Professional Documents
Culture Documents
Code Updates
Audio Seminar/Webinar
December 3, 2009
CPT® five digit codes, nomenclature, and other data are copyright 2009 American
Medical Association. All Rights Reserved. No fee schedules, basic units, relative
values or related listings are included in CPT®. The AMA assumes no liability for the
data contained herein.
Karen Scott is the owner of Karen Scott Seminars and Consulting, through which
she teaches seminars on coding, reimbursement, medical terminology, and
management. She has been an educator for many years, and has two AHIMA
publications: Coding and Reimbursement for Hospital Inpatient Services and
Medical Coding for the Non-Coder: Understanding Coding and Reimbursement in
Today’s Healthcare Society.
Disclaimer ..................................................................................................................... i
Faculty ......................................................................................................................... ii
Objectives of this Seminar............................................................................................... 1
Change Statistics............................................................................................................ 1
Resequencing ................................................................................................................ 2
Resequenced Codes ....................................................................................................... 2
Evaluation and Management ........................................................................................... 3
Consultation Codes: CPT vs. CMS .................................................................................... 3
Evaluation and Management ........................................................................................... 4
Concurrent Care ............................................................................................................. 4
Transfer of Care ............................................................................................................. 5
Transfer of care vs. Consultation ..................................................................................... 5
Consultation ............................................................................................................... 6-7
Nursing Facility Care ....................................................................................................... 8
Prolonged Services ...................................................................................................... 8-9
Anesthesia and (Humerus) .............................................................................................10
Fine Needle Aspiration ...................................................................................................10
Adjacent Tissue Transfer (ATT) ......................................................................................11
Integumentary ..............................................................................................................11
Other Flaps and Grafts...................................................................................................12
Destruction ...................................................................................................................12
Localization Clip ............................................................................................................13
Musculoskeletal ........................................................................................................ 13-14
Musculoskeletal Additions and Revisions ..................................................................... 15-20
Musculoskeletal Revisions ......................................................................................... 20-24
Respiratory ...................................................................................................................25
Respiratory Revisions ....................................................................................................25
Bronchoscopy Revisions .................................................................................................26
Respiratory Revisions ............................................................................................... 26-27
Bronchoscopy Additions .................................................................................................28
Chest Tube ...................................................................................................................28
Fibrinolysis ...................................................................................................................29
Cardiovascular Revisions ................................................................................................29
Cardiovascular Additions ................................................................................................30
Ventricular Assist Device Additions ..................................................................................30
Arteriovenous Shunt for Dialysis .....................................................................................31
