2010 Procedure Code Updates

2010 Procedure and Service
Code Updates
Audio Seminar/Webinar
December 3, 2009
Practical Tools for Seminar Learning

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AHIMA 2009 Audio Seminar Series • http://campus.ahima.org/audio i

American Health Information Management Association • 233 N. Michigan Ave., 21st Floor, Chicago, Illinois
Faculty
Margi Brown, RHIA, CCS, CCS-P, CPC, CCDS
Margi Brown is director at Precyse Solutions, specializing in clinical documentation

improvement, audits, education, and RAC services. She is a frequent speaker on
coding, documentation, and compliance topics. Ms. Brown has over 25 years of
experience in the HIM field covering hospital outpatient, inpatient, surgical
centers, physician office, clinic, law firms, consulting, and third-party carrier
areas.
Karen Scott, MEd, RHIA, CCS-P, CPC
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.
AHIMA 2009 Audio Seminar Series ii

Table of Contents
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)
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
Thank You ..................................................................................................................63

Audio Seminar Discussion ..............................................................................................63
Become an AHIMA Member Today! .................................................................................64
Audio Seminar Information Online ..................................................................................64
Upcoming Audio Seminars ............................................................................................65
Thank You/Evaluation Form and CE Certificate (Web Address) ..........................................65
Appendix ..................................................................................................................66
CE Certificate Instructions

2010 Procedure and Service Code Updates Notes/Comments/Questions
Objectives of this Seminar
Identify the additions and changes to

CY10 CPT that impact
physician/hospital reporting
Review new techniques used in
procedures and surgeries
Summarize changes by chapter
Page numbers provided will follow CPT
2010 – Professional Edition
1
Change Statistics
Per the AMA, the CPT code changes for

2010 includes:
• 225 new codes
• 155 revised codes
• 77 deleted codes
• Refer to Appendix B – summary of
additions, deletions, and revisions
AHIMA 2009 Audio Seminar Series 1

Resequencing
The “#” symbol will precede the code

References are inserted where the
code would have been numerically
which directs to the current
subsection of the resequenced
location
The instructions are more detailed
Refer to (new) Appendix N
3
Resequenced Codes
Musculoskeletal System
21552 25071 27059 28039 46946
21554 25073 27329 28041 46947
Digestive Urinary
23071 26111 27337 System System
23073 26113 27339 46220 51797

Pathology
24071 27043 27632 46320 and
Laboratory
24073 27045 27634 46945 82652

4

Evaluation and Management
Revisions to the guidelines

• “Extensive” in the consultations
• “Editorial” to the nursing facility services
• “Additional” to the prolonged services
and direct (face-to-face) patient contact
subsection
Consultation Codes: CPT vs. CMS
As stated in the PFS final rule, Medicare

will not cover consultation codes
• Inpatient and office/outpatient
• Except for telehealth consultation G-codes
Instead, use the E/M appropriate codes
Modifier - should be applied to the
“admitting” physician’s E/M initial code -
guidelines will be published

Evaluation and Management
Changes in the guidelines:

• Concurrent care
• Unit/floor time
• Instructions for selecting a E/M level
• Category and subcategory
– Refer to subsection “opener” in CPT, p 1-3
• Patient admitted from the office/outpatient
setting – see notes for initial hospital
inpatient care or nursing facility
7
Concurrent Care
“Concurrent care is the provision of

similar services to the same patient by
more than one physician on the same
day”
“No special reporting is required”

Transfer of Care
“Transfer of care is the process whereby the

physician who is proving management for some
or all of a patient’s problems relinquishes this
responsibility to another physician who
explicitly agrees to accept this responsibility
and who from the initial encounter is not
providing consultative services.
The physician transferring care is then no
longer providing care for these problems
though he/she may continue providing care for
other conditions when appropriate”.
9
Transfer of Care vs. Consultation
“Consultation codes should not be

reported by the physician who has
agreed to accept transfer of care
before an initial evaluation
But are appropriate to report if the
decision to accept transfer of care
cannot be made
Until after the initial consultation
evaluation, regardless of the service”
(CPT, p 4)
10

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
Documentation requirements in the

medical record
1. Request – either written or verbal
• By either the consulting or requesting
physician or appropriate source
2. The consultant’s opinion and any
services ordered or performed
3. Communication back (written) to the
requesting physician or appropriate
source
12

Consultation
Inpatient consultation code range

• 99251 - 99255
Physician consultations provided to
• Hospital inpatients, residents of nursing
facilities, or in a partial hospital setting
• ONE per admission
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
• See concurrent care and transfer of care
14

Nursing Facility Care
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
Prolonged Physician Service without

direct (face-to-face) patient contact
• “before and/or after direct (face-to-face)
patient care;
• 1st hour = 99358
– Use only once per date
– Regardless of the place of service
– Add-on status (+) removed
• Each additional 30 minutes = + 99359
16

Prolonged Services
Prolonged Physician Service without

direct (face-to-face) patient contact
• “Beyond the usual non face-to-face
component of physician service time”
• Report using the total duration of non
face-to-face time spent, even if not
continuous, on that date
• A typical time for the primary service
need not be established within CPT code
set
17
Prolonged Services
Prolonged Physician Service without direct

(face-to-face) patient contact
• Report in relation to other physician services
including E/M services at any level
• May report on a different date than the primary
service to which it is related
• Extensive medical record review
• Must relate to a service or patient where direct (face-to-
face) care has occurred or will occur and relate to ongoing
patient management
• Instruction to not report with time spent with other non
face-to-face services that have more specific codes and an
no upper time limit
• May report when related to other non face-to-face service
codes that have a published max time (ex: telephone
services)
18

