2015 Charge Master Update Mike Kovar Stacey Harper Partner Senior - - PowerPoint PPT Presentation

2015 Charge Master Update

Mike Kovar Stacey Harper Partner Senior Manager WeiserMazars LLP WeiserMazars LLP

HFMA NJ Chapter Revenue Integrity Committee December 16, 2014

Introductions

Mike Kovar has led over 400 charge master, revenue capture, and patient charge compliance reviews. He received his Masters’ in Business Administration from Loyola University of Chicago, is an advanced member of HFMA, and is a frequent speaker nationally on charge master and other revenue capture-related issues. Stacey Harper, RHIA, CPC, CPMA has over 7 years of experience in the charge master, charge capture and coding areas. She previously served as Executive Director of Revenue Integrity and HIM for a large academic medical center in the Midwest.

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Objectives of the Seminar

In our session, we will cover the following:

• How to prepare your charge master and

related processes for 2015

• Charge master and charge capture process

changes related to Medicare's implementation

• f the 2015 Outpatient Prospective Payment

System changes

• CPT Code additions, revisions, and deletions

for 2015

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Charge Master-Other Payors

• When updating the charge master understand impact of changes
• n other payors

– Medicaid – Top 3 to 5 managed care payors

• Rate sheets and Medicaid provider manual are good resources
• Review contract terms/ provider manuals/ remittance advices, etc.

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Charge Master Update

• The following resources are required:
• 2015 OPPS Final Rule and, if available, January OPPS

Medicare Transmittal

• 2015 CPT Manual
• 2015 HCPCS Code listing
• Other major payor information as applicable

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Charge Master Update-Plan

• Critical success factors in developing and executing a plan to

implement the 2015 update include: – Proactive versus reactive approach

• Initiate and complete prior to January 1, 2015

– Active Department participation and ownership – Develop and monitor deadlines – Implement CPT, HCPCS and UB-04 Revenue Code revisions and verify accuracy – Educate, educate, educate

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Charge Master Update- Monitoring

• Post implementation of the January 2015 update, monitor results

– Set up a tracking mechanism for key charge master changes

• Track for minimum of 3 months
• Drug testing in Lab is one area of focus

– Perform a claims review for selected charge master update issues – Initiate corrective actions as necessary

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Charge Master Update- Medicare Regulatory Process

• CMS publishes proposed annual rule changes to OPPS in

July/August each year in the Federal Register – Comments due 30 days post publication in Federal Register

• CMS publishes final annual changes to OPPS in

October/November each year in the Federal Register – Implementation January 1 each year

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Charge Master Update- Medicare Regulatory Process

• CMS through their sub-regulatory process details required OPPS

changes for the MACs using Medicare Program Transmittals – January OPPS changes published in January transmittal in late December/early January each year – Additional changes to OPPS issued for implementation in April, July, and October each year

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2015 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Payment System (ASC) Final Rule

• Display copy issued on October 31, 2014
• Rule is effective January 1, 2015

• 2.3% increase in Medicare payments in 2015 to all

hospitals including cancer and children’s hospitals and CMHCs (1.8% increase in 2014) – Estimated payments approximate $56.1 billion

• $5.1 billion increase over 2014

Overall Impact of 2015 OPPS Changes

• Impacts on different “hospital categories” are as follows:

– urban hospitals 2.3% – rural hospitals 1.9% – sole community rural hospitals 2.2% – urban hospitals 500 + beds 2.5% – major teaching hospitals 3.1% – non-teaching hospitals 2.0% – governmental hospitals 2.1% – proprietary hospitals 1.7% – CMHCs 1.3%

Overall Impact of 2015 OPPS Changes

Overall Impact of 2015 OPPS Changes (cont’d)

• CMS has a publicly available file to estimate the impact of the 2015 final

OPPS rule on it’s website for every OPPS hospital. – 2015 OPPS NPRM Facility-Specific Impacts

• http://www.cms.gov/apps/ama/license.asp?file=/Medicare/Medicare-

Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/CMS- 1613-P-Addenda.zip

Provider Number CBSA Code Total Discounted Units Rural Sole Community and Essential Access Hospitals Post Reclassification Wage Index All Rural Urban/Rural Geographic Location Region Disproportionate Share Patient Percentage Outpatient Cost-to- Charge Ratio Estimated 2014 OPPS payment Estimated 2015 OPPS payment Estimated 2015 Outlier Payment Number

• f Beds

Teaching Hospitals Ownership CMHC Provider Lines 010001 20020 167,323.8 0.7722 0 OURBAN ESC 29.6% 0.144 $35,011,510.14 $33,772,315.63 $31,516.88 408 NONE 3 N 292,816 010005 01 197,506.7 0.8137 1 RURAL ESC 29.4% 0.202 $20,156,309.67 $20,671,007.37 $18,064.33 196 NONE 3 N 271,019

Overall Impact of 2015 OPPS Changes (cont’d)

Top 10 CPT Code Winners-2015 Versus 2014

HCPCS Code Short Descriptor SI 2015 Payment Rate 2014 Payment Rate 2015 Payment Variance 63655 Implant neuroelectrodes J1 $17,099.35 $7,424.49 $9,674.86 64580 Implant neuroelectrodes J1 $17,099.35 $7,424.49 $9,674.86 63685 Insrt/redo spine n generator J1 $26,152.16 $17,232.90 $8,919.26 92933 Prq card stent/ath/angio J1 $14,840.64 $6,363.75 $8,476.89 33221 Insert pulse gen mult leads J1 $16,400.98 $8,387.53 $8,013.45 33229 Remv&replc pm gen mult leads J1 $16,400.98 $8,387.53 $8,013.45 0308T Insj ocular telescope prosth J1 $23,075.30 $15,551.23 $7,524.07 C9602 Perc d-e cor stent ather s J1 $14,840.64 $7,714.02 $7,126.62 C9606 Perc d-e cor revasc w ami s J1 $14,840.64 $7,714.02 $7,126.62 C9607 Perc d-e cor revasc chro sin J1 $14,840.64 $7,714.02 $7,126.62

Overall Impact of 2015 OPPS Changes (cont’d)

Top 10 CPT Code Losers-2015 Versus 2014

HCPCS Code Short Descriptor SI 2015 Payment Rate 2014 Payment Rate 2015 Payment Variance A9543 Y90 ibritumomab, rx K $16,966.82 $44,161.14

• $27,194.32

C9741 Impl pressure sensor w/angio T $2,575.33 $15,509.99

• $12,934.66

33225 L ventric pacing lead add-on N $10,588.40

• $10,588.40

37233 Tibper revasc w/ather add-on N $9,119.70

• $9,119.70

92925 Prq card angio/athrect addl N $8,842.66

• $8,842.66

C9601 Perc drug-el cor stent bran N $7,714.02

• $7,714.02

C9603 Perc d-e cor stent ather br N $7,714.02

• $7,714.02

C9605 Perc d-e cor revasc t cabg b N $7,714.02

• $7,714.02

C9608 Perc d-e cor revasc chro add N $7,714.02

• $7,714.02

23473 Revis reconst shoulder joint T $3,362.99 $9,732.07

• $6,369.08

Updates Affecting OPPS Payments

• Approximately 161 million (versus 158 million in 2014) final action claims

for services provided in a hospital outpatient setting from January 1, 2013 through December 31, 2013 were used to calculate the 2015 rates

• Single/”pseudo” claims process used in previous years was again used

for 2015 rate setting purposes – Medicare lists bypassed HCPCS Codes to determine single claims in Addendum N

Updates Affecting OPPS Payments

• CMS has created 25 comprehensive APCs (C-APCs) for 2015

(219 procedures)

– Comprehensive APC defined as a classification for provision of a primary service and all adjunctive services

• Single payment for all services
• Status J1 created for this classification
• Add-on device dependent CPT Codes will be packaged as

SI=N

• Pacemaker/AICD Insertions, Stent Insertions included in this

classification

• Only excludes services not covered by Medicare Part B or

are not payable under OPPS

• For 2015, CMS will require the reporting of a device C-code

for all procedures currently assigned a device-dependent APC in 2014

Updates Affecting OPPS Payments

• Includes the following:
• Diagnostic procedures, laboratory tests and other

diagnostic tests, and treatments that assist in delivery of the primary procedure;

• Visits and evaluations associated with the procedure;
• Uncoded services and supplies used during the service;
• Outpatient services similar to therapy delivered by

therapists and non-therapists;

• Durable medical equipment as well as prosthetic and
• rthotic supplies and items delivered as part of the

comprehensive service;

• Any other components reported with HCPCS Codes

except excluded services on next page;

• All drugs, biologicals and radiopharmaceuticals

regardless of cost, except pass-through drugs and those drugs that are typically self administered unless they function as packaged supplies

Updates Affecting OPPS Payments

Updates Affecting OPPS Payments

Updates Affecting OPPS Payments

Updates Affecting OPPS Payments

Updates Affecting OPPS Payments

• Complexity adjustment modified from OPPS 2014

– Complexity adjustment applied when:

• Qualifying J1 Status Indicator CPT Code combinations; and
• CPT Code combinations of “J1” services and certain add-on

CPT Codes – When one of the above conditions are met, the original C-APC will be complexity adjusted to the next higher C-APC within the same clinical family assuming the reassignment is clinically appropriate and the reassignment would not create a two times rule violation in the receiving APC

