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Complete 2013

Procedure Coding Updates

2012
AAPC 2480 South 3850 West, Suite B Salt Lake City, Utah 84120 800-626-CODE (2633), Fax 801-236-2258 www.aapc.com

Complete 2013 Procedure Coding Updates

Introduction

Disclaimer
This course was current when it was published. Every reasonable effort has been made to assure the accuracy of the information within these pages. Readers are responsible to ensure they are using the codes, and following applicable guidelines, correctly. AAPC employees, agents, and staff make no representation, warranty, or guarantee that this compilation of information is error-free, and will bear no responsibility or liability for the results or consequences of the use of this course. This guide is a general summary that explains guidelines and principles in profitable, efficient health care organizations.

US Government Rights
This product includes CPT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/ or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995), as applicable, for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provision of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

AMA Disclaimer
CPT copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommendation their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. Anatomical Illustrations are provided by OptumInsight and are copyright 2012, OptumInsight, Inc.

Written by Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC and G.J. Verhovshek, MA, CPC 2012 AAPC 2480 South 3850 West, Suite B, Salt Lake City, Utah 84120 800-626-CODE (2633), Fax 801-236-2258, www.aapc.com ISBN 978-1-937348-47-2 All rights reserved.

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Introduction

Introduction
As technology and clinical knowledge evolve, so does the practice of medicine. Health care also operates within a complex, ever-changing regulatory environment. To keep pace, the code sets we use to report medical services, procedures, devices, and drugs must be updated regularly. Each October, the American Medical Association releases a revised CPT code set for implementation the following January 1. At AAPC, our goal is to provide you with vital information to make the implementation process easier. This workbook summarizes significant CPT 2013 code changes available at press time. Additional changes released

subsequently, as addenda or errata, will be posted on the AAPC website (www.aapc.com). CPT 2013 contains revised section guidelines, parenthetical references, and appendices. This guide summarizes primarily revisions to the codes and code descriptors. Minor changes in grammar or spelling that do not affect code use may be omitted. This guide does not review in full all revisions within CPT, and is not meant as a replacement for the complete 2013 CPT codebook. Always use the most current version of CPT, and carefully follow all CPT section guidelines, parenthetical references, and other instruction when assigning codes.

Checklist for Updating Your Codes


Begin reviewing 2013 CPT code changes, using this guide

CPT for 2013 Revisions


Section Guidelines
New section guidelines occur throughout CPT 2013. New guidelines in the codebook are printed in green ink to allow easy identification.

Order 2013 code books Review all changes to guidelines, notes, and instructions in your book Highlight changes in the books index pertinent to your specialty, and review those changes Highlight changes in the books tabular (numeric) section pertinent to your specialty, and review those changes Create a documentation cheat sheet of 2013 updates that must be documented differently for coders to capture the information needed and distribute it to clinicians Review and update superbills, chargemasters, etc. Run utilization report of the deleted and revised codes using your practice management systems. Upload software change Train coding and billing staff on changes Check regularly for addenda or errata to the 2013 code set; if addenda are issued, communicate the contents to coding and clinical staff Review physician quality reporting system (PQRS) changes, if you are participating in PQRS, and educate providers/make adjustments in processes to accommodate the new reporting measures Communicate with payer/provider reps regarding reimbursement and coverage issues Archive last years books within three months of the new code implementation dates
= FDA Approval Pending = Add-on

Modifiers
CPT 2013 contains no new modifiers; however, complete descriptors for 16 modifiers in Appendix B have undergone revisions to include other qualified health care professional language, to specify that these modifiers may be appended to non-physician services. All genetic testing code modifiers, previously listed in CPT Appendix I, have been deleted. Genetic testing codes 83890-83914, to which the modifiers were applied, have been deleted and replaced by new molecular pathology codes 81200-81479.

Evaluation and Management Services


CPT 2013 revises 82 evaluation and management codes within the range 99201-99467 to specify that these E/M services may be provided by a physician or other qualified health care professional. Language suggesting that only a physician may legitimately report such services has been removed from the code descriptors. For example, the revised descriptor for a level I, new patient visit in the outpatient setting (99201) now specifies:

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Complete 2013 Procedure Coding Updates

Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components:
A problem focused history; A problem focused examination; Straightforward medical decision making.

Critical care during interfacility transport, critically ill or critically injured patient, 24 months of age or younger: 9946699467. E/M section guidelines also have been modified to allow non-physician providers to report services. For example, the descriptors for critical care services (9929199292, 9946899469, and 9947199476) have not been revised, but section guidelines now stipulate, Critical care is the direct delivery by a physician(s) or other qualified health care professional of medical care for a critically ill or critically injured patient. Revisions to include other qualified health care providers were made so that the type of provider (eg, physician, nurse practitioners, physician assistants, outpatient hospital facilities) does not dictate which codes may be reported. CPT codes describe the services performed, not the provider who performs the service. Each states scope-ofpractice laws determine the services an individual provider is qualified to perform. Providers typically considered to be other qualified health care professionals are advanced registered nurse practitioners (ARNP)s, physician assistants (PA)s, midwives, etc. CPT 2013 also adds seven new codes in three new E/M categories: Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient; Complex chronic care coordination services, and; Transitional care management services.

Counseling and/or coordination of care with other physicians, other providers qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patients and/or familys needs. Usually, the presenting problem(s) are self-limited or minor. Physicians typically spend Typically, 10 minutes are spent faceto- face with the patient and/or family.

New text (underlined) clarifies that counseling and/or coordination of care may be provided with other physicians or other qualified health care professionals. Deleted text (stricken) eliminates the reference to physician time, thereby allowing, per AMA guidelines, that other, nonphysician providers may provide the service. Descriptor changes throughout the E/M chapter are consistent with this example. A summary of the affected codes includes: Outpatient visits: 9920199215 Observation: 9921799226 Inpatient care (initial and subsequent): 9922199233 Observation or initial hospital care: 9923499236 Office consultations: 9924199245 Inpatient consultations: 9925199255 Emergency department visits: 9928199285 Direction of emergency medical services: 99288 Nursing facility care (initial and subsequent): 99304 99310 Annual nursing facility assessment: 99318 Domiciliary or rest home visits: 9932499337 Home visits: 9934199350 Standby services: 99360 Supervision of patient care: 99374-99380 Telephone E/M services: 99441-99443 Online E/M services: 99444-99464

E/M: Pediatric Critical Care Patient Transport


Subsection Guidance New, time-based codes report the non face-to-face work of a control physician directing care during interfacility transport. The patients age and medical condition (critical illness or critical injury), and the total time, must be documented. When determining time, do not include pretransport communication with the referring or accepting facility. Only the time spent directly by the transport team may be used to determine reportable time. The controlling provider cannot code for any of the procedures performed by the team performing the transport. Do not report 99485 or 99486 with 99466 or 99467 for the same patient.

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Complete 2013 Procedure Coding Updates

# 99485 Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data interpretation and report; first 30 minutes AAPC Rationale Code 99485 describes the first 30 minutes of care. Do not report 99485 for fewer than 15 minutes of care.
# 99486 Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes twoway communication with transport team before transport, at the referring facility and during the transport, including data interpretation and report; each additional 30 minutes (list separately in addition to code for primary procedure)

99489. The provider must determine which service type required the most time, and report those codes. A parenthetical note following 99489 lists the services that cannot be reported during the same month as 9948799489. 99487 Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with no face-to-face visit, per calendar month AAPC Rationale Code 99487 describes the first hour of clinical staff time for performing complex chronic care coordination, when there has been no face-to-face visit with the patient. The code is reported per calendar month. The patients medical condition must meet the requirements stated in the coding guidelines preceding 9948799489. 99488 Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with one face-to-face visit, per calendar month AAPC Rationale Code 99488 describes the first hour of clinical staff time for performing complex chronic care coordination. The patients medical condition must meet the requirements stated in the coding guidelines preceding 9948799489. This service includes one face-to-face encounter not separately reported. Additional, medically necessary encounters may be reported separately.
99489 Complex chronic care coordination services; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (list separately in addition to code for primary procedure)

AAPC Rationale Report one unit of add-on code 99486 for each additional 30 minutes of supervision of transport care, beyond the initial 30 minutes as reported with 99485.

E/M: Complex Chronic Care Coordination Services


Subsection Guidance A new E/M category reports coordination of care for patients with chronic illnesses. Effective coordination of services among providers to manage complex conditions requires significant staff and provider time. Patients with one or more chronic illnesses expected to last at least 12 months, acute exacerbation of an illness, or functional decline qualify for the use of these codes. The coordination activities are detailed in the coding guidelines preceding 9948799489. Codes are reported per calendar month. At least one hour must be documented to claim the services. Documentation templates to record the date, time spent on chronic care coordination, and the care coordinated will facilitate proper documentation to support the services. Other CPT codes describe specific coordination or monitoring of care services not reported with 9948799489. For example, end-stage renal disease services (9095190970) cannot be reported during the same month as 99487

AAPC Rationale Add-on code 99489 reports each additional 30 minutes of complex chronic care coordination beyond the first hour, to be reported in addition to 99487 or 99488.

E/M: Transitional Care Management Services


Subsection Guidance A new E/M subsection reports transitional care management for patients discharged from an inpatient hospital, observation, or a skilled nursing facility. The goal of transitional care is to provide services needed to transition the

= FDA Approval Pending = Add-on

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Complete 2013 Procedure Coding Updates

patient from a facility to his or her home, domiciliary, rest home, or assisted living. Such care helps to prevent readmissions and lowers the cost of health care (outpatient care is less expensive then inpatient care). To qualify for these codes, the medical decision-making must be of moderate to high complexity. The services include one face-to-face visit and non face-to-face services (eg, arranging home health agencies for patient care). Coding guidelines preceding this subsection list the services performed for transitional care. Codes are selected based on medical decision-making associated with the patients condition, when the communication is initiated with the patient, and when the face-to-face encounter occurs following discharge. The first face-to-face encounter is included. The codes may be reported only once per 30 calendar days. 99495 Transitional care management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge medical decision making of at least moderate complexity during the service period face-to-face visit, within 14 calendar days of discharge AAPC Rationale Report 99495 for transitional care management that includes initial communication within two business days of discharge, and a face-to-face encounter with 14 calendar days of discharge. Moderate or high complexity medical decision-making is required. 99496 Transitional care management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge medical decision making of high complexity during the service period face-to-face visit, within 7 calendar days of discharge AAPC Rationale Code 99496 is reported for transitional care management that includes initial communication within two business days of discharge, and a face-to-face encounter with seven calendar days of discharge. High complexity medical decision-making is required. Because the patients condition is more severe, the face-to-face encounter is expected to happen sooner when reporting 99496 than with 99495.

Anesthesia
Other Procedures
01991 Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider physician or other qualified health care professional); other than the prone position AAPC Rationale The code is revised to allow reporting by other qualified health care professional (eg, certified registered nurse anesthetist (CRNA)). 01992 Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider physician or other qualified health care professional); prone position AAPC Rationale The code is revised to allow reporting by other qualified health care professional (eg, certified registered nurse anesthetist (CRNA)).

Surgery
Integumentary System/Repair (Closure): Other Flaps and Grafts
15740 Flap; island pedicle requiring identification and dissection of an anatomically named axial vessel AAPC Rationale Code 15740 is revised to clarify the proper use of the island pedicle flap. When performing flap procedures, small blood vessels may be included as the tissue is transposed. An anatomically named axial vessel must be identified and dissected as part of the pedicle flap procedure. See image on next page.

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Complete 2013 Procedure Coding Updates

15740

Musculoskeletal System/Spine (Vertebral Column): Arthrodesis


22586 Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1 interspace AAPC Rationale The new code has been created to report pre-sacral interbody technique arthrodesis with posterior instrumentation. Code 22586 includes disc preparation, discectomy, posterior instrumentation, imaging guidance, and bone graft. Per CPT instructions, do not report 22586 with 2093020938, 22840, 22848, 72275, 77002, 77003, 77011, and 77012. For pre-sacral interbody technique arthrodesis without instrumentation, turn to Category III codes 0195T and 0196T. 22586

Anatomical Illustrations 2012, OptumInsight, Inc.

Musculoskeletal System/General: Introduction or Removal


20665 emoval of tongs or halo applied by another R physician individual AAPC Rationale The term individual replaces physician in the code descriptor, to allow a qualified health care provider other than a physician to report the service.

Musculoskeletal System/Spine (Vertebral Column): Vertebral Body, Embolization or Injection


22522 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure)

AAPC Rationale Add-on code 22522 now includes conscious sedation, when performed.
Anatomical Illustrations 2012, OptumInsight, Inc.

= FDA Approval Pending = Add-on

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Complete 2013 Procedure Coding Updates

Musculoskeletal System/Shoulder: Repair, Revision, and/or Reconstruction


23473 Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component AAPC Rationale Code 23473 has been added to report the revision of a total shoulder arthroplasty with removal and replacement of the artificial joint. Previously, two codes were reported for this procedure: 23472 for the arthroplasty and either 23331 or 23332 for removal of the implant. The new code includes the removal of the artificial joint and replacement with a new joint. Report 23473 when the procedure involves either a humeral or glenoid component. 23474 Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component AAPC Rationale Code 23474 has been added to report the revision of a total shoulder arthroplasty with removal and replacement of the artificial joint. Previously, two codes were reported for this procedure: 23472 for the arthroplasty and either 23331 or 23332 for removal of the implant. The new code includes the removal of the artificial joint and replacement with a new joint. Report 23474 when the procedure involves both a humeral and glenoid component.

24371 Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar component AAPC Rationale Code 24371 has been added to report the revision of a total elbow arthroplasty, which involves removal of the artificial joint and replacement with a new joint. Previously, this procedure was reported using two codes: 24363 for the total elbow arthroplasty and 24160 for artificial joint removal. The new code reports both services. Report 24371 when the procedure involves both a humeral and ulnar component.

Musculoskeletal System/Foot and Toes: Other Procedures


28890 Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 28890 has been amended to allow this service to be performed by a physician or other qualified health care professional.

Musculoskeletal System/Application of Casts and Strapping: StrappingAny Age


29590 Denis-Browne splint strapping

Musculoskeletal System/Humerus (Upper Arm) and Elbow: Repair, Revision, and/or Reconstruction
24370 Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component AAPC Rationale New code 24370 describes the revision of a total elbow arthroplasty, which involves removal of the artificial joint and replacement with a new joint. Previously, this procedure was reported using two codes: 24363 for the total elbow arthroplasty and 24160 for artificial joint removal. The new code reports both services. Report 24370 when the procedure involves either the humeral or ulnar component.

AAPC Rationale This procedure is no longer performed.

Respiratory System/Trachea and Bronchi: Endoscopy


Subsection Guidance New Category I codes replace deleted Category III codes 0250T0252T to report procedures performed for the insertion and removal for bronchial valves. Bronchial valves are inserted to treat patients with emphysema or lung damage. Valves are inserted to limit airflow to the damaged part of the lung to promote healing. There are a total of five lobes in the lungs (two in the left lung, three in the right).

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31647 Bronchoscopy, rigid or flexible, including fluoro-

scopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), initial lobe AAPC Rationale Report 31647 for insertion of bronchial valve(s) in an initial lobe. If performed in more than one lobe, report 31651 (below) for each additional lobe. Fluoroscopic guidance is included and may not be separately reported. 31647

add-on code 31649 for each additional lobe. Fluoroscopic guidance is included and may not be separately reported.
31651 Bronchoscopy, rigid or flexible, including fluoro-

scopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), each additional lobe (list separately in addition to code for primary procedure[s]) AAPC Rationale Report 31647 (above) is reported for the insertion of bronchial valve(s) in an initial lobe. If performed in more than one lobe, report add-on code 31651 for each additional lobe. Fluoroscopic guidance is included and may not be separately reported.
31656 Bronchoscopy, rigid or flexible, including fluoroscopic

guidance, when performed; with injection of contrast material for segmental bronchography (fiberscope only) AAPC Rationale Bronchography is no longer performed. Computed Tomography (CT) is the standard of care replacing bronchography.

Respiratory System/Trachea and Bronchi: Bronchial Thermoplasty


Anatomical Illustrations 2012, OptumInsight, Inc.
31648 Bronchoscopy, rigid or flexible, including fluoro-

scopic guidance, when performed; with removal of bronchial valve(s), initial lobe AAPC Rationale Report 31648 for removal of bronchial valve(s) in an initial lobe. If performed in more than one lobe, report 31649 (below) for each additional lobe. Fluoroscopic guidance is included and may not be separately reported.
31649 Bronchoscopy, rigid or flexible, including fluoro-

Subsection Guidance Category III codes 0276T0277T have been deleted and replaced with new codes to report bronchial thermoplasty. The procedure involves radiofrequency ablation to treat asthmatic patients by reducing the muscle associated with airway constriction.
31660 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe

AAPC Rationale Report 31660 for bronchial thermoplasty performed on one lobe. The procedure includes fluoroscopic guidance.
31661 Bronchoscopy, rigid or flexible, including fluoro-

scopic guidance, when performed; with removal of bronchial valve(s), each additional lobe (list separately in addition to code for primary procedure) AAPC Rationale Report 31648 (above) for removal of bronchial valve(s) in an initial lobe. If performed in more than one lobe, report

scopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes AAPC Rationale Report 31661 for bronchial thermoplasty performed on two or more lobes. The procedure includes fluoroscopic guidance. Complete 2013 Procedure Updates 7

= FDA Approval Pending = Add-on

Complete 2013 Procedure Coding Updates

Note that 31661 is not an add-on code: Select 31660 if the procedure is performed on one lobe or 31661 if performed on two or more lobes. Do not select 31660 and 31661 for the same surgical session.

32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance AAPC Rationale New codes replace 32421 and 32422 to more accurately describe procedures performed to aspirate fluid from the pleural space. A needle or catheter is used to puncture the pleural space and withdraw fluid. The new codes are selected based on whether imaging guidance is performed. When imaging guidance is not performed, report 32554. 32554

Respiratory System/Trachea and Bronchi: Introduction


31715 Transtracheal injection for bronchography

AAPC Rationale Bronchography is no longer performed. Computed tomography (CT) is the standard of care replacing bronchography.

Respiratory System/Lungs and Pleura: Removal


32420 Pneumocentesis, puncture of lung for aspiration

AAPC Rationale This procedure is no longer performed. See instead 32405.


32421 Thoracentesis, puncture of pleural cavity for aspiration,

initial or subsequent AAPC Rationale Code 32421 has been deleted and replaced with new codes 32554 and 32555.
32422 Thoracentesis with insertion of tube, includes water

seal (eg, for pneumothorax), when performed (separate procedure) AAPC Rationale Code 32422 has been deleted and replaced with new codes 32554 and 32555.

Respiratory System/Lungs and Pleura: Introduction and Removal


32551 Tube thoracostomy, includes water seal connection to drainage system (eg, for abscess, hemothorax, empyema water seal), when performed, open (separate procedure)

Anatomical Illustrations 2012, OptumInsight, Inc.

32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance AAPC Rationale New codes replace 32421 and 32422 to more accurately describe procedures performed to aspirate fluid from the pleural space. A needle or catheter is used to puncture the pleural space and withdraw fluid. The new codes are selected based on whether imaging guidance is performed.

AAPC Rationale The description for 32551 was revised to clarify proper use. This is an open procedure. The conditions (abscess, hemothorax, etc.) were removed to describe the procedure performed rather than the conditions treated.

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When imaging guidance is performed, report 32555. CPT includes a parenthetical note instructing you not to report imaging guidance separately. 32556 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance AAPC Rationale New codes have been created to report the percutaneous drainage of pleural fluid. Unlike thoracocentesis, a tube or catheter is left in place to allow for drainage. Code selection is based on whether imaging guidance is used. If imaging guidance is not used, report 32556. 32557 Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance AAPC Rationale New codes have been created to report the percutaneous drainage of pleural fluid. Unlike thoracocentesis, a tube or catheter is left in place to allow for drainage. Code selection is based on whether imaging guidance is used. When imaging guidance is used, report 32557. Do not report imaging guidance separately.

Cardiovascular System/Heart and Pericardium: Pacemaker or Pacing Cardioverter-Defibrillator


33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter- defibrillator or pacemaker pulse generator (including eg, for upgrade to dual chamber system and pocket revision) (List separately in addition to code for primary procedure)

AAPC Rationale The code descriptor was revised to remove pocket revision as a requirement, and parenthetical notes have been added to instruct when it is appropriate to report 33225 with other procedures. When reporting with 33322 or 33323, claim 33225 only when pocket relocation is performed. The table for pacemaker and cardioverter-defibrillator services also has been revised to indentify the proper codes for the conversion of an existing bi-ventricular system and removal and replacement of the pulse generator. When the procedure is performed for a pacemaker, report 33225 with 33228 (dual lead system) or 33229 (multiple lead system). When the procedure is performed for a cardioverterdefibrillator, report 33225 with 33263 (dual lead system) or 33264 (multiple lead system).

Respiratory System/Lungs and Pleura: Stereotactic Radiation Therapy


32701 Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment AAPC Rationale Stereotactic radiation therapy is a new subsection in CPT that includes new guidelines for proper use. Thoracic target delineation is performed to identify tumor borders, tumor volume, and tumor relationship to adjacent anatomic structures. Delineation of the tumor allows the radiation oncologist to properly plan and deliver radiation treatments. Code 32701 is not reported with the radiation treatment codes (7742777499). According to the coding guidelines, 32701 may be reported only once per course of treatment, not per session.

Cardiovascular System/Heart and Pericardium: Heart (Including Valves) and Great Vessels
Subsection Guidance Category III codes 0256T, 0258T, and 0259T have been deleted and replaced with Category I codes 3336133369 to report transcatheter aortic valve replacement. TAVR is a non-invasive procedure to replace the aortic valve for patients with aortic stenosis (narrowing of the aortic valve). New subsection guidelines provide instruction for proper use of the new codes, and identify the services included: Gaining access, deployment, and repositioning of the valve, temporary pacemaker insertion for rapid pacing, closure of arteriotomy, angiography, and radiologic supervision and interpretation. A team of providers is required for this procedure (eg, cardiologist, interventional radiologists). When two surgeons work together to perform these procedures, append modifier 62. Diagnostic coronary angiography may be reported separately when a prior coronary angiography was not per-

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formed or, if a prior coronary angiography was performed, the test is not adequate (eg, patients condition has changed since the original angiography, the initial study is inadequate visualization of anatomy). The new codes are selected based on whether the approach is open or percutaneous and the vessel the surgeon uses for the approach. Cardiopulmonary bypass is reported with the appropriate add-on code (3336733369), depending on the type of access performed. 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach AAPC Rationale Report 33361 for transcatheter aortic valve replacement using a percutaneous approach through the femoral artery. 33362 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach AAPC Rationale Report 33362 for transcatheter aortic valve replacement using an open approach through the femoral artery. 33363 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach AAPC Rationale Report 33363 for transcatheter aortic valve replacement using an open approach through the axillary artery. 33364 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach AAPC Rationale Report 33364 for transcatheter aortic valve replacement using an open approach through the iliac artery. 33365 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy) AAPC Rationale Report 33365 for transcatheter aortic valve replacement using a transaortic approach. This is an open procedure done via median sternotomy or mediastinotomy.

33367 Transcatheter aortic valve replacement (TAVR/

TAVI) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (eg, femoral vessels) (list separately in addition to code for primary procedure) AAPC Rationale Add-on codes have been created to report cardiopulmonary bypass support when performed during a transcatheter aortic valve replacement. The add-on codes are selected based on whether the cannulation is performed percutaneously, open, or centrally. Report 33367 when peripheral arterial and venous cannulation is performed percutaneously.
33368 Transcatheter aortic valve replacement (TAVR/

TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg, femoral, iliac, axillary vessels) (list separately in addition to code for primary procedure) AAPC Rationale Add-on codes have been created to report cardiopulmonary bypass support when performed during a transcatheter aortic valve replacement. The add-on codes are selected based on whether the cannulation is performed percutaneously, open, or centrally. Report 33368 when peripheral arterial and venous cannulation is performed as an open procedure.
33369 Transcatheter aortic valve replacement (TAVR/

TAVI) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (eg, aorta, right atrium, pulmonary artery) (list separately in addition to code for primary procedure) AAPC Rationale Add-on codes have been created to report cardiopulmonary bypass support when performed during a transcatheter aortic valve replacement. The add-on codes are selected based on whether the cannulation is performed percutaneously, open, or centrally. Report 33369 when peripheral arterial and venous cannulation is performed centrally through the aorta, right atrium, or pulmonary artery.

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Complete 2013 Procedure Coding Updates

Cardiovascular System/Heart and Pericardium: Cardiac Assist


Subsection Guidance Category III codes 0048T and 0050T have been deleted and replaced with new Category I codes 3399033993 for insertion, removal, and repositioning of percutaenous ventricle assist devices. Ventricle assist devices assist the patients heart to pump blood. The devices are used during high-risk procedures or for critically ill patients. Ventricle assist devices can be inserted percutaneously (33990 33991) or transthoracically (33975, 33976, 33979). Coding guidelines have been added to the categories of Heart (Including Valves) and Great Vessels, Cardiac Valves, and Coronary Bypass procedures to direct you to the correct codes when ventricular assist devices are inserted.
33990 Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only

33993 Repositioning of percutaneous ventricular assist

device with imaging guidance at separate and distinct session from insertion AAPC Rationale Report 33993 when the percutaneous ventricular assist device (pVAD) is repositioned during a separate session. Repositioning during the same session as the insertion is not reported separately. Imaging guidance is required to report this code.

Cardiovascular System/Heart and Pericardium: Vascular Injection Procedures


36010 Introduction of catheter, superior or

inferior vena cava AAPC Rationale Introduction of catheter, to the superior or inferior vena cava now includes conscious sedation, when performed.
36140 Introduction of needle or intracatheter;

AAPC Rationale Report 33990 when the percutaneous ventricular assist device (pVAD) involves arterial access only.
33991 Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; both arterial and venous access, with transseptal puncture

extremity artery AAPC Rationale Introduction of a needle or intracatheter into an extremity artery now includes conscious sedation, when performed.

