CPT Code Changes Effective January 1, 2015

 

By: Susan Rohde, RHIT, CCS-P, CPC

 

Approximately 500 coding changes will go into effect as of the first of the year including 134 revised codes, 143 deleted codes and 264 new codes. With the increased usage of Electronic Health Records (EHR's), failure to update your facilities' systems will result in increased denials.

 

Evaluation & Management

Numerous changes affect the Evaluation and Management (E/M) section of CPT 2015. The social history element has included the addition of "history of military service" to its guidelines. This will help assist with diagnosing, assessing and treating service members and veterans. Two new codes were added to the Advance Care Planning section: Codes 99497 (first 30 minutes) and 99498 (add on code for each additional 30 minutes) are time-based codes that are currently not reimbursed by Medicare.

 

The codes are used to report face-to-face service between a physician or other qualified health care professional and a patient, family member or surrogate in counseling and discussing advance directives. This can be done with or without the completion of relevant legal forms. No active management of a problem(s) is undertaken at this visit. Medicare is currently accepting comments on the final rule and will reconsider payment of these codes following the review of these comments.

 

Antepartum Care

A clarification comes in the E/M prenatal visit guidelines in that a "pregnancy confirmation during a problem-oriented or preventive visit is NOT considered a part of the antepartum care". Report using the appropriate E/M code for that visit. Antepartum care includes the initial prenatal history and physical examination".

 

Musculoskeletal System

Musculoskeletal system includes three revised and three new codes for arthrocentesis, aspiration and/or injection: small, intermediate and large joint. CPT codes 20600 (small), 20605 (intermediate) and 20610 (large) have been revised to state "without ultrasound guidance", while codes 20604 (small), 20606 (intermediate) and 20611 (large) include the phrase "with ultrasound guidance with permanent recording and reporting". The ultrasound must be saved to PACS and included in the patient's permanent record.

 

Three new codes were also added for open treatment of rib fracture(s). Codes 21811, open treatment of rib fracture with internal fixation 1-3 ribs, 21812, 4-6 ribs and 21813 7 or more ribs are considered unilateral codes and modifier -50 (bilateral procedure) must be appended when performing on both sides. CPT code 21800, closed treatment of an uncomplicated rib fracture has been deleted due to lack of use and an E/M code should be assigned to report this procedure if performed.

 

Cardiology

The Cardiology section saw one of the largest amounts of coding changes/revisions. With the addition of CPT code 34839, physician planning of a patient specific fenestrated visceral aortic endograft requiring a MINIMUM of 90 minutes of physician time, physicians now have a way to report the planning that includes the review of high resolution cross sectional images, computed tomography angiography (CTA), magnetic resonance imaging (MRI) and utilization of 3D software. Physician planning does not need to be continuous; however, it does need to be at least 90 minutes and may not include time spent on the day before the day of the actual procedure.

 

Extracorporeal Membrane Oxygenation or ECMO saw great increases in the Relative Value Units (RVU's) assigned to the codes 33960 and 33961. These codes were originally developed for neonatal patients following severe postpartum respiratory insufficiency. However, the therapy is now being used on adults with severe influenza, pneumonia and respiratory distress syndrome as well as pediatric patients. CPT codes 33960/33961 and 36822 have been deleted and codes 33946-33989 have been established to report ECMO procedures. There are two methods to perform ECMO: veno-arterial or veno-venous. The new codes include initiation codes and also daily management codes, as well as also including repositioning of the cannula, replacement of the cannula, removal and insertion of the ECMO cannula. Please see the CPT 2015 book for accurate code descriptions regarding ECMO treatment.

 

Interventional Radiology

Interventional Radiology saw the majority of changes in CPT 2015. The existing codes for carotid stent placement have been revised to clarify open versus percutaneous. CPT wanted to achieve consistent language throughout all endovascular codes. Also, codes 37215 (transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty when performed and radiological supervision and interpretation with distal embolic protection) and CPT code 37216 (without distal embolic protection), include all ipsilateral cervical and cerebral angiography as well as carotid angioplasty, stent placement, deployment and removal of distal embolic protection systems and all associated radiological S&I. 

 

Conclusion This article represents a very brief overview of the 2015 CPT code and verbiage changes. There are several more significant changes/additions/deletions to 2015 CPT that may impact your facility. Please refer to your 2015 CPT book for an entire listing of additions, deletions and revisions.

 

Please contact Susan Rohde with any questions or concerns regarding the new 2015 CPT changes.