Anesthesia and (Humerus)
Due to low reporting volume, the code

(set) for radical resection of bone
tumor proximal humerus was deleted
• 23221 – with autograft and
• 23222 – with prosthetic replacement
• 01632 – anesthesia
• Cross reference notes present
– (use 01630, 01638)
19
Fine Needle Aspiration
A cross reference note following

10022 – (FNA with imaging guidance)
was revised to use 19295
• for percutaneous placement of a
localization clip during breast biopsy
20

Adjacent Tissue Transfer (ATT)
New codes for adjacent tissue transfer

(ATT) or rearrangement, any area;
• 14301 – Defect 30.1 sq cm to 60.0 sq cm
• + 14302 – each additional 30.0 sq cm or
part thereof
• List separately with 14301
Guidelines expanded
21
Integumentary
The instruction guideline for closure of

defects with benign and malignant lesions
now includes the new codes 14301-2 (ATT)
Reminder to code separately:
• Intermediate or complex closure
• Reconstruction
Reminder that lesion excision is included in

the adjacent tissue transfer (ATT) codes
14000 – 14302
Refer to closure guidelines in CPT, p 64
22

Other Flaps and Grafts
Cross reference notes for ATT flaps

expanded to include the new codes
New introductory guidelines added to
define other flaps and grafts such as:
• 15740 – Cutaneous flap – island pedicle
• 15750 – Neurovascular pedicle
23
Destruction
Instruction cross reference note:

“for laser treatment for inflammatory
skin disease, see 96920 – 22”
24

Localization Clip
Cross reference note was revised to

include the clip placement during the
FNA with imaging guidance – 10022
Code + 19295
• Image guided placement, metallic
localization clip, percutaneous, during
breast biopsy/aspiration
25
Musculoskeletal
Biggest section of changes

• 41 new codes
• 53 revised codes
• 7 deleted codes
• New parenthetical and instructional
notes
26

Musculoskeletal
Many revisions
• Introductory guidelines to:
• Excision of:
– subcutaneous soft tissue tumors and
– fascial or subfascial soft tissue tumors and
• Radical resection of:

– soft tissue tumors
– bone tumors
• New codes to complete different

anatomic sites
27
Musculoskeletal
Reasons for changes due to the

“confusion” of:
• Malignant skin tumors vs. radical soft
tissue tumors
• Radical excisions vs. debridements vs.
benign tumors
28

Musculoskeletal
Additions and Revisions
Excision tumor, soft tissue of

Face or scalp
Radical Resection
Sub-Q Subfascial of Tumor
(eg, malignant neoplasm)
< 2 cm • 21011 • 21013 21015

(revision)
2 cm or
• 21012 • 21014 • 21016
greater
29
Musculoskeletal
Neck or anterior thorax
Radical Resection
< 3 cm 21555
3 cm or
• #21552
greater
< 5 cm 21556 21557
5 cm or
• #21554 • 21558
greater
30

Musculoskeletal
Back or flank
Radical Resection
< 3 cm 21930
3 cm or
• 21931
greater
< 5 cm • 21932 21935
5 cm or
• 21933 • 21936
greater
31
Musculoskeletal
Abdominal wall
Radical Resection
< 3 cm • 22902
3 cm or
• 22903
greater
< 5 cm 22900 • 22904
5 cm or
• 22901 • 22905
greater
32

Musculoskeletal
Shoulder area
Radical Resection
< 3 cm 23075
3 cm or
• #23071
greater
< 5 cm 23076 23077
5 cm or
• #23073 • 23078
greater
33
Musculoskeletal
Upper arm or elbow
Radical Resection
< 3 cm 24075
3 cm or
• #24071
greater
< 5 cm 24076 24077
5 cm or
• #24073 • 24079
greater
34

Musculoskeletal

Forearm and/or wrist area
Radical Resection
< 3 cm 25075 25076 25077

3 cm or
• #25071 • #25073 • 25078
greater
35
Musculoskeletal
Excision, tumor or vascular malformation, soft tissue of
Hand or finger
Radical Resection
< 1.15 cm 26115 26116

1.15 cm
• #26111 • #26113
or greater
< 3 cm 26117
3 cm or
• 26118
greater
36

Musculoskeletal
Pelvis and hip area
Radical Resection
< 3 cm 27047
3 cm or
• #27043
greater
< 5 cm 27048 27049
5 cm or
• #27045 • #27059
greater
37
Musculoskeletal
Thigh or knee area
Radical Resection
< 3 cm 27327
3 cm or
• #27337
greater
< 5 cm 27328 #27329
5 cm or
• #27339 • 27364
greater
38

Musculoskeletal
Leg or ankle area
Radical Resection
< 3 cm 27618
3 cm or
• #27632
greater
< 5 cm 27619 27615
5 cm or
• #27634 • 27616
greater
39
Musculoskeletal Revisions
CODE 2009 CPT 2010 CPT

Radical resection of tumor (eg, Radical resection of tumor (eg, malignant
21015 malignant neoplasm), soft tissue neoplasm), soft tissue of face or scalp;
of face or scalp less than 2 cm
Excision, tumor, soft tissue of neck or
Excision tumor, soft tissue of neck
21555 or thorax; subcutaneous
anterior thorax, subcutaneous; less than
3 cm
Excision tumor, soft tissue of neck Excision, tumor, soft tissue of neck or
21556 or thorax; deep, subfascial, anterior thorax, subfascial (eg,
intramuscular intramuscular); less than 5 cm
Radical resection of tumor (eg, Radical resection of tumor (eg, malignant
21557 malignant neoplasm), soft tissue neoplasm), soft tissue of neck or anterior
of neck or thorax thorax; less than 5 cm
Excision, tumor, soft tissue of Excision, tumor, soft tissue of back or
21930 back or flank flank, subcutaneous; less than 3 cm
Radical resection of tumor (eg,
Radical resection of tumor (eg, malignant
malignant neoplasm), soft tissue
21935 of back or flank
neoplasm), soft tissue of back or flank;
less than 5 cm
40