Updates Affecting OPPS Payments

– Criteria for a CPT Code combination to receive a complexity adjustment due to the CPT combination representing a costly, complex service are as follows:

• Frequency threshold of 25 or more claims with the CPT Code

combination

• Cost threshold where there is violation of the 2 times rule-

comprehensive mean geometric cost of the CPT Code combination exceeds the comprehensive mean geometric cost of the lowest CPT Code assigned to the C-APC – Addendum J lists the CPT Code combinations that qualify for a complexity adjusted payment

Updates Affecting OPPS Payments

Updates Affecting OPPS Payments

Updates Affecting OPPS Payments

Addendum J for CY2015 complexity adjustments of combinations of comprehensive HCPCS codes Primary HCPCS Code Primary Short Descriptor Primary SI Primary APC Assignment Secondary or Device Add-on HCPCS Code Secondary Short Descriptor Secondary SI Secondary APC Assignment Complexity Adjusted APC Assignment 61885 Insrt/redo neurostim 1 array J1 0039 61885 Insrt/redo neurostim 1 array J1 0039 0318 61885 Insrt/redo neurostim 1 array J1 0039 64553 Implant neuroelectrodes J1 0061 0318 61885 Insrt/redo neurostim 1 array J1 0039 64569 Revise/repl vagus n eltrd J1 0061 0318 64590 Insrt/redo pn/gastr stimul J1 0039 64555 Implant neuroelectrodes J1 0061 0318 64590 Insrt/redo pn/gastr stimul J1 0039 64575 Implant neuroelectrodes J1 0061 0318 64590 Insrt/redo pn/gastr stimul J1 0039 64590 Insrt/redo pn/gastr stimul J1 0039 0318 64555 Implant neuroelectrodes J1 0061 63650 Implant neuroelectrodes J1 0061 0039 64581 Implant neuroelectrodes J1 0061 64581 Implant neuroelectrodes J1 0061 0039 36870 Percut thrombect av fistula J1 0083 36870 Percut thrombect av fistula J1 0083 0229 92920 Prq cardiac angioplast 1 art J1 0083 92920 Prq cardiac angioplast 1 art J1 0083 0229 92920 Prq cardiac angioplast 1 art J1 0083 92921 Prq cardiac angio addl art N 0229 33207 Insert heart pm ventricular J1 0089 33225 L ventric pacing lead add-on N 0655 33208 Insrt heart pm atrial & vent J1 0089 33225 L ventric pacing lead add-on N 0655

Updates Affecting OPPS Payments

Addendum J for CY2015 complexity adjustments of combinations of comprehensive HCPCS codes Primary HCPCS Code Primary Short Descriptor Primary SI Primary APC Assignment Secondary or Device Add-on HCPCS Code Secondary Short Descriptor Secondary SI Secondary APC Assignment Complexity Adjusted APC Assignment 33208 Insrt heart pm atrial & vent J1 0089 93650 Ablate heart dysrhythm focus J1 0085 0655 33224 Insert pacing lead & connect J1 0089 33216 Insert 1 electrode pm-defib J1 0090 0655 33228 Remv&replc pm gen dual lead J1 0089 33225 L ventric pacing lead add-on N 0655 33233 Removal of pm generator J1 0090 33225 L ventric pacing lead add-on N 0089 33282 Implant pat-active ht record J1 0090 93619 Electrophysiology evaluation J1 0085 0089 33282 Implant pat-active ht record J1 0090 93620 Electrophysiology evaluation J1 0085 0089 57260 Repair of vagina J1 0202 57288 Repair bladder defect J1 0202 0385 57265 Extensive repair of vagina J1 0202 57288 Repair bladder defect J1 0202 0385 57282 Colpopexy extraperitoneal J1 0202 57260 Repair of vagina J1 0202 0385 57282 Colpopexy extraperitoneal J1 0202 57265 Extensive repair of vagina J1 0202 0385 57282 Colpopexy extraperitoneal J1 0202 57285 Repair paravag defect vag J1 0202 0385 57282 Colpopexy extraperitoneal J1 0202 57288 Repair bladder defect J1 0202 0385 57282 Colpopexy extraperitoneal J1 0202 58262 Vag hyst including t/o J1 0202 0385 57283 Colpopexy intraperitoneal J1 0202 57285 Repair paravag defect vag J1 0202 0385 57283 Colpopexy intraperitoneal J1 0202 57288 Repair bladder defect J1 0202 0385 57285 Repair paravag defect vag J1 0202 57288 Repair bladder defect J1 0202 0385 57288 Repair bladder defect J1 0202 57250 Repair rectum & vagina J1 0202 0385 57288 Repair bladder defect J1 0202 58260 Vaginal hysterectomy J1 0202 0385 57288 Repair bladder defect J1 0202 58263 Vag hyst w/t/o & vag repair J1 0202 0385 57288 Repair bladder defect J1 0202 58270 Vag hyst w/enterocele repair J1 0202 0385

Updates Affecting OPPS Payments

Addendum J for CY2015 complexity adjustments of combinations of comprehensive HCPCS codes Primary HCPCS Code Primary Short Descriptor Primary SI Primary APC Assignment Secondary or Device Add-

• n HCPCS Code

Secondary Short Descriptor Secondary SI Secondary APC Assignment Complexity Adjusted APC Assignment 58262 Vag hyst including t/o J1 0202 57288 Repair bladder defect J1 0202 0385 37221 Iliac revasc w/stent J1 0229 37236 Open/perq place stent 1st J1 0229 0319 37225 Fem/popl revas w/ather J1 0229 37221 Iliac revasc w/stent J1 0229 0319 37225 Fem/popl revas w/ather J1 0229 37236 Open/perq place stent 1st J1 0229 0319 37226 Fem/popl revasc w/stent J1 0229 37221 Iliac revasc w/stent J1 0229 0319 37226 Fem/popl revasc w/stent J1 0229 37225 Fem/popl revas w/ather J1 0229 0319 37226 Fem/popl revasc w/stent J1 0229 37226 Fem/popl revasc w/stent J1 0229 0319 37226 Fem/popl revasc w/stent J1 0229 37236 Open/perq place stent 1st J1 0229 0319 37226 Fem/popl revasc w/stent J1 0229 C9600 Perc drug-el cor stent sing J1 0229 0319 37241 Vasc embolize/occlude venous J1 0229 37238 Open/perq place stent same J1 0229 0319 37242 Vasc embolize/occlude artery J1 0229 37221 Iliac revasc w/stent J1 0229 0319 37242 Vasc embolize/occlude artery J1 0229 37236 Open/perq place stent 1st J1 0229 0319 37243 Vasc embolize/occlude organ J1 0229 37221 Iliac revasc w/stent J1 0229 0319 37243 Vasc embolize/occlude organ J1 0229 37236 Open/perq place stent 1st J1 0229 0319 37244 Vasc embolize/occlude bleed J1 0229 37221 Iliac revasc w/stent J1 0229 0319 37244 Vasc embolize/occlude bleed J1 0229 37236 Open/perq place stent 1st J1 0229 0319 37244 Vasc embolize/occlude bleed J1 0229 37238 Open/perq place stent same J1 0229 0319 92928 Prq card stent w/angio 1 vsl J1 0229 C9601 Perc drug-el cor stent bran N 0319 C9600 Perc drug-el cor stent sing J1 0229 33208 Insrt heart pm atrial & vent J1 0089 0319 C9600 Perc drug-el cor stent sing J1 0229 33210 Insert electrd/pm cath sngl J1 0090 0319 C9600 Perc drug-el cor stent sing J1 0229 37221 Iliac revasc w/stent J1 0229 0319 C9600 Perc drug-el cor stent sing J1 0229 37236 Open/perq place stent 1st J1 0229 0319 C9600 Perc drug-el cor stent sing J1 0229 92924 Prq card angio/athrect 1 art J1 0229 0319 C9600 Perc drug-el cor stent sing J1 0229 C9600 Perc drug-el cor stent sing J1 0229 0319 C9600 Perc drug-el cor stent sing J1 0229 C9601 Perc drug-el cor stent bran N 0319 C9600 Perc drug-el cor stent sing J1 0229 C9605 Perc d-e cor revasc t cabg b N 0319 C9604 Perc d-e cor revasc t cabg s J1 0229 C9600 Perc drug-el cor stent sing J1 0229 0319 C9604 Perc d-e cor revasc t cabg s J1 0229 C9601 Perc drug-el cor stent bran N 0319 C9604 Perc d-e cor revasc t cabg s J1 0229 C9604 Perc d-e cor revasc t cabg s J1 0229 0319 C9604 Perc d-e cor revasc t cabg s J1 0229 C9605 Perc d-e cor revasc t cabg b N 0319

Updates Affecting OPPS Payments

• For the following Composite APCs (Status Indicator Q3), no

changes in 2015

– Extended Assessment and Management (APC 8009) – LDR Prostate Brachytherapy (APC 8001) – Mental Health Services (APC 0034) – Multiple Imaging (APCs 8004, 8005, 8006, 8007 and 8008)

• Composite APCs for Cardiac Resynchronization Therapy (APC

0108) and EP Evaluation and Ablation (APC 8000) have been eliminated

• Both now paid as C-APCs

Packaging Policy Changes for 2015

Packaging Policy Changes for 2015

• Ancillary services/procedures with a geometric mean cost of $100 or less

will be conditionally packaged – Only paid if that is only service on claim – Excluded are preventive services that would be otherwise packaged

Packaging Policy Changes for 2015

• Ancillary services/procedures with a geometric mean cost of $100 will be

conditionally packaged – Also excluded are:

• Certain psychiatric and counseling services that are considered by

CMS to be visits and not ancillary such as psychotherapy, etc.