Cardiovascular Revisions ................................................................................................31
Ligation of Perforator Veins ............................................................................................32
Laparoscopy Additions ...................................................................................................32
Digestive Additions ........................................................................................................33
Digestive Revisions........................................................................................................34
(CONTINUED)
AHIMA 2009 Audio Seminar Series
Table of Contents
Hemorrhoidectomy Revisions .................................................................................... 34-35
Digestive Revisions........................................................................................................35
Urodynamics Additions and Revisions..............................................................................36
Urinary Revisions and Additions ......................................................................................36
Male Genital System Revisions........................................................................................37
Female Genital System ..................................................................................................37
Maternity Care and Delivery Revisions .............................................................................38
Nervous System Additions ..............................................................................................38
Paravertebal Spinal Nerves and Branches Additions ..........................................................39
Other Surgery Modifications ...........................................................................................39
Radiology .....................................................................................................................40
New Codes GI Tract ......................................................................................................41
Heart .......................................................................................................................41
New Cardiac MRI Codes .................................................................................................42
Two More Cardiac MRI Codes .........................................................................................42
Vascular Procedures ......................................................................................................43
Radiation Oncology .......................................................................................................43
Nuclear Medicine ...........................................................................................................44
Path/Lab ......................................................................................................................44
Pathology and Laboratory ......................................................................................... 45-46
Organ Panels ................................................................................................................46
More Chemistry.............................................................................................................47
Immunology New Codes ................................................................................................47
Tissue Typing ...............................................................................................................48
Microbiology .................................................................................................................48
Micro New Codes ..........................................................................................................49
Guidance for 87260-87999 .............................................................................................49
New Codes ...................................................................................................................50
Two More New Lab Codes..............................................................................................50
Medicine Section ...........................................................................................................51
Vaccines .......................................................................................................................52
ENT Services ................................................................................................................52
Audiologic Function Tests New Codes .............................................................................53
Implantable and Wearable Cardiac Device Evaluations......................................................53
New Definitions .............................................................................................................54
Echocardiography..........................................................................................................54
Noninvasive Physiologic Studies ......................................................................................55
Pulmonary ....................................................................................................................55