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
Radical resection of bone tumor, Radical resection of tumor, proximal

23220 proximal humerus humerus
41

Excision, tumor, soft tissue of upper
Excision, tumor, soft tissue of upper
24075 arm or elbow area; subcutaneous
arm or elbow area, subcutaneous; less
than 3 cm
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

malignant neoplasm), soft tissue of
24077 malignant neoplasm), soft tissue of
upper arm or elbow area; less than 5
upper arm or elbow area
cm
Radical resection for tumor, shaft or Radical resection of tumor, shaft or

24150 distal humerus; distal humerus
Radical resection of tumor, radial head

Radical resection for tumor, radial
24152 head or neck;
or neck
42


Excision, tumor, soft tissue of forearm and/or Excision, tumor, soft tissue of forearm and/or
25075 wrist area; subcutaneous wrist area, subcutaneous; less than 3 cm
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
Excision, tumor or vascular malformation, soft

Excision, tumor or vascular malformation,
26115 soft tissue of hand or finger; subcutaneous
tissue of hand or fingers, subcutaneous; less
than 1.5 cm
Excision, tumor, soft tissue, or vascular
Excision, tumor or vascular malformation,
malformation, of hand or finger, subfascial
26116 soft tissue of hand or finger; deep (subfascial
(eg, intramuscular); less than 1.5 cm
or intramuscular)
26117 neoplasm), soft tissue of hand or finger neoplasm), soft tissue of hand or finger; less
than 3 cm
43

Radical resection, metacarpal; (eg, Radical resection of tumor,
26250 tumor) metacarpal
Radical resection, proximal or middle Radical resection of tumor, proximal

26260 phalanx of finger (eg, tumor) or middle phalanx of finger
Radical resection, distal phalanx of Radical resection of tumor, distal

26262 finger (eg, tumor) phalanx of finger
Excision, tumor, soft tissue of pelvis

Excision, tumor, pelvis and hip area;
27047 subcutaneous tissue
and hip area, subcutaneous; less
than 3 cm
Excision, tumor, soft tissue of pelvis

Excision, tumor, pelvis and hip area;
27048 deep, subfascial, intramuscular
and hip area, subfascial (eg,
Radical resection of tumor, soft tissue Radical resection of tumor (eg,

27049 of pelvis and hip area
malignant neoplasm), soft tissue of
pelvis and hip area; less than 5 cm
44


Radical resection of tumor or infection; wing of
Radical resection of tumor; wing of ilium, 1
27075 ilium, one pubic or ischial ramus or symphysis
pubic or ischial ramus or symphysis pubis
pubis
Radical resection of tumor or infection; ilium, Radical resection of tumor; ilium, including
27076 including acetabulum, both pubic rami, or acetabulum, both pubic rami, or ischium
ischium and acetabulum and acetabulum
Radical resection of tumor or infection; Radical resection of tumor; innominate

27077 innominate bone, total bone, total
Radical resection of tumor or infection; ischial Radical resection of tumor; ischial

27078 tuberosity and greater trochanter of femur tuberosity or greater trochanter of femur
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
27329 neoplasm), soft tissue of thigh or knee area
neoplasm), soft tissue of thigh or knee area;
less than 5 cm
45

Radical resection of tumor, bone, femur Radical resection of tumor, femur or
27365 or knee knee
27615 malignant neoplasm), soft tissue of leg malignant neoplasm), soft tissue of
or ankle area leg or ankle area; less than 5 cm
Excision, tumor, soft tissue of leg or
Excision, tumor, leg or ankle area;
27618 subcutaneous tissue
ankle area, subcutaneous; less than
3 cm
Excision, tumor, soft tissue of leg or
Excision, tumor, leg or ankle area; deep,
27619 subfascial or intramuscular
ankle area, subfascial (eg,
46


Partial excision (craterization, Partial excision (craterization,
saucerization, or diaphysectomy) bone, saucerization, or
27640 (eg, for osteomyelitis or exostosis); diaphysectomy) bone (eg,
tibia osteomyelitis); tibia
Partial excision (craterization,
saucerization, or diaphysectomy) bone, Partial excision (craterization,
27641 (eg, for osteomyelitis or exostosis);
saucerization, or diaphysectomy)
bone (eg, osteomyelitis); fibula
fibula
27645 Radical resection of tumor, bone; tibia Radical resection of tumor; tibia
Radical resection of tumor;

27646 Radical resection of tumor, bone; fibula
fibula
Radical resection of tumor, bone; talus Radical resection of tumor;

27647 or calcaneus talus or calcaneus
47

Excision, tumor, foot; subcutaneous Excision, tumor, soft tissue of foot or
28043 tissue toe, subcutaneous; less than 1.5 cm
Excision, tumor, soft tissue of foot or
Excision, tumor, foot; deep,
28045 subfascial, intramuscular
toe, subfacial (eg, intramuscular); less
than 1.5 cm
28046 malignant neoplasm), soft tissue of malignant neoplasm), soft tissue of foot
foot or toe; less than 3 cm
Radical resection for tumor, bone; Radical resection of tumor; tarsal

28171 tarsal (except [talus or calcaneus]) (except talus or calcaneus)
Radical resection for tumor, bone;

