2014 CPT Coding Changes Effective January 1, 2014

By: Tabetha Schmeets

January 1, 2014, brings in several new coding changes. There were 335 changes made to the 2014 CPT book, 72 of those being additions to the surgery section. Also, there are enhanced parenthetical notes throughout the CPT book this year.

There are eight new codes in the Integumentary section for breast biopsy with imaging guidance, and breast localization device placement with imaging guidance (codes 19081 - 19086). The localization device has been bundled into the biopsy codes and there are add-on codes for each additional lesion.

Revisions to several radical resection codes were made in the Integumentary section. Code 13150 (1.0 cm or less, complex laceration repair of eyelids, nose, ears, and/or lips) has been deleted, due to being medically unlikely, and it is recommended to use simple or intermediate repair for these.

The Musculoskeletal section has made clarifications for excision of soft tissue subcutaneous tumors and radical resection of soft tissue tumors to indicate connective tissue only and to reference code set 11400 - 11406 for excision of benign lesions of cutaneous origin (i.e. sebaceous cysts). Also, one code (23333) has been added for deep foreign body removal from the shoulder and two codes (23334 - 23335) have been added for the removal of prosthesis of humeral and/or glenoid components.

The Cardiovascular section has made changes to include new codes (34841 - 34848, 37217, 37236 - 37239, 37241 - 37244) that include radiological supervision and interpretation which has resulted in deletion of codes to the Surgery and Radiology sections. Also, codes 33361 - 33366 used to report TAVI (transcatheter valve implementation) and TAVR (transcatheter aortic valve replacement) have moved from Category III codes (temporary codes) to Category I and have new guidelines; in addition, these codes require two physician operators and are reported using modifier 62.

Pacemaker pocket codes have been resequenced and have new parenthetical notes in the Cardiovascular section. Revision of the skin pocket for a pacemaker is included in 33206 - 33249, 33262 - 33264 and relocation of a skin pocket is reported separately in 33222 - 33223.

Embolization codes have undergone significant changes for 2014. Four new codes replace existing embolization codes of 37210 (uterine fibroid embolization) and the non-CNS, non-head embolization code, 37204. It is important to note that the existing embolization codes for CNS (61624) and intracranial (61626) embolization are still active. Because the new codes do not make a distinction based on CNS or intracranial, this may lead to some confusion in the proper code selection. The major distinction in the new codes is the reason for embolization (e.g., AVMs, varices, hemorrhage, tumor, ischemia, infarct, etc.). These codes also are defined by arterial or venous and once again include all radiological supervision and interpretation required to perform the procedure.

A large number of changes have been made to the Digestive section. Endoscopy guidelines now state that control of bleeding that occurs as a result of the endoscopic procedure is not separately reported during the same operative session. The biggest change in the Digestive section is to the Esophagus/Endoscopy category which has been divided into three subcategories: Esophagoscopy codes 43191 - 43233, Esophagogastroduodenoscopy (EGD) codes 43235 - 43259, and Endoscopic Retrograde Cholangiopancreatography (ERCP) codes 43260 - 43273.

Eight codes (64616 - 64617, 64642 - 64647) have been added to the Nervous section to include more specificity to the extremities, trunk and muscles treated for chemodenervation.

The Auditory section changed in that CPT 69210 (cerumen removal) specifies that it must be impacted cerumen which is removed by instrumentation. Removal of cerumen that is not impacted or does not require instrumentation should be reported with the appropriate E/M level.

The Medicine section has added four codes 90685 - 90688 for quadrivalent influenza virus products in the Vaccine/Toxoids section.

A new subcategory has been added to the E/M section to include guidelines and four new codes (99446 - 99449) for interprofessional telephone/ Internet consultative services. These codes are for consultants to use when assisting in the treatment of a patient in a complex or urgent situation in which a face-to-face service may not be possible. The consultant may not report if he/she has accepted transfer prior to the assessment, but may report if the decision to transfer has been made after the consultation.

Hospital discharge day management code 99239 has been updated to note other qualified healthcare professional providing the service ("physician" taken out).

One code (92506) has been deleted in speech pathology; four new codes (92521 - 92524) have been established to more clearly define the range of services provided.

Conclusion
This article represents a very brief overview of the 2014 CPT code and verbiage changes. Please refer to your 2014 CPT book for an entire listing of additions, deletions and revisions. Please contact Tabetha Schmeets with any questions or concerns regarding the new 2014 CPT changes.