Nerve Conduction Tests .................................................................................................56
Hydration, Injections/Infusions .......................................................................................56
Facility Hierarchy...........................................................................................................57
Category II Codes .................................................................................................... 57-58
(CONTINUED)
AHIMA 2009 Audio Seminar Series
Table of Contents
New Patient Management Codes ....................................................................................58
Patient History ..............................................................................................................59
Physical Exam ...............................................................................................................59
Screening/Diagnostic Results..........................................................................................60
More Screening/Diagnostic Results ............................................................................ 60-61
Therapeutic and Preventive Interventions........................................................................61
Category III Codes ........................................................................................................62
References ..................................................................................................................62
Appendix ..................................................................................................................66
CE Certificate Instructions
Change Statistics
Resequencing
Resequenced Codes
Musculoskeletal System
21552 25071 27059 28039 46946
21554 25073 27329 28041 46947
Digestive Urinary
23071 26111 27337 System System
Concurrent Care
Transfer of Care
Consultation
A consultation is an:
• “E/M service provided by a physician at the
request of another physician or appropriate
source (not the patient and/or family) to
• either recommend care for a specific
condition or problem or
• to determine whether to accept
responsibility for ongoing management of
the
• patient’s entire care or for the care of a
specific condition or problem”
(CPT, p 16-19) 11
Consultation
Consultation
Instruction
• Do not use both an inpatient and outpatient
consult for services related to the same stay
• CPT, p 18-19
13
Consultation
Instructions
• Use subsequent codes 99231 - 99233 or
99307 - 99310 for:
• Subsequent services during same admission
• Transfer of care services
14
Language change:
• Initial: 99304 - 99306
• Subsequent: 99307 - 99310
• Physician’s typically spend xx minutes
“at the bedside and on the patient’s
facility floor or unit”
• Revised from “with the patient and/or family
or caregiver”
15
Prolonged Services
16
Prolonged Services
Prolonged Services
19
20
Guidelines expanded
21
Integumentary
23
Destruction
24
Localization Clip
25
Musculoskeletal
26
Musculoskeletal
Many revisions
• Introductory guidelines to:
• Excision of:
– subcutaneous soft tissue tumors and
– fascial or subfascial soft tissue tumors and
Musculoskeletal
28
Musculoskeletal
Additions and Revisions
2 cm or
• 21012 • 21014 • 21016
greater
29
Musculoskeletal
Additions and Revisions
Excision tumor, soft tissue of
Neck or anterior thorax
Radical Resection
Sub-Q Subfascial of Tumor
(eg, malignant neoplasm)
< 3 cm 21555
3 cm or
• #21552
greater
< 5 cm 21556 21557
5 cm or
• #21554 • 21558
greater
30
Musculoskeletal
Additions and Revisions
Excision tumor, soft tissue of
Back or flank
Radical Resection
Sub-Q Subfascial of Tumor
(eg, malignant neoplasm)
< 3 cm 21930
3 cm or
• 21931
greater
< 5 cm • 21932 21935
5 cm or
• 21933 • 21936
greater
31
Musculoskeletal
Additions and Revisions
Excision tumor, soft tissue of
Abdominal wall
Radical Resection
Sub-Q Subfascial of Tumor
(eg, malignant neoplasm)
< 3 cm • 22902
3 cm or
• 22903
greater
< 5 cm 22900 • 22904
5 cm or
• 22901 • 22905
greater
32
Musculoskeletal
Additions and Revisions
Excision tumor, soft tissue of
Shoulder area
Radical Resection
Sub-Q Subfascial of Tumor
(eg, malignant neoplasm)
< 3 cm 23075
3 cm or
• #23071
greater
< 5 cm 23076 23077
5 cm or
• #23073 • 23078
greater
33
Musculoskeletal
Additions and Revisions
Excision tumor, soft tissue of
Upper arm or elbow
Radical Resection
Sub-Q Subfascial of Tumor
(eg, malignant neoplasm)
< 3 cm 24075
3 cm or
• #24071
greater
< 5 cm 24076 24077
5 cm or
• #24073 • 24079
greater
34
Musculoskeletal
Additions and Revisions
35
Musculoskeletal
Additions and Revisions
Excision, tumor or vascular malformation, soft tissue of
Hand or finger
Radical Resection
Sub-Q Subfascial of Tumor
(eg, malignant neoplasm)
Musculoskeletal
Additions and Revisions
Excision tumor, soft tissue of
Pelvis and hip area
Radical Resection
Sub-Q Subfascial of Tumor
(eg, malignant neoplasm)
< 3 cm 27047
3 cm or
• #27043
greater
< 5 cm 27048 27049
5 cm or
• #27045 • #27059
greater
37
Musculoskeletal
Additions and Revisions
Excision tumor, soft tissue of
Thigh or knee area
Radical Resection
Sub-Q Subfascial of Tumor
(eg, malignant neoplasm)
< 3 cm 27327
3 cm or
• #27337
greater
< 5 cm 27328 #27329
5 cm or
• #27339 • 27364
greater
38
Musculoskeletal
Additions and Revisions