• Drug administration and add-on drug administration CPT Codes

– “We are examining various alternative payment policies for drug administration services…..”

• Status Indicator X (Ancillary Services) is being eliminated since most

services are now conditionally packaged as Status Indicator Q1 (STV Packaged) – CPT Codes previously “X” and not “Q1” will be assigned as Status Indicator “S” (Significant Procedure Not Discounted)

Packaging Policy Changes for 2015

• Ancillary services/procedures with a geometric mean cost of $100 will be

conditionally packaged – Many, many procedures and tests are now packaged

• Check that list of CPT Codes with Comment Indicator “CH” and

Status Indicator “Q1”

• Partial list is included on the next page

– Includes many radiology exams, EKGs, laceration repairs, surgical pathology and cytology tests

• Prosthetic supplies that were paid separately in 2014 will now be packaged

into the related surgical procedure – This includes not only the prosthetic supplies related to an implanted device but also the implanted device – Status Indicator changed from “A” to “N” for all DMEPOS prosthetic supplies

Packing Policy Changes for 2015

HCPCS Code Short Descriptor CI SI APC Payment Rate 12001 Rpr s/n/ax/gen/trnk 2.5cm/< CH Q1 0012 $98.46 70160 X-ray exam of nasal bones CH Q1 0260 $59.34 71021 Chest x-ray frnt lat lordotc CH Q1 0260 $59.34 71022 Chest x-ray frnt lat oblique CH Q1 0261 $94.98 71023 Chest x-ray and fluoroscopy CH Q1 0261 $94.98 71030 Chest x-ray 4/> views CH Q1 0261 $94.98 71035 Chest x-ray special views CH Q1 0260 $59.34 71100 X-ray exam ribs uni 2 views CH Q1 0260 $59.34 71101 X-ray exam unilat ribs/chest CH Q1 0261 $94.98 71110 X-ray exam ribs bil 3 views CH Q1 0261 $94.98 73020 X-ray exam of shoulder CH Q1 0260 $59.34 73500 X-ray exam of hip CH Q1 0260 $59.34 73560 X-ray exam of knee 1 or 2 CH Q1 0260 $59.34 73562 X-ray exam of knee 3 CH Q1 0261 $94.98 73564 X-ray exam knee 4 or more CH Q1 0261 $94.98 73565 X-ray exam of knees CH Q1 0260 $59.34 73600 X-ray exam of ankle CH Q1 0261 $94.98 73610 X-ray exam of ankle CH Q1 0261 $94.98 73620 X-ray exam of foot CH Q1 0260 $59.34 73630 X-ray exam of foot CH Q1 0260 $59.34 73650 X-ray exam of heel CH Q1 0260 $59.34 73660 X-ray exam of toe(s) CH Q1 0260 $59.34 74000 X-ray exam of abdomen CH Q1 0260 $59.34 74010 X-ray exam of abdomen CH Q1 0260 $59.34 74020 X-ray exam of abdomen CH Q1 0261 $94.98

Updates Affecting OPPS Payments-Other Issues

• Calculation of the Adjusted Medicare Payment from the National

Unadjusted Medicare Payment

– Assuming the following: APC 0019=$380.32; Wage index for NY CBSA 35644= 1.3147

• Labor adjusted portion of full national adjusted payment= $300.00 (.60 *

$380.32 * 1.3147)

• The nonlabor-related portion of the full national unadjusted payment = $152.13

(.40 * $380.32)

• Total Adjusted Medicare Payment= $452.13 ($300.00 + $152.13)
• National beneficiary copayment cannot exceed 40% of the APC payment

in 2015 and cannot be less than 20% of the OPD fee schedule amount

– Beneficiary copayment collected is limited to the amount of the inpatient deductible.

OPPS APC Group Policies

OPPS APC Group Policies

OPPS APC Group Policies

OPPS APC Group Policies

OPPS APC Group Policies

OPPS APC Group Policies

OPPS APC Group Policies

• Process for new CPT Codes effective January 1, 2016

– Under the current process, CPT Codes effective January 1 are given interim Status Indicator and APC assignments until the following year’s OPPS Rule when Status Indicators and APCs are finalized for the previous year’s new CPT Codes – The following process will be implemented for January 1, 2016

• New and revised CPT Codes that are received too late for

inclusion in the 2016 OPPS Proposed Rule would not be used by CMS until January 1, 2017 – HCPCS G-codes would be created by CMS to describe the predecessor CPT Codes for the new or revised CPT Codes that are part of the annual 2016 CPT Code update

OPPS APC Group Policies

• Process for new CPT Codes effective January 1, 2016
• For new CPT Codes that are released publicly by the AMA prior

to the proposed 2016 rule, Status Indicators and APCs will be assigned for 2016

• CMS is hoping that AMA adjusts the timeline for the release of the

new CPT Codes to allow the new, revised, and deleted CPT Codes to be included in the Proposed OPPS Rule each year. – AMA requested a delay until 2017 but CMS refused

2015 OPPS APC Specific Policies

• APCs are being restructured in 3 areas this year:

– In ophthalmology, the number of APCs reduced from 24 levels in 2014 to 13 levels in 2015 – For female reproductive APCs, there is restructuring of the APCs resulting in 5 APC levels in 2015 versus 7 APC levels in 2014 – For cystourethroscopy and other genitourinary procedures, there is restructuring of the APCs resulting in 4 APC levels in 2015 versus 5 APC levels in 2014

2015 OPPS APC Specific Policies

• For image-guided breast biopsies, APC 037 is being deleted and all CPT Codes

reassigned to APC 005 resulting in a $350 increase in payment

2015 OPPS APC Specific Policies

• For image-guided breast biopsies, APC 037 is being deleted and all CPT Codes

reassigned to APC 005 resulting in a $350 increase in payment

2015 OPPS APC Specific Policies

• For image-guided breast biopsies, APC 037 is being deleted and all CPT Codes

reassigned to APC 005 resulting in a $350 increase in payment

2015 Payment Changes for Devices

• Pass-through Devices

– Devices with pass through status eligible for pass through payment for at least 2 years but not more than 3 years – Devices no longer eligible for pass through payment are packaged into the cost of the procedure – As of January 1, 2015, there is one device eligible for pass-through payment

• C1841 Retinal prosthesis, includes all internal and external

components – Pass-through status scheduled to expire as of January 1, 2016

2015 Payment Changes for Devices

• For replaced devices that there is at least 50% credit, current

2014 policy continues

– Credit amount reported in the amount field for Value Code “FD”

• Value Code FD=Credit received from manufacturer for replaced

medical device

2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals

• For drugs and biologicals, pass-through payment is the amount by which

the drug or biological exceeds the portion of the otherwise applicable Medicare OPD fee schedule that is associated with the drug or biological (SI=G)

• Due to the postponement of the Part B Drug Competitive Acquisition

Program, CMS pays the rate paid in the physician's office setting for all drugs and biologicals with pass-through status

– ASP + 6%

2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals

• 9 drugs with pass-through status ending December 31, 2014

2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals

• 22 drugs/biologicals have pass-through status (SI=G) in 2015

2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals

• 22 drugs/biologicals have pass-through status (SI=G) in 2015

2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals

• 22 drugs/biologicals have pass-through status (SI=G) in 2015

2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals

• $95 per day cost threshold for separate payment (SI=K) of non-pass through drugs with

payment at ASP+6% ($90 in 2014)

• Packaging determinations will be made on a drug-specific basis rather than a HCPCS

Code-specific basis for those HCPCS codes that describe the same drug or biological but different doses

• Non-pass-through therapeutic radiopharmaceuticals (per day cost of $95) payment is

ASP + 6%

• Currently one diagnostic radiopharmaceutical with pass-through payment
• A9520 (previously C1204) Technetium Tc 99m tilmanocept, diagnostic, up

to 0.5 millicuries

• Pass-through status granted October 1, 2013
• Blood clotting factors under OPPS to be paid at ASP+6%

2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals

• Methodology for calculating high cost versus low cost skin substitutes is

changing for 2015 – In 2014, skin substitutes with a July 2013 ASP + 6% amount above $32 per square cm were classified as “high cost” – In 2015, skin substitutes with a weighted average mean unit cost (MUC) above $25 per square cm using 2013 claims data will be classified as “high cost”

2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals

2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals

Other 2015 OPPS Payment and Coding Changes

• Hospital coding and payment for visits

– Current single HCPCS Code G0463 for clinic visits will continue to be used in 2015 – No changes to current ED level structure – For critical care CPT Code 99291, current policy continues in 2015 that conditionally packages ancillary services reported on same day as the critical care services

Other 2015 OPPS Payment and Coding Changes

• Inpatient only list is detailed in Addendum E
• One CPT Code added to the inpatient only list in 2015