28173 metatarsal
Radical resection of tumor; metatarsal
Radical resection for tumor, bone; Radical resection of tumor; phalanx of

28175 phalanx of toe toe
48

Respiratory
For the Nose, excision:

• The instructional note to use
• 30140 – 52 for “reduction” of turbinates was
deleted
• The cross reference note was revised
regarding closure and reconstruction
with the appropriate integumentary code
ranges
49
Respiratory Revisions

Ablation, soft tissue of inferior
Cautery and/or ablation,
turbinates, unilateral or bilateral,
mucosa of inferior turbinates,
30801 unilateral or bilateral, any
any method (eg, electrocautery,
radiofrequency ablation, or tissue
method; superficial
volume reduction); superficial
Ablation, soft tissue of inferior
Cautery and/or ablation, turbinates, unilateral or bilateral,
mucosa of inferior turbinates, any method (eg, electrocautery,
30802 unilateral or bilateral, any radiofrequency ablation, or tissue
method; intramural volume reduction); intramural (ie,
submucosal)
Radiofrequency is inherent to the ablation.

Both codes also include reduction of the turbinates.
50

Bronchoscopy Revisions
The bronchoscopy main term was

changed to:
• Bronchoscopy, rigid or flexible,
• “including fluoroscopic guidance, when
performed”
– From “with or without fluoroscopic guidance”
• “with cell washing, when performed”
– From “with or without cell washing”
51
The bronchoscopy family of codes

31641 – 31656 codes are revised with
the new heading of the parent code
31622
52

Bronchoscopy, rigid or Bronchoscopy, rigid or flexible,

flexible, with or without including fluoroscopic guidance,
fluoroscopic guidance; when performed;
diagnostic, with or without diagnostic, with cell washing,

31622 cell washing (separate when performed (separate
procedure) procedure)
53
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
with injection of contrast material for

with injection of contrast material for
31656 segmental bronchography
segmental bronchography (fiberscope
only)
54

Bronchoscopy Additions
Bronchoscopy, rigid or flexible,

including fluoroscopic guidance, when
performed;
• 31626: with placement of fiducial
markers, single or multiple
• +31627: with computer-assisted image-
guided navigation
• Notes added to
– Includes 3D reconstruction
– Use in conjunction with codes …..
55
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
Lungs, pleura – Destruction: installation of a

fibrolytic agent
Revised code:
• 32560: Chemical pleurodesis (eg, for recurrent or
persistent pneumothorax) to
• Instillation, via chest tube/catheter, agent for pleurodesis
(eg, talc, for recurrent or persistent pneumothorax)
New codes:
• Instillation(s) via chest tube/catheter, agent for
fibrinolysis (eg-fibrinolytic agent for break up of
multiloculated effusion)
• 32561: Initial day
– Report only x1
• 32562: Subsequent day
All 3 codes have instructional notes for chest
tube insertion, to use 32551
57
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
Revision of skin pocket for single or

Revision of skin pocket for
33223 dual chamber pacing cardioverter-
defibrillator
58

Cardiovascular Additions
Transposition of the great vessels new

codes:
• Aortic root translocation with ventricular
septal defect and pulmonary stenosis
repair (eg-Nikaidoh procedure);
• 33782: without coronary ostium
reimplantation
– Note included to restrict the use with other cardiac repairs
• 33783: with reimplantation of 1 or both
coronary ostia
59
Ventricular Assist Device Additions
Replacement of ventricular assist

device - VAD –
• 33981: extracorporeal, single or
biventricular, pump(s); single or each
pump
• 33982: pump(s); implantable
intracorporeal, single ventricle without
cardiopulmonary bypass
• 33983: with cardiopulmonary bypass
60

Arteriovenous Shunt for Dialysis
Introduction of needle and/or catheter,

arteriovenous shunt created for dialysis
(graft/fistula);
• 36147: Initial access with complete radiological
evaluation of dialysis access, including fluoroscopy ,
image documentation, and report (includes access of
shunt, injection(s) of contrast, all necessary imaging
from the arterial anastomosis and adjacent artery
through entire venous outflow, including the inferior
or superior vena cava)
• Do not report in addition 75791
• 36148: additional access for therapeutic intervention
• List separately in addition to code for primary procedure)
61
Cardiovascular Revisions
Percutaneous portal vein Same – includes the moderate sedation

36481 catheterization by any method symbol
Revision of TIPS – transvenous

Same – includes the moderate sedation
37183 intrahepatic portosystemic symbol
shunt(s)….
62

Ligation of Perforator Veins
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
Laparoscopy surgical, repair of

paraesophageal hernia, includes
fundoplasty when performed;
• 43281: without implantation of mesh
• 43282: with implantation of mesh
Instructional notes
64

Digestive Additions
43775: Laparoscopy, surgical, gastric

restrictive procedure; longitudinal
gastrectomy
• (sleeve gastrectomy)
Excision of rectal tumor, transanal approach;
• 45171: not including muscularis propria
• (partial thickness)
• 45172: including muscularis propria
• (full-thickness)
46707: Repair of anorectal fistula with plug
• (Porcine small intestine submucosa (SIS))
65
Digestive Additions
49411: Placement of interstitial

device(s) for radiation therapy guidance,
(eg-fiducial markers, dosimeter),
percutaneous, intra-abdominal, intra-
pelvic, (except prostate), and/or
retroperitoneum, single or multiple
• Instructional notes:
• For imaging guidance
• Report supply of device separately
• For percutaneous placement of … for
intrathoracic,… use 32553
66