Excision tumor, soft tissue of
Leg or ankle area
Radical Resection
Sub-Q Subfascial of Tumor
(eg, malignant neoplasm)
< 3 cm 27618
3 cm or
• #27632
greater
< 5 cm 27619 27615
5 cm or
• #27634 • 27616
greater
39
Musculoskeletal Revisions
Musculoskeletal Revisions
CODE 2009 CPT 2010 CPT
Excision, tumor, soft tissue of
Excision, abdominal wall tumor,
22900 subfascial (eg, desmoid)
abdominal wall, subfascial (eg,
intramuscular); less than 5 cm
Excision, tumor, soft tissue of
Excision, soft tissue tumor,
23075 shoulder area; subcutaneous
shoulder area, subcutaneous; less
than 3 cm
Excision, soft tissue tumor, Excision, tumor, soft tissue of
23076 shoulder area; deep, subfascial or shoulder area, subfascial (eg,
intramuscular intramuscular); less than 5 cm
Radical resection of tumor (eg, Radical resection of tumor (eg,
23077 malignant neoplasm), soft tissue of malignant neoplasm), soft tissue of
shoulder area shoulder area; less than 5 cm
23200 Radical resection for tumor; clavicle Radical resection of tumor; clavicle
23210 Radical resection for tumor; scapula Radical resection of tumor; scapula
Musculoskeletal Revisions
Excision, tumor, soft tissue of upper Excision, tumor, soft tissue of upper
24076 arm or elbow area; deep (subfascial arm or elbow area, subfascial (eg,
or intramuscular) intramuscular); less than 5 cm
42
Musculoskeletal Revisions
Excision, tumor, soft tissue of forearm and/or Excision, tumor, soft tissue of forearm and or
25076 wrist area; deep (subfascial or wrist area, subfascial (eg, intramuscular); less
intramuscular) than 3 cm
Radical resection of tumor (eg, malignant Radical resection of tumor (eg, malignant
25077 neoplasm), soft tissue of forearm and/or neoplasm), soft tissue of forearm and/or wrist
wrist area area; less than 3 cm
25170 Radical resection for tumor, radius or ulna Radical resection of tumor, radius or ulna
Radical resection of tumor (eg, malignant Radical resection of tumor (eg, malignant
26117 neoplasm), soft tissue of hand or finger neoplasm), soft tissue of hand or finger; less
than 3 cm
43
Musculoskeletal Revisions
Musculoskeletal Revisions
Excision, tumor, thigh or knee area; Excision, tumor, soft tissue of thigh or knee
27327 subcutaneous area, subcutaneous; less than 3 cm
Excision, tumor, thigh or knee area; deep, Excision, tumor, soft tissue of thigh or knee
27328 subfascial, or intramuscular
area, subfascial (eg, intramuscular); less
than 5 cm
Radical resection of tumor (eg, malignant Radical resection of tumor (eg, malignant
27329 neoplasm), soft tissue of thigh or knee area
neoplasm), soft tissue of thigh or knee area;
less than 5 cm
45
Musculoskeletal Revisions
46
Musculoskeletal Revisions
27645 Radical resection of tumor, bone; tibia Radical resection of tumor; tibia
47
Musculoskeletal Revisions
48
Respiratory
49
Respiratory Revisions
Bronchoscopy Revisions
51
Respiratory Revisions
52
Respiratory Revisions
53
Respiratory Revisions
CODE 2009 CPT 2010 CPT
Bronchoscopy, rigid or flexible,
Bronchoscopy (rigid or flexible); including fluoroscopic guidance,
when performed;
with destruction of tumor or relief of with destruction of tumor or relief of
stenosis by any method other than stenosis by any method other than
31641 [excision] (eg, laser therapy, excision (eg, laser therapy,
cryotherapy) cryotherapy)
with placement of catheter(s) for
31643 intracavitary radioelement same
application
with therapeutic aspiration of
31645 tracheobronchial tree, initial (eg, same
drainage of lung abscess)
with therapeutic aspiration of
31646 tracheobronchial tree, subsequent
same
Bronchoscopy Additions
Chest Tube
New codes:
• 32552: Removal of indwelling tunneled
pleural catheter with cuff
• 32553: Placement of interstitial
device(s) for radiation therapy guidance
(eg-fiducial markers, dosimeter),
percutaneous, intra-thoracic, single or
multiple
• Instructional notes added
56
Fibrinolysis
Cardiovascular Revisions
Insertion of a transvenous
electrode; single chamber (one Insertion of a single transvenous
33216 electrode) permanent pacemaker electrode, permanent pacemaker or
or single chamber pacing cardioverter-defibrillator
cardioverter-defibrillator
Insertion of a transvenous
electrode; dual chamber (two Insertion of 2 transvenous electrodes
33217 electrodes) permanent pacemaker permanent pacemaker or cardioverter-
or dual chamber pacing defibrillator
cardioverter-defibrillator
58
Cardiovascular Additions
Cardiovascular Revisions
62
Ligation of perforator …
• 37760: veins, subfascial, radical (Linton
type), including skin graft, when
performed, open, 1 leg (revised code for
unilateral)
• 37761: vein(s), open including
ultrasound guidance when performed, 1
leg (new code)
• Instructional notes present to apply
modifier 50 for bilateral or use 37500 if
endoscopic 63
Laparoscopy Additions
64
Digestive Additions
Digestive Additions
Digestive Revisions
Hemorrhoidectomy Revisions
CODE 2009 CPT 2010 CPT
Hemorrhoidectomy, external, Hemorrhoidectomy, external, 2 or
46250 complete more columns/groups
Hemorrhoidectomy Revisions
Digestive Revisions
70
Urodynamics
Additions and Revisions
“Urodynamics (51725 – 51792) lists procedures
that may be used separately or in varied
combinations”
Complex cystometrogram (ie, calibrated
electronic equipment):
• 51726 – (revised - now a parent code to the following