– CPT 22222-Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; thoracic

• Two CPT Codes removed from the inpatient only list in 2015

– CPT 63043-Laminonotomy with decompression of nerve root, each additional cervical interspace – CPT 63044-Laminonotomy with decompression of nerve root, each additional lumbar interspace

2015 Nonrecurring Policy Changes

• Collecting data on services furnished in off-campus provider-based

departments

– Increased trend toward hospitals acquisition of physician practices, integration of those practices as hospital departments, and resultant increase in physician services being provided in hospital setting

• CMS interested in how this trend affects payment under MPFS and

OPPS

• Conditions required for a provider to treat off-campus facility as

provider based are included under 42 CFR 413 .65 – Campus defined as physical area immediately adjacent to the providers main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and other areas determined on an individual case basis, by the CMS regional

• ffice, to be part of the provider’s campus

2015 Nonrecurring Policy Changes

• CMS to create a HCPCS modifier to be reported on the CMS-1450

for hospital outpatient services – Voluntary reporting of the modifier in 2015 and required in 2016 – HCPCS modifier “PO” - Services, procedures and/or surgeries furnished at off-campus provider based outpatient departments

• CMS to create two new “Place of Service” (POS) Codes to be

reported on the CMS-1500 for physician services – Voluntary reporting of the modifier in 2015 and required in 2016 – POS 22 to be deleted and replaced with 2 new POS codes

OPPS Payment Status and Comment Indicators

• Addendum B of the Federal Register is your "guide"

– Pay attention to items with the following status indicators changes:

• “X"-This status indicator will be deleted and replaced with either

“Q1” or “S”

• Complete list of 2015 status indicators are listed in Addendum D1

OPPS Payment Status and Comment Indicators

• Addendum B of the Federal Register is your "guide"

– Pay attention to items with the following comment indicators:

• "CH"-Active HCPCS code with change in status indicator or APC

assignment or active HCPCS code that is being discontinued.

• "NI"-New code for 2015 or existing code with substantial change in

2015 with code descriptor or APC assignment

CPT Code Revisions

• Determine what the CPT Code revision impacts
• Revise charge master and related subsystems
• Provide education to clinical department
• Verify the CPT codes are revised accurately
• Determine if pricing change is required
• Monitor and test CPT Codes

66

CPT Code Additions

• Determine if new CPT Code is new service or replaces a deleted CPT

Code

• Determine if new CPT Code is reimburseable

– Category 3 CPT Codes implemented by CMS in July

• Determine if new CPT Code requires a pricing revision
• Revise charge master and related subsystems
• Provide education to clinical department
• Verify the CPT codes are added correctly
• Monitor and test CPT Codes

67

CPT Code Deletions

• Determine if there is a replacement for CPT Code deletion

– Determine replacement CPT Code

• Revise charge master and related subsystems
• Provide education to clinical department
• Verify the CPT codes are deleted
• Monitor and test replacement CPT Codes

68

Laboratory

• Major changes to the Drug Assay Section (Note that CMS is not

implementing these changes in 2015-all are Status Indicator B))

– Drug Assay section divided into two major categories:

• Presumptive Drug Class procedures

– Identifies possible use or non-use of a drug or a drug class – Includes immunoassays (EIA, ELISA, etc.), enzymatic methods, and chromatographic methods without mass spectrometry

• Definitive Drug Class procedures

– Qualitative or quantitative tests to identify possible use or non-use of a drug – Includes gas chromatography with mass spectrometry and liquid chromatography mas spectrometry but excludes immunoassays and enzymatic methods

69

Laboratory

• Presumptive Drug Class Screening
• Divided into Drug Class List A or Drug Class List B
• Drug Class List A typically consists of method in which results are

capable of being read by:

–

direct optical observation; or – by instrumented test systems such as discrete multichannel chemistry analyzers using immunoassay or enzyme assay

• Drug Class List B typically consists of methods that require more

resources than a List A” drug test – Manual process such as ELISA

70

Laboratory

• Presumptive Drug Class Screening
• CPT Code structure is based on type of method and whether Drug Class

A or B – Separate CPT Codes for Thin Layer Chromatography (TLC) and separate CPT Codes for non-TLC methods: – For Class A Drugs, use 80300 for any number of drug classes with non-TLC method per date of service – For Class A Drugs, use 80303 for any number of drug classes using TLC per date of service – For Class A Drugs, use 80301 for single drug class method, non- TLC per date of service – For Class B Drugs, use 80302 for any number of drug classes with non-TLC method each procedure – For Class B Drugs, use 80303 for any number of drug classes using TLC per date of service – For either Drug Class A or B, not otherwise specified method such as DART, DESI, each procedure

71

Laboratory

• Definitive Drug Testing
• Definitive drug testing methods include:

– Gas chromatography with spectrometry – Liquid chromatography mass spectrometry – Excludes immunoassays and enzymatic assays

• Definitive drug classes listing provides:

– Drug classes and associated CPT Codes – Listing of drugs included in the drug class – Metabolites not listed may be reported using parent drug code – Drug classes may contain one or more CPT Codes based on the number of analytes – Includes CPT Codes 80320 through 80377

72

Laboratory

• Several changes to the Molecular Pathology Section

– Several CPT Codes added to the Tier 1 molecular pathology procedures – For CPT Codes 81400-81408, numerous revisions to genes tested – New section created for Genomic Sequencing procedures and Molecular Multianalyte Assays

• CPT Codes 81410 through 81471

73

Laboratory

• In Surgical Pathology, there were a number of changes to “correct”

problems

– In 2014, CPT Codes were added/revised related to immunohistochemistry antibody slides:

• 88342 revised to “Immunohistochemistry, each separately identifiable

antibody per block, first separately identifiable antibody per slide”

• 88343 was added- “Immunohistochemistry, each separately identifiable

antibody per block, each additional separately identifiable antibody per slide” – In 2015, CPT Codes were again added/revised related to immunohistochemistry antibody slides:

• 88342 revised to “Immunohistochemistry, per specimen, initial single

antibody stain procedure”

• 88343 was deleted
• 88341 was added- “Immunohistochemistry, per specimen, each

additional single antibody stain procedure”

• 88344 was added- “Immunohistochemistry, per specimen, each

multiplex antibody stain procedure” (replaces G0461 and G0462)

• More than one unit of 88341, 88342 or 88344 cannot be reported for

same antibody

74

Laboratory CPT Additions

• For Presumptive Drug Class Screening, the following CPT Codes were

added:

75 2015 CPT Code Description Department 80300 DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES Laboratory 80301 DRUG SCREEN LIST A SINGLE DRUG CLASS METHOD Laboratory 80302 DRUG SCREEN PRESUMPTIVE 1 CLASS METHOD LIST B Laboratory 80303 DRUG SCREEN PRSMPTV 1/MULT CLASS METHOD TLC Laboratory 80304 DRUG SCREEN PRSMPTV 1/MULT CLASS METHOD Laboratory

Laboratory CPT Additions

• For Definitive Drug Class Screening, the following CPT Codes were

added:

76

2015 CPT Code Description Department 80163 DRUG SCREEN QUANTITATIVE DIGOXIN FREE Laboratory 80165 DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE Laboratory 80320 DRUG SCREEN QUANTITATIVE ALCOHOLS Laboratory 80321 DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 Laboratory 80322 DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 3 OR MORE Laboratory 80323 ALKALOIDS NOT OTHERWISE SPECIFIED Laboratory 80324 DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 Laboratory 80325 DRUG SCREEN QUANT AMPHETAMINES 3 OR 4 Laboratory 80326 DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE Laboratory 80327 DRUG SCREEN QUANT ANABOLIC STEROID 1 OR 2 Laboratory 80328 DRUG SCREEN QUANT ANABOLIC STEROID 3 OR MORE Laboratory 80329 DRUG SCREEN ANALGESICS NON‐OPIOID 1 OR 2 Laboratory 80330 DRUG SCREEN ANALGESICS NON‐OPIOID 3‐5 Laboratory 80331 DRUG SCREEN ANALGESICS NON‐OPIOID 6 OR MORE Laboratory 80332 ANTIDEPRESSANTS SEROTONERGIC CLASS 1 OR 2 Laboratory 80333 ANTIDEPRESSANTS SEROTONERGIC CLASS 3‐5 Laboratory 80334 ANTIDEPRESSANTS SEROTONERGIC CLASS 6 OR MORE Laboratory 80335 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 Laboratory

Laboratory CPT Additions

• For Definitive Drug Class Screening, the following CPT Codes were

added:

77

2015 CPT Code Description Department 80336 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 3‐5 Laboratory 80337 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 6/MORE Laboratory 80338 ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED Laboratory 80339 ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1‐3 Laboratory 80340 ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 4‐6 Laboratory 80341 ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 7/MORE Laboratory 80342 ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1‐3 Laboratory 80343 ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 4‐6 Laboratory 80344 ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 7/MORE Laboratory 80345 DRUG SCREENING BARBITURATES Laboratory 80346 DRUG SCREENING BENZODIAZEPINES 1‐12 Laboratory 80347 DRUG SCREENING BENZODIAZEPINES 13 OR MORE Laboratory 80348 DRUG SCREENING BUPRENORPHINE Laboratory 80349 DRUG SCREENING CANNABINOIDS NATURAL Laboratory 80350 DRUG SCREENING CANNABINOIDS SYNTHETIC 1‐3 Laboratory 80351 DRUG SCREENING CANNABINOIDS SYNTHETIC 4‐6 Laboratory 80352 DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE Laboratory 80353 DRUG SCREENING COCAINE Laboratory 80354 DRUG SCREENING FENTANYL Laboratory 80355 DRUG SCREENING GABAPENTIN NON‐BLOOD Laboratory