Digestive Revisions

Resection of pharyngeal wall requiring
Resection of pharyngeal wall closure with myocutaneous or
42894 requiring closure with fasciocutaneous flap or free muscle,
myocutaneous flap skin, or fascial flap with microvascular
anastomosis
Repositioning of the gastric feeding Repositioning of a naso- or oro- gastric

43761 tube, through the duodenum for feeding tube, through the duodenum for
enteric nutrition enteric nutrition
Fissurectomy, with or without Fissurectomy, including sphincterotomy,

46200 sphincterotomy when performed
Papillectomy or excision of single Excision of single external papilla or tag,

#46220 tag, anus (separate procedure) anus
Hemorrhoidectomy, by simple Hemorrhoidectomy, internal by rubber

46221 ligature (eg, rubber band) band ligation(s)
Excision of external hemorrhoid Excision of multiple external papillae or

46230 tags and/or multiple papillae tags, anus
67
Hemorrhoidectomy Revisions
Hemorrhoidectomy, external, Hemorrhoidectomy, external, 2 or
46250 complete more columns/groups
Hemorrhoidectomy internal and Hemorrhoidectomy internal and

46255 external, simple; external, single column/group;

46257 external, simple; with external, single column/group; with
fissurectomy fissurectomy

external, simple; with external, single column/group; with
46258 fistulectomy, with or without fistulectomy, including
fissurectomy fissurectomy, when performed
Note: The “simple” is changed to single column/group” and
the “complete” is changed to “2 or more columns/groups”.
68

Hemorrhoidectomy Revisions

Hemorrhoidectomy, internal and
46260 external, complex or extensive;
external, 2 or more
columns/groups;
Hemorrhoidectomy, internal and Hemorrhoidectomy, internal and

46261 external, complex or extensive; external, 2 or more
with fissurectomy columns/groups; with fissurectomy

external, 2 or more
external, complex or extensive;
46262 with fistulectomy, with or
columns/groups; with fistulectomy,
including fissurectomy, when
without fissurectomy
performed
Note: The “complex or extensive” is changed to “2

or more columns/groups”.
69
Digestive Revisions

Surgical treatment of anal fistula Surgical treatment of anal fistula
46275 (fistulectomy, fistulotomy); (fistulectomy, fistulotomy);
submuscular intersphincteric
Surgical treatment of anal fistula

Surgical treatment of anal fistula
(fistulectomy, fistulotomy);
(fistulectomy, fistulotomy);
46280 complex or multiple, with or
transsphincteric, suprasphincteric,
extrasphincteric or multiple, including
without placement of seton
placement of seton, when performed
Enucleation or excision of external Excision of thrombosed hemorrhoid,

#46320 thrombotic hemorrhoid external
Hemorrhoidectomy, internal by other

Ligation of internal hemorrhoids;
#46945 single procedure
than rubber band; single hemorrhoid
column/group
Hemorrhoidectomy, internal by other

Ligation of internal hemorrhoids;
#46946 multiple procedures
than rubber band; 2 or more
hemorrhoid columns/groups
70

Urodynamics
“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
Urinary Revisions and Additions
Voiding pressure studies (VP);

Voiding pressure studies; intra-
intra-abdominal voiding
abdominal (ie, rectal, gastric,
pressure (AP) (rectal, gastric,
#+51797 intraperitoneal) (List
intraperitoneal) (List separately in
addition to code for primary
separately in addition to code
procedure)
for primary procedure)
Cystourethroscopy, with Cystourethroscopy, with insertion

52282 insertion of urethral stent of permanent urethral stent
New code 53855: Insertion of a temporary prostatic

urethral stent, including urethral measurement
72

Male Genital System Revisions
Cryosurgical ablation of the

prostate (includes Cryosurgical ablation of the
55873 ultrasonic guidance for prostate (includes ultrasonic
interstitial cryosurgical guidance and monitoring)
probe placement)
Placement of interstitial
device(s) for radiation Placement of interstitial
therapy guidance (eg, device(s) for radiation therapy
55876 fiducial markers, guidance (eg, fiducial markers,
dosimeter), prostate (via dosimeter), percutaneous
needle, any approach), prostate, single or multiple
single or multiple
73
Female Genital System
New code:
• 57426: Revision (including removal) of
prosthetic vaginal graft, laparoscopic
approach
Revisions of cross reference notes to
include reference to this code
74

Maternity Care and

Delivery Revisions
Unlisted fetal invasive

Unlisted fetal invasive
procedure, including
59897 procedure, including
ultrasound guidance, when
ultrasound guidance
performed
75
Nervous System Additions
Spinal neurostimulator electrode

• 63661: Removal of … percutaneous array(s), …
• 63662: Removal of … plate/paddle(s) via
laminotomy or laminectomy, …
• 63663: Revision including replacement, when
performed, … percutaneous array(s), …
• 63664: Revision including replacement, when
performed, … plate/paddle(s) via laminotomy or
laminectomy, …
• All … including fluoroscopy, when performed
76

Paravertebral Spinal Nerves and

Branches Additions
Injection(s), diagnostic or therapeutic agent,
paravertebral facet (zygapophyseal) joint (or
nerves innervating that joint) with image
guidance, fluoroscopy or CT,
• Cervical or thoracic
• 64490: single level
• +64491: 2nd level
• +64492: 3rd and any additional level(s)
– Do not use more than once per day
• Lumbar or sacral
• 64493: single level
• +64494: 2nd level
• +64495: 3rd and any additional level(s)
– Do not use more than once per day
77
Other Surgery Modifications
Conscious sedation not separately

reportable bullseye added to codes
22520, 22521, 36481, 37183, 47382,
47525, 50200, 77371
78