AAPC Rationale Report 33991 when the percutaneous ventricular assist device (pVAD) involves arterial and venous access and transseptal puncture.
33992 Removal of percutaneous ventricular assist device at separate and distinct session from insertion

Cardiovascular System/Arteries and Veins: Vascular Injection Procedures


Subsection Guidance The AMA/Specialty Society RVS Update Committee (RUC) reviewed codes for carotid catheter procedures because the codes were reported together more than 75 percent of the time. New codes have been created to prevent duplicated services. The new codes report selective and non-selective arterial catheter placement and angiography in the aortic arch, and carotid and vertebral arteries. They include vessel access, placement of catheter(s), contrast injection(s), fluoroscopy, radiological supervision and interpretation, and closure of the arteriotomy. The codes are unilateral; therefore, modifier 50 is appropriate if the service is performed bilaterally. CPT provides specific instruction on appending modifier 59 for these services. New guidelines provide instruction for proper use of 3622136228. The codes are built on a hierarchy of ser-

AAPC Rationale Report 33992 when the percutaneous ventricular assist device (pVAD) is removed during a separate session. Removal during the same session as the insertion is not reported separately.

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 11

Complete 2013 Procedure Coding Updates

vices. When more than one procedure is performed on the ipsilateral (same side) vessel, report only the most complex procedure. For example, a selective catheterization of the left common carotid, including an angiography of the ipsilateral extracranial circulation, is performed with a selective catheterization of the right internal carotid artery. This would be reported 36224, 36222-59. If both procedures were performed on the left (same) side (left common carotid and left internal carotid), you would report 36224 only. Radiological supervision and interpretation is included in codes 3622136228; however, if a 3D rendering is performed, coding guidelines allow separate reporting of 76376 or 76377. Likewise, if ultrasound guidance is required to access the vessel, report 76937; and, 75774 may be reported if the angiography is not performed for the extracranial and intracranial cervicocerebral vessels (eg, upper extremities).
36221 Non-selective catheter placement, thoracic aorta,

phy of the extracranial carotid and cervicocerebral arch, when performed AAPC Rationale Report 36223 for selective catheter placement in the common carotid or innominate artery, including angiography of ipsilateral (same side) intracranial carotid circulation, the extracranial carotid, and the cervicocerebral arch.
36224 Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed

AAPC Rationale Report 36224 for selective catheter placement in the internal carotid artery, including angiography of ipsilateral (same side) intracranial carotid circulation, the extracranial carotid, and the cervicocerebral arch. 36224

with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed AAPC Rationale Report 36221 for non-selective thoracic aorta catheter placement. This procedure includes angiography of the cervicocerebral arch. Do not report 36221 with 36222 36226.
36222 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

AAPC Rationale Report 36222 for selective catheter placement in the common carotid or innominate artery, including angiography of ipsilateral (same side) extracranial carotid circulation.
36223 Selective catheter placement, common carotid or

Anatomical Illustrations 2012, OptumInsight, Inc.


36225 Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiogra-

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Complete 2013 Procedure Coding Updates

AAPC Rationale Report 36225 for selective catheter placement in the subclavian artery. The procedure includes angiography of ipsilateral (same side) vertebral circulation and of the cervicocerebral arch.
36226 Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 36400 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 36405 Venipuncture, younger than age 3 years, necessitating physicians the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; scalp vein AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 36405 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 36406 Venipuncture, younger than age 3 years, necessitating physicians the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; other vein AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 36406 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 36410 Venipuncture, age 3 years or older, necessitating physicians the skill of a physician or other qualified health care professional, for diagnostic or therapeutic purposes (not to be used for routine venipuncture) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 36410 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

AAPC Rationale Report 36226 for selective catheter placement in the vertebral artery. The procedure includes angiography of ipsilateral (same side) vertebral circulation and of the cervicocerebral arch.
36227 Selective catheter placement, external carotid

artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (list separately in addition to code for primary procedure) AAPC Rationale Report add-on code 36227 in addition to 36222, 36223, or 36224 for selective catheter placement in the external carotid artery.
36228 Selective catheter placement, each intracranial

branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery) (list separately in addition to code for primary procedure) AAPC Rationale Report add-on code 36228 in addition 36224 or 36226 for selective catheter placement in each intracranial branch of the internal carotid or vertebral arteries. Do not report 36228 more than twice, per side. 36400 Venipuncture, younger than age 3 years, necessitating physicians the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; femoral or jugular vein

Cardiovascular System/Arteries and Veins: Transcatheter Procedures


37197 Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured venous or arterial catheter), includes radiological supervision and interpretation, and imaging guidance (ultrasound or fluoroscopy), when performed

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 13

Complete 2013 Procedure Coding Updates

AAPC Rationale Code 37197 has been created to bundle radiological supervision and interpretation to percutaneous transcatheter retrieval of a foreign body. The creation of the bundled code resulted in the deletion of 37203. Report retrieval of the vena cava filter with 37193.
37201 Transcatheter therapy, infusion for thrombolysis other

AAPC Rationale Report 37211 for infusion thrombolysis of an artery other than coronary, once per day for the initial service. 37212 Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day AAPC Rationale Report 37212 for infusion thrombolysis of a vein, once per day for the initial service. 37213 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; AAPC Rationale Report 37213 for infusion thrombolysis of an artery (other than coronary) or vein on a subsequent day of therapy. You would report this service only if the infusion thrombolysis was initiated on a previous date of service. Position change or exchange is included with the subsequent code.

than coronary AAPC Rationale CPT 2013 deletes 37201 and adds new codes 37211 37214 that bundle the surgical and radiological supervision and interpretation services. Radiology code 75896 has been revised to remove mention of thrombolysis.
37203 Transcatheter retrieval, percutaneous, of intravascular

foreign body (eg, fractured venous or arterial catheter) AAPC Rationale Code 37203 has been deleted and replaced by 37197, which bundles surgical and radiological supervision and interpretation to percutaneous transcatheter retrieval of a foreign body.
37209 Exchange of a previously placed intravascular catheter

during thrombolytic therapy AAPC Rationale Codes 37209 and 75900 have been deleted and replaced by new codes 3721137214 that bundle surgical and radiological supervision and interpretation services with infusion thrombolysis. Subsection Guidance New codes bundle surgical and radiological supervision and interpretation services with infusion thrombolysis when performed in arterial and venous vessels. During the procedure, chemicals are infused to break down clots. Codes are selected for the initial treatment day. If the treatment extends over more than one date of service, you may use separate codes to report the subsequent treatment day and the cessation or last treatment day. 37211 Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day
# 37214 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method

AAPC Rationale Report 37214 for the cessation of infusion thrombolysis of an artery (other than coronary), including removal of the catheter and closure of the vessel. Claim 37214 only if the infusion thrombolysis was initiated on a previous date of service. If the initiation and cessation are performed on the same date of service, report either 37211 or 37212 only, depending on the type of vessel.

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Complete 2013 Procedure Coding Updates

Hemic and Lymphatic Systems: Transplantation and Post-Transplantation Cellular Infusions


38240 Bone marrow or blood-derived peripheral stem Hematopoietic progenitor cell transplantation (HPC); allogeneic transplantation per donor AAPC Rationale Codes for HPC transplantation have been revised to assist with code selection. Allogenic transplantation means the recipient is not the donor. Because the procedure can involve cells from more than one donor, the procedure is reported per donor. The procedure includes the physician monitoring physiological parameters, verification of cell processing, patient evaluation, and direct supervision of the infusion. 38241 Bone marrow or blood-derived peripheral stem Hematopoietic progenitor cell transplantation (HPC); autologous transplantation AAPC Rationale Codes for HPC transplantation have been revised to assist with code selection. Autologous transplantation means the recipient and donor are the same person. The procedure includes the physician monitoring physiological parameters, verification of cell processing, patient evaluation, and direct supervision of the infusion.
# 38243 Hematopoietic progenitor cell (HPC); HPC boost

Digestive System/Esophagus: Endoscopy


# 43206 Esophagoscopy, rigid or flexible; with optical

endomicroscopy AAPC Rationale Code 43206 has been created to describe esophagoscopy performed with optical endomicroscopy. Optical endomicroscopy allows the provider to eliminate random sampling and perform targeted biopsies through real-time cellular observation of mucosal tissue. The procedure is performed when the provider suspects preneoplastic diseases. Code 43026 includes moderate sedation.

43206

AAPC Rationale A new code has been created to report HPC boost which may occur days, months, or years from the original HPC transplantation. The boost comes from the original HPC donor from the initial transplantation. This procedure is performed to treat a relapse or posttransplant cytopenia (deficiency or lack of cellular elements in the circulating blood). 38242 allogenic Allogenic donor lymphocyte infusions AAPC Rationale With revisions to 38240 and 38241, 38242 is no longer a child of parent code 38240. Report 38242 for lymphocyte infusions in patients who have had a previous bone marrow transplant.

Anatomical Illustrations 2012, OptumInsight, Inc.

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 15

Complete 2013 Procedure Coding Updates

43234 Upper gastrointestinal endoscopy, simple primary

examination (eg, with small diameter flexible endoscope) (separate procedure) AAPC Rationale Upper gastrointestinal endoscopy with a small diameter endoscope (43234) is now rarely performed. The most common gastrointestinal endoscopy is 43235.
43252 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with optical endomicroscopy

Urinary System/Bladder: Transurethral Surgery


52287 Cystourethroscopy, with injection(s) for chemodenervation of the bladder AAPC Rationale Code 52287 has been created to report injections for chemodenervation of the bladder (eg, for neurogenic incontinence).

Maternity Care and Delivery: Repair


59300 Episiotomy or vaginal repair, by other than attending physician AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 59300 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation also may be reported by other (non-physician), qualified attending health care professionals.

AAPC Rationale Code 43252 has been created to report upper gastrointestinal endoscopy performed with optical endomicroscopy. Optical endomicroscopy allows the provider to eliminate random sampling and perform targeted biopsies through real-time cellular observation of mucosal tissue. The procedure is performed when the provider suspects preneoplastic diseases. Code 43252 includes moderate sedation.

Digestive System/Intestines (Except Rectum): Other Procedures


44705 Preparation of fecal microbiota for instillation, including assessment of donor specimen AAPC Rationale Code 44705 has been created to report the preparation of fecal microbiota for instillation in a patient with Clostridium difficile infection. Clostridium difficile (C. difficile) is a bacterium commonly found in the intestines that can grow out of control from use of antibiotics, which kill good bacteria in the gut. The procedure includes collecting fecal material from a donor, preparing the fecal material in a slurry, and evaluating the material prior to instillation. This service includes only the preparation prior to instillation, not the work to instill the fecal microbiota. A separate code is reported for the instillation either through colonoscopy or sigmoidoscopy. A parenthetical note following 44705 instructs you to report 44799 for oro-nasogastric tube or enema.

Nervous System/Spine and Spinal Cord: Reservoir/Pump Implantation


62370 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill (requiring skill physicians of a physician or other qualified health care professional) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 62370 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System: Neurostimulators (Peripheral Nerve)
64561 Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed AAPC Rationale Percutaneous implantation of neurostimulator electrode array to the sacral nerve now includes image guidance, when performed.

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Complete 2013 Procedure Coding Updates

Nervous System/Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System: Destruction by Neurolytic Agent, Chemodenervation
64612 Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm) AAPC Rationale The descriptor of 64612 was revised to add unilateral to clarify proper code application. If the procedure is performed bilaterally, append modifier 50. 64614 Chemodenervation of muscle(s); extremity(s) and/ or trunk muscle(s) (eg, for dystonia, cerebral palsy, multiple sclerosis) AAPC Rationale Code 64614 was revised to specify extremity (singular). Because the procedure includes chemodenervation of multiple muscles, it is reported once per session for extremity or trunk muscles. Do not report 64614 with modifier 50. 64615 Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine) AAPC Rationale Code 64615 has been created to report bilateral chemodenervation of muscles innervated by facial, trigeminal, cervical spine, and accessory nerves. This procedure typically includes 31 injection sites to treat migraine headaches. The procedure must be performed bilaterally and is valued as such: Do not append modifier 50 to 64615. Do not report 64615 with 64612, 64613, or 64614.

65805 Paracentesis of anterior chamber of eye (separate pro-

cedure); with therapeutic release of aqueous AAPC Rationale To simplify code selection, 65805 has been deleted and 65800 (above) was revised to report removal of aqueous for either diagnostic or therapeutic purposes.
# 67810 Biopsy Incisional biopsy of eyelid skin including lid margin

AAPC Rationale Code 67810 was revised to include the anatomic site of the eyelid and the depth of tissue removed. This code is sometimes used in error when the proper integumentary biopsy code should be reported. To report 67810, the biopsy must be of the lid margin. Because this is an incisional procedure, it was resequenced under the incisional subsection instead of the excisional heading, where it previously appeared. Report 11100, 11101, or 11310-11313 for biopsy of the skin of the eyelid.

Eye and Ocular Adnexa: Anterior Segment Incision


65800 Paracentesis of anterior chamber of eye (separate procedure); with diagnostic aspiration removal of aqueous AAPC Rationale To simplify code selection, 65805 (below) has been deleted and 65800 was revised to report removal of aqueous for either diagnostic or therapeutic purposes.

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 17

Complete 2013 Procedure Coding Updates

67810
A portion of a lesion or suspect tissue is removed for analysis

Diagnostic Radiology: Spine and Pelvis


72040 Radiologic examination, spine, cervical; 2 3 views or less AAPC Rationale Codes for radiology examination of the cervical spine have been revised to include the number of views to accurately capture the work performed. When three or fewer views are performed, report 72040. 72050 Radiologic examination, spine, cervical; 4 minimum or 5 views AAPC Rationale Codes for radiology examination of the cervical spine have been revised to include the number of views to accurately capture the work performed. When four or five views are performed, report 72050. 72052 Radiologic examination, spine, cervical; complete, including oblique and flexion and/ 6 or extension studies more views AAPC Rationale Codes for radiology examination of the cervical spine have been revised to include the number of views to accurately capture the work performed. When six or more views are performed, report 72052.

Lesion to be biopsied

The incision may be repaired with sutures Anatomical Illustrations 2012, OptumInsight, Inc.

Radiology
Diagnostic Radiology: Chest
71040 Bronchography, unilateral, radiological supervision and

Diagnostic Radiology/Vascular: Aorta and Arteries


75650 Angiography, cervicocerebral, catheter, including vessel

origin, radiological supervision and interpretation AAPC Rationale Code 75650 has been deleted. Refer to 3622136226.
75660 Angiography, external carotid, unilateral, selective,

interpretation AAPC Rationale Bronchography is no longer performed. Computed tomography (CT) is now the standard of care replacing bronchography.
71060 Bronchography, bilateral, radiological supervision and

radiological supervision and interpretation AAPC Rationale Code 75660 has been deleted. Refer to 3622136226.
75662 Angiography, external carotid, bilateral, selective, radio-

interpretation AAPC Rationale Bronchography is no longer performed. Computed tomography (CT) is now the standard of care replacing bronchography.

logical supervision and interpretation AAPC Rationale Code 75662 has been deleted. Refer to 36227.

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Complete 2013 Procedure Coding Updates

75665 Angiography, carotid, cerebral, unilateral, radiological

supervision and interpretation AAPC Rationale Code 75665 has been deleted. Refer to 36223 and 36224.
75671 Angiography, carotid, cerebral, bilateral, radiological

AAPC Rationale New codes (3721137214) have been created for infusion thrombolysis. The new codes include radiological supervision and interpretation; therefore, 75898 was revised to exclude thrombolysis.
75900 Exchange of a previously placed intravascular catheter

supervision and interpretation AAPC Rationale Code 75671 has been deleted. Refer to 36223 and 36224.
75676 Angiography, carotid, cervical, unilateral, radiological

during thrombolytic therapy with contrast monitoring, radiological supervision and interpretation AAPC Rationale New codes (3721137214) have been created for infusion thrombolysis. The new codes include radiological supervision and interpretation; therefore, 75900 has been deleted.
75961 Transcatheter retrieval, percutaneous, of intravascular

supervision and interpretation AAPC Rationale Code 75676 has been deleted. Refer to 3622236224.
75680 Angiography, carotid, cervical, bilateral, radiological

foreign body (eg, fractured venous or arterial catheter), radiological supervision and interpretation AAPC Rationale Code 75961 has been deleted and replaced by 37197.

supervision and interpretation AAPC Rationale Code 75680 has been deleted. Refer to 3622236224.
75685 Angiography, vertebral, cervical, and/or intracranial,

Diagnostic Radiology: Other Procedures


76000 Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 (eg, cardiac fluoroscopy) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 76000 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 76001 Fluoroscopy, physician or other qualified health care professional time more than 1 hour, assisting a nonradiologic physician or other qualified health care professional (eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 76001 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 76376 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postpro-

radiological supervision and interpretation AAPC Rationale Code 75685 has been deleted. Refer to 3622536226.

Diagnostic Radiology, Vascular: Transcatheter Procedures


75896 Transcatheter therapy, infusion, any method (eg, thrombolysis other than for thrombolysis, radiological supervision and interpretation AAPC Rationale New codes (3721137214) have been created for infusion thrombolysis. The new codes include radiological supervision and interpretation; therefore, 75896 was revised to exclude thrombolysis. 75898 Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 19

Complete 2013 Procedure Coding Updates

cessing under concurrent supervision; not requiring image postprocessing on an independent workstation AAPC Rationale Code 76376 was revised to include image postprocessing under concurrent supervision. The parenthetical note was revised to list procedures not reported with 76376. 76377 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation AAPC Rationale Code 76377 was revised to include image postprocessing under concurrent supervision. The parenthetical note was revised to list procedures not reported with 76377.

AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 77051 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation also may be reported by other (non-physician) health care professionals.
77052 Computer-aided detection (computer algorithm

analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 77052 has been amended to allow that, per AMA guidelines, this service may be performed by a qualified health care professional other than a physician.

Diagnostic Ultrasound: Extremities


76885 Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health care professional manipulation) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 76885 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 76886 Ultrasound, infant hips, real time with imaging documentation; limited, static (not requiring physician or other qualified health care professional manipulation) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 76886 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

Bone and Joint Studies


77071 Manual application of stress performed by physician or other qualified health care professional for joint radiography, including contralateral joint if indicated AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 77071 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

Nuclear Medicine/Diagnostic: Endocrine System


78000 Thyroid uptake; single determination

AAPC Rationale Codes 7800078011 have been deleted. See 7801278014.


78001 Thyroid uptake; multiple determinations

Breast, Mammography
+77051 Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; diagnostic mammography (list separately in addition to code for primary procedure)

AAPC Rationale Codes 7800078011 have been deleted. See 7801278014.


78003 Thyroid uptake; stimulation, suppression or discharge

(not including initial uptake studies) AAPC Rationale Codes 7800078011 have been deleted. See 7801278014.

20 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates

78006 Thyroid imaging, with uptake; single determination

AAPC Rationale Codes 7800078011 have been deleted. See 7801278014.


78007 Thyroid imaging, with uptake; multiple determinations

performed. Use 78014 when the services identified in 78012 and 78013 are performed during the same session. 78070 Parathyroid planar imaging (including subtraction, when performed) AAPC Rationale Revisions were made to 78070 to more accurately describe the procedure performed. New codes 7807178072 have been added to report Single Photon Emission Computed Tomography (SPECT) and SPECT/CT performed for parathyroid planar imaging. 78071 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT) AAPC Rationale Prior to the creation of 78071, no CPT code properly described SPECT performed during parathyroid planar imaging. 78072 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired computed tomography (CT) for anatomical localization AAPC Rationale Prior to the creation of code 78072, no CPT code properly described SPECT/CT performed during parathyroid planar imaging.

AAPC Rationale Codes 7800078011 have been deleted. See 7801278014.


78010 Thyroid imaging; only

AAPC Rationale Codes 7800078011 have been deleted. See 7801278014.


78011 Thyroid imaging; with vascular flow

AAPC Rationale Codes 7800078011 have been deleted. See 7801278014. 78012 Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed) AAPC Rationale Codes 7800078011 have been deleted and new codes have been created to consolidate services and more accurately describe the types of thyroid nuclear medicine scans performed. Code 78012 is performed to evaluate the function of the gland. 78013 Thyroid imaging (including vascular flow, when performed); AAPC Rationale Codes 7800078011 have been deleted and new codes have been created to consolidate services and more accurately describe the types of thyroid nuclear medicine scans performed. Code 78013 is performed to determine the size, shape, and position of the thyroid gland. 78014 Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed) AAPC Rationale Codes 7800078011 have been deleted and new codes have been created to consolidate services and more accurately describe the types of thyroid nuclear medicine scans

Pathology and Laboratory


Molecular Pathology
Last year, CPT added a new subsection and 101 new codes (8120081408) to the Pathology and Laboratory chapter to describe molecular pathology procedures. Molecular pathology is the study and diagnosis of disease through the examination of nucleic acid (including DNA and RNA), for the purposes of: detecting and monitoring infectious agents; establishing clonality (cells descended from and genetically identical to a single common ancestor), particularly for lymphoid diseases; assessing the presence of minimal residual disease for certain malignancies following therapy; determining prognosis and/or predicting response to therapy, and; testing for inherited diseases. For 2013, CPT adds 13 new Tier 1 molecular pathology procedure codes, as well as an unlisted molecular pathology procedure code (81479), and revises the descriptors for

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 21

Complete 2013 Procedure Coding Updates

all nine Tier 2 (8140081408) procedures. Because molecular pathology procedures are highly specialized and infrequently reported, we will not cover these code revisions and additions individually as part of this course. Consult your 2013 CPT codebook for complete instructions and parenthetical guidelines, definitions, and descriptors for molecular pathology codes. Molecular pathology instructions have been added to the beginning of the CPT codebook. The information provides a history for the creation of the molecular pathology codes, instructions for use, and frequently asked questions to assist with proper code selection.

81506 Endocrinology (type 2 diabetes), biochemical assays of seven analytes (glucose, HBA1C, insulin, HS-CRP, adoponectin, ferritin, interleukin 2-receptor alpha), utilizing serum or plasma, algorithm reporting a risk score AAPC Rationale This new MAAA procedure is used to determine risk score for type 2 diabetes via assays of the seven analytes listed (glucose, HBA1C, insulin, HS-CRP, adoponectin, ferritin, interleukin 2-receptor alpha). 81508 Fetal congenital abnormalities, biochemical assays of two proteins (PAPP-A, HCG [any form]), utilizing maternal serum, algorithm reported as a risk score AAPC Rationale This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of two proteins. 81509 Fetal congenital abnormalities, biochemical assays of three proteins (PAPP-A, HCG [any form], DIA), utilizing maternal serum, algorithm reported as a risk score AAPC Rationale This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of three proteins. 81510 Fetal congenital abnormalities, biochemical assays of three analytes (AFP, UE3, HCG [any form]), utilizing maternal serum, algorithm reported as a risk score AAPC Rationale This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of three analytes. 81511 Fetal congenital abnormalities, biochemical assays of four analytes (AFP, UE3, HCG [any form], DIA) utilizing maternal serum, algorithm reported as a risk score (may include additional results from previous biochemical testing) AAPC Rationale This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of four analytes.

Multianalyte Assays with Algorithmic Analysis (MAAA)


A new category, including coding guidelines, has been created to report MAAA. MAAAs are algorithmic analysis using the results of assays (molecular pathology assays, fluorescent in situ hybridization assays, and nonnucleic acid-based assays) and patient information, when appropriate, to report a numeric score(s) or probability of developing specific conditions. The code descriptions include the disease type, material analyzed, number of markers, specimen type, algorithm, and report. 81500 Oncology (ovarian), biochemical assays of two proteins (CA-125 and HE4), utilizing serum, with menopausal status, algorithm reported as a risk score AAPC Rationale This new MAAA procedure is used to determine risk score for ovarian cancer. Report 81500 when biochemical assays of two proteins and menopausal status are used for the algorithm. 81503 Oncology (ovarian), biochemical assays of five proteins (CA-125, apoliproprotein A1, beta-2 microglobulin, transferrin, and pre-albumin), utilizing serum, algorithm reported as a risk score AAPC Rationale This new MAAA procedure is used to determine risk score for ovarian cancer. Report 81503 for biochemical assays of five proteins.

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Complete 2013 Procedure Coding Updates

81512 Fetal congenital abnormalities, biochemical assays of five analytes (AFP, UE3, total HCG, hyperglycosylated HCG, DIA) utilizing maternal serum, algorithm reported as a risk score AAPC Rationale This new MAAA procedure is used to determine risk score for fetal congenital abnormalities using biochemical assays of five analytes. 81599 Unlisted multianalyte assay with algorithmic analysis AAPC Rationale An unlisted code has been created for MAAA tests when a Category I code does not exist and there is no appropriate code in Appendix O. Appendix O lists alphanumeric codes that include four numeric digits followed by M. Report codes in Appendix O by the proprietary name and clinical lab or manufacturer. These codes are in an Appendix because Category I codes report the service work and cannot include proprietary names.

AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 81200-81479.
83891 Molecular diagnostics; isolation or extraction of highly

purified nucleic acid, each nucleic acid type (ie, DNA or RNA) AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83892 Molecular diagnostics; enzymatic digestion, each

enzyme treatment AAPC Rationale Codes 8389083914 have been deleted. To report, refer to molecular pathology codes 8120081479.
83893 Molecular diagnostics; dot/slot blot production, each

nucleic acid preparation AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83894 Molecular diagnostics; separation by gel electrophoresis

Chemistry
82009 Acetone or other ketone bodies Ketone body(s) (eg, acetone, acetoacetic acid, serum beta-hydroxybutyrate); qualitative AAPC Rationale Code 82009 was revised to reflect current clinical practice. 82010 Acetone or other ketone bodies Ketone body(s) (eg, acetone, acetoacetic acid, serum beta-hydroxybutyrate); quantitative AAPC Rationale Code 82010 was revised to reflect current clinical practice. 82777 Galectin-3 AAPC Rationale Code 82777 has been created to report measuring of galectin-3, which can be used to assess the prognosis of heart failure patients.
83890 Molecular diagnostics; molecular isolation or extraction,

(eg, agarose, polyacrylamide), each nucleic acid preparation AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83896 Molecular diagnostics; nucleic acid probe, each

AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83897 Molecular diagnostics; nucleic acid transfer (eg, South-

ern, Northern), each nucleic acid preparation AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83898 Molecular diagnostics; amplification, target, each

each nucleic acid type (ie, DNA or RNA)

nucleic acid sequence

= FDA Approval Pending = Add-on

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Complete 2013 Procedure Coding Updates

AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83900 Molecular diagnostics; amplification, target, multiplex,

83906 Molecular diagnostics; mutation identification by allele

specific translation, single segment, each segment AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83907 Molecular diagnostics; lysis of cells prior to nucleic acid

first 2 nucleic acid sequences AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83901 Molecular diagnostics; amplification, target, multiplex,

extraction (eg, stool specimens, paraffin embedded tissue), each specimen AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83908 Molecular diagnostics; amplification, signal, each

each additional nucleic acid sequence beyond 2 (List separately in addition to code for primary procedure) AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83902 Molecular diagnostics; reverse transcription

nucleic acid sequence AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83909 Molecular diagnostics; separation and identification by

AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83903 Molecular diagnostics; mutation scanning, by physical

high resolution technique (eg, capillary electrophoresis), each nucleic acid preparation AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83912 Molecular diagnostics; interpretation and report

properties (eg, single strand conformational polymorphisms [SSCP], heteroduplex, denaturing gradient gel electrophoresis [DGGE], RNAase A), single segment, each AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83904 Molecular diagnostics; mutation identification by

AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83913 Molecular diagnostics; RNA stabilization

sequencing, single segment, each segment AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83905 Molecular diagnostics; mutation identification by allele

AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.
83914 Mutation identification by enzymatic ligation or primer

specific transcription, single segment, each segment AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.

extension, single segment, each segment (eg, oligonucleotide ligation assay [OLA], single base chain extension [SBCE], or allele-specific primer extension [ASPE]) AAPC Rationale Codes 8389083914 have been deleted; refer to molecular pathology codes 8120081479.

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Immunology
Codes 0279T and 0280T have been deleted and replaced with Category I codes to report testing for tumor cells circulating in the blood. The test is used to determine the prognosis for cancer patients.
# 86152 Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood);

etry); qualitative assessment of the presence or absence of antibody(ies) to HLA class I and class II HLA antigens AAPC Rationale Report 86828 for qualitative assessment for the presence or absence of HLA class I and class II. A qualitative test tells you if a particular substance (analyte) is present in the specimen. 86829 Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); qualitative assessment of the presence or absence of antibody(ies) to HLA class I or class II HLA antigens AAPC Rationale Report 86829 for qualitative assessment for the presence or absence of HLA class I or class II. A qualitative test tells you if a particular substance (analyte) is present in the specimen. 86830 Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); antibody identification by qualitative panel using complete HLA phenotypes, HLA class I AAPC Rationale Report 86830 for qualitative panel using HLA class I. A qualitative test tells you if a particular substance (analyte) is present in the specimen. 86831 Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); antibody identification by qualitative panel using complete HLA phenotypes, HLA class II AAPC Rationale Report 86831 for qualitative panel using HLA class II. A qualitative test tells you if a particular substance (analyte) is present in the specimen. 86832 Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), HLA class I AAPC Rationale Report 86832 for qualitative panel for identification of antibody specificities for HLA class I. A qualitative test tells you if a particular substance (analyte) is present in the specimen. Complete 2013 Procedure Updates 25

AAPC Rationale Code 86152 has been created to report the technical component; the interpretation and report are reported using 86153 (below). When the same provider performs the test and interpretation and report, report both 86152 and 86153.
# 86153 Cell enumeration using immunologic selection and

identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required AAPC Rationale Code 86152 (above) has been created to report the technical component; the interpretation and report are reported using 86153. When the same provider performs the test and interpretation and report, report both 86152 and 86153. 86711 Antibody; JC (John Cunningham) virus AAPC Rationale Code 86711 has been created to report the testing to detect the John Cunningham virus, which causes progressive multifocal leukoencephalopathy (PML), a rare but often fatal condition that destroys myelin, a protective covering of nerve cells in the brain.

Immunology: Tissue Typing


Subsection Guidance New codes 8682886835 report testing for antibodies to human leukocyte antigens (HLA). HLA typing identifies the unique HLA antigens for an individual. Tests of HLAclass I (A, B, C) and class II (DR, DQ, DP) are performed for solid organ and bone marrow transplants. 86828 Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytom-

= FDA Approval Pending = Add-on

Complete 2013 Procedure Coding Updates

86833 Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), HLA class II AAPC Rationale Report 86833 for qualitative panel for identification of antibody specificities for HLA class II. 86834 Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); semi-quantitative panel (eg, titer), HLA class I AAPC Rationale Report 86834 for semi-quantitative panel for HLA class I. 86835 Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); semi-quantitative panel (eg, titer), HLA class II AAPC Rationale Report 86835 for semi-quantitative panel for HLA class II.

AAPC Rationale Codes 8749887539 have been revised to include reverse transcription, which more accurately reports the procedure performed. 87535 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, reverse transcription and amplified probe technique AAPC Rationale Codes 8749887539 have been revised to include reverse transcription, which more accurately reports the procedure performed. 87536 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, reverse transcription and quantification AAPC Rationale Codes 8749887539 have been revised to include reverse transcription, which more accurately reports the procedure performed. 87538 Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, reverse transcription and amplified probe technique AAPC Rationale Codes 8749887539 have been revised to include reverse transcription, which more accurately reports the procedure performed. 87539 Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, reverse transcription and quantification AAPC Rationale Codes 8749887539 have been revised to include reverse transcription, which more accurately reports the procedure performed. 87631 Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), multiplex reverse transcription and amplified probe technique, multiple types or subtypes, 3-5 targets AAPC Rationale New codes 8763187633 have been created for the nucleic acid tests performed to detect respiratory viruses. The codes are selected based on the number of targets for the test. Report 87631 for three to five targets.

Microbiology
87498 Infectious agent detection by nucleic acid (DNA or RNA); enterovirus, reverse transcription and amplified probe technique AAPC Rationale Codes 8749887539 have been revised to include reverse transcription, which more accurately reports the procedure performed. 87521 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, reverse transcription and amplified probe technique AAPC Rationale Codes 8749887539 have been revised to include reverse transcription, which more accurately reports the procedure performed. 87522 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, reverse transcription and quantification

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87632 Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), multiplex reverse transcription and amplified probe technique, multiple types or subtypes, 6-11 targets AAPC Rationale New codes 8763187633 have been created for the nucleic acid tests performed to detect respiratory viruses. The codes are selected based on the number of targets for the test. Report 87632 for six to 11 targets. 87633 Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), multiplex reverse transcription and amplified probe technique, multiple types or subtypes, 12-25 targets AAPC Rationale New codes 87631-87633 have been created for the nucleic acid tests performed to detect respiratory viruses. The codes are selected based on the number of targets for the test. Report 87633 for 12 to 25 targets. 87910 Infectious agent genotype analysis by nucleic acid (DNA or RNA); cytomegalovirus AAPC Rationale Code 87910 has been created to report genotype analysis by nucleic acid for cytomegalovirus, which are herpes viruses (eg, herpes simplex viruses, varicella-zoster virus, Epstein-Barr virus) 87901 Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, reverse transcriptase and protease regions AAPC Rationale Code 87901 has become a child code indexed to new parent code of 87910. Code application is not affected by this change. 87912 Infectious agent genotype analysis by nucleic acid (DNA or RNA); hepatitis B virus AAPC Rationale New code 87912 describes genotype analysis by nucleic acid for the hepatitis B virus.

Surgical Pathology
88375 Optical endomicroscopic image(s), interpretation and report, real-time or referred, each endoscopic session AAPC Rationale Code 88375 describes interpretation and report of optimal endomicroscopic images obtained. The use of optical endomicroscopic imaging allows for more precise biopsies. Report this code only when performed by a provider (eg, pathologist) other than the provider performing the endoscopic procedure. Do not report 88375 with 43206 or 43252.
88384 Array-based evaluation of multiple molecular probes; 11

through 50 probes AAPC Rationale Codes 8838488386 have been deleted. See molecular pathology codes 8120081479.
88385 Array-based evaluation of multiple molecular probes; 51

through 250 probes AAPC Rationale Codes 8838488386 have been deleted. See molecular pathology codes 81200-81479.
88386 Array-based evaluation of multiple molecular probes;

251 through 500 probes AAPC Rationale Codes 8838488386 have been deleted. See molecular pathology codes 8120081479.

Medicine
Many codes in the Medicine section of CPT 2013 have seen descriptor revisions similar to those found in E/M chapter (and less frequently, throughout the Surgery and Radiology chapters), which now specifically allow the reporting of services by other, qualified non-physician practitioners. Other significant changes include new (replacement) codes for psychotherapy; percutaneous angioplasty, atherectomy, and stent placement; nerve conduction studies, and; intraoperative monitoring.

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Complete 2013 Procedure Coding Updates

Immunization Administration for Vaccines/Toxoids


90653 Influenza vaccine, inactivated, subunit, adjuvanted,

90660 Influenza virus vaccine, trivalent, live, for intranasal use AAPC Rationale Codes 9065590660 have been revised to include trivalent. Trivalent means the vaccine includes three viral strains.
90665 Lyme disease vaccine, adult dosage, for intramuscular use

for intramuscular use AAPC Rationale Code 90653 has been created to report the supply of adjuvanted seasonal trivalent influenza vaccine. The product is currently pending FDA approval. 90655 Influenza virus vaccine, trivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use AAPC Rationale Codes 9065590660 have been revised to include trivalent. Trivalent means the vaccine includes three viral strains. 90656 Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use AAPC Rationale Codes 9065590660 have been revised to include trivalent. Trivalent means the vaccine includes three viral strains. 90657 Influenza virus vaccine, trivalent, split virus, when administered to children 6-35 months of age, for intramuscular use AAPC Rationale Codes 9065590660 have been revised to include trivalent. Trivalent means the vaccine includes three viral strains. 90658 Influenza virus vaccine, trivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use AAPC Rationale Codes 9065590660 have been revised to include trivalent. Trivalent means the vaccine includes three viral strains.

AAPC Rationale Code 90665 has been deleted: The indicated vaccine is no longer available.
# 90672 Influenza virus vaccine, quadrivalent, live, for intranasal use

AAPC Rationale Code 90672 has been created to report quadrivalent (four viral strains) influenza vaccine for intranasal use.

90701 Diphtheria, tetanus toxoids, and whole cell pertussis

vaccine (DTP), for intramuscular use AAPC Rationale Code 90701 has been deleted: The vaccine was removed from the market due to safety concerns.
90718 Tetanus and diphtheria toxoids (Td) adsorbed when

administered to individuals 7 years or older, for intramuscular use AAPC Rationale Code 90718 has been deleted to prevent confusion for Td vaccine. All Td vaccines are preservative free (see 90714).
90739 Hepatitis B vaccine, adult dosage (2 dose sched-

ule), for intramuscular use AAPC Rationale Code 90739 has been created to report two dose schedule for Hepatitis B vaccine. The vaccine is currently pending FDA approval.

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90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use AAPC Rationale Code 90746 was revised to specify three does schedule, which distinguishes it from new two-dose schedule code 90739.

per day, but not on the same day as E/M services. If the psychiatric diagnostic evaluation is performed on the same date as a medical service, report 90792.
90801 Psychiatric diagnostic interview examination

AAPC Rationale
Codes 90801 and 90802 have been deleted and replaced with 90791 and 90792.
90802 Interactive psychiatric diagnostic interview examination

Psychiatry
The psychiatry category received a major overhaul with creation of new codes and guidelines, as well as substantial code deletions. The revised code set more accurately report the services behavioral health providers now perform.

using play equipment, physical devices, language interpreter, or other mechanisms of communication AAPC Rationale Codes 90801 and 90802 have been deleted and replaced with 90791 and 90792.
90804 Individual psychotherapy, insight oriented, behavior

Psychiatry/Interactive Complexity
90785 Interactive complexity (list separately in addition to the code for primary procedure)

AAPC Rationale This is an add-on code reported for patients whose communication factors complicate the delivery of psychiatric services (eg, the patient is verbally underdeveloped, or an emotional caregiver complicates the session with the patient). CPT includes a list of codes with which you may report 90785. Do not report 90785 with E/M services.

modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient AAPC Rationale Codes 90804, 90805, 90806, 90808, and 90809 have been deleted. See new codes 9083290838.
90805 Individual psychotherapy, insight oriented, behavior

Psychiatry/Psychiatric Diagnostic Procedures


90791 Psychiatric diagnostic evaluation AAPC Rationale New codes 90791 and 90792 (below) replace deleted codes 90801 and 90802. Psychiatric diagnostic evaluation is an assessment that includes obtaining a history, mental status, and recommendations. The service may require speaking with the family or other sources. Report 90791/90792 once per day, but not on the same day as E/M services. If the psychiatric diagnostic evaluation is performed without a medical service, report 90791. 90792 Psychiatric diagnostic evaluation with medical services AAPC Rationale New codes 90791 (above) and 90792 replace deleted codes 90801 and 90802. Psychiatric diagnostic evaluation is an assessment that includes obtaining a history, mental status, and recommendations. The service may require speaking with the family or other sources. Report 90791/90792 once

modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services AAPC Rationale Codes 90804, 90805, 90806, 90808, and 90809 have been deleted. See new codes 9083290838.
90806 Individual psychotherapy, insight oriented, behavior

modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient AAPC Rationale Codes 90804, 90805, 90806, 90808, and 90809 have been deleted. See new codes 9083290838.

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Complete 2013 Procedure Coding Updates

90807 Individual psychotherapy, insight oriented, behavior

90812 Individual psychotherapy, interactive, using play equip-

modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services AAPC Rationale Codes 90804, 90805, 90806, 90808, and 90809 have been deleted. See new codes 9083290838.
90808 Individual psychotherapy, insight oriented, behavior

ment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient AAPC Rationale Codes 90810, 90811, 90812, 90813, 90814, and 90815 have been deleted. See 9083290838.
90813 Individual psychotherapy, interactive, using play equip-

modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient AAPC Rationale Codes 90804, 90805, 90806, 90808, and 90809 have been deleted. See new codes 9083290838.
90809 Individual psychotherapy, insight oriented, behavior

ment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services AAPC Rationale Codes 90810, 90811, 90812, 90813, 90814, and 90815 have been deleted. See 9083290838.
90814 Individual psychotherapy, interactive, using play equip-

modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services AAPC Rationale Codes 90804, 90805, 90806, 90808, and 90809 have been deleted. See new codes 9083290838.
90810 Individual psychotherapy, interactive, using play equip-

ment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient AAPC Rationale Codes 90810, 90811, 90812, 90813, 90814, and 90815 have been deleted. See 9083290838.
90815 Individual psychotherapy, interactive, using play equip-

ment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient AAPC Rationale Codes 90810, 90811, 90812, 90813, 90814, and 90815 have been deleted. See 9083290838.
90811 Individual psychotherapy, interactive, using play equip-

ment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services AAPC Rationale Codes 90810, 90811, 90812, 90813, 90814, and 90815 have been deleted. See 9083290838.
90816 Individual psychotherapy, insight oriented, behavior

ment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services AAPC Rationale Codes 90810, 90811, 90812, 90813, 90814, and 90815 have been deleted. See 9083290838.

modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient AAPC Rationale Codes 90816, 90817, 90818, 90819, 90821, and 90822 have been deleted. See 9083290838.

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90817 Individual psychotherapy, insight oriented, behavior

90823 Individual psychotherapy, interactive, using play equip-

modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services AAPC Rationale Codes 90816, 90817, 90818, 90819, 90821, and 90822 have been deleted. See 9083290838.
90818 Individual psychotherapy, insight oriented, behavior

ment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient AAPC Rationale Codes 90823, 90824, 90826, 90827, 90828, and 90829 have been deleted. Refer to 9083290838.
90824 Individual psychotherapy, interactive, using play equip-

modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient AAPC Rationale Codes 90816, 90817, 90818, 90819, 90821, and 90822 have been deleted. See 9083290838.
90819 Individual psychotherapy, insight oriented, behavior

ment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services AAPC Rationale Codes 90823, 90824, 90826, 90827, 90828, and 90829 have been deleted. Refer to 9083290838.
90826 Individual psychotherapy, interactive, using play equip-

modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services AAPC Rationale Codes 90816, 90817, 90818, 90819, 90821, and 90822 have been deleted. See 9083290838.
90821 Individual psychotherapy, insight oriented, behavior

ment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient AAPC Rationale Codes 90823, 90824, 90826, 90827, 90828, and 90829 have been deleted. Refer to 9083290838.
90827 Individual psychotherapy, interactive, using play equip-

modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient AAPC Rationale Codes 90816, 90817, 90818, 90819, 90821, and 90822 have been deleted. See 9083290838.
90822 Individual psychotherapy, insight oriented, behavior

ment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services AAPC Rationale Codes 90823, 90824, 90826, 90827, 90828, and 90829 have been deleted. Refer to 9083290838.

modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services AAPC Rationale Codes 90816, 90817, 90818, 90819, 90821, and 90822 have been deleted. See 9083290838.

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Complete 2013 Procedure Coding Updates

90828 Individual psychotherapy, interactive, using play equip-

ment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient AAPC Rationale Codes 90823, 90824, 90826, 90827, 90828, and 90829 have been deleted. Refer to 9083290838.
90829 Individual psychotherapy, interactive, using play equip-

90833 Psychotherapy, 30 minutes with patient and/ or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure)

ment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services AAPC Rationale Codes 90823, 90824, 90826, 90827, 90828, and 90829 have been deleted. Refer to 9083290838.

AAPC Rationale Report 90833 when 16-37 minutes of psychotherapy is provided on the same date as an E/M service. The time must be face-to-face with the patient and/or family. Do not include time spent performing the E/M service as part of the psychotherapy service. Select the appropriate E/M code based on the documentation. 90834 Psychotherapy, 45 minutes with patient and/or family member AAPC Rationale Report 90834 for 38-52 minutes of psychotherapy. The time must be face-to-face with the patient and/or family.
90836 Psychotherapy, 45 minutes with patient and/ or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure)

Psychiatry/Psychiatric Diagnostic Procedures: Psychotherapy


Subsection Guidance Psychotherapy is the treatment of mental illness and behavioral disturbances, including therapeutic communication to help the patient with emotional disturbances, adjust behaviors, and encourage personal growth. New, timebased codes simplify psychotherapy services reporting. Add-on codes have been created to report psychotherapy with an appropriate E/M code if a significant and separately identifiable evaluation and management is performed. Do not include time spent performing the E/M service as part of the psychotherapy service. 90832 Psychotherapy, 30 minutes with patient and/or family member AAPC Rationale Report 90832 for 16-37 minutes of psychotherapy. The time must be face-to-face with the patient and/or family.

AAPC Rationale Report 90836 when 38-52 minutes of psychotherapy is provided on the same date as an E/M service. The time must be face-to-face with the patient and/or family. Do not include time spent performing the E/M service as part of the psychotherapy service. Select the appropriate E/M code based on the documentation. 90837 Psychotherapy, 60 minutes with patient and/or family member AAPC Rationale Report 90837 for 53 or more minutes of psychotherapy. The time must be face-to-face with the patient and/or family.
90838 Psychotherapy, 60 minutes with patient and/

or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) AAPC Rationale Report 90838 when 53 or more minutes of psychotherapy are provided on the same date as an E/M service. The time must be face-to-face with the patient and/or family. Do not

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include time spent performing the E/M service as part of the psychotherapy service. Select the appropriate E/M code based on the documentation.

Psychiatry/Psychiatric Diagnostic Procedures: Psychotherapy for Crises


New, time-based crisis codes have been established to report treatment for urgent assessment and treatment for a patient in a crisis state. The patients condition is typically life threatening or complex. 90839 Psychotherapy for crisis; first 60 minutes AAPC Rationale Report 90839 for the first 60 minutes and 90840 (below) for each additional 30 minutes. Time must be face-to-face but is not required to be continuous.
90840 Psychotherapy for crisis; each additional 30 minutes (list separately in addition to code for primary service)

AAPC Rationale Code 90863 has been created to report pharmacologic management when performed with psychotherapy services. If the providers scope of practice allows for reporting E/M codes, report the appropriate E/M instead of 90863. A parenthetical note instructs you to report 90863 with 90832, 90834, or 90837. 90875 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); approximately 20-30 minutes AAPC Rationale To be consistent with the other codes in the psychiatry category, 90875 has been revised to specify 30 minutes. 90876 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); approximately 45-50 minutes AAPC Rationale To be consistent with the other codes in the psychiatry category, 90876 has been revised to specify 45 minutes. 90889 Preparation of report of patients psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other physicians individuals, agencies, or insurance carriers AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90889 has been amended to allow that this service may be provided by providers other than a physician, to report preparation of a patients psychiatric status, history, treatment, or progress for other qualified individuals, physicians, agencies, or insurance carriers.

AAPC Rationale Report 90839 (above) for the first 60 minutes and add-on 90840 for each additional 30 minutes. Time must be faceto-face but is not required to be continuous.
90857 Interactive group psychotherapy

AAPC Rationale Code 90857 has been deleted. Refer to 90785 with 90853.
90862 Pharmacologic management, including prescription,

use, and review of medication with no more than minimal medical psychotherapy AAPC Rationale Code 90862 has been deleted. A parenthetical note directs you to 90863, or the appropriate E/M level if the providers scope of practice allows reporting E/M service.

Psychiatry/Psychiatric Diagnostic Procedures: Other Services or Procedures


90863 Pharmacologic management, including prescription

and review of medication, when performed with psychotherapy services (list separately in addition to the code for primary procedure)

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Hemodialysis
90935 Hemodialysis procedure with single evaluation by a physician evaluation or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90935 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

90952 End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-toface visits by a physician visits or other qualified health care professional per month AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90952 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 90953 End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-toface visits by a physician visits or other qualified health care professional per month AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90953 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 90954 End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician visits or other qualified health care professional per month AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90954 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 90955 end-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician visits or other qualified health care professional per month AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90955 has been amended to allow that this

Miscellaneous Dialysis Procedures


90945 Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies), with single evaluation by a physician evaluation or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90945 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 90947 Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies) requiring repeated evaluation by a physician evaluation or other qualified health care professional, with or without substantial revision of dialysis prescription AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90947 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

End-Stage Renal Disease Services


90951 End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician visits or other qualified health care professional per month AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptors for 90951 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

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service may be performed by a physician or other qualified health care professional. 90956 End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visits by a physician visits or other qualified health care professional per month AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90956 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 90957 End-stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician visits or other qualified health care professional per month AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90957 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 90958 End-stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician visits or other qualified health care professional per month AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90958 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 90959 End-stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 1 face-to-face visits by a physician visits or other qualified health care professional per month

AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90959 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 90960 End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician visits or other qualified health care professional per month AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90960 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 90961 End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 2-3 faceto-face visits by a physician visits or other qualified health care professional per month AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90961 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 90962 End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 1 faceto-face visits by a physician visits or other qualified health care professional per month AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 90962 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

Gastroenterology
91110 Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with physician interpretation and report AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 91110 has been amended to allow that this service is not limited to physician reporting, and per AMA

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recommendation may be reported by other (non-physician), qualified attending health care professionals. 91111 Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus with physician interpretation and report AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 91111 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. 91112 Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report AAPC Rationale Code 91112 replaces Category III code 0242T. The procedure involves pressure measurements from the stomach to the colon.

AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 92613 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. 92615 Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording; physician interpretation and report only AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 92615 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. 92617 Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording; physician interpretation and report only AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 92617 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals.

Special Ophthalmological Services: Other


92286 Special anterior Anterior segment photography imaging with interpretation and report; with specular endothelial microscopy and endothelial cell count analysis AAPC Rationale Because films have been replaced by digital images, the code descriptor has been revised to more accurately report the work done. 92287 Special anterior Anterior segment photography imaging with interpretation and report; with fluorescein angiography AAPC Rationale Because films have been replaced by digital images, the code descriptor has been revised to more accurately report the work done.

Cardiovascular: Coronary Therapeutic Services and Procedures


92980 Transcatheter placement of an intracoronary stent(s),

percutaneous, with or without other therapeutic intervention, any method; single vessel AAPC Rationale Codes 92980, 92981, 92982, and 92984 have been deleted. See 9292092944.
92981 Transcatheter placement of an intracoronary stent(s),

Special Otorhinolaryngologic Services: Evaluative and Therapeutic Services


92613 Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording; physician interpretation and report only

percutaneous, with or without other therapeutic intervention, any method; each additional vessel (List separately in addition to code for primary procedure) AAPC Rationale Codes 92980, 92981, 92982, and 92984 have been deleted. See 9292092944.