new codes)
• 51727: with urethral pressure profile studies (ie-
urethral closure pressure profile), any technique
• 51728: with voiding pressure studies (ie-bladder
voiding pressure), any technique
• 51729: with voiding pressure studies (ie-bladder
voiding pressure) and urethral pressure profile studies
(ie-urethral closure pressure profile), any technique
71
72
73
New code:
• 57426: Revision (including removal) of
prosthetic vaginal graft, laparoscopic
approach
Revisions of cross reference notes to
include reference to this code
74
75
76
78
Radiology
Radiology
CODE 2009 CPT 2010 CPT
Radiological supervision and
Radiological supervision and
interpretation, percutaneous
interpretation, percutaneous
vertebroplasty or vertebral augmentation,
vertebroplasty or vertebral
72291 augmentation including cavity
or sacral augmentation (sacroplasty),
including cavity creation, per vertebral
creation, per vertebral body; under
body or sacrum; under fluoroscopic
fluoroscopic guidance
guidance
Radiological supervision and Radiological supervision and
interpretation, percutaneous interpretation, percutaneous
vertebroplasty or vertebral vertebroplasty or vertebral augmentation,
72292 augmentation including cavity or sacral augmentation (sacroplasty),
creation, per vertebral body; under including cavity creation, per vertebral
CT guidance body or sacrum; under CT guidance
Fluoroscopic guidance and
localization of needle or catheter tip Fluoroscopic guidance and localization of
for spine or paraspinous diagnostic or needle or catheter tip for spine or
therapeutic injection procedures paraspinous diagnostic or therapeutic
77003 (epidural, transforaminal epidural, injection procedures (epidural,
subarachnoid, paravertebral facet transforaminal epidural, subarachnoid, or
joint, pravertebral facet joint nerve, sacroiliac joint), including neurolytic
or sacroiliac joint), including agent destruction
neurolytic agent destruction
80
Heart
Vascular Procedures
75791
Angiography
• Arteriovenous shunt
• Dialysis patient fistula or graft
• Complete eval of dialysis access
• Fluoro, image doc and report
– Injections of contrast, all necessary imaging from arterial
anastomosis, adjacent artery through entire venous outflow
including inferior or superior vena cava
• And Rad S&I
• Can code catheter intro
• Must be done through already existing access
not direct puncture of shunt
• See surgery code for shunt procedure
85
Radiation Oncology
Nuclear Medicine
Path/Lab
Table of Drugs/Appropriate
Qualitative Screening, Confirmatory
and Quantitative Codes
Just before Guidelines
88
Obstetric panel THIS PANEL MUST Obstetric panel THIS PANEL MUST
INCLUDE THE FOLLOWING: Syphilis INCLUDE THE FOLLOWING: Syphilis test
80055 test; qualitative (eg, VDRL, RPR, non-treponemal antibody; qualitative
ART) (86592) (eg, VDRL, RPR, ART) (86592)
Gammaglobulin (immunoglobulin);
Gammaglobulin; immunoglobulin
82787 subclasses, (IgG1, 2, 3, or 4), each
immunoglobulin subclasses, (eg, IgG1,
2, 3, or 4), each
89
83986 pH, body fluid, except [blood] pH, body fluid, not otherwise specified
90
Special stains (List separately in addition Special stains; Group I for microorganisms
to code for primary service); Group I for (eg, Gridley, acid fast, methenamine silver),
88312 microorganisms (eg, Gridley, acid fast, including interpretation and report, each
methenamine silver), each
Organ Panels
New instructions
• Don’t report two or more panel codes that
include any of same constituent tests
performed from same patient collection
• If group tests overlaps panels, report the
panel incorporates greater number of tests
to fulfill code definition
• Report remainder of tests using individual
test codes
• Example: don’t use 80047 and 80053
together
92
More Chemistry
93
86305
• Human epididymis protein 4 (HE4)
86352
• Cellular function assay involving
stimulation (mitogen or antigen) and
detection of biomarker (such as ATP)
86780
• Treponema pallidum
94
Tissue Typing
New Codes
86825 Human leukocyte antigen
crossmatch, noncytotoxic, first serum
sample or dilution
86826 each additional serum
sample/sample dilution
• Add on code
95
Microbiology
Presumptive id of microorganisms
defined
• “id by colony morphology, growth on
selective media, gram stains, or up to
three tests”
• Definitive id “id to the genus or species
level requires additional tests”
Notes to show which codes can be
used together
96
87150
• Id by nucleic acid probe, amplified probe
technique, per culture/isolate, each
organism probed
87153
• Id by nucleic acid sequencing method
each isolate
97
New Codes
In Vivo Procedures
88738
• Hemoglobin (Hgb) quantitative,
transcutaneous
89398
• Unlisted reproductive medicine lab
procedure
100
Medicine Section
CODE 2009 CPT 2010 CPT
Respiratory syncytial virus immune Respiratory syncytial virus monoclonal antibody,
90378 globulin (RSV-IgM), for intramuscular use, recombinant, for intramuscular use, 50 mg, each
50 mg, each
Medicine
New Heading
• Immune globulins, serum or recombinant
products
• Not new codes
• Instructions on usage of codes
• Coded in conjunction with admin codes
• Do not use mod 51
• 90379 deleted
102
Vaccines
103
ENT Services
105
106
New Definitions
Echocardiography
109
Pulmonary
Measurement
• 94011 spirometric forced expiratory
flows in infant/child to two yrs.
