI (19083, +19084) (19085, +19086)
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Integumentary - Breast Procedures (cont.)
New introduction codes for localization devices Differ based on type of guidance Mammographic (19281, +19282) Stereotactic Ultrasound MRI (19283, +19284) (19285, +19286) (19287, +19288)
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Musculoskeletal
Tumor resections Changed terminology from: Malignant neoplasm to sarcoma New and revised codes for removal of foreign body and removal of prosthesis Specifically describes what is removed foreign body or prosthesis 10
AAPC Richmond Va. Chapter - January 2014
Respiratory
Pleural catheter & thoracentesis Parenthetical notes revised to state not to report in conjunction when performed on the same side of the chest 11
AAPC Richmond Va. Chapter - January 2014
Cardiovascular
Pacemaker or Pacing Cardioverter Defibrillator Guidelines revised Relocation of skin pocket: requires creation of a new skin pocket Revision of skin pocket, not reported separately Subcutaneous implantable defibrillator system TAVI/TARI new code for transapical exposure 12
AAPC Richmond Va. Chapter - January 2014
Cardiovascular (cont.)
New codes Fenestrated Endovascular Repair of the Visceral and Infrarenal Aorta (34841 - 34848) Transcather placement of an intravascular stent(s) (37217, 37236 - 37239) Vascular Embolization and Occlusion (37241 - 37244) 13
AAPC Richmond Va. Chapter - January 2014
Digestive - BIG CHANGES
Endoscopy codes: specifically rigid and flexible esophagoscopy= significant changes 13 new codes Description revision for nearly all remaining codes New parenthetical instructions
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Digestive - BIG CHANGES
Esophagoscopy (43191 - 43232) Esophagogastroduodenoscopy (43233 - 43259) Endoscopic Retrograde Cholangiopancreatography - ERCP (43260 43278) Abdomen, Peritoneum, and Omentum Introduction, Revision, and Removal
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Digestive (cont.)
Esophagoscopy Cricopharyngeus muscle (upper esophageal sphincter) to and including the gastoesophageal junction Includes examination of the proximal region of the stomach via retroflexion when performed Selecting code need to know if a rigid or flexible scope is used Reason for separating the code is the different types of anesthesia used
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Digestive (cont.)
Esophagogastroduodenoscopy (AKA: Upper GI) Cricopharyngeus muscle (upper esophageal sphincter) to and including the duodenum Consistent terminology Explanation of proper modifier use Duodenum deliberately not examined Modifier 52 - Repeat examination not planned Modifier 53 - Repeat examination planned
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Digestive (cont.)
ERCP Requires visualization of one or more of the ductal systems Pancreatic Biliary Altered postoperative anatomy Unlisted codes (47999 or 48999) for ERCP via gastrostomy or via Roux-en-Y
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Digestive (cont.)
New codes for image-guided fluid collection draining by catheter (abdomen, peritoneum, and omentum) 49405 Visceral Percutaneous 49406 49407 Peritoneal or Retroperitoneal, Percutaneous Peritoneal or Retroperitoneal, Transvaginal or Transrectal 19
AAPC Richmond Va. Chapter - January 2014
Urinary
One new code Combination code 52356 Cystourethroscopy with ureteroscopy with lithotripsy including insertion of indwelling ureteral stent(eg, Gibbons or double-J type) 20
AAPC Richmond Va. Chapter - January 2014
Nervous
New Codes in the Chemodenervation Section - Somatic Nerves 64616 64617 64642 +64643 64644 +64645 64646 64647 Neck muscle(s) excluding larynx (unilateral) Larynx, unilateral, percutaneous includes needle EMG guidance One extremity; 1 -4 muscles Each additional extremity, 1 - 4 muscles One extremity; 5+ muscles Each additional extremity, 5+ muscles Trunk muscles; 1 - 5 muscles Trunk muscles; 6+ muscles
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Eye & Ocular Adnexa
One new code - Anterior Sclera - Aqueous Shunt 66183 Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach Replaces the category III code 0192T 22
AAPC Richmond Va. Chapter - January 2014
Auditory System
Guideline for cerumen removal 69210 Clarifies that an instrument is required Revised to report unilateral procedure (continue to use modifier 50 for bilateral procedures) Added guidance from CPT ® Assistant 23
AAPC Richmond Va. Chapter - January 2014
Radiology
Radiologic exam of spine 72040 now specifies “2 or 3 views instead of “3 or less” Revisions to guidance codes and parenthetical references based on codes for which guidance is now included: Transcatheter Procedures- supervision included in new codes 37236-37239 Fluoroscopic Guidance Magnetic Resonance Guidance Revisions to radiation oncology simulation guidelines: inappropriately described as “simulation”, more appropriately labeled as “planning”
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Pathology & Laboratory
New Molecular Pathology Table Expansion of molecular pathology parenthetical lists of included items 10 New Therapeutic Drug Assay Codes 25
AAPC Richmond Va. Chapter - January 2014
Medicine
Vaccines - New Flu Codes Includes four strains (two type A and two type B) Patients age determines the code Special Otorhinolaryngologic Services New speech related codes Repair of Structural Heart Defects Two new percutaneous transcatheter repair codes Intracardiac Electrophysiological Procedures/Studies 3 revised codes - all for comprehensive electrophysiologic evaluations
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Medicine (cont.)
Intraoperative Neurophysiology Guidelines revised to define specifically what the time monitoring and time in the OR includes Monitoring - Time to set up, record, and interpret the baseline studies, and to remove electrodes at the end of the procedure OR - Time is cumulative and only includes time physically present in the room; may begin prior to incision Active Wound Care Management One new code - low frequency non-contact non-thermal US for wound assessment (per day)
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Next Steps
Review all new codes, guidelines, and parenthetical Highlight the changes for your specialty New guidelines/parenthetical printed in green. Look in the index for any changes.
Update coding cheat sheets with the new codes Make sure super bills, charge masters are updated with the new codes Load new codes into software Educate staff on changes
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Questions? & Reminders…
Current 2014 CPT 2014 CPT® Errata 2014 CPT® Changes: An Insider’s View CPT Assistant AHA Coding Clinic
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Contact Information
Presentation Prepared by- Chandra Stephenson, CPC, CPC-H, CPCO, CPMA, CPC-I, CANPC, CEMC, CFPC, CIMC, COSC Presentation Presented by- Colleen Mescall, MHA/E, CPC, CPMA, CPC-I, 2014 RAC President, 2013-2015 National Advisory Board Member
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