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92982 Percutaneous transluminal coronary balloon angio-

plasty; single vessel AAPC Rationale Codes 92980, 92981, 92982, and 92984 have been deleted. See 9292092944.
92984 Percutaneous transluminal coronary balloon angio-

Combination codes are used when the same vessel requires angioplasty, stent, and atherectomy. You should report only the most extensive procedure performed in each vessel. During PCI, multiple procedures may be performed in multiple vessels. You may report codes for the major coronary arteries, as well as well as for branches of the coronary arteries. The coronary arteries are left main, left anterior descending, left circumflex, right main, and ramus intermedius. All segments (proximal, mid, distal) are included in the major coronary artery procedure, unless one of the segments requires access through a bypass graft, in which case the bypass graft may be reported separately. For coding purposes, the recognized branches of the major coronary arteries are the diagonals of the left anterior descending, marginals of left circumflex, and posterior descending posterolaterals of the right. You may code no more than two branches for a major coronary artery. Base codes (92920, 92924, 92928, 92933, 92937, 92941, and 92943) are reported for the most extensive procedure in a major coronary artery. If PCI is performed during the same session in additional major coronary arteries or bypass graft, report the appropriate base code. If PCI is performed in additional coronary branches, report the applicable add-on code (92921, 92925, 92929, 92934, 92938, or 92944). PCI includes access, selective catheterization, radiologic supervision and interpretation, closure of arteriotomy, and imaging to document completion of the procedure. Diagnostic coronary angiography is usually included, but may be separately reported under the circumstances explained in the guidelines preceding the PCI codes.

plasty; each additional vessel (List separately in addition to code for primary procedure) AAPC Rationale Codes 92980, 92981, 92982, and 92984 have been deleted. See 9292092944.
92995 Percutaneous transluminal coronary atherectomy, by

mechanical or other method, with or without balloon angioplasty; single vessel AAPC Rationale Codes 92995, 92996 have been deleted. See new codes 92924, 92925, and 9293392944.
92996 Percutaneous transluminal coronary atherectomy, by

mechanical or other method, with or without balloon angioplasty; each additional vessel (List separately in addition to code for primary procedure) AAPC Rationale Codes 92995, 92996 have been deleted. See new codes 92924, 92925, and 9293392944.

Cardiovascular/Therapeutic Services and Procedures: Coronary


Subsection Guidance A new subsection has been added to CPT for coronary therapeutic services and procedures, which includes guidelines to define services and provide instruction for code use. To properly code percutaneous coronary interventions (PCI), you must know the type of procedure(s) performed (angioplasty, stent, and/or atherectomy). During angioplasty, a balloon-tipped catheter is inserted and inflated to open an occluded vessel. Stent(s) may be required to prop open the vessel. During atherectomy, a catheter with a sharp blade is used to cut away the occlusion.

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92920
# 92924 Percutaneous transluminal coronary atherec-

tomy, with coronary angioplasty when performed; single major coronary artery or branch AAPC Rationale Report 92924 for atherectomy in a major coronary artery or branch. Angioplasty performed in the same vessel is included.
# 92925 Percutaneous transluminal coronary ather-

ectomy, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) AAPC Rationale Report 92925 for each additional branch of a major coronary artery. A parenthetical note lists which primary codes 92925 may be reported with. Angioplasty performed in the same vessel is included.
# 92928 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch

Anatomical Illustrations 2012, OptumInsight, Inc.

AAPC Rationale Report 92928 when one or more stents are placed in a major coronary artery. The procedure is coded per major coronary arterynot per stent placed. Angioplasty performed in the same vessel is included.
# 92929 Percutaneous transcatheter placement of

# 92920 Percutaneous transluminal coronary angio-

plasty; single major coronary artery or branch AAPC Rationale Report angioplasty when no other invention (stent or atherectomy) is performed in the major coronary artery. Claim one unit of 92990 for each major coronary vessel.
# 92921 Percutaneous transluminal coronary angio-

intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) AAPC Rationale Report 92929 when one or more stents are placed in an additional branch of a major coronary artery. The procedure is coded per major coronary artery branchnot per stent placed. Angioplasty performed in the same vessel is included.

plasty; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) AAPC Rationale Report 92921 for each additional branch of a major artery. A parenthetical note describes which primary codes 92921 may be reported with. Claim 92921 when angioplasty is the only intervention performed in the vessel.

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# 92933 Percutaneous transluminal coronary atherec-

# 92941 Percutaneous transluminal revascularization of

tomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch AAPC Rationale Report combination code 92933 for angioplasty, stent(s), and atherectomy performed in the same major coronary artery or branch.
# 92934 Percutaneous transluminal coronary atherec-

acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel AAPC Rationale Report 92941 for any combination of services (angiography, stent, atherectomy) for a patient having an acute myocardial infarction causing an acute, subtotal occlusion. Mechanical thrombectomy (92973) may be reported separately, if performed.
# 92943 Percutaneous transluminal revascularization

tomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure) AAPC Rationale Report combination code 92934 for angioplasty, stent(s), and atherectomy performed in each additional branch of a major coronary artery.
# 92937 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel

of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel AAPC Rationale Report 92943 for any combination of services (angiography, stent, atherectomy) for a patient with chronic total occlusion. CPT defines chronic occlusion as no antegrade flow through the true lumen, accompanied by suggestive angiographic and clinical criteria. The clinical criterion is included in the coding guidelines preceding the PCI codes.
# 92944 Percutaneous transluminal revascularization

AAPC Rationale New codes have been created to report any intervention (angioplasty, stent, and/or atherectomy) performed through a coronary bypass graft. When multiple interventions are performed on native vessels in addition to bypass grafts, select a base code for the intervention for the native vessels, as well as the bypass graft.
# 92938 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure)

of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (list separately in addition to code for primary procedure) AAPC Rationale Report 92944 for each additional coronary artery, branch, or bypass graft for any combination of services (angiography, stent, atherectomy) for a patient with chronic total occlusion. CPT defines chronic occlusion as no antegrade flow through the true lumen, accompanied by suggestive angiographic and clinical criteria. The clinical criterion is included in the coding guidelines preceding the PCI codes.

AAPC Rationale Report add-on code 92938 for any intervention (angioplasty, stent, atherectomy) performed in each additional branch subtended by the bypass graft.

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# 92973 Percutaneous transluminal coronary throm-

bectomy mechanical (list separately in addition to code for primary procedure) AAPC Rationale 92973 was revised to add mechanical to promote proper coding. This code is not reported for chemical thrombectomy.

93227 External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; physician review and interpretation by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93227 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93228 External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; physician review and interpretation by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93228 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93229 External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and physician prescribed transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93229 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

Cardiography
93015 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93015 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. 93016 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93016 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals.

Cardiovascular Monitoring Services


93224 External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, physician review and interpretation by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93224 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

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93268 External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, physician review and interpretation by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93268 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93272 External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; physician review and interpretation by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93272 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93280 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93281 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93281 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93282 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report by a physician or other qualified health care professional; single lead implantable cardioverter-defibrillator system AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93282 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93283 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report by a physician or other qualified health care professional; dual lead implantable cardioverter-defibrillator system AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93283 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

Implantable and Wearable Cardiac Device Evaluations


93279 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93279 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93280 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values physician analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system

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Complete 2013 Procedure Coding Updates

93284 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report by a physician or other qualified health care professional; multiple lead implantable cardioverter-defibrillator system AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93284 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93285 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report by a physician or other qualified health care professional; implantable loop recorder system AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93285 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93286 Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with physician analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93286 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93287 Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with physician analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable cardioverterdefibrillator system AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93287 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

93288 Interrogation device evaluation (in person) with physician analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93288 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93289 Interrogation device evaluation (in person) with physician analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead implantable cardioverter-defibrillator system, including analysis of heart rhythm derived data elements AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93289 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93290 Interrogation device evaluation (in person) with physician analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93290 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93291 Interrogation device evaluation (in person) with physician analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable loop recorder system, including heart rhythm derived data analysis AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93291 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

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Complete 2013 Procedure Coding Updates

93292 Interrogation device evaluation (in person) with physician analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; wearable defibrillator system AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93292 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93293 Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with physician analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93293 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93294 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim physician analysis, review and report(s) by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93294 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93295 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable cardioverterdefibrillator system with interim physician analysis, review and report(s) by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93295 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

93297 Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, physician analysis, review and report(s) by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93297 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93298 Interrogation device evaluation(s), (remote) up to 30 days; implantable loop recorder system, including analysis of recorded heart rhythm data, physician analysis, review and report(s) by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93298 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

Echocardiography
93351 Echocardiography, transthoracic, real-time with image documentation (2d), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with supervision by a physician supervision or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93351 has been amended to allow that the supervision service may be performed by a physician or other qualified health care professional.

Intracardiac Electrophysiological Procedure/Studies


Subsection Guidance To combine comprehensive electrophysiologic evaluation with intracardiac catheter ablation of arrhythmogenic focus services, codes 93651 and 93652 have been deleted and replaced by new codes 9365393657.

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 43

Complete 2013 Procedure Coding Updates

93651 Intracardiac catheter ablation of arrhythmogenic focus;

for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination AAPC Rationale Codes 93651 and 93562 have been deleted. See new codes 9365393657.
93652 Intracardiac catheter ablation of arrhythmogenic focus;

93655 Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (list separately in addition to code for primary procedure)

AAPC Rationale Report 93655 with 93653, 93654, or 93656 when an additional mechanism of arrhythmia requires ablation in addition to the primary site.
93656 Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with atrial recording and pacing, when possible, right ventricular pacing and recording, his bundle recording with intracardiac catheter ablation of arrhythmogenic focus, with treatment of atrial fibrillation by ablation by pulmonary vein isolation

for treatment of ventricular tachycardia AAPC Rationale Codes 93651 and 93562 have been deleted. See new codes 9365393657.
93653 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording, HIS recording with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry

AAPC Rationale Report 93653 when comprehensive electrophysiologic evaluation is performed in addition to ablation of supraventricular tachycardia. Ablation is the destruction of tissue in the heart to correct arrhythmia. Supraventricular tachycardia (SVT) is rapid heart rhythm originating above the ventricular tissue.
93654 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording, HIS recording with intracardiac catheter ablation of arrhythmogenic focus; with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3d mapping, when performed, and left ventricular pacing and recording, when performed

AAPC Rationale Report 93656 when comprehensive electrophysiologic evaluation is performed in addition to ablation of atrial fibrillation. Atrial fibrillation is an abnormal heart rhythm where the upper chambers of the heart (atria) beat irregularly and rapidly.
93657 Additional linear or focal intracardiac catheter

ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (list separately in addition to code for primary procedure) AAPC Rationale Report 93657 with 93657 if ablation of the left or right atrium is required for atrial fibrillation remaining after pulmonary vein isolation.

Noninvasive Physiologic Studies and Procedures


93745 Initial set-up and programming by a physician or other qualified health care professional of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93745 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

AAPC Rationale Report 93654 when comprehensive electrophysiologic evaluation is performed in addition to ablation of ventricular tachycardia or focus of ventricular ectopy. Ablation is the destruction of tissue in the heart to correct arrhythmia. Ventricular tachycardia is rapid heartbeat that starts in the ventricles.

44 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates

93750 Interrogation of ventricular assist device (VAD), in person, with physician or other qualified health care professional analysis of device parameters (eg, drivelines, alarms, power surges), review of device function (eg, flow and volume status, septum status, recovery), with programming, if performed, and report AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93750 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93790 Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; physician review with interpretation and report AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93790 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals.

Pulmonary: Diagnostic Testing and Therapies


94014 Patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and physician review and interpretation by a physician or other qualified health care professional

AAPC Rationale
Consistent with revisions throughout CPT 2013, the descriptor for 94014 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 94016 Patient-initiated spirometric recording per 30-day period of time; physician review and interpretation by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 94016 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 94452 High altitude simulation test (HAST), with physician interpretation and report by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 94452 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 94453 High altitude simulation test (hast), with physician interpretation and report by a physician or other qualified health care professional; with supplemental oxygen titration AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 94453 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

Cardiovascular: Other Procedures


93797 Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93797 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 93798 Physician or other qualified health care professional services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 93798 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 45

Complete 2013 Procedure Coding Updates

94610 Intrapulmonary surfactant administration by a physician or other qualified health care professional through endotracheal tube AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 94610 has been amended to allow that this service may be performed by a physician or other qualified health care professional. Code 94610 is Modifier 51 exempt. 94774 Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; includes monitor attachment, download of data, physician review, interpretation, and preparation of a report by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 94774 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 94777 Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; physician review, interpretation, and preparation of a report by a physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 94777 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

95010 Percutaneous tests (scratch, puncture, prick) sequential

and incremental, with drugs, biologicals or venoms, immediate type reaction, including test interpretation and report by a physician, specify number of tests AAPC Rationale Codes 95010 and 95015 have been deleted and replaced by 95017 and 95018.
95015 Intracutaneous (intradermal) tests, sequential and

incremental, with drugs, biologicals, or venoms, immediate type reaction, including test interpretation and report by a physician, specify number of tests AAPC Rationale Codes 95010 and 95015 have been deleted and replaced by 95017 and 95018. 95017 Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests AAPC Rationale Codes 95010 and 95015 have been deleted. New codes describe percutaneous and/or intracutaneous allergy testing. The codes are selected based on whether the testing is with venoms or drugs and biological. Report 95017 for allergy testing with venoms. 95018 Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests AAPC Rationale Codes 95010 and 95015 have been deleted. New codes describe percutaneous and/or intracutaneous allergy testing. The codes are selected based on whether the testing is with venoms or drugs and biological. Report 95017 when performing allergy testing with drugs or biologicals.

Allergy and Clinical Immunology: Allergy Testing


95004 Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95004 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals.

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Complete 2013 Procedure Coding Updates

95024 Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95024 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. 95027 Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report by a physician, specify number of tests AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95027 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals.

AAPC Rationale Report add-on code 95079 for each additional 60 minutes, beyond the initial 120 minutes of testing (95076), to confirm an allergy by ingestion challenge test. Time-based codes 95076 and 95079 replace deleted code 95075.

Allergy and Clinical Immunology: Allergen Immunotherapy


95120 Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; single injection AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95120 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. 95125 Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 2 or more injections AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95125 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. 95130 Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; single stinging insect venom AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95130 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. 95131 Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 2 stinging insect venoms

Allergy and Clinical Immunology: Ingesting Challenge Testing


95075 Ingestion challenge test (sequential and incremental

ingestion of test items, eg, food, drug or other substance such as metabisulfite) AAPC Rationale Code 95075 has been deleted and replaced with timebased codes 95076 and 95079. 95076 Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); initial 120 minutes of testing AAPC Rationale Report 95076 for the first 120 minutes of testing to confirm an allergy by ingestion challenge test. Time-based codes 95076 and 95079 replace deleted code 95075.
95079 Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); each additional 60 minutes of testing (list separately in addition to code for primary procedure)

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 47

Complete 2013 Procedure Coding Updates

AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95131 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. 95132 Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 3 stinging insect venoms AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95132 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. 95133 Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 4 stinging insect venoms AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95133 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals. 95134 Professional services for allergen immunotherapy in prescribing physicians the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 5 stinging insect venoms AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95134 has been amended to allow that this service is not limited to physician reporting, and per AMA recommendation may be reported by other (non-physician), qualified attending health care professionals.

Neurology and Neuromuscular Procedures: Sleep Medicine Testing


95808 Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist AAPC Rationale New polysomnography codes specify patient age, as well as type of study performed: 95808 has been revised to indicate the code may be reported for any age. 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist AAPC Rationale New polysomnography codes specify patient age, as well as type of study performed: 95810 has been revised to indicate the code can be reported for patients six years of age, or older. 95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist AAPC Rationale New polysomnography codes specify patient age, as well as type of study performed: 95811 was revised to indicate the code may be reported for patients six years old, or older. This code differs from 95810 in that it includes initiation of continuous positive airway pressure (CPAP) therapy or bilevel ventilation. CPAP is performed by a machine that uses mild air pressure to keep the airways open. If obstructive sleep apnea is identified during a polysomnography, CPAP titration is performed to determine the pressure needed to resolve the sleep apnea, and to determine the appropriate settings if the patient needs a positive airway pressure device for treatment.

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Complete 2013 Procedure Coding Updates

# 95782 Polysomnography; younger than 6 years, sleep

staging with 4 or more additional parameters of sleep, attended by a technologist AAPC Rationale Code 95782 describes polysomnography in patients younger than 6 years of age. The study includes sleep staging and four or more additional sleep parameters. The additional parameters are defined in the coding guidelines preceding the polysomnography codes. If fewer than seven hours of reporting are performed, append modifier 52.
# 95783 Polysomnography; younger than 6 years, sleep

Neurology and Neuromuscular Procedures: Routine Electroencephalography


95830 Insertion by physician or other qualified health care professional of sphenoidal electrodes for electroencephalographic (EEG) recording AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95830 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

Neurology and Neuromuscular Procedures: Nerve Conduction Tests


Subsection Guidance New coding guidelines define services performed for motor and nerve conduction studies. Motor nerve conduction studies require electrodes to be placed over the motor points of the muscle being tested. Nerve conduction studies require electrodes to be placed over the specific nerve to be tested. Codes are selected based on the number of studies performed. A study is defined as sensory conduction test, a motor conduction test with or without an F-wave test, or an H-reflex test. Nerve conduction studies are reported only once when the test includes multiple sites on the same nerve. To assist with coding, Appendix J includes a list of nerves and a table indicating the reasonable maximum number of studies performed for common diagnosis. When electromyography is performed with nerve conduction studies, use 9588595887.
95900 Nerve conduction, amplitude and latency/velocity study,

staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist AAPC Rationale Code 95783 describes polysomnography in patients younger than 6 years of age. The study includes sleep staging and four or more additional sleep parameters. The additional parameters are defined in the coding guidelines preceding the polysomnography codes. This study also includes the initiation of continuous positive airway pressure (CPAP) or bi-level ventilation. CPAP is performed by a machine that uses mild air pressure to keep the airways open. If obstructive sleep apnea is identified during a polysomnography, CPAP titration is performed to determine the pressure needed to resolve the sleep apnea, and to determine the appropriate settings if the patient needs a positive airway pressure device for treatment. If fewer than seven hours of reporting are performed, append modifier 52.

each nerve; motor, without F-wave study AAPC Rationale Codes 9500095004 have been deleted. See new codes 9590795913.
95903 Nerve conduction, amplitude and latency/velocity study,

each nerve; motor, with F-wave study AAPC Rationale Codes 9500095004 have been deleted. See new codes 9590795913.
= FDA Approval Pending = Add-on

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Complete 2013 Procedure Coding Updates

95904 Nerve conduction, amplitude and latency/velocity study,

each nerve; sensory AAPC Rationale Codes 9500095004 have been deleted. See new codes 9590795913. 95907 Nerve conduction studies; 1-2 studies AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95907 for one or two studies. 95908 Nerve conduction studies; 3-4 studies AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95908 for three to four studies. 95909 Nerve conduction studies; 5-6 studies AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95909 for five to six studies. 95910 Nerve conduction studies; 7-8 studies AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95910 for seven to eight studies. 95911 Nerve conduction studies; 9-10 studies AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95911 for nine to 10 studies. 95912 Nerve conduction studies; 11-12 studies AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95912 for 11 to 12 studies. 95913 Nerve conduction studies; 13 or more studies AAPC Rationale Report nerve conduction studies based on the number of studies performed: Claim 95913 for 13 or more studies.

Neurology and Neuromuscular Procedures: Autonomic Function Tests


95920 Intraoperative neurophysiology testing, per hour (List

separately in addition to code for primary procedure) AAPC Rationale Code 95920 has been deleted. For intraoperative neurophysiology monitoring, see new add-on codes 95940 and 95941.

Subsection Guidance Continuous intraoperative neurophysiology monitoring can be performed either in or outside of the operating room. These add-on codes are reported for monitoring time, in addition to the codes for the baseline studies (a parenthetical note lists the appropriate baseline study codes). Intraoperative monitoring performed by the surgeon or anesthesiologist is not reported separately.
# 95940 Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (list separately in addition to code for primary procedure)

AAPC Rationale Report 95940 for intraoperative neurophysiology monitoring, for each 15 minutes of monitoring time performed in the operating room. Do not count the time performing baseline tests in the time for monitoring. No other cases can be monitored when reporting 95940.
# 95941 Continuous intraoperative neurophysiology

monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (list separately in addition to code for primary procedure) AAPC Rationale Report 95941 for intraoperative neurophysiology monitoring, per hour, for monitoring outside of the operating room, or when monitoring more than one case in the operating room. Do not count the time performing baseline tests in the time for monitoring. Do not report if monitoring lasts 30 minutes or less.

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Complete 2013 Procedure Coding Updates

# 95924 Testing of autonomic nervous system function;

combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt AAPC Rationale Code 95924 describes combined parasympathetic and sympathetic adrenergic function tests. The tests are performed to determine the presence and site of autonomic dysfunction, and the autonomic subsystems that may be disordered. Report 95924 if the service described by 95921 and 95922 are performed during the same session.
# 95943 Simultaneous, independent, quantitative mea-

service may be performed by a physician or other qualified health care professional. 95961 Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of attendance by a physician attendance or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95961 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 95962 Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; each additional hour of attendance by a physician attendance or other qualified health care professional (list separately in addition to code for primary procedure) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95962 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

sures of both parasympathetic function and sympathetic function, based on time-frequency analysis of heart rate variability concurrent with time-frequency analysis of continuous respiratory activity, with mean heart rate and blood pressure measures, during rest, paced (deep) breathing, Valsalva maneuvers, and head-up postural change AAPC Rationale Report 95943 if a tilt table is not used during autonomic function tests: 9592195924 require the use of a tilt table.
95934 H-reflex, amplitude and latency study; record gastrocne-

mius/soleus muscle AAPC Rationale Codes 95934, 95936 have been deleted. Refer to 95907 95913.
95936 H-reflex, amplitude and latency study; record muscle

Neurology and Neuromuscular Procedures: Other


95991 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; requiring skill of a physicians skill or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95991 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

other than gastrocnemius/soleus muscle AAPC Rationale Codes 95934, 95936 have been deleted. Refer to 95907 95913.

Neurology and Neuromuscular Procedures: Special EEG Tests


95954 Pharmacological or physical activation requiring physician or other qualified health care professional attendance during EEG recording of activation phase (eg, thiopental activation test) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 95954 has been amended to allow that this

Neurology and Neuromuscular Procedures: Motion Analysis


96004 Physician review Review and interpretation by physician or other qualified health care professional of comprehensive computer-based motion analysis, dynamic plantar pressure

= FDA Approval Pending = Add-on

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measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, with written report AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 96004 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

97533 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, by the provider each 15 minutes AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 97533 has been amended to allow greater flexibility in who may report this service. 97535 Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, by the provider each 15 minutes AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 97535 has been amended to allow greater flexibility in who may report this service. 97537 Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact by provider, each 15 minutes AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 97537 has been amended to allow greater flexibility in who may report this service.

Neurology and Neuromuscular Procedures: Functional Brain Mapping


96020 Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional (ie, psychologist), with review of test results and report AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 96020 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

Physical Medicine and Rehabilitation: Therapeutic Procedures


97530 Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 97530 has been amended to allow greater flexibility in who may report this service. 97532 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 minutes AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 97532 has been amended to allow greater flexibility in who may report this service.

Physical Medicine and Rehabilitation: Tests and Measurements


97755 Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact by provider, with written report, each 15 minutes AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 97755 has been amended to allow greater flexibility in who may report this service.

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Non-Face-to-Face Nonphysician Services: On-line Medical Evaluation


98969 Online assessment and management service provided by a qualified nonphysician health care professional to an established patient, or guardian, or health care provider, not originating from a related assessment and management service provided within the previous 7 days, using the internet or similar electronic communications network AAPC Rationale This code was revised to remove "other qualified health care professional" because a health care provider would not provide an assessment on another health care provider. The code was revised to correct an error made in the code description.

99070 Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99070 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 99071 Educational supplies, such as books, tapes, and pamphlets, provided by the physician for the patients education at cost to physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99071 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 99078 Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99078 has been amended to allow that this service may be performed by a physician or other qualified health care professional qualified by education, training, licensure/regulation. 99091 Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/ or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99091 has been amended to allow that this service may be performed by a physician or other qualified health care professional qualified by education, training, licensure/regulation.

Special Services, Procedures and Reports: Miscellaneous


99000 Handling and/or conveyance of specimen for transfer from the physicians office to a laboratory AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99000 has been amended to allow greater flexibility in who may report this service. 99001 Handling and/or conveyance of specimen for transfer from the patient in other than a physicians an office to a laboratory (distance may be indicated) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99001 has been amended to allow greater flexibility in who may report this service. 99002 Handling, conveyance, and/or any other service in connection with the implementation of an order involving devices (eg, designing, fitting, packaging, handling, delivery or mailing) when devices such as orthotics, protectives, prosthetics are fabricated by an outside laboratory or shop but which items have been designed, and are to be fitted and adjusted by the attending physician or other qualified health care professional AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99002 has been amended to allow that this service may be performed by a physician or other qualified health care professional.
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Complete 2013 Procedure Coding Updates

Moderate (Conscious) Sedation


99143 Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousness and physiological status; younger than 5 years of age, first 30 minutes intra-service time AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99143 has been amended to allow that this service may be performed by a physician or other qualified health care professional. Code 99143 is modifier 51 exempt. 99144 Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99144 has been amended to allow that this service may be performed by a physician or other qualified health care professional. Code 99144 is modifier 51 exempt.
99145 Moderate sedation services (other than those

99148 Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; younger than 5 years of age, first 30 minutes intra-service time AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99148 has been amended to allow that this service may be performed by a physician or other qualified health care professional. 99149 Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; age 5 years or older, first 30 minutes intra-service time AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99149 has been amended to allow that this service may be performed by a physician or other qualified health care professional.
99150 Moderate sedation services (other than those

services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intra-service time (list separately in addition to code for primary service) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99150 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousness and physiological status; each additional 15 minutes intra-service time (list separately in addition to code for primary service) AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99145 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

Medicine: Other Services and Procedures


99174 Ocular photoscreening with interpretation and report Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral AAPC Rationale Code 99174 has been revised to more accurately describe the procedure performed. Photoscreening and automated refraction instruments are used when performing this screening test.

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99183 Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session AAPC Rationale Consistent with revisions throughout CPT 2013, the descriptor for 99183 has been amended to allow that this service may be performed by a physician or other qualified health care professional.