Laboratory CPT Additions

• For Definitive Drug Class Screening, the following CPT Codes were

added:

78

2015 CPT Code Description Department 80356 DRUG SCREENING HEROIN METABOLITE Laboratory 80357 DRUG SCREENING KETAMINE AND NORKETAMINE Laboratory 80358 DRUG SCREENING METHADONE Laboratory 80359 DRUG SCREENING METHYLENEDIOXYAMPHETAMINES Laboratory 80360 DRUG SCREENING METHYLPHENIDATE Laboratory 80361 DRUG SCREENING OPIATES 1 OR MORE Laboratory 80362 DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2 Laboratory 80363 DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 3 OR 4 Laboratory 80364 DRUG SCREENING OPIOIDS & OPIATE ANALOGS 5/MORE Laboratory 80365 DRUG SCREENING OXYCODONE Laboratory 80366 DRUG SCREENING PREGABALIN Laboratory 80367 DRUG SCREENING PROPOXYPHENE Laboratory 80368 DRUG SCREENING SEDATIVE HYPNOTICS Laboratory 80369 DRUG SCREENING SKELETAL MUSCLE RELAXANTS 1 OR 2 Laboratory 80370 DRUG SCREENING SKEL MUSCLE RELAXANTS 3 OR MORE Laboratory 80371 DRUG SCREENING STIMULANTS SYNTHETIC Laboratory 80372 DRUG SCREENING TAPENTADOL Laboratory 80373 DRUG SCREENING TRAMADOL Laboratory 80374 DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS Laboratory 80375 DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1‐3 Laboratory 80376 DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 4‐6 Laboratory 80377 DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7/MORE Laboratory

Laboratory CPT Additions

• For Tier 1 Molecular Pathology Procedures, there were several additions:

79

2015 CPT Code Description Department 81246 FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS Moleculary Pathology 81288 MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS Moleculary Pathology 81313 PCA3/KLK3 PROSTATE SPECIFIC ANTIGEN RATIO Moleculary Pathology

Laboratory CPT Additions

• For Genomic Sequencing Procedures, the following CPT Codes were

added:

80

2015 CPT Code Description Department 81410 AORTIC DYSFUNCTION/DILATION GENOMIC SEQ ANALYSIS Moleculary Pathology 81411 AORTIC DYSFUNCTION/DILATION DUP/DEL ANALYSIS Moleculary Pathology 81415 EXOME SEQUENCE ANALYSIS Moleculary Pathology 81416 EXOME SEQUENCE ANALYSIS EACH COMPARATOR EXOME Moleculary Pathology 81417 EXOME RE‐EVAL OF PREVIOUSLY OBTAINED EXOME SEQ Moleculary Pathology 81420 FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS Moleculary Pathology 81425 GENOME SEQUENCE ANALYSIS Moleculary Pathology 81426 GENOME SEQUENCE ANALYSIS EACH COMPARATOR GENOME Moleculary Pathology 81427 GENOME RE‐EVALUATION OF PREC OBTAINED GENOME SEQ Moleculary Pathology 81430 HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES Moleculary Pathology 81431 HEARING LOSS DUP/DEL ANALYSIS Moleculary Pathology 81435 HEREDITARY COLON CA GENOMIC SEQ ANALYS 7 GENES Moleculary Pathology 81436 HEREDITARY COLON CA SYND DUP/DEL ANALYS 8 GENES Moleculary Pathology 81440 NUCLEAR MITOCHONDRIAL 100 GENE GENOMIC SEQ Moleculary Pathology 81445 TARGETED GENOMIC SEQ ANALYS DNA ANALYS 5‐50 GENE Moleculary Pathology 81450 GENOMIC SEQ ANALYS DNA&RNA ANALYS 5‐50 GENE Moleculary Pathology 81455 GENOMIC SEQ ANALYS DNA&RNA ANALYS 51/MORE GENES Moleculary Pathology 81460 WHOLE MITOCHONDRIAL GENOME Moleculary Pathology 81465 WHOLE MITOCHONDRIAL GENOME ANALYSIS PANEL Moleculary Pathology 81470 X‐LINKED INTELLECTUAL DBLT GENOMIC SEQ ANALYS Moleculary Pathology 81471 X‐LINKED INTELLECTUAL DBLT DUP/DEL GENE ANALYS Moleculary Pathology 81519 ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES Moleculary Pathology

Laboratory CPT Additions

• Other additions include:

81

2015 CPT Code Description Department 83006 GROWTH STIMULATION EXPRESSED GENE 2 Laboratory 87505 NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN Laboratory 87506 IADNA‐DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6‐11 Laboratory 87507 IADNA‐DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12‐25 Laboratory 87623 IADNA HUMAN PAPILLOMAVIRUS LOW‐RISK TYPES Laboratory 87624 IADNA HUMAN PAPILLOMAVIRUS HIGH‐RISK TYPES Laboratory 87625 IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY Laboratory 87806 IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES Laboratory

Laboratory CPT Additions

• Other additions in Pathology include:

82 2015 CPT Code Description Department 88341 IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE Pathology 88344 IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE Pathology 88364 IN SITU HYBRIDIZATION EA ADDL PROBE STAIN Pathology 88366 IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN Pathology 88369 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH Pathology 88373 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH Pathology 88374 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB Pathology 88377 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB Pathology 89337 CRYOPRESERVATION MATURE OOCYTE(S) Pathology 0357T CRYOPRESERVATION IMMATURE OOCYTE(S) Pathology

Laboratory CPT Deletions

83 2014 CPT Code Description Department Replacement 2015 CPT Code 80100 DRUG SCR QUAL MLT DRUG CLASSES CHROM EA PX Laboratory 80300‐80304 80101 DRUG SCR QUAL 1 DRUG CLASS METH EA DRUG CLASS Laboratory 80300‐80304 80102 DRUG CONFIRMATION EACH PROCEDURE Laboratory 80300‐80304 80103 TISSUE PREPARATION DRUG ANALYSIS Laboratory 80300‐80304 80104 DRUG SCRN QUAL MLT CLASS NONCHROMOTOGRAPHIC EACH Laboratory 80300‐80304 80152 DRUG SCREEN QUANTITATIVE AMITRIPTYLINE Laboratory 80335‐80337 80154 DRUG SCREEN QUANTITATIVE BENZODIAZEPINES Laboratory 80346, 80347 80160 DRUG SCREEN QUANTITATIVE DESIPRAMINE Laboratory 80335‐80337 80166 DRUG SCREEN QUANTITATIVE DOXEPIN Laboratory 80335‐80337 80172 DRUG SCREEN QUANTITATIVE GOLD Laboratory 80375 80174 DRUG SCREEN QUANTITATIVE IMIPRAMINE Laboratory 80335‐80337 80182 DRUG SCREEN QUANTITATIVE NORTRIPTYLINE Laboratory 80335‐80337 80196 DRUG SCREEN QUANTITATIVE SALICYLATE Laboratory 80329‐80331 80440 THYROTROPIN RELEAS HORMONE HYPRPROLACTINEMIA Laboratory 84146

Laboratory CPT Deletions

84

2014 CPT Code Description Department Replacement 2015 CPT Code 82000 ASSAY ACETALDEHYDE BLOOD Laboratory None 82003 ASSAY OF ACETAMINOPHEN Laboratory 80329‐80331 82055 ALCOHOL ANY SPECIMEN EXCEPT BREATH Laboratory 80320‐80322 82101 ALKALOIDS URINE QUANTITATIVE Laboratory 80323 82145 AMPHETAMINE/METHAMPHETAMINE Laboratory 80324‐80326 82205 BARBITURATES NOT ELSEWHERE SPECIFIED Laboratory 80345 82520 COCAINE/METABOLITE Laboratory 80353 82646 ASSAY OF DIHYDROCODEINONE Laboratory 80361 82649 ASSAY OF DIHYDROMORPHINONE Laboratory 80361 82651 ASSAY OF DIHYDROTSTOSTERONE Laboratory 80327, 80328 82654 ASSAY OF DIMETHADIONE Laboratory 80339‐80341 82666 ASSAY OF EPIANDROSTERONE Laboratory 80327, 80328 82690 ASSAY OF ETHCHLORVYNOL Laboratory 80320 82742 ASSAY OF FLURAZEPAM Laboratory 80346, 80347 82953 GLUC TOLBUTAMIDE TOLERANCE TST Laboratory None 82975 ASSAY OF GLUTAMINE Laboratory 8217, 82128, 82 82980 ASSAY OF GLUTETHIMIDE Laboratory None 83008 ASSAY OF GUANOSINE MONOPHOSPHATE CYCLIC Laboratory None 83055 HEMOGLOBIN SULFHEMOGLOBIN QUALITATIVE Laboratory None 83071 ASSAY OF HEMOSIDERIN QUANTITATIVE Laboratory None 83634 LACTOSE URINE QUANTITATIVE Laboratory None 83805 ASSAY OF MEPROBAMATE Laboratory 80369, 80370 83840 METHADONE Laboratory 80358