Radiology
Defined “special report” in guidelines

“Service that is rarely provided, unusual,
variable or new may require special
report”
Include
• “adequate” definition/description of
• Nature
• Extent
• Need for procedure
• Time, effort, equipment needed to perform
79
Radiology
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

New Codes GI Tract
74261 CT colonography, Diagnostic

including image postprocessing,
without contrast
74262 with contrast including non-
contrast images if done
74263 CT colonography, screening,
including image postprocessing
Watch “do not report” notes
81
Heart
Cardiac magnetic resonance imaging

Different from regular MRI because can give
physiologic eval of cardiac function
• Flow and velocity assessment for valves and
intracardiac shunts
• Function and morphologic eval
Performed at rest and/or during stress
testing
Most codes are one per session
Inclusive of most testing performed at same
time so read notes carefully
82

New Cardiac MRI Codes
75565 add on code for velocity flow

mapping
75571 CT heart, without contrast,
with quantitative eval of coronary
calcium
75572 CT Heart with contrast for eval
cardiac structure/morphology
• Includes 3D image postprocessing,
assessment cardiac function, eval venous
structures (if done)
83
Two More Cardiac MRI
75573 CT heart with contrast for eval of

cardiac structure/morphology in congenital
heart disease
• Includes 3D postprocessing
• Assess LV cardiac function, RV
structure/function/eval of venous structures if
done
• 75574 CT angiography, heart, coronary arteries
and bypass grafts when present, with contrast
• Includes 3D postprocessing: eval cardiac
structure/morphology/function, eval venous
structures if done
84

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
New code 77338

• Multi-leaf collimator MCL
• For intensity modulated radiation therapy
(IMRT) design and construction per IMRT
plan
• Not more than once per IMRT plan
Revised code 77371
• Rad tx delivery, stereotactic radiosurgery
complete course of tx cranial lesion(s) 1
session; multi-source Cobalt 60 based
86

Nuclear Medicine
Cardiovascular system new codes

• Myocardial perfusion and cardiac blood pool
imaging studies done at rest or with stress
• 78451 SPECT single study at rest or stress
• 78452 multiple studies, at rest and/or stress and/or
redistribution and/or rest reinjection
• 78453 Planar, includes qual or quan wall motion,
EF by first pass or gated technique, add
quantification, when performed, single study at
rest or stress
• 78454 multiple studies at rest and/or stress and/or
redistribution and/or rest reinjection
87
Path/Lab
Table of Drugs/Appropriate
Qualitative Screening, Confirmatory
and Quantitative Codes
Just before Guidelines
88

Pathology and Laboratory

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)
Vitamin D; 25 hydroxy, includes

82306 Calcifediol (25-OH Vitamin D-3)
fraction(s), if performed
1, 25-dihydroxy, includes fraction(s), if

82652 Dihydroxyvitamin D, 1, 25-
performed
Gammaglobulin; IgA, IgD, IgG, IgM, Gammaglobulin (immunoglobulin); IgA,

82784 each IgD, IgG, IgM, each
82785 Gammaglobulin; IgE Gammaglobulin (immunoglobulin); IgE
Gammaglobulin (immunoglobulin);
Gammaglobulin; immunoglobulin
82787 subclasses, (IgG1, 2, 3, or 4), each
immunoglobulin subclasses, (eg, IgG1,
2, 3, or 4), each
89

Immunoassay for analyte other than
[infectious agent antibody or
infectious agent antibody or infectious
83516 infectious agent antigen],
agent antigen, qualitative or
qualitative or semiquantitative;
semiquantitative; multiple step method
multiple step method

[infectious agent antibody or
infectious agent antibody or infectious
infectious agent antigen];
83518 qualitative or semiquantitative,
agent antigen, qualitative or
semiquantitative; single step method
single step method (eg, reagent
(eg, reagent strip)
strip)
Immunoassay, analyte, quantitative;
Quantitative; by radioimmunoassay (eg,
83519 by radiopharmaceutical technique
RIA)
(eg, RIA)
Immunoassay, analyte, quantitative;

83520 not otherwise specified
Quantitative; not otherwise specified
83986 pH, body fluid, except [blood] pH, body fluid, not otherwise specified
90


Syphilis test; qualitative (eg, VDRL, RPR, Syphilis test non-treponemal antibody;
86592 ART) qualitative (eg, VDRL, RPR, ART)
Syphilis test non-treponemal antibody;
86593 Syphilis test; quantitative
quantitative
Culture typing; identification by nucleic acid
Culture typing; identification by nucleic (DNA or RNA) probe, direct probe
87149 acid probe technique, per culture or isolate, each
organism probed
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
Special stains (List separately in addition

Special stains; Group II, all other (eg, iron,
to code for primary service); Group II, all
trichrome), except immunocytochemistry
88313 other (eg, iron, trichrome), except
and immunoperoxidase stains, including
immunocytochemistry and
interpretation and report, each
immunoperoxidase stains, each
Special stains; histochemical staining with

Special stains (List separately in addition
frozen section(s), including interpretation
to code for primary service);
+88314 histochemical staining with frozen
and report (List separately in addition to
code for primary service)
section(s)
91
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
83986 revised pH body fluid NOS

New Codes:
• 83987 exhaled breath condensate
84145 Procalcitonin PCT
84431 Thromboxane metabolite(s)
including thromboxane if performed,
urine
93
Immunology New Codes
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

Micro New Codes
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
Guidance for 87260-87999
Note above 87260

Codes to be used for primary source only
Other rules included regarding selection
of most specific code possible
Separate results reported for different
species/strains, each coded separately
Use -59 when separate results reported
for diff species described by same code
98