Category III Code


0030T Antiprothrombin (phospholipid cofactor) antibody, each

Ig class AAPC Rationale Code 0030T has been deleted. Use 86849 for antiprothrombin antibody.
0048T Implantation of a ventricular assist device, extracorporeal,

Category II Codes
Category II codes are supplemental tracking codes to report performance measures, which are specific services and test results that have been shown through evidencebased medicine to support and contribute to quality patient care. Reporting of Category II codes is optional, at this time. Category II codes have no relative value associated with them because they describe clinical components included in E/M or other clinical services. Category II codes should not be used in place of Category I or Category III codes. For 2013, CPT has added seven new Category II codes, revised six codes, and deleted one code. For additional information on these codes, consult your CPT codebook or the AMA website at: www.ama-assn.org/ama/pub/ physician-resources/solutions-managing-your-practice/ coding-billing-insurance/cpt/about-cpt/category-iicodes.page?.

percutaneous transseptal access, single or dual cannulation AAPC Rationale Code 00487 has been deleted. Refer to new code 33991.
0050T Removal of a ventricular assist device, extracorporeal,

percutaneous transseptal access, single or dual cannulation AAPC Rationale Code 0050T has been deleted. Refer to new codes 3399033993.
0173T Monitoring of intraocular pressure during vitrectomy sur-

gery (List separately in addition to code for primary procedure) AAPC Rationale Code 0173T has been deleted. 0195T Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, including without instrumentation, imaging (when performed) with image guidance, and discectomy to prepare interspace, lumbar includes bone graft when performed; single L5-S1 interspace AAPC Rationale Code 0195T was revised to include bundled services and to indicate the procedure is performed without instrumentation, to distinguish it from 22586.
0196T Arthrodesis, pre-sacral interbody technique, disc

Category III Codes


Category III codes describe emerging technologies and, unlike Category I unlisted procedure codes, allow for tracking and collection of specific data. If a Category III code is available, it must be reported instead of a Category I unlisted procedure code. Category III codes have a fiveyear life span: Per CPT guidelines, if a Category III code is not replaced by a Category I code (or otherwise revised) within five years, the Category III code will sunset (i.e., be archived), unless it is demonstrated that a temporary code is still needed.

space preparation, discectomy, including without instrumentation, imaging (when performed) with image guidance, and discectomy to prepare interspace, lumbar includes bone graft when performed; each additional L4-L5 interspace (list separately in addition to code for primary procedure) AAPC Rationale Code 0196T was revised to include bundled services and to indicate the procedure is performed without instrumentation, to distinguish it from 22586.

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Complete 2013 Procedure Coding Updates

0206T Algorithmic Computerized database analysis of multiple cycles of digitized cardiac electrical data from two or more ECG leads, including transmission to a remote center, application of electrocardiographic-derived data multiple nonlinear mathematical transformations, with computer probability assessment, including report coronary artery obstruction severity assessment AAPC Rationale Code 0206T has been revised to more accurately describe the procedure. This code is used to identify coronary artery obstruction, and is not intended for cardiac ischemia.
0242T Gastrointestinal tract transit and pressure measure-

0257T Implantation of catheter-delivered prosthetic aortic heart

valve; open thoracic approach (eg, transapical, transventricular) AAPC Rationale Code 0257T has been deleted. Refer to new codes 33365 and 0318T.
0258T Transthoracic cardiac exposure (eg, sternotomy, thora-

cotomy, subxiphoid) for catheter-delivered aortic valve replacement; without cardiopulmonary bypass AAPC Rationale Code 0258T has been deleted. Refer to new codes 33365 and 33366.
0259T Transthoracic cardiac exposure (eg, sternotomy, thora-

ment, stomach through colon, wireless capsule, with interpretation and report AAPC Rationale Code 0242T has been deleted. Refer to new code 91112.
0250T Airway sizing and insertion of bronchial valve(s), each

cotomy, subxiphoid) for catheter-delivered aortic valve replacement; with cardiopulmonary bypass AAPC Rationale Code 0259T has been deleted. Refer to new codes 33365 33369.
0276T Bronchoscopy, rigid or flexible, including fluoroscopic

lobe (List separately in addition to code for primary procedure) AAPC Rationale Code 0250T has been deleted. Refer to new codes 3164731649.
0251T Bronchoscopy, rigid or flexible, including fluoroscopic

guidance, when performed; with bronchial thermoplasty, 1 lobe AAPC Rationale Codes 0276T and 0277T have been deleted. Refer to new codes 31660 and 31661.
0277T Bronchoscopy, rigid or flexible, including fluoroscopic

guidance, when performed; with removal of bronchial valve(s), initial lobe AAPC Rationale Code 0251T has been deleted. Refer to new codes 31647 31649.
0252T Bronchoscopy, rigid or flexible, including fluoroscopic

guidance, when performed; with bronchial thermoplasty, 2 or more lobes AAPC Rationale Codes 0276T and 0277T have been deleted. Refer to new codes 31660 and 31661.
0279T Cell enumeration using immunologic selection and iden-

guidance, when performed; with removal of bronchial valve(s), each additional lobe (List separately in addition to code for primary procedure) AAPC Rationale Code 0252T has been deleted. Refer to new codes 31647 31649.
0256T Implantation of catheter-delivered prosthetic aortic

tification in fluid specimen (eg, circulating tumor cells in blood) AAPC Rationale Codes 0279T and 0280T have been deleted. Refer to new codes 86152 and 86153.

heart valve; endovascular approach AAPC Rationale Code 0256T has been deleted. Refer to new codes 33361 33364.

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0280T Cell enumeration using immunologic selection and iden-

tification in fluid specimen (eg, circulating tumor cells in blood); interpretation and report AAPC Rationale Codes 0279T and 0280T have been deleted. Refer to new codes 86152 and 86153.
0291T intravascular optical coherence tomography (coro-

and interpretation and associated injection procedures, when performed (list separately in addition to code for primary procedure) AAPC Rationale Report 0294T for insertion of a device to monitor left atrial pressure, when performed during insertion of a pacing cardioverter-defibrillator. The device is used to identify pressure changes in patients with heart failure. Claim 0294T in addition to 33230, 33231, 33240, 33262 33264, or 33249. Do not report with 93462 or 93662. 0295T External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation AAPC Rationale New codes describe external electrocardiographic recording for more than 48 hours, up to 21 days. Current codes (9322492337) report similar recording when performed up to 48 hours. Combination code 0295T describes all the components (recording, scanning analysis with report, review and interpretation). Codes 0296T0298T report the component services separately, in case the services are performed by different providers. 0296T External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; recording (includes connection and initial recording) AAPC Rationale New codes describe external electrocardiographic recording for more than 48 hours, up to 21 days. Current codes (9322492337) report similar recording when performed up to 48 hours. Report 0296T for recording only. If the same provider performs recording, scanning analysis with report, review and interpretation, report 0295T. 0297T External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; scanning analysis with report AAPC Rationale New codes describe external electrocardiographic recording for more than 48 hours, up to 21 days. Current codes

nary native vessel or graft) during diagnostic evaluation and/ or therapeutic intervention, including imaging supervision, interpretation, and report; initial vessel (list separately in addition to primary procedure) AAPC Rationale Intravascular optical coherence tomography provides microstructural information on atherosclerotic plaques. Report 0291T in addition to cardiac catheterization (92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975, 9345493461, 93563, 93564) for the initial vessel.
0292T Intravascular optical coherence tomography

(coronary native vessel or graft) during diagnostic evaluation and/or therapeutic intervention, including imaging supervision, interpretation, and report; each additional vessel (list separately in addition to primary procedure) AAPC Rationale Intravascular optical coherence tomography provides microstructural information on atherosclerotic plaques. Report 0292 for each additional vessel, as an add-on with 0291T and primary cardiac catheterization (92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975, 93454-93461, 93563, 93564).
0293T Insertion of left atrial hemodynamic monitor;

complete system, includes implanted communication module and pressure sensor lead in left atrium including transseptal access, radiological supervision and interpretation, and associated injection procedures, when performed AAPC Rationale Code 0293T describes insertion of a device to monitor left atrial pressure, to identify pressure changes in patients with heart failure. Do not report 0293T with 93462 or 93662.
0294T Insertion of left atrial hemodynamic monitor; pressure sensor lead at time of insertion of pacing cardioverterdefibrillator pulse generator including radiological supervision

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Complete 2013 Procedure Coding Updates

(9322492337) report similar recording when performed up to 48 hours. Report 0297T for scanning analysis with report only. If the same provider performs recording, scanning analysis with report, review and interpretation, report 0295T. 0298T External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; review and interpretation AAPC Rationale New codes describe external electrocardiographic recording for more than 48 hours, up to 21 days. Current codes (9322492337) report similar recording when performed up to 48 hours. Report 0298T for review and interpretation only. If the same provider performs recording, scanning analysis with report, review and interpretation, report 0295T. 0299T Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound AAPC Rationale Extracorporeal shock wave treatment (ESWT) has been shown in the clinical setting to promote the healing of burns and other difficult-to-heal wounds. Codes for ESWT for wound healing are reported per wound. Claim 0299T for the initial wound.
0300T Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; each additional wound (list separately in addition to code for primary procedure)

AAPC Rationale Code 0301T describes focused microwave thermotherapy of the breast. Microwave applicators are placed on either side of the compressed breast. A probe is placed within the breast to monitor the interstitial temperature. The technique is based on the preferential microwave heating that occurs in high-water content breast carcinoma, compared to the surrounding lower water content healthy breast tissues. The procedure includes imaging guidance. Do not report 0301T with 76645, 76942, 76998, or 7760077615.
0302T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; complete system (includes device and electrode)

AAPC Rationale An intracardiac ischemic monitoring device system includes a generator, adaptor, and transvenous lead. The system detects and warns patients during a major ischemic coronary event (eg, coronary plaque rupture). New codes report insertion of the system, insertion of individual components when the entire system is not inserted, removal of the system, programming, and interrogation. Report 0302T when the entire system is inserted or replaced. The procedure includes interrogation and programming.
0303T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; electrode only

AAPC Rationale Codes for ESWT for wound healing are reported for each wound. Report +0300T for each additional wound, in addition to 0299T for the initial wound.
0301T Destruction/reduction of malignant breast tumor with externally applied focused microwave, including interstitial placement of disposable catheter with combined temperature monitoring probe and microwave focusing sensocatheter under ultrasound thermotherapy guidance

AAPC Rationale An intracardiac ischemic monitoring device system includes a generator, adaptor, and transvenous lead. The system detects and warns patients during a major ischemic coronary event (eg, coronary plaque rupture). New codes report insertion of the system, insertion of individual components when the entire system is not inserted, removal of the system, programming, and interrogation. Report 0303T when the electrode is inserted or replaced. The procedure includes interrogation and programming.

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0304T Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; device only

0307T Removal of intracardiac ischemia monitoring device

AAPC Rationale An intracardiac ischemic monitoring device system includes a generator, adaptor, and transvenous lead. The system detects and warns patients during a major ischemic coronary event (eg, coronary plaque rupture). New codes report insertion of the system, insertion of individual components when the entire system is not inserted, removal of the system, programming, and interrogation. Report 0304T when the device is inserted or replaced. The procedure includes interrogation and programming. 0305T Programming device evaluation (in person) of intracardiac ischemia monitoring system with iterative adjustment of programmed values, with analysis, review, and report AAPC Rationale An intracardiac ischemic monitoring device system includes a generator, adaptor, and transvenous lead. The system detects and warns patients during a major ischemic coronary event (eg, coronary plaque rupture). New codes report insertion of the system, insertion of individual components when the entire system is not inserted, removal of the system, programming, and interrogation. Report 0305T for programming and adjustments of the system, including analysis, review, and report. The service must be performed in person. 0306T Interrogation device evaluation (in person) of intracardiac ischemia monitoring system with analysis, review, and report AAPC Rationale An intracardiac ischemic monitoring device system includes a generator, adaptor, and transvenous lead. The system detects and warns patients during a major ischemic coronary event (eg, coronary plaque rupture). New codes report insertion of the system, insertion of individual components when the entire system is not inserted, removal of the system, programming, and interrogation. Report 0306T for interrogation of the system, including analysis, review, and report. The service must be performed in person.

AAPC Rationale An intracardiac ischemic monitoring device system includes a generator, adaptor, and transvenous lead. The system detects and warns patients during a major ischemic coronary event (eg, coronary plaque rupture). New codes report insertion of the system, insertion of individual components when the entire system is not inserted, removal of the system, programming, and interrogation. Report 0307T when the device is removed without replacement.
0308T Insertion of ocular telescope prosthesis including removal of crystalline lens

AAPC Rationale Code 0308T describes insertion and implantation of a telescope into the lens capsule. The procedure is performed on patients with central vision loss caused by end-stage, age-related macular degeneration. Code 0308T is modifier 51 exempt.
0309T Arthrodesis, pre-sacral interbody technique, includ-

ing disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft, when performed, lumbar, L4-L5 interspace (list separately in addition to code for primary procedure) AAPC Rationale The new code has been created to report pre-sacral interbody technique arthrodesis with posterior instrumentation. Code 0309T includes the disc preparation, discectomy, posterior instrumentation, imaging guidance, and bone graft. Report 0309T when the procedure is performed at the L4-L5 interspace. This code is used with 22586. Do not report with 2093020938, 22840, 22848, 72275, 77002, 77003, 77011, or 77012. 0310T Motor function mapping using non-invasive navigated transcranial magnetic stimulation (nTMS) for therapeutic treatment planning, upper and lower extremity AAPC Rationale Report 0310T for motor function mapping accomplished by combining transcranial magnetic stimulation (TMS) and electromyography (EMG) with guidance, with magnetic resonance. The test is performed to identify functional motor cortex prior to brain surgery. Complete 2013 Procedure Updates 59

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0311T Non-invasive calculation and analysis of central arterial pressure waveforms with interpretation and report AAPC Rationale Code 0311T describes central arterial pressure waveforms to evaluate patients with difficult-to-treat hypertension (eg not responding to medication). 0312T Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming AAPC Rationale Vagal blocking employs a device to block hunger and satiety signals from the vagus nerve. The procedure is performed laparoscopically and does not alter the anatomy of the stomach. A total of six Category III codes were created to report the insertion of the system, revision or replacement of the components of the system, removal of components, and analysis and reprogramming. Report 0312T for laparoscopic implantation of the neurostimulator electrode array, pulse generator, and programming. 0313T Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator AAPC Rationale Vagal blocking employs a device to block hunger and satiety signals from the vagus nerve. The procedure is performed laparoscopically and does not alter the anatomy of the stomach. A total of six Category III codes were created to report the insertion of the system, revision or replacement of the components of the system, removal of components, and analysis and reprogramming. Report 0313T for laparoscopic revision or replacement of the electrode array, and connection to the existing pulse generator.

0314T Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator AAPC Rationale Vagal blocking employs a device to block hunger and satiety signals from the vagus nerve. The procedure is performed laparoscopically and does not alter the anatomy of the stomach. A total of six Category III codes were created to report the insertion of the system, revision or replacement of the components of the system, removal of components, and analysis and reprogramming. Report 0314T for laparoscopic removal of the electrode array and pulse generator only. 0315T Vagus nerve blocking therapy (morbid obesity); removal of pulse generator AAPC Rationale Vagal blocking employs a device to block hunger and satiety signals from the vagus nerve. The procedure is performed laparoscopically and does not alter the anatomy of the stomach. A total of six Category III codes were created to report the insertion of the system, revision or replacement of the components of the system, removal of components, and analysis and reprogramming. Report 0315T for removal of the pulse generator only. 0316T Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator AAPC Rationale Vagal blocking employs a device to block hunger and satiety signals from the vagus nerve. The procedure is performed laparoscopically and does not alter the anatomy of the stomach. A total of six Category III codes were created to report the insertion of the system, revision or replacement of the components of the system, removal of components, and analysis and reprogramming. Report 0316T for replacement of the pulse generator only.

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0317T Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed AAPC Rationale Vagal blocking employs a device to block hunger and satiety signals from the vagus nerve. The procedure is performed laparoscopically and does not alter the anatomy of the stomach. A total of six Category III codes were created to report the insertion of the system, revision or replacement of the components of the system, removal of components, and analysis and reprogramming. Report 0317T for electronic analysis and reprogramming of the pulse generator. 0318T Implantation of catheter-delivered prosthetic aortic heart valve, open thoracic approach, (eg, transapical, other than transaortic) AAPC Rationale Procedures for the implantation of a prosthetic aortic heart valve are reported based on approach. Report 0318T when the procedure is performed using an open thoracic approach. A parenthetical note directs you to 33361-33365 for other approaches.

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Complete 2013 ProcedurePracticalUpdates Coding Activity

Practical Activity
During this portion of the workshop, you will be coding five cases. These cases were selected to test new codes or coding concepts for 2013. You will be given time to code the cases on your own. After you complete the cases, your presenter will review the answers and rationales with you. For each case, select the appropriate CPT codes, and modifiers if applicable.

Case 1
DATE OF PROCEDURE: January 31, 2013 PROCEDURE PERFORMED: 1. Cervical cerebral arch angiography 2. Selective catheter placement, bilateral common carotid artery 3. Selective innominate and bilateral carotid, cervical, and intracervical angiography BRIEF HISTORY OF PRESENT ILLNESS: This is a 67-year-old Caucasian female who presented with abnormal Doppler study with outpatient carotid bruit. She underwent cardiac vascular consultation, and elected to proceed with carotid angiography to accurately assess disease severity and plan for management. Carotid velocities were 317/132 cm per second with a ratio of 4.88. Left internal carotid velocities were 166/67 cm per second with a ratio of 1.58. Bilateral vertebral artery flow direction with antegrade and normal. Informed consent was obtained. The risk/benefit ratio of the procedure was explained. On arrival to the lab, the patient was in pain-free, hemodynamically stable condition. A 5-French sheath was placed in right common femoral artery over a J-wire. A pigtail catheter was advanced and was parked in the ascending aorta and 25 mL of contrast was injected at 20 mL per second and a cerebral arch angiography was performed. Subsequently, a Bernstein-2 catheter was advanced and sequentially placed with the help of a Glidewire in the innominate, right common, and left common carotid artery, selective innominate, bilateral cervical carotid, and intracerebral carotid angiography was performed using diluted Visipaque dye injection. Complications were none immediate. FINDINGS: This is a type 2 (B) arch with a slight downward displacement of innominate artery and left common carotid artery. Innominate artery is widely patent and bifurcates normally into the subclavian and common carotid artery. Subclavian artery has mild, non-obstructive plaque and gives rise to dominant vertebral and internal mammary artery, which are unremarkable. The right common carotid artery is free of significant disease. The right internal carotid artery at its origin has complex hazy 90 percent grade stenosis. There is a faint contrast line, and it appears there is significant calcification on the back wall of this vessel. The remainder of the cervical internal carotid artery is unremarkable. Right external carotid artery has mild non-obstructed plaque at its origin. Intracerebral right angiography reveals unremarkable intracerebral internal carotid artery sub-segments and normal cerebral artery and middle cerebral artery. No intracerebral aneurysms are identified. Capillary phases and venous phases are unremarkable. The left common carotid artery has non-obstructing plaque at its origin. The left carotid bulb has out-pouching and a small contained ulcerated area. The left internal carotid artery at its origin has 60 percent smooth excentric stenosis. The remainder of the left cervical and intracerebral internal carotid artery are unremarkable.

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The left middle cerebral and internal carotid arteries are unremarkable. Vertebral artery angiography was not performed due to lack of any posterior fossa symptoms. Subclavian artery was unremarkable. All the equipment was removed and access site hemostasis was achieved with manual compression. IMPRESSION: Critical right internal carotid artery and moderate-grade left internal carotid artery stenosis. CPT code(s): ___________________________________________________________

Case 2
CARDIOPULMONARY SERVICES/CATHETERIZATION LABORATORY REPORT DATE OF PROCEDURE: 7/10/13 PROCEDURES PERFORMED: 1. Rotational atherectomy of the mid left anterior descending utilizing a 1.5- mm bur. 2 Cutting balloon atherectomy of the mid left anterior descending, 3. Intracoronary stent placement utilizing a 3.5 x 23 Promus stent in the mid left anterior descending. 4. Percutaneous transluminal coronary angioplasty of the first diagonal branch. 5. Intravascular ultrasound-guided percutaneous coronary intervention of the left anterior descending. CLINICAL PROFILE: This is an 87-year-old man with a history of angina and complex two-vessel coronary artery disease, referred for intervention. PROCEDURAL DETAILS: Pre-procedure informed consent was obtained. The patient was brought to the cardiac catheterization laboratory and sedated with low doses of Versed and Fentanyl, as detailed in the event log. Using standard sterile percutaneous technique and local administration of 2 percent lidocaine, the right femoral artery was entered with an #8Fr. short sheath. IV Angiomax was begun. We then advanced an #8Fr. XB 3.5 guiding catheter but this would not engage the left main trunk, which arose low off a very long and dilated ascending aorta. A total of nine different guides were then attempted in a series without successfully cannulating the left main trunk. Ultimately, we switched out the short sheath for a long #8Fr. sheath, as it appeared that tortuosity in the iliacs was in part impeding our ability to manipulate guide and cannulate the vessel. After this and utilizing a #7Fr. XB-5 guide, we were successfully able to cannulate the left main trunk, although guide support was mediocre. Please see the event log for a detailed list of the guide catheters. Altogether, it took 38 minutes to cannulate the left main trunk. We then advanced a short Runthrough wire into the apex of the LAD. There was an obvious, complex, calcified lesion in the mid vessel. We attempted to pre dilate this with a cutting balloon, but this balloon would not cross the lesion. We then pre dilated the mid LAD with a 2.5 Voyager balloon. Following this, we again tried to advance the cutting balloon across the lesion but this was not successful. We therefore advanced a Rotablator GoldWire into the distal LAD and removed the Runthrough wire. The mid LAD was rotablated with a 1.5-mm burr. Following this, we successfully advanced the Cutting balloon. This was a 3.0 X 10 Cutting balloon. We then performed baseline IVUS with an Eagle Eye ultrasound catheter. A 3.5 x 23 Pronmus stent was then advanced across the lesion and deployed successfully. The first diagonal branch was subtotally occluded after stenting the LAD and was noted to be 90 percent at baseline. A Whisper ES wire was then advanced into the first diagonal branch. We then attempted to pass a 2.0 x 12 Sprinter balloon in the first diagonal branch and it would not cross. A 1.5 x 12 Maverick Fire Star balloon, crossed with difficulty and multiple balloon inflations were obtained. We then advanced a 2.0 x 12 Quantum balloon and performed additional balloon dilations with an excellent result. We then performed post procedure IVUS of the LAD and this showed adequate stent expansion. Final angiograms were then performed with all devices removed, and the patient

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returned to the holding area in stable condition. Total fluoroscopic time was 30 minutes. He was loaded with Plavix post procedure. He will be observed overnight. Sheath management will be per protocol on the floor. ANGIOGRAPHIC FINDINGS: Left Selective Coronary Angiography: Left selective coronary angiograms demonstrate a superiorly-directed left main trunk which arises low in the aortic root. The LAD shows moderate ostial disease of 50 percent or less severity. A 90 percent stenosis is present in the mid LAD. This is complex calcified lesion arising between the first and second diagonal branches. The first diagonal branch shows 90 percent baseline stenosis. Following intervention, there is zero percent residual stenosis in the LAD, and a 20 percent or less residual stenosis in the first diagonal branch. A 60 percent stenosis in the LAD beyond the stent is to be treated medically. There is TIMI grade-III flow post procedure. FINAL SUMMARY: Successful but technically difficult interventional procedure to the mid left anterior descending, involving the combination of Rotablator, cutting balloon atherectomy, and stenting. CPT code(s): __________________________________________________________________________

Case 3
I discussed the procedure, risks, benefits, and alternatives regarding placement of a chest tube with the patient prior to the procedure. Patient understood and consented to the procedure. SHORT HISTORY INDICATIONS FOR OPERATION: Female had a horseback riding accident yesterday and over the last day has acquired a pneumothorax, which has been enlarging. It became very large, at least a 50 percent, maybe more, pneumothorax later this morning. Because it was enlarging and getting to the point of being dangerous, I felt that a small chest tube would be indicated to expand the lungs and to decrease the chance of a complete collapse of her lung. ANESTHESIA: Of note; also 1 gram of Ancef was given preprocedure for coverage. DESCRIPTION OF PROCEDURE: The patient was placed in the right lateral decubitus position and the area was prepped and draped. Under sterile conditions a #12 French chest tube was placed in the left lateral chest wall as high as could be and the chest tube going over the rib, approximately the 3 to 4 rib that the chest tube went over. It was placed into position. I felt with my finger and felt no lung material, only the fluid that I pushed through and the chest tube was placed easily in the proper position. If was sewn in place using 2-0 silk suture. Chest tube was placed on suction and in the recovery room, a post chest tube chest x-ray was taken and it shows that the lung has expanded to near completion and the chest tube is in proper position. The patient was brought to the recovery room in stable condition. CPT code(s): __________________________________________________________________________

Case 4
PROGRESS NOTE: Pharmacologic Management SUBJECTIVE/OBJECTIVE: The patient brought in lab results he recently had done at the hospital from his physician, showing he had CBC, kidney function test, blood sugar, liver function test, and thyroid function test that were within normal limits, and his total cholesterol was 188. His HDL was 53. His LDL was 119 and his triglycerides were 78. The patient says he is feeling well. He has good focus and is working well. The only thing he is requesting is to go back to the immediate release Ritalin because of the cost. He says he is a bit short of money, although he knows that the Ritalin IR does not work as well for him, he wants to try that again. His energy is good. His sleep is good. MENTAL STATUS EXAMINATION: Shows a gentleman who looks his stated age. He is cooperative and pleasant. Has good eye contact. His mood is euthymic. His affect is congruent. He denies auditory or visual hallucinations, suicidal or homicidal ideations. He denies delusions. He is alert and oriented x 4.