Laboratory CPT Deletions

85 2014 CPT Code Description Department Replacement 2015 CPT Code 83858 METHSUXIMIDE Laboratory 80339‐80341 83866 MUCOPOLYSACCHARIDES ACID SCREEN Laboratory None 83887 ASSAY OF NICOTINE Laboratory 80323 83925 OPIATE(S) DRUG AND METABOLITES EACH PROCEDURE Laboratory 80361‐80364 84022 ASSAY OF PHENOTHIAZINE Laboratory 80342‐80344 84127 PORPHYRINS FECES QUALITATIVE Laboratory None 87001 ANIMAL INOCULATION SMALL ANIMAL W/OBSERVATION Laboratory None 87620 IADNA PAPILLOMAVIRUS HUMAN DIRECT PROBE TQ Laboratory 87623‐87625 87621 IADNA PAPILLOMAVIRUS HUMAN AMPLIFIED PROBE TQ Laboratory 87623‐87625 87622 IADNA PAPILLOMAVIRUS HUMAN QUANTIFICATION Laboratory 87623‐87625 88343 IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE Pathology 88344 0059T CRYOPRESERVATION OOCYTES Pathology 89337

Laboratory Drug Testing CMS Exceptions

• For drug screening of drug classes, the new CPT Codes-80300 through

80304 are Status Indicator B – The HCPCS Codes used by CMS were changed in 2015 to Status Indicator N

• G0431 Drug screen, qualitative; multiple drug classes by highly

complex method per patient encounter – Used for instrument driven testing and chromatographic methods – 80301, 80302, 80303 and 80304 are probably the comparable 2015 CPT Codes

• G0434 Drug screen, other than chromatographic; any number of

drug classes, by CLIA waived test or moderate complexity test, per patient encounter – Used for CLIA waived tests and dipsticks, cups, cassettes – 80300 is probably the comparable 2015 CPT Code

86

Laboratory Drug Testing CMS Exceptions

• CMS is not accepting the new drug codes created by the AMA and has

developed alternative HCPCS Codes

87

2015 CMS HCPCS Description Deleted 2014 CPT Code 2015 CPT Code G6030 Assay of amitriptyline 80152 80335,80336, or 80337 G6031 Assay of benzodiazepines 80154 80346, 80347 G6032 Assay of desipramine 80160 80335,80336, or 80337 G6034 Assay of doxepin 80166 80335,80336, or 80337 G6035 Assay of gold 80172 80375 G6036 Assay of Imipramine 80174 80335,80336, or 80337 G6037 Assay of nortiptyline 80182 80335,80336, or 80337 G6038 Assay of salicylate 80196 80329,80330 or 80331 G6039 Assay of acetaminophen 82003 80329,80330 or 80331 G6040 Assay of ethanol 82055 80320, 80321, or 80322 G6041 Assay of urine alkaloids 82101 80323

Laboratory Drug Testing CMS Exceptions

• CMS is not accepting the new drug codes created by the AMA and has

developed alternative HCPCS Codes

88

2015 CMS HCPCS Description Deleted 2014 CPT Code 2015 CPT Code G6042 Assay of amphetamines 82145 80324,80325, or 80326 G6043 Assay of barbiturates 82205 80345 G6044 Assay of cocaine 82520 80353 G6045 Assay of dihydrocodeinone 82646 80361 G6046 Assay of dihydromorphinone 82649 80361 G6047 Assay of dihydrotestosterone 82651 80327, 80328 G6048 Assay of dimethadione 82654 80339, 80340, or 80341 G6049 Assay of Epiandrosterone 82666 80327, 80328 G6050 Assay of Ethchlorvynol 82690 80320 G6051 Assay of flurazepam 82742 80346, 80347 G6052 Assay of meprobamate 83805 80369, 80370 G6053 Assay of methadone 83840 80358 G6054 Assay of methsuximide 83858 80339, 80340, or 80341

Laboratory Drug Testing CMS Exceptions

• CMS is not accepting the new drug codes created by the AMA and has

developed alternative HCPCS Codes

89

2015 CMS HCPCS Description Deleted 2014 CPT Code 2015 CPT Code G6055 Assay of nicotine 83887 80323 G6056 Opiate(s),drug and metabolites, each procedure 83925 80361, 80362, 80363, or 80364 G6057 Assay of phenothiazine 84022 80342, G6058 drug confirmation 80102 Many

Laboratory CPT Revisions

90

2015 CPT Code Description Department 80162 DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL Laboratory 80164 DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL Laboratory 80171 DRUG SCREEN QUANTITATIVE GABAPENTIN Laboratory 80299 QUANTITATION DRUG NOT ELSEWHERE SPECIFIED Laboratory 84600 ASSAY OF VOLATILES Laboratory 86900 BLOOD TYPING SEROLOGIC ABO Laboratory 86901 BLOOD TYPING SEROLOGIC RH (D) Laboratory 86902 BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH Laboratory 86904 BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT Laboratory 86905 BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH Laboratory 86906 BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE Laboratory 87501 INFECTIOUS AGENT DNA/RNA INFLUENZA EA TYPE Laboratory 87502 INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES Laboratory 87503 NFCT AGENT DNA/RNA INFLUENZA 1/> TYPES EA ADDL Laboratory 87631 IADNA RESPIRATRY PROBE & REV TRNSCR 3‐5 TARGETS Laboratory 87632 IADNA RESPIRATRY PROBE & REV TRNSCR 6‐11 TARGETS Laboratory 87633 IADNA RESPIRATRY PROBE & REV TRNSCR 12‐25 TARGET Laboratory 88342 IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE Pathology 88360 M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL Pathology 88361 M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST Pathology 88365 IN SITU HYBRIDIZATION 1ST PROBE STAIN Pathology 88367 M/PHMTRC ALYS ISH CPTR‐ASST TECH 1ST PROBE STAIN Pathology 88368 M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL Pathology

Radiology

• For myelograms, the imaging and lumbar injection procedures are compressed

into a single CPT Code for 2015:

• 62302-cervical
• 62303-thoracic
• 62304-lumbosacral
• 62305-2 or more regions
• Arthrocentesis is now frequently done under ultrasound guidance. New 2015

CPT Codes created that compress the arthrocentesis and ultrasound guidance into a single CPT Code;

• 20604 small joint
• 20606 intermediate joint
• 20611 large joint
• If arthrocentesis done under fluoroscopic, CT or MRI guidance , report

surgical and imaging components separately

• 20600, 20605 or 20610 plus 77002, 77012, or 77021

91

Radiology

• For vertebroplasties and kyphoplasties, CPT Codes for the procedures were

deleted: 22520 through 22525 along with the related imaging components: 72291 and 72292. Combined surgical/imaging CPT Codes were created:

• 22510-22512 for vertebroplasties
• 22513-22515 for kyphoplasties
• In Ultrasound, CPT 76645- “Ultrasound, breast, unilateral or bilateral” was

deleted and replaced:

• 76641-Breast unilateral
• 76642-Breast bilateral
• In Mammography, CPT Codes were added for digital breast tomosynthesis
• 77061-Digital breast tomosynthesis, unilateral (Not paid by Medicare SI=E)
• 77062-Digital breast tomosynthesis, bilateral (Not paid by Medicare SI=E)
• G0279-Add on code for Digital breast tomosynthesis(SI=A $57) ?
• 77063 Screening digital breast tomosynthesis, bilateral(SI=A $57)
• This is an add-on Code to 77057 Screening Mammography

92

Radiology CPT Additions

• The following CPT Codes were added in Diagnostic Radiology and DEXA

93

2015 CPT Code Description Department 62302 MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL Diagnostic Radiology 62303 MYELOGRAPHY VIA LUMBAR INJECTION RS&I THORACIC Diagnostic Radiology 62304 MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL Diagnostic Radiology 62305 MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS Diagnostic Radiology 77085 DXA BONE DENSITY STUDY AXIAL SKELETON DEXA Radiology 77086 VERTEBRAL FRACTURE ASSESSMENT VIA DXA DEXA Radiology

Radiology CPT Additions

• The following CPT Codes were added in Interventional Radiology

94

2015 CPT Code Description Department 20604 ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT Interventional Radiology 20606 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US Interventional Radiology 20611 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US Interventional Radiology 20983 ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD Interventional Radiology, CT, MRI 22510 PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC Interventional Radiology 22511 PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL Interventional Radiology 22512 VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL Interventional Radiology 22513 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION Interventional Radiology 22514 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR Interventional Radiology 22515 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH Interventional Radiology 27279 ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS Interventional Radiology 37218 TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE Interventional Radiology 47383 ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION Interventional Radiology, CT, MRI 0340T ABLATE PULM TUMORS W/PLEURA/CHEST WALL EXTSN Interventional Radiology 0347T PLACE INTERSTITIAL DEVICE(S) IN BONE FOR RSA Interventional Radiology 0348T RADIOSTEREOMETRIC ANALYSIS SPINE EXAM Interventional Radiology 0349T RADIOSTEREOMETRIC ANALYSIS UPPER EXTREMITY EXAM Interventional Radiology 0350T RADIOSTEREOMETRIC ANALYSIS LOWER EXTREMITY EXAM Interventional Radiology 0351T INTRAOP OCT BREAST OR AXILL NODE EACH SPECIMEN Interventional Radiology 0352T OCT BREAST OR AXILL NODE SPECIMEN I&R Interventional Radiology 0353T OCT OF BREAST SURG CAVITY REAL TIME INTRAOP Interventional Radiology 0354T OCT BREAST SURG CAVITY REAL TIME/REFERRED I&R Interventional Radiology