• 94012 spirometric forced expiratory
flows, before and after bronchodialator,
infant/child to age two
• 94013 lung volumes infant/child to age
two
• Include functional residual capacity
• Forced vital capacity
• Expiratory reserve volume
110
Hydration, Injections/Infusions
112
Facility Hierarchy
Chemo
Therapeutic services
Hydration
Infusions primary to pushes
Pushes primary to hydration
Hierarchy rules supersedes
instructions in the book regarding add
on code usage
113
Category II Codes
CODE 2009 CPT 2010 CPT
Planned chemotherapy regimen,
Planned chemotherapy regimen, including
including at a minimum: drug(s)
at a minimum: drug(s) prescribed, dose, and
0519F prescribed, dose, and duration,
duration, documented prior to initiation of a
documented prior to course of
new treatment regimen (ONC)1
treatment (ONC)1
Normal tissue dose constraints
Radiation dose limits to normal tissues
established within 5 treatment days
established prior to the initiation of a course
0520F from the initiation of a course of 3D
of 3D conformal radiation for a minimum of
conformal radiation for a minimum of
two tissues/organs (ONC)1
one tissue/organ (ONC)1
Plan of care to address pain Plan of care to address pain documented
0521F documented (ONC)1 (COA)2 (ONC)1
One of the following diagnostic
1 of the following diagnostic imaging
imaging studies ordered: chest X-ray,
3319F CT, ultrasound, MRI, PET, or nuclear
studies ordered: chest X-ray, CT, ultrasound,
MRI, PET, or nuclear medicine scans (ML)5
medicine scans (ML)5
Oral antiplatelet therapy prescribed
(eg, aspirin, clopidogrel/Plavix, or Oral antiplatelet therapy prescribed (CAD)1
4011F combination of aspirin and
dipyridamole/Aggrenox) (CAD)1
Patient education regarding risk of
Patient counseled about risks of alcohol use
4158F alcohol consumption performed
(HEP-C)1
(HEP-C)1 114
Category II Codes
CODE 2009 CPT 2010 CPT
Adjuvant chemotherapy prescribed or Adjuvant chemotherapy referred, prescribed or
4180F previously received for Stage IIIA previously received for Stage IIIA through Stage IIIC
through Stage IIIC colon cancer (ONC)1 colon cancer (ONC)1
External beam radiotherapy to prostate External beam radiotherapy as primary therapy to
4200F only (PRCA)1 prostate with or without nodal radiation (PRCA)1
External beam radiotherapy with or without nodal
External beam radiotherapy for prostate
irradiation as adjuvant or salvage therapy for prostate
4201F cancer to region(s) other than prostate
cancer patient (PRCA)1
only (PRCA)1
0528F-0575F
• Recommended follow up repeat
colonoscopy
• At least 10 years documented
• 3 or more years since patient last
colonoscopy
• Dyspnea mgmt plan of care
• Glucocorticoid mgmt plan
• HIV RNA control plan of care
116
Patient History
New codes 1150F-1220F
• patient high risk for death within 1 year
• patient is not at high risk of death within 1 year
• Advanced disease diagnosis
• Goals: comfort
• Advanced disease diagnosis
• Goals don’t prioritize comfort
• Advance care plan present in health record
• Discussion of advance care plan documented
• Medication list documented
• Review of medications
• Functional status assessment
• Thromboembolic risk factors documented
• Screening for depression 117
Physical Exam
2050F
Documentation of wound
• Size
• Nature
• Drainage amount
Prior to debridement
118
Screening/Diagnostic Results
3016F
• Screening for alcohol use/abuse
3018F
• Colonoscopy documentation
• Risk assessment, depth of insertion
• Prep quality
• Findings: details of polyps found
• Location, size, morphology
• Recommendations
3250F
• Specimen site
• More than just location of primary tumor
119
References
124
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