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PLAN: As per patients request, we will switch over to Ritalin Immediate Release 40 mg bid because of cost, #60. I gave him a prescription with todays date, not to be filled until September 24 and I noted that on the prescription, because the patient had his last prescription called on August 24, 2013. Prescription: Ritalin IR 40 mg bid #60, no refills, to be filled only on September 24, 2013. Follow Up: The patient is to follow up in the office in six weeks. M Smith, MD CPT code(s): __________________________________________________________________________

Case 5
PREOPERATIVE DIAGNOSIS: 1. Right Shoulder Failed Hemiarthroplasty for Superior Proximal Humerus Fracture 2. Right Shoulder Chronic Anterior Inferior Dislocation POSTOPERATIVE DIAGNOSIS: 1. Right Shoulder Failed Hemiarthroplasty for Superior Proximal Humerus Fracture 2. Right Shoulder Chronic Anterior Inferior Dislocation NAME OF PROCEDURE: 1. Right Shoulder Arthroplasty Revision 2. Right Shoulder Anterior Capsular Shift ANESTHESIA: General PREOPERATIVE PREAMBLE: This patient is a delightful female who has a right shoulder anterior inferior dislocation with loosening of the soft tissue anteriorly. This is a chronic condition. I have counseled this patient at length regarding the natural history of this problem, as well as potential risks, complications, and benefits of surgical versus nonsurgical management. The patient and the patients family state they understand the risks include, but are not limited to, infection, component loosening, dislocation, injury to myotendinous units, injury to neurovascular bundles, deep venous thrombosis, pulmonary embolus, anesthesia problems, and even death. She has been given no warranties, no guarantees, no promises. Full informed consent has been obtained. The patient was taken to the operating room and in the supine position successfully induced with a general anesthesia using endotracheal intubation. After adequate analgesia was obtained, the right shoulder was prepped and draped in the usual sterile fashion, standard deltopectoral interval approach was used to incise the epidermis, dermis, and subcutaneous tissue with a #10 blade. The dissection was carried down through the deltopectoral interval, then the clavipectoral interval was then entered, gaining access to the joint. The patient had a large redundant anterior joint capsule, thick and fibrotic material. The patient was also found to have a component, which had subsided some and loosened some. Therefore, it was removed, as well as a portion of the proximal cement mantle in the proximal humerus. I then debrided the intraarticular aspect of the joint, removing any obstructive fibrious tissue and obstructive debris, gaining access to the glenoid, which was found to have some minimal degenerative change but no significant arthritis. The labrum was also somewhat atrophied anteriorly but was largely intact. I removed the existing humeral component and I resized the component for a smaller diameter component, which would allow cementing into the preexisting cement mantle. I also over retroverted the components to try to prevent further anterior interior dislocation. I gained length through the soft tissue envelope, approximately 2 cm, which should also keep 66 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

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the component from moving inferiorly, therefore by retroversion and lengthening I was able to create significant stability. The final component was opened, which was 2 mm smaller in diameter than the original component, giving an adequate cement mantle. I cemented into the original cement mantle with more retroversion and more length. When the cement dried, the shoulder was reduced and found to be stable. I then performed an anterior capsulorrhaphy, capsular tightening, capsular shift by bringing up the anterior interior capsule material and taking away the redundancy anteriorly and inferiorly. This was done with multiple interrupted sutures. The wound was then copiously irrigated and closed in standard fashion. Sterile dressing was placed over the wounds. At the end of this procedure, the sponge, needle, and instrument counts were correct. This procedure was completed without event. Patient is now convalescing without event in the recovery room. CPT code(s): __________________________________________________________________________

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Practical Exercise Answer Key and Rationales


Case 1
CPT code(s): 36223-50 Rationale: Look in the CPT index for Angiography/Common Carotid/Selective Catheterization (36222, 36223). Selective catheterization of the right common carotid was followed by angiography and interpretation of the right common carotid, right external carotid, right internal carotid and the right intracerebral arteries (36223). Selective catheterization of the left common carotid was followed with angiography and interpretation of the left common carotid, the left internal carotid, and left intracerebral arteries, which again is code 36223. The left and right external carotid angiography was not performed; however, the descriptor indicates it is included when performed. Arch angiography is also included in this code. Modifier 50 is appended to indicate a bilateral procedure. The documentation notes that the right subclavian has mild non-obstructive plaque and right internal mammary is normal. The left subclavian artery was unremarkable. This is included in the arch angiography, which is bundled. Do not report 36215-59, 75716-26. The final code selection is 36223-50.

Case 2
CPT code(s): 92933-LD, 92921-LD, 92978 Rationale: Angioplasty, followed by atherectomy, then stent placement in the LD was performed. Report only the most intensive procedure, which is the atherectomy. New combination codes were created to report atherectomy, stent, and angioplasty performed in the same major coronary artery. See 9293392934. This was a single major coronary artery reported with 92933. Modifier LD is appended for the left anterior descending artery. Next report the angioplasty of the first diagonal branch of the LD. Look in the CPT index for Angioplasty/Coronary Artery/Percutaneous Transluminal 9292092921. This is an additional branch of the left anterior descending; therefore, add-on code 92921-LD is correct. Next, report the IVUS. Look in the CPT index for Vascular Procedures/Intravascular Ultrasound/Coronary Vessels 9297892979. Although IVUS was used pre- and post-procedure, it is only reported once per vessel. You might have considered adding modifier 22 Increased procedural service because it took 38 minutes to cannulate the left main trunk and the case was difficult; however, the documentation does not substantiate that the case took much longer and was more difficult than usual. Do not report moderate sedation. The bullseye next the codes indicate it is included (further, no time is listed for moderate sedation).

Case 3
CPT: 32556-LT Rationale: This is the placement of a chest tube. Look in the CPT index for Insertion/Catheter/Pleural Cavity 32550, 32556. Image guidance was not performed to place the tube. The correct code is 32556 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance.

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Case 4
CPT code(s): 99212 Rationale: The new pharmacologic management code (90863) is an add-on code that may be reported only with psychotherapy services; psychotherapy services were not provided. According to the coding guidelines, providers who are permitted should report the service with E/M codes. The provider rendering the service is an MD; therefore, you would select the appropriate E/M code using the three key components (history, exam, and medical decision making). The provider documented: Problem focused history: brief HPI, problem focused ROS Expanded problem focused exam: limited exam of 2-7 body areas and/or organ systems (1995) or a problem focused exam for 1997 Psychiatric Exam (4 elements) Straightforward MDM: One established stable diagnosis, one data point (review of labs), moderate risk (prescription drug management). Only 2 of the 3 key components are needed; however, this will not change the assignment of 99212.

Case 5
CPT code(s): 23473-RT Rationale: The procedure preformed is the revision of an arthroplasty of the shoulder. From the CPT index, look up Revision/Shoulder. You are referred to Arthroplasty/Shoulder Joint, which directs you to 23470, 2347223474. The code is selected based on whether the procedure involves the humeral and/or glenoid component. The description of the procedure states the humeral component was removed and replaced (23473). Debris was removed from the glenoid but the component did not require revision. According to the NCCI edits an anterior capsulorrhaphy is bundled with shoulder arthroplasty; therefore, it is not reported separately. The notes for 23473 instruct not to report 23331 Removal of foreign body, shoulder; deep with 23473

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Slide Presentation

2013CPTCodingUpdates
Presentedby:RaemarieJimenez,CPC,CPMA, CPCI,CANPC,CRHC DirectorofEducation CowrittenbyJohnVerhovshek,CPC

CPTDisclaimer
CPTcopyright2012AmericanMedicalAssociation.Allrights reserved. Feeschedules,relativevalueunits,conversionfactorsand/or relatedcomponentsarenotassignedbytheAMA,arenotpart ofCPT,andtheAMAisnotrecommendingtheiruse.TheAMA doesnotdirectlyorindirectlypracticemedicineordispense medicalservices.TheAMAassumesnoliabilityfordata containedornotcontainedherein. CPTisaregisteredtrademarkoftheAmericanMedical Association.

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Objective
OverviewoftheNew,RevisedandDeletedCPT codesfor2013 Reviewdocumentationrequirementsforthenew codes Handsonexercisestopracticeusingthenewand revisedcodes

CodeChangesNowWhat?
Review2013CPTcodechanges,usingthis guide Order2013codebooks Reviewallchangestoguidelines,notesand instructionsinyourbook Highlightchangesinthebooksindex pertinenttoyourspecialtyandreviewthose changes
4

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CodeChangesNowWhat?
Highlightchangesinthetabularsectionpertinentto yourspecialty Createadocumentationcheatsheetof2013 updatesthatmustbedocumenteddifferentlyfor coderstocapturetheinformationneededand distributeittoclinicians Reviewandupdatesuperbills,chargemasters,etc. Runutilizationreportofthedeletedandrevised codes.
5

CodeChangesNowWhat?
Uploadsoftwarechange Traincodingandbillingstaffonchanges Checkforaddendaorerrata(www.ama

assn.org/resources/doc/cpt/cptcorrectionserrata.pdf)

ReviewPQRSchanges Communicatewithpayer/providerreps regardingreimbursementandcoverageissues Archivelastyearsbooks


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TimeDefined
TimedefinedintheIntroduction
Usethefollowingcriteriaunlesssectionor subsectionguidelinesinstructotherwise Timeismetwhenthemidpointispassed
Codesreportinganhourrequireaminimumof31 minutestoreportthecode

Donotreporttimeperformingaconcurrent service
Example:deductthetimespentperformingbillable services(eg,CPR)fromcriticalcaretime
7

E/MChanges
82E/Mcodesrevisedtoincludeotherqualified healthcareprofessionals
Example:Descriptorrevisionsfor99201 Counselingand/orcoordinationofcarewithotherphysicians, otherproviders qualifiedhealthcareprofessionals,or agenciesareprovidedconsistentwiththenatureofthe problem(s)andthepatientsand/orfamilysneeds.Usually, thepresentingproblem(s)areselflimitedorminor.Physicians typicallyspend Typically,10minutesarespentfaceto face withthepatientand/orfamily.
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E/MChanges
OtherQualifiedHealthCareProfessionals
CPTcodedescriptionchangedtodescribethe service,nottheproviderperformingtheservice CPTcodesareusedbyotherprovidersnotjust physicians Examples:
Outpatienthospitals/ASC Nursepractitioners/PhysicianAssistants PhysicalTherapist/OccupationalTherapist
9

E/MChanges
OtherQualifiedHealthCareProfessional
StateScopeofPractice FacilityRequirements PayerPolicies MedicareClaimsProcessingManual

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PediatricCriticalCareTransport
Newcodesreportservicesprovidedbythe controlphysicianduringaninterfacility transport
99485and99486 Basedontime Patients24monthsofageoryounger Mustbecriticallyillorcriticallyinjured

11

PediatricCriticalCareTransport
Servicesinclude:
Twowaycommunicationwithtransportteam

Time
Beginswhenthecontrolphysicianfirstcontacts thetransportteam Endswhenpatientcareistakenoverbythe receivingfacility

12

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PediatricCriticalCareTransport
Donotreport:
Servicesperformedbythetransportteam Pretransportcommunicationtimewithreceiving facility Directfacetofacetransport(99466,99467)with 99485,99486

13

ComplexChronicCareCoordinationServices
Forclinicalstafftimedirectedbyaphysician orotherqualifiedhealthcareprovider Reportedforcoordinationofservices(medical andpsychosocial) Timebased
Reportedpercalendarmonth

Basedonwhetherpatienthasfacetoface encounterduringthemonth
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ComplexChronicCareCoordinationServices
Clinicalindicationsthatqualify:
Oneormorechronicillnessesexpectedtolastat least12months Acuteexacerbationordecompensation Functionaldecline MedicalDecisionMakingmustbemoderateor high

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ComplexChronicCareCoordinationServices
Documentationmustinclude:
Conditionofthepatient Totaltimespentperformingcoordinationservices forcomplexchroniccare Basedonclinicalstafftime
Ifphysicianperformscoordinationservices,thetimeis addedtotheclinicalstafftimetosupportthecode

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ComplexChronicCareCoordinationServices
Facttofaceencounter(during calendarmonth)

Yes

No

99488(first hour)

99489(each additional30 minutes)

99487(first hour)

99489(each additional30 minutes)

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ComplexChronicCareCoordinationServices
PatientDiagnosis:MultipleSclerosisandCOPDexacerbation Date 1/10/13 Time 20minutes ServicesCoordinated ContactedHomeHealthtoarrangeforoxygeninthe patientshome.Patientisscheduledtoreceivetheoxygen thisafternoon.TheCMNwascompletedandsenttothe homehealthagency.Discussedthearrangementsand properuseofoxygenwiththepatientsdaughter.Patient anddaughterunderstand Patientsdaughtercalledstatingthepatientisdepressed duetothelimitationssheisexperiencingduetotheMS. Arrangedforthepatienttoseepsychologistandevaluation fromPTtoseeiftherecanbeanyimprovementinmobility.

1/15/13

15minutes

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ComplexChronicCareCoordinationServices
Donotreportwith
Careplanoversight(99339,99340,9937499380) Prolongedserviceswithoutdirectcontact(99358, 99359) Anticoagulantmanagement(99363,99364) Medicalconferenceteam(9936699368) Educationandtraining(9896098962,99071, 99078) Telephoneservices(9896698968,9944199443)
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ComplexChronicCareCoordinationServices
Donotreportwith
Onlinemedicalevaluationservices(9896999444) Preparationofspecialreports(99080) Analysisofdata(99090,99091) Transitionalcaremanagement(99495,99496) Medicationtherapymanagementservices(99605 99607) ESRDservices(9095190970)
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TransitionalCareManagementServices
Reportedfortransitionalcareforpatients dischargedfromthehospital,SNF,rehab hospital,partialhospitalorobservationto home,domiciliary,resthomeorassistedliving Propertransitionalcareisimportantto preventrepeatadmissions Reportedbyphysicianorotherqualified healthcareprovider.Canbereportedbythe sameindividualwhodischargedthe
21

TransitionalCareManagementServices
Documentationmustinclude:
Contactwiththepatient(telephoneorelectronic) withintwobusinessdaysofdischarge DocumentationtosupportMDM
99495requiresatleastmoderateMDM 99496requireshighMDM

Facetofacevisit
99495within14businessdays 99496within7businessdays
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TransitionalCareManagementServices
MDM Facetoface visitwithin7 days 99495 99496 Facetoface visitin8to14 days 99495 99495

Moderate High

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TransitionalCareManagementServices
Documentationshouldinclude:
Dateofthepatientsdischarge Initialpatientcontactwithin2days(phoneor email) MDMmustbedocumented
RefertotheMDMcriteriausingtheCPTcoding guidelinesor1995/1997CMSDocumentation Guidelines

Documentedfacetofaceencounter
DonotreportaseparatecodefortheE/M
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TransitionalCareManagementServices
Donotreportwith
Careplanoversight(99339,99340,9937499380) Prolongedserviceswithoutdirectcontact(99358, 99359) Anticoagulantmanagement(99363,99364) Medicalconferenceteam(9936699368) Educationandtraining(9896098962,99071, 99078) Telephoneservices(9896698968,9944199443)
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TransitionalCareManagementServices
Donotreportwith
ESRDservices(9095190970) Onlinemedicalevaluationservices(9896999444) Preparationofspecialreports(99080) Analysisofdata(99090,99091) Complexchroniccarecoordination(9948799489) Medicationtherapymanagementservices(99605 99607)
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Anesthesia
01991Anesthesiafordiagnosticortherapeutic
nerveblocksandinjections(whenblockorinjection isperformedbyadifferentprovider physicianor otherqualifiedhealthcareprofessional);otherthan theproneposition

Samechangeismadeto01992 Revisiontoincludeotherqualifiedhealthcare professionals


27

Integumentary
15740Flap;islandpediclerequiring identificationanddissectionofan anatomicallynamedaxialvessel Revisionmadetoclarifypropercodeuse becausereasontobelievecodeismisused Mostcommonlyreportedwithskin malignancydiagnosis
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Integumentary
Documentationforislandpedicleflap
Islandofskinisdetachedfromitsepidermaland dermalattachmentswhileretainingitsvascular supply(anatomicallynamedaxialvessel) Mostcommonlyusedonthelipandnose

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Musculoskeletal
20665Removaloftongsorhaloappliedby anotherphysician individual
Revisiontoremovephysicianastheonlyprovider

+22522Percutaneousvertebroplasty
Includesmoderatesedation 22520and22521alreadyincludedmoderate sedation
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Musculoskeletal
22586Arthrodesis,presacralinterbody technique,includingdiscspacepreparation, discectomy,withposteriorinstrumentation, withimageguidance,includesbonegraft whenperformed,L5S1interspace

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Musculoskeletal
Documentationfor22586
Unlikeotherspinecodes,thiscodeisspecificto theinterspace(L5S1) Posteriorinstrumentationrequired Imagingguidancecannotbereportedseparately

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Musculoskeletal
23473Revisionoftotalshoulderarthroplasty, includingallograftwhenperformed;humeral or glenoidcomponent 23474Revisionoftotalshoulderarthroplasty, includingallograftwhenperformed;humeral and glenoidcomponent

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Musculoskeletal
Documentationfor23473
Revisionofapreviousshoulderarthroplasty Includestheremovalofpreviousplacedcomponents Humeralor glenoidcomponent

Documentationfor23474
Revisionofapreviousshoulderarthroplasty Includestheremovalofpreviousplacedcomponents Humeraland glenoidcomponent

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Musculoskeletal
24370Revisionoftotalelbowarthroplasty, includingallograftwhenperformed;humeral or ulnarcomponent 24371Revisionoftotalelbowarthroplasty, includingallograftwhenperformed;humeral and ulnarcomponent

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Musculoskeletal
Documentationfor24370
Revisionofapreviouselbowarthroplasty Includestheremovalofpreviousplacedcomponents Humeralor ulnarcomponent

Documentationfor24371
Revisionofapreviouselbowarthroplasty Includestheremovalofpreviousplacedcomponents Humeraland ulnarcomponent

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Musculoskeletal
28890Extracorporealshockwave,highenergy, performedbyaphysicianorotherqualifiedhealth careprofessional,requiringanesthesiaotherthan local,includingultrasoundguidance,involvingthe plantarfascia Revisiontoremovephysicianastheonlyprovider

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Musculoskeletal
29590 DenisBrownesplintstrapping Nolongerperformed

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Respiratory
Newcodes3164731651replaceCategoryIIIcodes 0250T0252Tforinsertion/removalforbronchial valves
Bronchialvalvesareinsertedtotreatpatientswith emphysemaorlungdamage
Valveslimitairflowtothedamagedpartofthelungtopromote healing

Thereareatotaloffivelobesinthelungs
Twolobesintheleftlung Threelobesintherightlung

Proceduresincludeconscioussedation
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Respiratory
31647Bronchoscopy,rigidorflexible,including fluoroscopicguidance,whenperformed;with balloonocclusion,whenperformed,assessmentof airleak,airwaysizing,andinsertionofbronchial valve(s),initiallobe 31648Bronchoscopy,rigidorflexible,including fluoroscopicguidance,whenperformed;with removalofbronchialvalve(s),initiallobe

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Respiratory
+31649Bronchoscopy,rigidorflexible,includingfluoroscopic guidance,whenperformed;withremovalofbronchial valve(s),eachadditionallobe(listseparatelyinadditionto codeforprimaryprocedure) +31651Bronchoscopy,rigidorflexible,includingfluoroscopic guidance,whenperformed;withballoonocclusion,when performed,assessmentofairleak,airwaysizing,andinsertion ofbronchialvalve(s),eachadditionallobe(listseparatelyin additiontocodeforprimaryprocedure[s])

41

Respiratory
DocumentationRequirements3164731651 Insertionofvalves Howmanylobes Removalofvalves Howmanylobes

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Respiratory
Bronchographyisnolongerperformed
Deletedcodesinclude: 31656Bronchoscopy,rigidorflexible,including fluoroscopicguidance,whenperformed;with injectionofcontrastmaterialforsegmental bronchography(fiberscopeonly) 31715Transtrachealinjectionfor bronchography ComputedTomography(CT)isthecurrent standardofcare
43

Respiratory
CategoryIIIcodes0276T0277Thavebeen deletedandreplacedwithnewcodes(31660 31661)forbronchialthermoplasty
Usesradiofrequencyablationtotreatasthmatic patients Reducesthemuscleassociatedwithairway constriction Proceduresincludeconscioussedation

44

92 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

Respiratory
31660Bronchoscopy,rigidorflexible, includingfluoroscopicguidance,when performed;withbronchialthermoplasty,1 lobe 31661Bronchoscopy,rigidorflexible, includingfluoroscopicguidance,when performed;withbronchialthermoplasty,2or morelobes
45

Respiratory
Documentationfor31660,31661
Thermoplasty:therapeuticradiofrequencyenergy usedtoheatandreducethetissueofsmooth musclepresentintheairwaywall Ifperformedononelobe,report31660 Ifperformedontwoormorelobes,report31661 Thecodesincludefluoroscopicguidanceand conscioussedation

46

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 93

Slide Presentation Complete 2013 Procedure Coding Updates

Respiratory
32420Pneumocentesis,punctureoflungfor aspiration Nolongerperformed Directedtouse32405Biopsy,lungor mediastinum,percutaneousneedle

47

Respiratory
32421Thoracentesis,punctureofpleuralcavityfor aspiration,initialorsubsequent Deleted See32554/32555 32422Thoracentesiswithinsertionoftube,includes waterseal(eg,forpneumothorax),whenperformed (separateprocedure) Deleted See32554/32555
48

94 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

Respiratory
32551Tubethoracostomy,includeswater seal connectiontodrainagesystem (eg,for abscess,hemothorax,empyema waterseal), whenperformed,open (separateprocedure)
Clarifyaccess
Openprocedure

Conditionsremovedsoasnottolimitusetoonly abscess,hemothorax,empyema Includesconscioussedation


49

Respiratory
32554Thoracentesis,needleorcatheter, aspirationofthepleuralspace;withoutimaging guidance 32555Thoracentesis,needleorcatheter, aspirationofthepleuralspace;withimaging guidance
Aneedleorcatheterisusedtopuncturethepleuralspace andwithdrawfluid Replace32420/32422 Selectcodesbasedonwhetherimagingguidanceis performed
50

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 95

Slide Presentation Complete 2013 Procedure Coding Updates

Respiratory
Documentationrequirements32554,32555
Surgicalpunctureanddrainageofthepleural space Thecatheterorneedleisnotleftinovertime
Thepunctureisperformedandthefluidisaspirated

Codeselectionbasedonwhetherimaging guidanceisperformed
Donotreportaseparatecodefortheimaging

51

Respiratory
32556Pleuraldrainage,percutaneous,with insertionofindwellingcatheter;withoutimaging guidance 32557Pleuraldrainage,percutaneous,with insertionofindwellingcatheter;withimaging guidance

52

96 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

Respiratory
Documentationrequirements32556,32557
Reportspercutaneousdrainageofpleuralfluid
Ifperformedasanopenprocedurereport32551

Tubeorcatheterisleftinplace(unlike thoracocentesis) Codeselectionisbasedonwhetherimaging guidanceisused


Donotreportaseparatecodefortheimaging

53

Respiratory
32701Thoracictarget(s)delineationfor stereotacticbodyradiationtherapy (SRS/SBRT),(photonorparticlebeam),entire courseoftreatment
Newsubsectionandguidelines
Performedtoidentifytumorborders,volumeand relationshiptoadjacentanatomicstructures

Donotreportwith7742777499 Reportonlyoncepercourseoftreatment
54

= FDA Approval Pending = Add-on

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Slide Presentation Complete 2013 Procedure Coding Updates

Cardiovascular
+33225Insertionofpacingelectrode,cardiac venoussystem,forleftventricularpacing,attimeof insertionofpacingcardioverter defibrillatoror pacemakerpulsegenerator(including eg,for upgradetodualchambersystemandpocket revision)(Listseparatelyinadditiontocodefor primaryprocedure)
revisedtoremovepocketrevisionasarequirement parentheticalnoteshavebeenaddedtoinstructwhenitis appropriatetoreport33225withotherprocedures
55

Cardiovascular
CategoryIIIcodes0256T,0258Tand0259Tdeleted andreplacedby3336133367forTAVR
noninvasiveproceduretoreplacetheaorticvalvefor patientswithaorticstenosis(narrowingoftheaorticvalve) Servicesinclude:

56

Gainingaccess Deploymentandrepositioningofthevalve Temporarypacemakerinsertionforrapidpacing Closureofarteriotomy Angiography Radiologicsupervisionandinterpretation

98 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

Cardiovascular
3336133367,cont
Twoprovidersarerequiredforthisprocedure(eg, cardiologist,interventionalradiologists)
Whentwosurgeonsworktogethertoperformtheseprocedures, appendmodifier62

Diagnosticcoronaryangiographymaybereported separatelywhen:
apriorcoronaryangiographywasnotperformed ifapriorcoronaryangiographywasperformed,thetestisnot adequate(eg,patientsconditionhaschangedsincetheoriginal angiography,theinitialstudyisinadequatevisualizationof anatomy)
57

Cardiovascular
3336133367,cont Codesselectionisbasedon
whethertheapproachisopenorpercutaneous thevesselthesurgeonusesfortheapproach

Cardiopulmonarybypassmaybereported withtheappropriateaddoncode(33367 33369),dependingonthetypeofaccess performed


58

= FDA Approval Pending = Add-on

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Slide Presentation Complete 2013 Procedure Coding Updates

Cardiovascular
33361
percutaneousapproach femoralartery

33362
openapproach femoralartery

33363
openapproach axillaryartery
59

Cardiovascular
33364
openapproach iliacartery

33365
transaorticapproach openprocedureviamediansternotomyor mediastinotomy

60

100 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

Cardiovascular
Addons3336733369report cardiopulmonarybypassduringaTAVR
Selectcodesbasedonwhetherthecannulationis performedpercutaneously,openorcentrally +33367percutaneousperipheralarterialand venouscannulation +33368openperipheralarterialandvenous cannulation +33369centralarterialandvenouscannulation
61