Radiology CPT Additions

• The following CPT Codes were added in Ultrasound/Mammography

95

2015 CPT Code Description Department 76641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE Ultrasound/Mammography 76642 US BREAST UNI REAL TIME WITH IMAGE LIMITED Ultrasound/Mammography 77061 DIGITAL BREAST TOMOSYNTHESIS UNILATERAL Mammography 77062 DIGITAL BREAST TOMOSYNTHESIS BILATERAL Mammography 77063 SCREENING DIGITAL BREAST TOMOSYNTHESIS BI Mammography

Radiology CPT Deletions

• The following CPT Codes were deleted in Diagnostic Radiology and

DEXA

96

2014 CPT Code Description Department Replacement 2015 CPT Code 74291 CHOLECYST ORAL CNTRST ADDL/REPEAT XM/MULT DAY XM Diagnostic Radiology None 77082 DXA BONE DENSITY STUDY VERTEBRAL FRACTURE Radiology DEXA 77086

Radiology CPT Deletions

• The following CPT Codes were deleted in Interventional Radiology

97 2014 CPT Code Description Department Replacement 2015 CPT Code 22520 PERCUTANEOUS VERTEBROPLSTY THORACIC W/WO BONE BX Interventional Radiology 22510 22521 PERCUTANEOUS VERTEBROPLASTY LUMBAR W/WO BNE BX Interventional Radiology 22511 22522 PERCUTANEOUS VERTEBROPLASTY EA ADDL THRC/LMBR Interventional Radiology 22512 22523 PERCUTANEOUS VERTEBRAL AUGMENTATION THORACIC Interventional Radiology 22513 22524 PERCUTANEOUS VERTEBRAL AUGMENTATION LUMBAR Interventional Radiology 22514 22525 PERQ VERTEBRAL AUGMENTATION EA ADDL THRC/LMBR Interventional Radiology 22515 72291 RAD S&I PERQ VRTPLS/SACRPLSTY PR VRT BODY FLUO Interventional Radiology 22510‐22515 72292 RAD S&I PERQ VRTPLS/SACRPLSTY PER VRT BODY CT Interventional Radiology 22510‐22515

Radiology CPT Deletions

• The following CPT Codes were deleted in Ultrasound:

98

2014 CPT Code Description Department Replacement 2015 CPT Code 76645 US BREAST REAL TIME W/IMAGE DOCUMENTATION Ultrasound Mammography 76641, 76642

Radiology CPT Revisions

• The following CPT Codes were revised in Diagnostic Radiology

99

2015 CPT Code Description Department 27370 INJECTION KNEE ARTHROGRAPHY Diagnostic Radiology 62284 INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR Diagnostic Radiology

Radiology CPT Revisions

• The following CPT Codes were revised in Interventional Radiology

100

2015 CPT Code Description Department 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US Interventional Radiology 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US Interventional Radiology 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US Interventional Radiology 20982 ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE Interventional Radiology, CT, MRI 27280 ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT Interventional Radiology 37215 TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ Interventional Radiology 37216 TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ Interventional Radiology 37217 TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE Interventional Radiology 37236 OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL Interventional Radiology 37237 OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL Interventional Radiology 61055 CISTERNAL/LATERAL C1‐C2 PUNCTURE W/INJECTION Interventional Radiology 0075T TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL Interventional Radiology 0076T TCAT PLMT XTRC VRT CRTD STENT RS&IPRQ EA VSL Interventional Radiology 0200T PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL Interventional Radiology 0201T PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS Interventional Radiology

Radiation Oncology

• Radiation treatment delivery CPT Code structure significant revised in 2015
• In previous years, CPT codes were based on both the number of treatment

areas and the megavoltage (MeV) used

• In 2015, assuming > 1MeV, (megavoltage) is no longer used as part of the

CPT Code structure.

• CPTs are compressed from 12 CPT Codes into three based on the following

criteria for simple, intermediate and complex:

• Simple (CPT 77402)-All of the following criteria is met (None of the

intermediate or complex criteria is met): single treatment area, one or two ports, and two or fewer simple blocks

• Intermediate (CPT 77407)-Any of the following criteria are met (None of the

complex criteria is met): two separate treatment areas, three or more ports

• n a single treatment area, or three or more simple blocks
• Complex (CPT 77412)-Any of the following criteria are met: three or more

separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, field-in-field or other tissue compensation that does not meet IMRT guidelines or electron beam

101

Radiation Oncology

• Intensity Modulated Radiation Treatment (IMRT) delivery CPT Code structure

significant revised in 2015

• In previous years, there was a single CPT-77418 for IMRT regardless of

complexity/location of treatment

• In 2015, IMRT is split into 2 CPTs based on complexity:
• Simple (CPT 77385)-Any of the following: prostate, breast, and all sites using

physical compensator based IMRT

• Complex (CPT 77386)-Includes all other sites if not using physical

compensator based IMRT

102

Radiation Oncology CPT Additions

• Teletherapy planning and Brachytherapy planning now include basic

dosimetry (77300)

103

2015 CPT Code Description Department 77306 TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION Radiation Oncology 77307 TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY Radiation Oncology 77316 BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL Radiation Oncology 77317 BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL Radiation Oncology 77318 BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL Radiation Oncology 77385 INTENSITY MODULATED RADIATION TX DLVR SIMPLE Radiation Oncology 77386 INTENSITY MODULATED RADIATION TX DLVR COMPLEX Radiation Oncology 77387 GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR Radiation Oncology

Radiation Oncology CPT Deletions

104

2014 CPT Code Description Department Replacement 2015 CPT Code 76950 US GUIDANCE PLACEMENT RADIATION THERAPY FIELDS Radiation Oncology 77387 77305 TELETHERAPY ISODOSE PLAN SIMPLE Radiation Oncology 77306 77310 TELETHERAPY ISODOSE PLAN INTERMEDIATE Radiation Oncology 77306, 77307 77315 TELETHERAPY ISODOSE PLAN COMPLETE Radiation Oncology 77307 77326 BRACHYTHERAPY ISODOSE PLAN SIMPLE Radiation Oncology 77316 77327 BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE Radiation Oncology 77317 77328 BRACHYTHERAPY ISODOSE PLAN COMPLEX Radiation Oncology 77318 77403 RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL 6‐10MEV Radiation Oncology 77402 77404 RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL 11‐19MEV Radiation Oncology 77402 77406 RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL 20MEV/< Radiation Oncology 77402 77408 RADJ DLVR 2 AREAS 3/>PORTS 1 MLT BLKS 6‐1MEV Radiation Oncology 77407 77409 RADJ DLVR 2 AREAS 3/>PORTS 1 MLT BLKS 11‐19MEV Radiation Oncology 77407 77411 RADJ DLVR 2 AREAS 3/> PORTS 1 TX AREA 20 MEV/< Radiation Oncology 77407 77413 RADJ DLVR 3/> AREAS CUSTOM BLKING 6‐10MEV Radiation Oncology 77412 77414 RADJ DLVR 3/> AREAS CUSTOM BLKING 11‐19MEV Radiation Oncology 77412 77416 RADJ DLVR 3/> AREAS CUSTOM BLKING 20MEV/< Radiation Oncology 77412 77418 NTSTY MODUL DLVR 1/MLT FLDS/ARCS PR TX SESSION Radiation Oncology 77301 77421 STRSC X‐RAY GDN LOCLZJ TARGET VOL DLVR RADJ THER Radiation Oncology 77387 0197T IFXJ LOCLZ&TRAKG TRGT/PT MTN DUR RADTX EA FXJ Radiation Oncology 77387

Radiation Oncology CPT Revisions

• CPT Code revisions include:

105

2015 CPT Code Description Department 77401 RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA Radiation Oncology 77402 RADIATION TREATMENT DELIVERY 1 MEV >= SIMPLE Radiation Oncology 77407 RADIATION TX DELIVERY 1 MEV >=INTERMEDIATE Radiation Oncology 77412 RADIATION TREATMENT DELIVERY 1 MEV >= COMPLEX Radiation Oncology

Cardiology

• CPT Codes created for subcutaneous implantable defibrillators

– CPT 33270 Insertion or replacement of permanent subcutaneous implantable defibrillator system – CPT 33271 Insertion subcutaneous implantable defibrillator electrode – CPT 33272 Removal subcutaneous implantable defibrillator electrode – CPT 33273 Repositioning of previously implanted subcutaneous implantable defibrillator electrode – CPT 93260 Programming device evaluation (in person) with iterative adjustment of device to test device function, implantable subcutaneous lead defibrillator system – CPT 93261 Interrogation device evaluation (in person) with analysis includes connection, recording and disconnection, implantable subcutaneous lead defibrillator system – 93644 EP evaluation of subcutaneous

106

Cardiology

• In echocardiography, a new CPT Code (93355) added for TEE guidance related

to:

– Transcatheter intracardiac or great vessel structural intervention such as:

• TAVR, transcatheter pulmonary valve replacement, mitral valve repair, etc.