New Codes
87493 Clostridium difficile, toxin gene(s)

amplified probe technique
88387
• Macroscopic exam, dissection, prep tissues
for non-microscopic analytical studies
• Nucleic-based molecular studies
– Each tissue prep
88388
• In conjunction with touch imprint, intraop
consult, or frozen section
– Each tissue prep
• Example: single lymph node
• Add on code, use with 88329-88334 99
Two More New Lab Codes
In Vivo Procedures
88738
• Hemoglobin (Hgb) quantitative,
transcutaneous
89398
• Unlisted reproductive medicine lab
procedure
100

Medicine Section
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
Pneumococcal conjugate vaccine,

polyvalent, when administered to children Pneumococcal conjugate vaccine, 7 valent, for
90669 younger than 5 years, for intramuscular intramuscular use
use
Programming device evaluation with
Programming device evaluation (in person) with
iterative adjustment of the implantable
93279- device to test the function of the device
iterative adjustment of the implantable device to
test the function of the device and select optimal
and select optimal permanent programmed
93287 values with physician analysis, review and
permanent programmed values with physician
analysis, review and report;
report;
Bioimpedance-derived physiologic cardiovascular
93701 Bioimpedance, thoracic, electrical
analysis
Sleep study, simultaneous recording of Sleep study, unattended, simultaneous recording

ventilation, respiratory effort, ECG or heart of heart rate, oxygen saturation, respiratory
95806 rate, and oxygen saturation, unattended by airflow, and respiratory effort (eg,
a technologist thoracoabdominal movement)
Photodynamic therapy by endoscopic

application of light to ablate abnormal Photodynamic therapy by endoscopic application
+96570 of light to ablate abnormal tissue via activation of
tissue via activation of photosensitive
- drug(s); … (List separately in addition to
photosensitive drug(s); … (List separately in
addition to code for endoscopy or bronchoscopy
+96571 code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract)
procedures of lung and esophagus)
101
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
90670 new code

• Pneumococcal conjugate vaccine, 13
valent for IM use
90738 Japanese encephalitis virus
vaccine, inactivated, for intramuscular
list revised to show now on FDA
approved list
103
ENT Services
92540 Basic vestibular eval

• Includes spontaneous nystagmus test
with eccentric gaze fixation nystagmus
• Recording, positional nystagmus test, min 4
positions, with recording optokinetic
nystagmus test
• Bidirectional foveal/peripheral stimulation
• Recording, oscillating tracking test with
recording
• “Do Not Report with” notes
104

Audiologic Function Tests

New Codes
92550 Tympanometry and reflex

threshold measurements
92570 Acoustic immittance testing,
includes tympanometry
• Impedance testing
• Acoustic reflex threshold testing
• Acoustic reflex decay testing
105
Implantable and Wearable

Cardiac Device Evaluations
New instructions and information on

how to use codes
In person vs. remote
Technical/professional physician
Service center practice
Some are once per 90 days/30
days/10 days
106

New Definitions
Electrocardiographic rhythm derived

elements
• Include heart rhythm, rate, ST analysis,
heart rate variability, T-wave alternans
Interrogation device evaluation
• Of implantable device such as
• Pacemaker, implantable cardioverter-defibrillator,
implantable cardiovascular monitor, implantable
loop recorder
Programming device eval
• In person programming
107
Echocardiography
Instructions and definitions

• Complex transthoracic echo includes two
dimensional and selected M-Mode exam
of left/right atria, ventricles, aortic,
mitral tricuspid valves, pericardium,
adjacent portions of aorta if performed
• If an element cannot be visualized, it
must be documented
• Stress echo done with stress test use one
code only
108

Noninvasive Physiologic Studies
New code 93750

• Interrogation of ventricular assist device
(VAD) in person
• With physician analysis of device parameters
• Review of device function
• With programming, if performed
• Report
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

Nerve Conduction Tests
Instructions on specificity of what is

included and that tests are
individualized to patient’s anatomy
95905 New code
• Motor/sensory nerve conduction
• Using preconfigured electrode array(s)
• Amplitude/latency/velocity study, each limb
• Only once per limb
• Don’t use with other nerve conduction study
codes
111
Hydration, Injections/Infusions
Updated instructions regarding

hierarchy for multiple services
• Physician Hierarchy
• Dependent on physician knowledge of
clinical conditions and treatments
• Initial = best describes primary reason for
encounter
• Does not matter what order they are given
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
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
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
Active warming used intraoperatively for

the purpose of maintaining
Active warming used intraoperatively for the purpose of
normothermia, OR at least one body
maintaining normothermia, OR at least one body
temperature equal to or greater than 36
temperature equal to or greater than 36 degrees
4250F degrees Centigrade (or 96.8 degrees
Centigrade (or 96.8 degrees Fahrenheit) recorded
Fahrenheit) recorded within the 30
within the 30 minutes immediately before or the 15
minutes immediately before or the 30
minutes immediately after anesthesia end time (CRIT)1
minutes immediately after anesthesia
end time (CRIT)1
Treatment summary report
Treatment summary report communicated to
communicated to physician(s) managing
5020F continuing care within 1 month of
physician(s) managing continuing care and to the
patient within 1 month of completing treatment (ONC)1
completing treatment (ONC)1
All elements of maximal sterile barrier All elements of maximal sterile barrier technique
technique including: cap AND mask AND followed including: cap AND mask AND sterile gown
sterile gown AND sterile gloves AND a AND sterile gloves AND a large sterile sheet AND hand
6030F large sterile sheet AND hand hygiene hygiene AND 2% chlorhexidine for cutaneous
AND 2% chlorhexidine for cutaneous antisepsis, (or acceptable alternative antiseptics, per
antisepsis, followed (CRIT)1 current guideline) (CRIT)1
115
New Patient Management Codes
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
More Screening/Diagnostic Results
3321F AJCC cancer stage 0/1A Melanoma