Cardiovascular
Newcodes3399033993describeinsertion,removal andrepositioningofpercutaenousventricleassist devices(pVAD)
ReplacecategoryIIIcodes0048Tand0050T

Ventricleassistdevicesassistthepatientsheartto pumpbloodduringhighriskproceduresorfor criticallyillpatients CodingguidelineshavebeenaddedtoHeart (IncludingValves)andGreatVessels,CardiacValves andCoronaryBypasssubcategories


62

= FDA Approval Pending = Add-on

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Slide Presentation Complete 2013 Procedure Coding Updates

Cardiovascular
33990
arterialaccessonly

33991
arterialandvenousaccessandtransseptalpuncture

33992
Removalduringaseparatesession
Removalduringthesamesessionasinsertionincluded

33993
repositioning duringaseparatesession
Repositioningduringthesamesessionasinsertionisincluded
63

Cardiovascular
Documentationfor3399033993
Includeconscioussedation Typeofaccess
arterialorarterialandvenous,whichrequires transseptalpuncture

Removaliscodedifperformedataseparate session Repositioningiscodedifperformedataseparate session


64

102 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

Cardiovascular
Conscioussedationnowincluded:
36010Introductionofcatheter,superioror inferiorvenacava 36140Introductionofneedleorintracatheter; extremityartery

65

Cardiovascular
Newcodes3622136225describeselectiveandnonselective arterialcatheterplacementandangiographyintheaortic arch,andcarotidandvertebralarteries Included:
vesselaccess placementofcatheter(s) contrastinjection(s) fluoroscopy radiologicalsupervisionandinterpretation closureofthearteriotomy

Newguidelinesprovideinstructionforproperuse
66

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 103

Slide Presentation Complete 2013 Procedure Coding Updates

Cardiovascular
3622136225,cont Codesareunilateral
Modifier50isforbilateralservice

CPTprovidesspecificinstructiononappending modifier59fortheseservices Codesarebuiltonahierarchyofservices


Whenmorethanoneprocedureisperformedonthe ipsilateral(sameside)vessel,reportonlythemostcomplex procedure

67

Cardiovascular
3622136225,cont Radiologicalsupervisionandinterpretationis included;however
ifa3Drenderingisperformed,youmayseparatelyreport 76376or76377 ifultrasoundguidanceisrequiredtoaccessthevessel, report76937 75774maybereportediftheangiographyisnot performedfortheextracranialandintracranial cervicocerebralvessels(eg,upperextremities)

Conscioussedationisincluded
68

104 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

Cardiovascular
36221
Nonselectivethoracicaortacatheterplacement Includesangiographyofthecervicocerebralarch Donotreportwith3622236226

36222
Selectivecatheterplacementincommoncarotidorinnominateartery includesangiographyofipsilateralextracranialcarotidcirculation

36223
Selectivecatheterplacementincommoncarotidorinnominateartery Includesangiographyofipsilateral(sameside)intracranialcarotid circulation,extracranialcarotidandcervicocerebralarch
69

Cardiovascular
36224
Selectivecatheterplacementininternalcarotidartery Includesangiographyofipsilateralintracranialcarotidcirculation, extracranialcarotidandcervicocerebralarch

36225
Selectivecatheterplacementinthesubclavianartery Includesangiographyofipsilateralvertebralcirculationand cervicocerebralarch

36226
Selectivecatheterplacementinthevertebralartery Includesangiographyofipsilateralvertebralcirculationand cervicocerebralarch
70

= FDA Approval Pending = Add-on

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Slide Presentation Complete 2013 Procedure Coding Updates

Cardiovascular
+36227
Reportinadditionto36222,36223,or36224for selectivecatheterplacementintheexternal carotidartery

+36228
Reportinaddition36224or36226forselective catheterplacementineachintracranialbranchof theinternalcarotidorvertebralarteries Donotreport36228morethantwice,perside
71

Cardiovascular
Venipuncturecodedescriptorsarerevisedto allowreportingbyotherqualifiedhealthcare professional
36400 36405 36406 36410

72

106 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

Cardiovascular
37197Transcatheterretrieval,percutaneous,of intravascularforeignbody(eg,fracturedvenousor arterialcatheter),includesradiologicalsupervision andinterpretation,andimagingguidance (ultrasoundorfluoroscopy),whenperformed
BundlesradiologicalS&Itopercutaneoustranscatheter retrievalofaforeignbody 37203deleted Reportretrievalofthevenacavafilterwith37193

73

Cardiovascular
Newcodes3721137214bundleinfusion thrombolysiswithradiologicalS&Iwhen performedinarterialandvenousvessels
37201deleted 75896revised 37203deleted 75900deleted

Duringtheprocedures,chemicalsareinfused tobreakdownclots
74

= FDA Approval Pending = Add-on

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Slide Presentation Complete 2013 Procedure Coding Updates

Cardiovascular
3721137214,cont Codesareselectedperday
Ifthetreatmentextendsovermorethanonedateofservice,youmay useseparatecodestoreportthesubsequenttreatmentdayandthe cessationorlasttreatmentday

37211
Forinfusionthrombolysisofarteryotherthancoronary Onceperdayfortheinitialservice

37212
Forinfusionthrombolysisofavein Onceperdayfortheinitialservice
75

Cardiovascular
3721137214,cont 37213
Infusionthrombolysisofanartery(otherthancoronary)or vein Subsequent dayoftherapy

37214
Cessationofinfusionthrombolysisofanartery(otherthan coronary Includesremovalofthecatheterandclosureofthevessel

76

108 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

HemicandLymphaticSystems
Codesforhematopoieticprogenitorcell(HPC) transplantation(38240,38241)havebeen revisedtoassistwithcodeselection
Allogenictransplantation=therecipientisnotthe donor
Becausetheprocedurecaninvolvecellsfrommore thanonedonor,theprocedureisreportedperdonor Includesthephysicianmonitoringphysiological parameters,verificationofcellprocessing,patient evaluationanddirectsupervisionoftheinfusion
77

HemicandLymphaticSystems
Autologoustransplantation=therecipientisthe donor
Includesthephysicianmonitoringphysiological parameters,verificationofcellprocessing,patient evaluationanddirectsupervisionoftheinfusion

78

= FDA Approval Pending = Add-on

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Slide Presentation Complete 2013 Procedure Coding Updates

HemicandLymphaticSystems
Codesforhematopoieticprogenitorcell(HPC) transplantation(38240,38241)havebeen revisedtoassistwithcodeselection
Allogenictransplantation=therecipientisnotthe donor
Becausetheprocedurecaninvolvecellsfrommore thanonedonor,theprocedureisreportedperdonor Includesthephysicianmonitoringphysiological parameters,verificationofcellprocessing,patient evaluationanddirectsupervisionoftheinfusion
77

HemicandLymphaticSystems
Autologoustransplantation=therecipientisthe donor
Includesthephysicianmonitoringphysiological parameters,verificationofcellprocessing,patient evaluationanddirectsupervisionoftheinfusion

78

110 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

HemicandLymphaticSystems
38243Hematopoieticprogenitorcell(HPC)boost
Mayoccurdays,monthsoryearsfromtheoriginalHPC transplantation ComesfromtheoriginalHPCdonorfromtheinitial transplantation Totreatarelapseorposttransplantcytopenia(deficiency orlackofcellularelementsinthecirculatingblood)

38242
Nolongerachildof38240 Forpatientswithpreviousbonemarrowtransplant
79

DigestiveSystem
43206Esophagoscopy,rigidorflexible;with opticalendomicroscopy 43252Uppergastrointestinalendoscopyincluding esophagus,stomach,andeithertheduodenum and/orjejunumasappropriate;withoptical endomicroscopy
Eliminatesrandomsamplingandallowstargetedbiopsy throughrealtimecellularobservationofmucosaltissue Performedforsuspectedpreneoplasticdiseases Includesmoderatesedation
80

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 111

Slide Presentation Complete 2013 Procedure Coding Updates

DigestiveSystem
43234Uppergastrointestinalendoscopy, simpleprimaryexamination(eg,withsmall diameterflexibleendoscope)(separate procedure)
Deleted/rarelyperformed MostcommonGIendoscopeis43235

81

DigestiveSystem
44705Preparationoffecalmicrobiotafor instillation,includingassessmentofdonorspecimen
forClostridiumdifficileinstillation
Bacteriumcangrowoutofcontrolfromuseofantibiotics

Includescollectingfecalmaterialfromadonor,preparing thefecalmaterialinaslurryandevaluatingthematerial priortoinstillation Includesonlythepreparationpriortoinstillation,not the worktoinstillthefecalmicrobiota


Reportinstillationthroughcolonoscopyorsigmoidoscopy separately
82

112 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

UrinarySystem
52287Cystourethroscopy,withinjection(s) forchemodenervationofthebladder Forchemodenervationofthebladder
eg,neurogenicincontinence

83

MaternityCareandDelivery:Repair
59300Episiotomyorvaginalrepair,by otherthanattendingphysician
Revisedtoallowreportingbyattendingprovider otherthanphysician
Midwife

84

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 113

Slide Presentation Complete 2013 Procedure Coding Updates

NervousSystem
62370Electronicanalysisofprogrammable, implantedpumpforintrathecalorepiduraldrug infusion(requiringskillphysicians ofaphysicianor otherqualifiedhealthcareprofessional)
Nolongerlimitedtophysicianreporting

64561Percutaneousimplantationof neurostimulatorelectrodearray;sacralnerve (transforaminalplacement)includingimage guidance,ifperformed


Nowincludesimagingguidance
85

NervousSystem
64612
Revisedtoaddunilateral Ifperformedbilaterally,appendmodifier50

64614
Revisedtospecifyextremity(singular) Reportoncepersessionforextremityand/or trunkmuscles Donotreportwithmodifier50
86

114 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

NervousSystem
64615
Describesbilateralchemodenervationofmuscles innervatedbyfacial,trigeminal,cervicalspineand accessorynerves Inherentlybilateral
Donotappendmodifier50

Donotreportwith64612,64613or64614

87

EyeandOcularAdnexa
65800Paracentesisofanteriorchamberofeye (separateprocedure);withdiagnosticaspiration removal ofaqueous 65805Paracentesisofanteriorchamberofeye (separateprocedure);withtherapeuticreleaseof aqueous
65805deleted 65800nowreporteither diagnosticor therapeuticremoval ofaqueous

88

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 115

Slide Presentation Complete 2013 Procedure Coding Updates

EyeandOcularAdnexa
67810Biopsy Incisionalbiopsy ofeyelid skinincludinglidmargin
Biopsymustbeofthelidmargin Report11100,11101or1131011313forbiopsy oftheskinoftheeyelid

89

Radiology
71040Bronchography,unilateral,radiological supervisionandinterpretation 71060Bronchography,bilateral,radiological supervisionandinterpretation
Bronchographyisnolongerperformed Computedtomography(CT)isnowthestandard ofcarereplacingbronchography

90

116 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

Radiology
Codesforradiologyexaminationofthe cervicalspinehavebeenrevisedtoincludethe numberofviews 72040Radiologicexamination,spine, cervical;3viewsorless 720504or5views 720526ormoreviews
91

Radiology
Angiographycodes7565075685have beendeleted
Replacedbycombinationcodesthat bundlesurgicalandradiologicalservices See3622136227

92

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 117

Slide Presentation Complete 2013 Procedure Coding Updates

Radiology
75896Transcathetertherapy,infusion,anymethod(eg, thrombolysisotherthanforthrombolysis,radiological supervisionandinterpretation 75898Angiographythroughexistingcatheterforfollowup studyfortranscathetertherapy,embolizationorinfusion, otherthanforthrombolysis 75900Exchangeofapreviouslyplacedintravascularcatheter duringthrombolytictherapywithcontrastmonitoring, radiologicalsupervisionandinterpretation Newcodesinfusionthrombolysiscodes3721137214 includeradiologicalsupervisionandinterpretation
93

Radiology
75961Transcatheterretrieval,percutaneous, ofintravascularforeignbody(eg,fractured venousorarterialcatheter),radiological supervisionandinterpretation
Replacedby37197

94

118 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

Radiology
Revisedtoincludeotherqualifiedhealthcare professional
76000/76001Fluoroscopy 76885/76886Ultrasound +77051/+77052Computeraidedmammography 77071Jointradiography

95

Radiology
763763Drenderingwithimagepostprocessing underconcurrentsupervision;notrequiringimage postprocessingonanindependentworkstation 763773Drenderingwithimagepostprocessing underconcurrentsupervision;requiringimage postprocessingonanindependentworkstation
Revisedtoincludeimagepostprocessingunderconcurrent supervision Parentheticalnotelistsproceduresnotreportedwith 76376/76377
96

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 119

Slide Presentation Complete 2013 Procedure Coding Updates

Radiology
Newcodes7801278014replace7800078011 forthyroidimaging
78012toevaluatethefunctionofthegland 78013todeterminethesize,shapeandposition ofthethyroidgland 78014whentheservicesidentifiedin78012and 78013areperformedduringthesamesession

97

Radiology
78070Parathyroidplanar imaging(including subtraction,whenperformed) 78071Parathyroidplanarimaging(including subtraction,whenperformed);withtomographic (SPECT) 78072Parathyroidplanarimaging(including subtraction,whenperformed);withtomographic (SPECT),andconcurrentlyacquiredcomputed tomography(CT)foranatomicallocalization
98

120 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

PathologyandLaboratory
MolecularPathology 13NewTier1molecularpathologyprocedure codes Anunlistedmolecularpathologyprocedure codeadded(81479) RevisedthedescriptorsforallnineTier2 (8140081408)procedures

99

PathologyandLaboratory
MultianalyteAssayswithAlgorithmicAnalysis (MAAA) Newsubsectionwithguidelinesforproperuse 9newcodes(8150081599) Algorithmicanalysisusingtheresultsofassays (molecularpathologyassays,fluorescentinsitu hybridizationassays,andnonnucleicacidbased assays)andpatientinformation,when appropriate,toreportanumericscore(s)or probabilityofdevelopingspecificconditions
100

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 121

Slide Presentation Complete 2013 Procedure Coding Updates

PathologyandLaboratory
MultianalyteAssayswithAlgorithmicAnalysis (MAAA) Example: 81503Oncology(ovarian),biochemical assaysoffiveproteins(CA125, apoliproproteinA1,beta2microglobulin, transferrin,andprealbumin),utilizingserum, algorithmreportedasariskscore
101

PathologyandLaboratory
Chemistry 82009Acetoneorotherketonebodies Ketonebody(s)(eg,acetone,acetoaceticacid, serum betahydroxybutyrate);qualitative
82010Acetoneorotherketonebodies Ketone body(s)(eg,acetone,acetoaceticacid, serum beta hydroxybutyrate);quantitative Changesmadetoreflectcurrentclinicalpractice
102

122 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

PathologyandLaboratory
Chemistry 82777Galectin3 Usedtoassesstheprognosisofpatientwith heartfailure

103

PathologyandLaboratory
Chemistry 8389083914havebeendeleted
Refertomolecularpathologycodes8120081479

104

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 123

Slide Presentation Complete 2013 Procedure Coding Updates

PathologyandLaboratory
Immunology # 86152Cellenumerationusingimmunologic selectionandidentificationinfluidspecimen (eg,circulatingtumorcellsinblood); # 86153Cellenumerationusingimmunologic selectionandidentificationinfluidspecimen (eg,circulatingtumorcellsinblood);physician interpretationandreport,whenrequired
105

PathologyandLaboratory
Immunology 86711Antibody;JC(JohnCunningham)virus

106

124 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

PathologyandLaboratory
TissueTyping Newcodes8682886835werecreatedto reporttissuetypingforsolidorganandbone marrowtransplants

107

PathologyandLaboratory
Microbiology 87498Infectiousagentdetectionbynucleicacid (DNAorRNA);enterovirus,reversetranscriptionand amplifiedprobetechnique 87521Infectiousagentdetectionbynucleicacid (DNAorRNA);hepatitisC,reversetranscriptionand amplifiedprobetechnique 87522HepatitisC,reversetranscriptionand quantification

108

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 125

Slide Presentation Complete 2013 Procedure Coding Updates

PathologyandLaboratory
Microbiology 87535Infectiousagentdetectionbynucleicacid (DNAorRNA);HIV1,reversetranscriptionand amplifiedprobetechnique 87536HIV1,reversetranscriptionand quantification 87538HIV2,reversetranscriptionand amplified probetechnique 87539HIV2,reversetranscriptionand quantification
109

PathologyandLaboratory
Newcodes8763187633describenucleicacid testsperformedtodetectrespiratoryviruses
Codesareselectedbasedonthenumberof targetsforthetest

Parenthetical
Forassaysthatareusedtotypeandsubtype influenzavirusesonly,see8750187503 Forassaysthatincludeinfluenzaviruseswith additionalrespiratoryviruses,see8763187633
110

126 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

PathologyandLaboratory
Microbiology 87910Infectiousagentgenotypeanalysis bynucleicacid(DNAorRNA); cytomegalovirus 87901Infectiousagentgenotypeanalysis bynucleicacid(DNAorRNA);HIV1,reverse transcriptaseandproteaseregions 87912Infectiousagentgenotypeanalysis bynucleicacid(DNAorRNA);hepatitisBvirus
111

PathologyandLaboratory
SurgicalPathology 88375Opticalendomicroscopicimage(s), interpretationandreport,realtimeor referred,eachendoscopicsession
Usedtoreportinterpretationandreportwhen43206 or43252areperformed Notreportedbythesurgeon,onlywhenperformed byanotherphysician(eg,pathologist)

112

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 127

Slide Presentation Complete 2013 Procedure Coding Updates

PathologyandLaboratory
Codes8838488386havebeendeleted
Seemolecularpathologycodes8120081479

113

Medicine
Manycodesrevisedtoincludeotherqualified healthcareprofessional,ortoremove physicianfromthecodedescription
Hemodialysis(90935,90945,90947) EndStageRenalDiseaseServices(9095190962) Gastroenterology(91110,91111) EvaluativeandTherapeuticServices(92613,92615, 92617)

114

128 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

Medicine
Otherqualifiedproviders,cont Cardiography(93015,93016) CardiovascularMonitoringServices(93224, 93227,93228,93229,93268,93272) ImplantableandWearableCardiacDevice Evaluations(9327993298) Echocardiography(93351)

115

Medicine
Otherqualifiedproviders,cont NoninvasivePhysiologicStudiesand Procedures(93745,93750,93790) OtherProcedures(93797,93798) PulmonaryDiagnosticTestingandTherapies (94014,94016,94452,94453,94610,94774) AllergyTesting(95004,95024,95027) AllergenImmunotherapy(9512095134)
116

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 129

Slide Presentation Complete 2013 Procedure Coding Updates

Medicine
Otherqualifiedproviders,cont SpecialEEGTests(95954,95961,95962) OtherProcedures(95991) MotionAnalysis(96004) FunctionalBrainMapping(96020) TherapeuticProcedures(9753097537) TestsandMeasurements(97755) OnlineMedicalEvaluation(98969)
117

Medicine
Otherqualifiedproviders,cont SpecialServices,ProceduresandReports (9900099002,99070,+99071,99078,99091) Moderate(Conscious)Sedation(99143 99150) OtherServicesandProcedures(99174,99183)

118

130 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Complete 2013 Procedure Coding Updates Slide Presentation

Medicine
Psychiatry:Significantchangestocodesand guidelines Newcodes
Interactivecomplexity Psychiatricdiagnosticevaluation Psychotherapy Psychotherapyforcrisis Pharmacologicmanagement
119

Medicine
InteractiveComplexity
Addoncode(90785)usedtoreport communicationfactorsthatcomplicatepsychiatric services Typicalfactors
Thirdpartiesinvolvedwithcare(guardians,caregivers) Requireotherstobeinvolvedwiththecare (interpreters) Requirethirdparties(welfareagencies,schools)
120

= FDA Approval Pending = Add-on

Complete 2013 Procedure Updates 131

Slide Presentation Complete 2013 Procedure Coding Updates

Medicine
InteractiveComplexitycont
Mustincludeoneofthefollowing:
Managemaladaptivecommunication(highreactivity) Caregiveremotionsorbehaviorinterferes Disclosureofsentineleventsandmandatedreporting (abusetostateagency) Useofplayequipmentorphysicaldevices Requireotherstobeinvolvedwiththecare (interpreters) Hasnotdevelopedorlostexpressivelanguage communicationskills.
121

Medicine
InteractiveComplexitycont
Canbeusedwiththefollowingcodes:
Diagnosticpsychiatricevaluation(90791,90792) Psychotherapy(90832,90834,90837) PsychotherapywithE/M(90833,90836,90838,99201 99255,9930499337,9934199350) Grouppsychotherapy(90853)

122

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Medicine
InteractiveComplexity,cont
Donotreportwith:
Psychotherapyforcrisis(90839,90840) E/Mperformedwithoutpsychotherapy

123

PsychiatricDiagnosticEvaluation(90791,90792) 90801,90802deleted Biophysicalassessmentincludinghistory,mental statusandrecommendations DonotreportonthesamedateasE/M


IfmedicalserviceisperformedonsameDOSas psychiatricdiagnosticevaluation,report90792

Medicine

Forinteractivecomplexity,report90785with90791 or90792 Donotreport90791and90792onthesameDOS


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Medicine
Psychotherapy(9083290838)
9080490809,9081090815,9081690822and9082390829 deleted Newcodesarebasedontime Addoncodesusedwhenpsychotherapyisperformedonthe sameDOSasE/M DonotincludetimeperformingtheE/Mserviceas psychotherapytime Forinteractivepsychotherapy,report90785withthe psychotherapycode

125

Time Psycho Psychand (min) therapy E/M 1637 90832 E/M,90833

Psychand Interactive Psych 90832,90785

Psych,Interactive PsychandE/M E/M,90833, 90785 E/M,90836, 90785 E/M,90838, 90785

3852 90834 53> 90837

E/M,90836 E/M,90838

90834,90785 90837.90785

126

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Medicine
PsychotherapyinCrisis(90839,90840) Urgentassessmentofapatientwithalife threateningorcomplexcondition Reportedbasedontime
Ifperformed30minutesorless,reportwith90832or 90833

Donotreportwithpsychiatricdiagnosticevaluation (90791,90792),psychotherapycodes(9083290838) orotherpsychiatricservices(9078590899)


127

Medicine
Pharmacologicmanagement(90863) 90862wasdeleted Newcodeisanaddoncodethatcanonlybe reportedwithpsychotherapycodes Donotusetimespentperformingpharmacologic managementtodeterminepsychotherapycodes IftheproviderispermittedtobillwithE/Mcodes (eg,psychiatrist),reporttheserviceasanE/M Donotreport90863withanE/Mcode
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Medicine
Gastroenterology 0242Twasdeletedandreplacedwith91112 91112Gastrointestinaltransitandpressure measurement,stomachthroughcolon, wirelesscapsule,withinterpretationand report

129

Medicine
Ophthalmoscopy 92286Specialanterior Anterior segment photography imaging withinterpretationandreport; withspecularendothelial microscopyand endothelial cellcount analysis 92287Specialanterior Anterior segment photography imaging withinterpretationandreport; withfluoresceinangiography

130

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Medicine
CoronaryTherapeuticServicesandProcedures Codes92980,92981,92982,92984,92995,92996 weredeleted Servicesinthissubsectioninclude:atherectomy,stent
andangioplastyoncoronaryarteries

Servicesinclude:access,selectivecatheterization, radiologicsupervisionandinterpretation,closureof arteriotomy,andimagingtodocumentcompletionof theprocedure


131

Medicine
CoronaryTherapeuticServicesandProcedures,cont Coronaryarteries:leftmain,leftanteriordescending, leftcircumflex,rightmainandramusintermedius Coronarybranches:diagonalsoftheleftanterior descending,marginalsofleftcircumflexand posteriordescendingposterolateralsoftheright

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Medicine
Documentationmustinclude:
Majorcoronaryarteriesandbranchesinvolvedinthe procedure(s) Proceduresbeingperformed Morethanoneinterventioncanbeperformedon multiplevessels Patientscondition:acutemyocardialinfarctionorchronic totalocclusion
Therearespecificcodesforthis

Istheprocedurebeingperformedonabypassgraft?
133

Medicine
PCIcodeselection: Reportonebasecodeforthemostcomplex procedureforeachmajorcoronaryartery involvedinthecase
Atherectomy>stent>angioplasty

Canreportuptotwobranches Conscioussedationincluded

134

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Medicine
92920Percutaneoustransluminalcoronary angioplasty;singlemajorcoronaryarteryor branch +92921Percutaneoustransluminalcoronary angioplasty;eachadditionalbranchofamajor coronaryartery(listseparatelyinadditionto codeforprimaryprocedure)

135

Medicine
92924Percutaneoustransluminalcoronary atherectomy,withcoronaryangioplastywhen performed;singlemajorcoronaryarteryor branch +92925Percutaneoustransluminalcoronary atherectomy,withcoronaryangioplastywhen performed;eachadditionalbranchofamajor coronaryartery (listseparatelyinadditionto codeforprimaryprocedure)
136

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Medicine
92928Percutaneoustranscatheterplacementof
intracoronarystent(s),withcoronaryangioplasty whenperformed;singlemajorcoronaryarteryor branch +92929Percutaneoustranscatheterplacementof intracoronarystent(s),withcoronaryangioplasty whenperformed;eachadditionalbranchofamajor coronaryartery(listseparatelyinadditiontocodefor primaryprocedure)

137

Medicine
92933Percutaneoustransluminalcoronary atherectomy,withintracoronarystent,withcoronary angioplastywhenperformed;singlemajorcoronary arteryorbranch +92934Percutaneoustransluminalcoronary atherectomy,withintracoronarystent,withcoronary angioplastywhenperformed;eachadditionalbranch ofamajorcoronaryartery (listseparatelyinaddition tocodeforprimaryprocedure)
138