3322F Melanoma >Stage 0/1A
3370F-3390F
• Staging of breast and colon cancer
3450F-3452F Dyspnea screening
3455F TB screening and results prior to tx
3470F-3476F Rheumatoid arthritis
screening
3490F-3503F HIV screening and cell
counts
120

More Screening/Diagnostic Results
3510F TB Test Screening

3511F-3512F STD screening
3513F-3515F Hepatitis screening
3550F-3552F Thromboembolism
screening
3555F INR performed
3570F Bone scintigraphy study
3572F-3573F Risk assessment for
fracture 121
Therapeutic and Preventive

Interventions
Hepatitis Vaccine given
Patient counseling for alcohol risks/screening
for drug abuse
Chemotherapy for Stage III Colon Cancer
Status of patient getting/not getting types of
therapy (glucocorticoid, arthritis drugs)
Radiotherapy
Wound tx
HIV therapy
Immunizations given such as flu, Hep B
Foot care
122

Category III Codes
Note in guidelines explaining usage of the

alphanumeric codes
New Codes 0197T-0207T
• Patient tracking during radiation therapy
• Ocular blood flow measurement
• Tremor recording
• Sacroplasty with injections
• Vertebral joint arthroplasty
• Sleep Studies
• IV catheter based coronary vessel spectroscopy
• Analysis of EKG data with computer probability
assessment
• Evacuation meibomian glands using heat/pressure
unilateral 123
References
CPT® 2010 Professional Edition,

American Medical Association
CPT® 2010 Changes; An Insider’s View,
American Medical Association
CPT® Coding Symposium November
11-13, 2009, American Medical
Association
124

Audio Seminar Discussion
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While online, you can also register
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Upcoming Seminars
2010 Procedure and Service Code

Updates (Rebroadcast)
December 8, 2009
CY10 CMS OPPS Update

December 10, 2009
Advanced Coding Scenarios:

An Expert Review
December 15, 2009
Thank you for joining us today!

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and receive your CE Certificate online at:
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Practical Tools for Seminar Learning

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AHIMA 2009 Audio Seminar Series • http://campus.ahima.org/audio i

Margi Brown is director at Precyse Solutions, specializing in clinical documentation

Karen Scott, MEd, RHIA, CCS-P, CPC

AHIMA 2009 Audio Seminar Series ii

Thank You ..................................................................................................................63

AHIMA 2009 Audio Seminar Series

Objectives of this Seminar

 Identify the additions and changes to

 Per the AMA, the CPT code changes for

AHIMA 2009 Audio Seminar Series 1

 The “#” symbol will precede the code

23073 26113 27339 46220 51797

24073 27045 27634 46945 82652

AHIMA 2009 Audio Seminar Series 2

Evaluation and Management

 Revisions to the guidelines

Consultation Codes: CPT vs. CMS

 As stated in the PFS final rule, Medicare

AHIMA 2009 Audio Seminar Series 3

Evaluation and Management

 Changes in the guidelines:

 “Concurrent care is the provision of

AHIMA 2009 Audio Seminar Series 4

 “Transfer of care is the process whereby the

Transfer of Care vs. Consultation

 “Consultation codes should not be

AHIMA 2009 Audio Seminar Series 5

 Documentation requirements in the

AHIMA 2009 Audio Seminar Series 6

 Inpatient consultation code range

• See concurrent care and transfer of care

AHIMA 2009 Audio Seminar Series 7

Nursing Facility Care

 Prolonged Physician Service without

AHIMA 2009 Audio Seminar Series 8

 Prolonged Physician Service without

 Prolonged Physician Service without direct

AHIMA 2009 Audio Seminar Series 9

Anesthesia and (Humerus)

 Due to low reporting volume, the code

Fine Needle Aspiration

 A cross reference note following

AHIMA 2009 Audio Seminar Series 10

Adjacent Tissue Transfer (ATT)

 New codes for adjacent tissue transfer

 The instruction guideline for closure of

 Reminder that lesion excision is included in

AHIMA 2009 Audio Seminar Series 11

Other Flaps and Grafts

 Cross reference notes for ATT flaps

 Instruction cross reference note:

AHIMA 2009 Audio Seminar Series 12

 Cross reference note was revised to

 Biggest section of changes

AHIMA 2009 Audio Seminar Series 13

• Radical resection of:

• New codes to complete different

 Reasons for changes due to the

AHIMA 2009 Audio Seminar Series 14

Excision tumor, soft tissue of

Identify the additions and changes to

Per the AMA, the CPT code changes for

The “#” symbol will precede the code

Revisions to the guidelines

As stated in the PFS final rule, Medicare

Changes in the guidelines:

“Concurrent care is the provision of

“Transfer of care is the process whereby the

“Consultation codes should not be

Documentation requirements in the

Inpatient consultation code range

Prolonged Physician Service without

Prolonged Physician Service without

Prolonged Physician Service without direct

Due to low reporting volume, the code

A cross reference note following

New codes for adjacent tissue transfer

The instruction guideline for closure of

Reminder that lesion excision is included in

Cross reference notes for ATT flaps

Instruction cross reference note:

Cross reference note was revised to

Biggest section of changes

Reasons for changes due to the

For the Nose, excision:

The bronchoscopy main term was

The bronchoscopy family of codes

Bronchoscopy, rigid or flexible,

Lungs, pleura – Destruction: installation of a

Transposition of the great vessels new

Replacement of ventricular assist

Introduction of needle and/or catheter,

Laparoscopy surgical, repair of