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Medicine
92937Percutaneoustransluminalrevascularization oforthroughcoronaryarterybypassgraft(internal mammary,freearterial,venous),anycombinationof intracoronarystent,atherectomyandangioplasty, includingdistalprotectionwhenperformed;single vessel 92938eachadditionalbranchsubtendedbythe bypassgraft(listseparatelyinadditiontocodefor primaryprocedure)
139

Medicine
92941Percutaneoustransluminal revascularizationofacutetotal/subtotal occlusionduringacutemyocardialinfarction, coronaryarteryorcoronaryarterybypass graft,anycombinationofintracoronarystent, atherectomyandangioplasty,including aspirationthrombectomywhenperformed, singlevessel
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Medicine
92943Percutaneoustransluminalrevascularization
ofchronictotalocclusion,coronaryartery,coronary arterybranch,orcoronaryarterybypassgraft,any combinationofintracoronarystent,atherectomyand angioplasty;singlevessel +92944eachadditionalcoronaryartery,coronary arterybranch,orbypassgraft(listseparatelyin additiontocodeforprimaryprocedure)

141

Medicine
PCIexample:Stentplacedandangioplasty performedonLAD,stentplacedinD1, angioplastyinD2

142

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Medicine
Correct Codes: 92928-LD, 92929-LD, 92921-LD

Picture Source: Radiology Assistant http://www.radiologyassistant.nl/en/p48275120e2ed5 143

Medicine
+92973Percutaneoustransluminalcoronary thrombectomymechanical (listseparatelyin additiontocodeforprimaryprocedure) Coderevisedbecausethiscodeisnotusedfor chemicalthrombectomyonlymechanical

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Medicine
IntracardiacElectrophysiologicalProcedures 93651and93562havebeendeleted Newcodes9365393657reportedfor comprehensiveelectrophysciologicevaluation andablationofarrhythmia
Codeisselectedbasedonthearrhythmiatreated

145

Medicine
AllergyTesting Codes95010and95015weredeleted Reportwith95017or95018basedon whethervenomordrugsandbiologicalsare usedinthetesting

146

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Medicine
Code95075hasbeendeletedandreplacedwithtime basedcodes95076and95079 95076Ingestionchallengetest(sequentialand incrementalingestionoftestitems,eg,food,drugor othersubstance);initial120minutesoftesting +95079eachadditional60minutesoftesting(list separatelyinadditiontocodeforprimaryprocedure)

147

Medicine
SleepMedicineTesting Codesrevisedtoincludetheageofthepatient
95808reportedforanyage 95810,95811forages6yearsandolder

Newcodes95782,95783forpatientsyounger than6years

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Medicine
NerveConductionStudies Codes9500095004weredeleted Newcodes9590795913reportedbasedonthe numberofstudiesperformed Motornerveconductionstudies:electrodesplaced overthemotorpointsofthemusclebeingtested Nerveconductionstudies:electrodesplacedoverthe specificnervetobetested

149

Medicine
NerveConductionStudies,cont Astudyisdefinedassensoryconductiontest, amotorconductiontestwithorwithoutanF wavetest,oranHreflextest UseAppendixJtoassistwithcoding

150

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Medicine
IntraoperativeNeurophysiology 95920isdeleted Codesreportedbasedonwhetherthemonitoringis oneononeintheoperatingroom(95940)orremote (95941) Reportaddonswiththebaselinestudies Ifmorethanonepatientismonitoredinthe operatingroom,report95941 Cannotbereportedbythesurgeonor anesthesiologist
151

CategoryII
Supplementalcodesfortrackingperformance measures MoreinformationontheAMAsite
www.amaassn.org/ama/pub/physicianresources/solutionsmanaging yourpractice/codingbillinginsurance/cpt/aboutcpt/categoryii codes.page

MoreinformationontheCMSsite
http://www.cms.gov/Medicare/QualityInitiativesPatientAssessment Instruments/PQRS/MeasuresCodes.html

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CategoryIII
DeletedCat.Code ReplacementCode

0030T 0048T 0050T 0173T 0242T 0250T0252T

86849 33991 3399033993 N/A 91112 3164731649

153

CategoryIIICodes
DeletedCat.IIICode ReplacementCode

0256T 0257T 0258T 0259T 0276T,0277T 0279T,0280T

3336133364 33365+0318T 33365+33366 3336533369 31660,31661 86152,86153

154

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CategoryIIICodes
0195TArthrodesis,presacral interbodytechniquewithout instrumentationL5S1interspace +0196TL4L5interspace
Codesrevisedtoindicatewithout instrumentation Distinguishfrom22586(with instrumentation)
155

CategoryIIICodes
0206TAlgorithmic Computerizeddatabase analysisofmultiplecyclesofdigitizedcardiac electricaldatafromtwoormoreECGleads,including transmissiontoa remotecenter,application of electrocardiographicderiveddata multiplenonlinear mathematicaltransformations, withcomputer probabilityassessment,includingreport coronary arteryobstructionseverityassessment
Revisedtodescribecoronaryarteryobstruction Not intendedforcardiacischemia
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CategoryIIICodes
+0291Tintravascularopticalcoherence tomographyinitialvessel(listseparatelyin additiontoprimaryprocedure)
Providesmicrostructuralinformationon atheroscleroticplaques Reportwith92920,92924,92928,92933,92937, 92941,92943,92975,9345493461,93563,93564 fortheinitialvessel Includesconscioussedation
157

CategoryIIICodes
+0292TIntravascularopticalcoherence tomographyeachadditionalvessel(list separatelyinadditiontoprimaryprocedure)
Addonwith0291T Reportwith92920,92924,92928,92933,92937, 92941,92943,92975,9345493461,93563,93564 fortheinitialvessel Includesconscioussedation

158

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CategoryIIICodes
0293TInsertionofleftatrialhemodynamic monitor;completesystem,includesimplanted communicationmoduleandpressuresensorlead inleftatriumincludingtransseptalaccess, radiologicalsupervisionandinterpretation,and associatedinjectionprocedures,whenperformed
Insertiontomonitorleftatrialpressure Donotreportwith93462or93662 Includesconscioussedation
159

CategoryIIICodes
+0294TInsertionofleftatrialhemodynamic monitor;pressuresensorleadattimeofinsertionof pacingcardioverterdefibrillatorpulsegenerator includingradiologicalsupervisionandinterpretation andassociatedinjectionprocedures
Devicetomonitorleftatrialpressureduringinsertionofa pacingcardioverterdefibrillator Claimwith33230,33231,33240,3326233264or33249 Donotreportwith93462or93662 Includesconscioussedation
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CategoryIIICodes
Newcodesdescribeexternalelectrocardiographic recordingformorethan48hours,upto21days.
Currentcodes(9322492337)reportsimilarrecording whenperformedupto48hours.

0295Trecording,scanninganalysiswithreport, reviewandinterpretation 0296Trecording(includesconnectionandinitial recording) 0297Tscanninganalysiswithreport 0298Treviewandinterpretation


161

CategoryIIICodes
0299TExtracorporealshockwavefor integumentarywoundhealing,highenergy, includingtopicalapplicationanddressing care;initialwound +0300Teachadditionalwound(list separatelyinadditiontocodeforprimary procedure)
Promoteshealingofburnwounds Reportperwound
162

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CategoryIIICodes
0301TDestruction/reductionofmalignantbreast tumorwithexternallyappliedfocusedmicrowave, includinginterstitialplacementofdisposable catheterwithcombinedtemperaturemonitoring probeandmicrowavefocusingsensocatheterunder ultrasoundthermotherapyguidance

163

Focusedmicrowavethermotherapyofthebreast Includesimagingguidance Includesconscioussedation Donotreportwith76645,76942,76998or7760077615

CategoryIIICodes
Intracardiacischemicmonitoringsystemdetects/warns patientsofmajorischemiccoronaryevent
eg,coronaryplaquerupture Includesagenerator,adaptorandtransvenouslead

0302TInsertionorremovalandreplacementof intracardiacischemiamonitoringsystemincludingimaging supervisionandinterpretationwhenperformedandintra operativeinterrogationandprogrammingwhenperformed; completesystem(includesdeviceandelectrode)


Includesconscioussedation Insertorremovecompletesystem
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CategoryIIICodes
Intracardiacischemicmonitoring,cont 0303TInsertionorremovalandreplacement electrodeonly
Electrodeonlyinsertion/replacement Includesinterrogationandprogramming Includesconscioussedation

0304Tdeviceonly
Deviceonlyinsertion/replacement Includesinterrogationandprogramming Includesconscioussedation
165

CategoryIIICodes
Intracardiacischemicmonitoring,cont 0305TProgrammingdeviceevaluation(inperson)of intracardiacischemiamonitoringsystemwithiterative adjustmentofprogrammedvalues,withanalysis,review,and report
Programmingandadjustments Mustbeperformedinperson

0306TInterrogationdeviceevaluation(inperson)of intracardiacischemiamonitoringsystemwithanalysis,review, andreport


Systeminterogation,includinganalysis,reviewandreport Mustbeperformedinperson
166

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CategoryIIICodes
Intracardiacischemicmonitoring,cont

0307TRemovalofintracardiacischemia monitoringdevice
Deviceremovalwithoutreplacement Includesconscioussedation

167

CategoryIIICodes
0308TInsertionofoculartelescope prosthesisincludingremovalofcrystallinelens
Insertion/implantationofatelescope Forpatientswithcentralvisionlosscausedby endstage,agerelatedmaculardegeneration Modifier51exempt Includesconscioussedation

168

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CategoryIIICodes
+0309TArthrodesis,presacralinterbody technique,includingdiscspacepreparation, discectomy,withposteriorinstrumentation,with imageguidance,includesbonegraft,when performed,lumbar,L4L5interspace(listseparately inadditiontocodeforprimaryprocedure)
Presacralinterbodytechniquearthrodesiswith posterior instrumentation Includesdiscpreparation,discectomy,posterior instrumentation,imagingguidanceandbonegraft PerformedatL4L5interspace
169

CategoryIIICodes
0310TMotorfunctionmappingusingnon invasivenavigatedtranscranialmagnetic stimulation(nTMS)fortherapeutictreatment planning,upperandlowerextremity
Motorfunctionmappingcombiningtranscranial magneticstimulation(TMS)andelectromyography (EMG)withguidance,withmagneticresonance Performedtoidentifyfunctionalmotorcortex priortobrainsurgery
170

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CategoryIIICodes
0311TNoninvasivecalculationand analysisofcentralarterialpressurewaveforms withinterpretationandreport
Centralarterialpressurewaveformsforpatients withdifficulttotreathypertension

171

CategoryIIICodes
Vagalblockingforweightloss
0312T=laparoscopicimplantationofthe neurostimulatorelectrodearray,pulsegenerator andprogramming 0313T=laparoscopicrevisionorreplacementof theelectrodearray,andconnectiontotheexisting pulsegenerator 0314T=laparoscopicremovaloftheelectrode arrayandpulsegeneratoronly
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CategoryIIICodes
Vagalblockingforweightloss,cont
0315T=removalofthepulsegeneratoronly 0316T=replacementofthepulsegeneratoronly 0317T=electronicanalysisandreprogramming ofthepulsegenerator

173

CategoryIIICodes
0318TImplantationofcatheterdelivered prostheticaorticheartvalve,openthoracic approach,(eg,transapical,otherthan transaortic) Implantationofaprostheticaorticheartvalve Reportedbasedonapproach
0318T=openthoracicapproach 3336133365forotherapproaches
174

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The Official American Medical Association CPT Errata

CORRECTIONS DOCUMENTCPT 2013


Introduction
Current Procedural Terminology (CPT), Fourth Edition, is a set of Inclusion of a descriptor and its associated five-digit code number in
Add new text symbols to denote revision of the text in the Introduction to the CPT code set.

Evaluation and Management (E/M) Services Guidelines Counseling


Counseling is a discussion with a patient and/or family concerning one or more of the following areas: Diagnostic results, impressions, and/or recommended diagnostic studies Prognosis Risks and benefits of management (treatment) options Instructions for management (treatment) and/or follow-up Importance of compliance with chosen management (treatment) options Risk factor reduction Patient and family education

(For psychotherapy, see 90832-90834, 90836-90840)


Add an instructional parenthetical note following the counseling guidelines to coincide with the new psychotherapy range of codes 90832-90834 and 90836-90840.

Evaluation and Management Tables Initial Neonatal Intensive Care

Remove reference to weight 1500-5000 gms from the (E/M) Initial Neonatal Intensive Care table.

Revised: 10/19/2012 - 9:49:26 AM Copyright 1995-2012 American Medical Association All Rights Reserved

Evaluation and Management Table Continuing Neonatal and Infant Inpatient Low Birth-Weight Intensive Care

Remove reference to age 28 days of age or less from the (E/M) Continuing Neonatal and Infant Inpatient Low Birth-Weight Intensive Care table.

Evaluation and Management Nursing Facility Services guidelines


The following codes are used These codes should also be used Nursing facilities that provide Physicians and other qualified health care professionals have a central role in assuring that all residents receive thorough assessments and that medical plans of care are instituted or revised to enhance or maintain the residents physical and psychosocial functioning. This role includes providing input in the development of the MDS and a multi-disciplinary plan of care, as required by regulations pertaining to the care of nursing facility residents. Two major subcategories of nursing facility services For definitions of key components...
Revise the Nursing Facility Services guidelines by removing reference to the terms and other qualified health care professionals as initial assessments in the nursing facility are only done by physicians.

Revised: 10/19/2012 - 9:49:26 AM Copyright 1995-2012 American Medical Association All Rights Reserved

Evaluation and Management Hospital Inpatient Services Subsequent Hospital Care Hospital Discharge Services
The hospital discharge day 99238 99239 Hospital discharge day management; 30 minutes or less more than 30 minutes (These codes are to be utilized by the physician to report all services provided to a patient on the date of discharge, if other than the initial date of inpatient status. To report services to a patient who is admitted as an inpatient and discharged on the same date, see codes 99234-99236 for observation or inpatient hospital care including the admission and discharge of the patient on the same date. To report concurrent care services provided by a physician[s] other than the ordering physician or another qualified health care professional, use subsequent hospital care codes [99231-99233] on the day of discharge.)
Revise the parenthetical note following code 99239 to remove reference to provider

Surgery Musculoskeletal System General Grafts (or Implants)


20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) (Use 20930 in conjunction with 22319, 22532, 22533, 22548-22558, 2259022612, 22630, 22633, 22634, 22800-22812, 0195T, 0196T) 20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) (Use 20936 in conjunction with 22319, 22532, 22533, 22548-22558, 2259022612, 22630, 22633, 22634, 22800-22812, 0195T, 0196T) 20937 morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure) (Use 20937 in conjunction with 22319, 22532, 22533, 22548-22558, 2259022612, 22630, 22633, 22634, 22800-22812, 0195T, 0196T)
Revise the parenthetical notes following 20930, 20936 and 20937 by removing reference to Category III codes 0195T and 0196T to reflect code revisions that now make these inappropriate for reporting with these graft services.
Revised: 10/19/2012 - 9:49:26 AM Copyright 1995-2012 American Medical Association All Rights Reserved 3

Surgery Respiratory System Trachea and Bronchi Endoscopy


For endoscopy procedures, code appropriate endoscopy of each anatomic site examined. Surgical bronchoscopy always includes diagnostic bronchoscopy when performed by the same physician. Codes 31622-3164931651, 31660, 31661 include fluoroscopic guidance, when performed. (For tracheoscopy, see laryngoscopy codes 31515-31578) 31615 Tracheobronchoscopy through established tracheostomy incision

Revise the Endoscopy introductory guidelines to include the new range of codes 3162231651, 31660, 31661 that include fluoroscopic guidance when performed.

Surgery Respiratory System Trachea and Bronchi Endoscopy


31622

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure) with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s]) (31627 includes 3D reconstruction. Do not report 31627 in conjunction with 76376, 76377) (Use 31627 in conjunction with 31615, 31622-31631, 31622-31626. 3162831631, 31635, 31636, 31638-31643)

31627

Revise the second parenthetical note following 31627 by expanding the code range 3162231631 to exclude code 31627.

Surgery Respiratory System Trachea and Bronchi Endoscopy

Bronchoscopy (Illustration) 31622-31646 31651

A rigid or flexible bronchoscope is inserted through the oropharynx and vocal cords and beyond the trachea into the right or left bronchi.
Revise the range of codes included in the bronchoscopy illustration to include the entire range of bronchoscopy codes.

Revised: 10/19/2012 - 9:49:26 AM Copyright 1995-2012 American Medical Association All Rights Reserved

Surgery Cardiovascular System Heart and Pericardium Patient-Activated Event Recorder


33282 Implantation of patient-activated cardiac event recorder (Initial implantation includes programming. For subsequent electronic analysis and/or reprogramming, use 93285, 93291, 93298, 93299)
Add code 93299 to the parenthetical note following 33282.

Surgery Cardiovascular System Arteries and Veins Transcatheter Procedures Other Procedures
37205

Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity arteries), percutaneous; initial vessel (For radiological supervision and interpretation, use 75960) (For transcatheter placement of intravascular cervical carotid artery stent(s), see 37215, 37216) (For transcatheter placement of intracranial stents, use 61635) (For transcatherter transcatheter coronary stent placement, see 92980, 92981)

Revise the misspelled word transcatheter noted in the parenthetical note following 37205.

Surgery Digestive System Pharynx, Adenoids, and Tonsils Excision, Destruction


42894

Resection of pharyngeal wall requiring closure with myocutaneous or fasciocutaneous flap or free muscle, skin, or fascial flap with microvascular anastamosis anastomosis

Revise the misspelled word anastomosis noted in code 42894.

Revised: 10/19/2012 - 9:49:26 AM Copyright 1995-2012 American Medical Association All Rights Reserved

Pathology and Laboratory Molecular Pathology Tier 1 Molecular Pathology Procedures


#81161 DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy) deletion analysis, and duplication analysis, if performed

Add code 81161 as an active code for 2013.

Pathology and Laboratory Molecular Pathology Tier 1 Molecular Pathology Procedures


81201 APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; full gene sequence

Revise code 81201 by italicizing the gene name APC (adenomatous polyposis coli).

Pathology and Laboratory Molecular Pathology Tier 1 Molecular Pathology Procedures


81252

GJB2 (gap junction protein, beta 2, 26kDa;, connexin 26) (eg, nonsyndromic hearing loss) gene analysis; full gene sequence

Revise code 81252 by adding a comma after 26KDa, and removing the semicolon.

Pathology and Laboratory Tier 2 Molecular Pathology Procedures


81401

Molecular pathology procedure, Level 2 (eg, 2-10 SNPs, 1 methylated variant, or 1 somatic variant [typically using nonsequencing target variant analysis], or detection of a dynamic mutation disorder/triplet repeat) EWSR1/ERG (t(21;22)) (eg, Ewing sarcoma/peripheral neuroectodermal tumor), translocation analysis, qualitative, and quantitative, if performed EWSR1/FLI1 (t(11;22)) (eg, Ewing sarcoma/peripheral neuroectodermal tumor), translocation analysis, qualitative, and quantitative, if performed EWSR1/WT1 (t(11;22)) (eg, Ewing sarcoma/peripheral neuroectodermal tumor), translocation analysis, qualitative, and quantitative, if performed

Revise 81401 to include the following missing analyte EWSR1/WT1

Revised: 10/19/2012 - 9:49:26 AM Copyright 1995-2012 American Medical Association All Rights Reserved

Pathology and Laboratory Tier 2 Molecular Pathology Procedures


81402 Molecular pathology procedure, Level 3 (eg, >10 SNPs, 2-10 methylated variants, or 2-10 somatic variants [typically using non-sequencing target variant analysis], immunoglobulin and T-cell receptor gene rearrangements, duplication/deletion variants 1 exon) TCD@ TRD@ (T cell antigen receptor, delta) (eg, leukemia and lymphoma), gene rearrangement analysis, evaluation to detect abnormal clonal population
Revise the analyte following 81402 by removing [TCD@] and replacing it with [TRD@].

Pathology and Laboratory


Multianalyte Assays with Algorithmic Analyses 81503

Oncology (ovarian), biochemical assays of five proteins (CA-125, apoliproprotein apolipoprotein A1, beta-2 microglobulin, transferrin, and prealbumin), utilizing serum, algorithm reported as a risk score

Revise the misspelled word apolipoprotein noted in code 81503.

Pathology and Laboratory


Multianalyte Assays with Algorithmic Analyses 81506

Endocrinology (type 2 diabetes), biochemical assays of seven analytes (glucose, HbA1c, insulin, hs-CRP, adoponectin adiponectin, ferritin, interleukin 2-receptor alpha), utilizing serum or plasma, algorithm reporting a risk score

Revise the misspelled word adiponectin noted in code 81506.

Pathology and Laboratory Transfusion Medicine


86890 86891

Autologous blood or component, collection processing and storage; predeposited intra- or postoperative salvage (For physician services to autologous donors, see 99201-99204)

Delete the parenthetical note following 86891.

Revised: 10/19/2012 - 9:49:26 AM Copyright 1995-2012 American Medical Association All Rights Reserved

Medicine Cardiovascular Cardiography


Codes 93040-93042 are appropriate when an order for the test is triggered by an event, the rhythm strip is used to help diagnose the presence or absence of an arrhythmia, and a report is generated. There must be a specific order for an electrocardiogram or rhythm strip followed by a separate, signed, written, and retrievable report. It is not appropriate to use these codes for reviewing the telemetry monitor strips taken from a monitoring system. The need for an electrocardiogram or rhythm strip should be supported by documentation in the patient medical record. (For echocardiography, see 93303-93350) (For electrocardiogram, 64 leads or greater, with graphic presentation and analysis, see 0178T0180T use 93799) 93000 Electrocardiogram, routine ECG

Delete reference to code 93799 from the parenthetical note preceding 93000 and replace with codes 0178T-0180T.

Category III
(0258T has been deleted. To report, see 33365, 33366 0318T) Revise the instructional parenthetical note for deleted code 0258T by removing code 33366 and adding Category III code 0318T.

Appendix D Summary of CPT Add-on Codes

95915 95916
Delete reference to codes 95915 and 95916 from Appendix D, as these are not active CPT codes.

Appendix F Summary of CPT Codes Exempt from Modifier 63


99337

Delete reference to code 99337 from Appendix F.

Revised: 10/19/2012 - 9:49:26 AM Copyright 1995-2012 American Medical Association All Rights Reserved

Appendix O Multianalyte Assays with Algorithmic Analyses


Proprietary Name and Clinical Laboratory or Manufacturer Alpha-Numeric Code Code Descriptor

Category I Codes for Multianalyte Assays with Algorithmic Analyses (MAAA) No proprietary name and clinical laboratory or manufacturer: Maternal serum screening procedures are well established procedures and are performed by many labs throughout the country. The concept of prenatal screens has existed and evolved for over ten years and is not exclusive to any one facility. 81508 Fetal congenital abnormalities, biochemical assays of two proteins (PAPP-A, hCG [any form]), utilizing maternal serum, algorithm reported as a risk score Fetal congenital abnormalities, biochemical assays of three proteins (PAPP-A, hCG [any form], DIA), utilizing maternal serum, algorithm reported as a risk score Fetal congenital abnormalities, biochemical assays of three analytes (AFP, uE3, hCG [any form]), utilizing maternal serum, algorithm reported as a risk score Fetal congenital abnormalities, biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) utilizing maternal serum, algorithm reported as a risk score (may include additional results from previous biochemical testing) Fetal congenital abnormalities, biochemical assays of five analytes (AFP, uE3, total hCG, hyperglycosylated hCG, DIA) utilizing maternal serum, algorithm reported as a risk score Unlisted Multianalyte assay with algorithmic analysis

81509

81510

81511

81512

81599

Add multianalyte assay reference codes 81508 and 81599 to the Appendix O table.
Revised: 10/19/2012 - 9:49:26 AM Copyright 1995-2012 American Medical Association All Rights Reserved 9

Medium Descriptors Short Descriptors


95907 MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB MOTOR&/SENS 1-2 NRV CNDJ TST NERVE CONDUCTION STUDIES 1-2 STUDIES NVR CNDJ TST 1-2 STUDIES 95908 MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB MOTOR&/SENS 3-4 NRV CNDJ TST NERVE CONDUCTION STUDIES 3-4 STUDIES NRV CNDJ TST 3-4 STUDIES 95909 MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB MOTOR&/SENS 5-6 NRV CNDJ TST NERVE CONDUCTION STUDIES 5-6 STUDIES NRV CNDJ TST 5-6 STUDIES 95910 MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB MOTOR&SENS 7-8 NRV CNDJ TEST NERVE CONDUCTION STUDIES 7-8 STUDIES NRV CNDJ TEST 7-8 STUDIES 95911 MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB MOTOR&SEN 9-10 NRV CNDJ TEST NERVE CONDUCTION STUDIES 9-10 STUDIES NRV CNDJ TEST 9-10 STUDIES 95912 MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB MOTOR&SEN 11-12 NRV CND TEST NERVE CONDUCTION STUDIES 11-12 STUDIES NRV CNDJ TEST 11-12 STUDIES 95913 MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB MOTOR&SENS 13/> NRV CND TEST NERVE CONDUCTION STUDIES 13/> STUDIES NRV CNDJ TEST 13/> STUDIES
Revise medium and short descriptor for codes 95907-95913.

Revised: 10/19/2012 - 9:49:26 AM Copyright 1995-2012 American Medical Association All Rights Reserved

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Medium Descriptor
27499 75956 75957 75958 75959 88154 88167 93459 DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&AM NRVE EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I CYTP SLIDES C/V MNL SCR&CPTR-RESCR CELL S&I CYTP SLIDES C/V MNL SCR&CPTR RESCR CELL S&I CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I

Revise medium descriptor for codes 27499, 75956, 75957, 75958, 75959, 88154, 88167, and 93459.

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Revised: 10/19/2012 - 9:49:26 AM Copyright 1995-2012 American Medical Association All Rights Reserved

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