– CPT Code 93355 includes diagnostic TEE, administration of contrast, Doppler, color flow and 3D when performed

107

Cardiology CPT Additions

108

2015 CPT Code Description Department 33270 INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD Invasive Cardiology 33271 INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE Invasive Cardiology 33272 RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE Invasive Cardiology 33273 REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB Invasive Cardiology 93260 PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM Cardiology 93261 INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB Cardiology 93355 ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN Cardiology

Cardiology EP Study CPT Additions

109

2015 CPT Code Description Department 93644 EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR EP Study

Cardiology CPT Deletions

110

2014 CPT Code Description Department Replacement 2015 CPT Code 0319T INS/REPLCMT SUBQ IMPLT DEFIB SYSTEM W/SUBQ ELTRD Cardiology 33240, 33241, 33262, 33270, 33271, 33272, 33273, 93260, 93261, 93644 0320T INSERTION SUBCUTANEOUS DEFIBRILLATOR ELECTRODE Cardiology 33240, 33241, 33262, 33270, 33271, 33272, 33273, 93260, 93261, 93644 0321T INSERTION SUBQ IMPLT DEFIB PLS GEN W/SUBQ ELTRD Cardiology 33240, 33241, 33262, 33270, 33271, 33272, 33273, 93260, 93261, 93644 0322T REMOVAL SUBQ IMPLT DEFIB PULSE GENERATOR Cardiology 33240, 33241, 33262, 33270, 33271, 33272, 33273, 93260, 93261, 93644 0323T RMVL W/REPLCMT SUBQ IMPLT DEFIB PULSE GENERATOR Cardiology 33240, 33241, 33262, 33270, 33271, 33272, 33273, 93260, 93261, 93644 0324T REMOVAL SUBCUTANEOUS DEFIBRILLATOR ELECTRODE Cardiology 33240, 33241, 33262, 33270, 33271, 33272, 33273, 93260, 93261, 93644 0325T REPOSITN SUBQ IMPLANT DEFIB ELECTRODE/PULSE GEN Cardiology 33240, 33241, 33262, 33270, 33271, 33272, 33273, 93260, 93261, 93644 0326T EPHYS EVAL SUBQ IMPLT DEFIB PRGRMG/REPRGRMG Cardiology 33240, 33241, 33262, 33270, 33271, 33272, 33273, 93260, 93261, 93644 0327T IMPLT SUBQ DEFIB SYS INTERROGATION DEVICE EVAL Cardiology 33240, 33241, 33262, 33270, 33271, 33272, 33273, 93260, 93261, 93644 0328T IMPLT SUBQ DEFIB SYS PROGRAMMING DEVICE EVAL Cardiology 33240, 33241, 33262, 33270, 33271, 33272, 33273, 93260, 93261, 93644

Cardiology CPT Revisions

• The following CPT Codes were revised:

111 2015 CPT Code Description Department 33215 RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE Invasive Cardiology 33216 INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB Invasive Cardiology 33217 INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB Invasive Cardiology 33218 RPR 1 TRANSVNS ELTRD PRM PM/PACING IMPLNTBL DFB Invasive Cardiology 33220 RPR 2 TRANSVNS ELECTRODES PRM PM/IMPLANTABLE DFB Invasive Cardiology 33223 RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR Invasive Cardiology 33224 INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN Invasive Cardiology 33225 INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN Invasive Cardiology 33230 INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS Invasive Cardiology 33231 INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS Invasive Cardiology 33240 INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD Invasive Cardiology 33241 REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY Invasive Cardiology 33243 RMVL 1/DUAL CHAMBER DEFIB ELECTRODE BY THORACOM Invasive Cardiology

Cardiology CPT Revisions

• The following CPT Codes were revised:

112 2015 CPT Code Description Department 33244 RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ Invasive Cardiology 33249 INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR Invasive Cardiology 33262 RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD Invasive Cardiology 33263 RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD Invasive Cardiology 33264 RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD Invasive Cardiology 93282 PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB Cardiology 93283 PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB Cardiology 93284 PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB Cardiology 93287 PERI‐PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB Cardiology 93289 INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB Cardiology 93295 INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD DFB Cardiology 93296 INTERROGATION REMOTE </90 D TECHNICIAN REVIEW Cardiology

Endoscopy

• Continued expansion of CPT Codes choices in the following areas:
• Ileoscopy
• Colonoscopy
• Sigmoidoscopy
• Anoscopy

113

Endoscopy CPT Additions

114

2015 CPT Code Description Department 43180 ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH Endoscopy 44381 ILEOSCOPY STOMA W/BALLOON DILATION Endoscopy 44384 ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT Endoscopy 44401 COLONOSCOPY STOMA ABLATION LESION Endoscopy 44402 COLONOSCOPY STOMA W/ENDOSCOPIC STENT PLCMT Endoscopy 44403 COLONOSCOPY STOMA W/ENDOSCOPIC MUCOSAL RESCJ Endoscopy 44404 COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION Endoscopy 44405 COLONOSCOPY STOMA W/BALLOON DILATION Endoscopy 44406 COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM Endoscopy 44407 COLONOSCOPY STOMA W/US GID NDL ASPIR/BX Endoscopy 44408 COLONOSCOPY THROUGH STOMA WITH DECOMPRESSION Endoscopy 45346 SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES Endoscopy 45347 SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT Endoscopy 45349 SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION Endoscopy 45350 SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S) Endoscopy 45388 COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES Endoscopy 45389 COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT Endoscopy 45390 COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION Endoscopy 45393 COLONOSCOPY FLEXIBLE WITH DECOMPRESSION Endoscopy 45398 COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S) Endoscopy 45399 UNLISTED PROCEDURE COLON Endoscopy 46601 ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT Endoscopy 46607 ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX Endoscopy 52441 CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE Endoscopy 52442 CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL Endoscopy 0377T ANOSCOPY W/BULKING AGENT INJ FOR FECAL INCONT Endoscopy

Endoscopy CPT Additions

115

2015 CPT Code Description Department 0355T GI TRACT IMAGING INTRALUMINAL COLON WITH I&R Nuclear Medicine

Endoscopy CPT Deletions

116 2014 CPT Code Description Department Replacement 2015 CPT Code 43350 ESOPHAGOSTOMY FSTLJ ESOPH XTRNL ABDL APPR Endoscopy None 44383 ILEOSCOPY STOMA W/TNDSC STENT PLMT Endoscopy 44384 44393 COLONOSCOPY STOMA ABLATION LESION Endoscopy 44401 45355 COLSC RGD/FLX TABDL VIA COLOTOMY 1/MLT Endoscopy 45399 45383 COLSC FLX PROX SPLENIC FLXR ABLTJ LES Endoscopy 45388 45387 COLSC FLX PROX SPLENIC FLXR TNDSC STENT PLMT Endoscopy 45389 0226T ANOSCOPY HIGH RESOLUTION W/SPECIMEN COLLECTION Endoscopy 46601 0227T ANOSCOPY HIGH RESOLUTION W/BIOPSY Endoscopy 46607

Endoscopy CPT Revisions

117

2015 CPT Code Description Department 43194 ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY Endoscopy 43197 ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC Endoscopy 43215 ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY Endoscopy 43216 ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS Endoscopy 43247 EGD FLEXIBLE FOREIGN BODY REMOVAL Endoscopy 43250 EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS Endoscopy 44360 ENDOSCOPY UPPER SMALL INTESTINE Endoscopy 44363 ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY Endoscopy 44380 ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD Endoscopy 44385 NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX Endoscopy 44386 NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE Endoscopy 44388 COLONOSCOPY STOMA DX INDUDING COLLJ SPEC SPX Endoscopy 44390 COLONOSCOPY STOMA W/RMVL FOREIGN BODY Endoscopy 44391 COLONOSCOPY STOMA CONTROL BLEEDING Endoscopy 44392 COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS Endoscopy 44799 UNLISTED PROCEDURE SMALL INTESTINE Endoscopy 45330 SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD Endoscopy

Endoscopy CPT Revisions

118

2015 CPT Code Description Department 45332 SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY Endoscopy 45333 SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS Endoscopy 45334 SIGMOIDOSCOPY FLX CONTROL BLEEDING Endoscopy 45337 SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE Endoscopy 45340 SIGMOIDOSCOPY FLX TNDSC BALO DILAT Endoscopy 45378 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD Endoscopy 45379 COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S) Endoscopy 45380 COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE Endoscopy 45381 COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST Endoscopy 45382 COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD Endoscopy 45384 COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS Endoscopy 45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ Endoscopy 45386 COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT Endoscopy 45391 COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX Endoscopy 45392 COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL Endoscopy 46600 ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD Endoscopy

Surgery CPT Additions

119 2015 CPT Code Description Department 21811 OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1‐3 RIBS Operating Room 21812 OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4‐6 RIBS Operating Room 21813 OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS Operating Room 22858 TOT DISC ARTHRP ANT APPR DISC 2ND LEVEL CERVICAL Operating Room 33418 TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS Operating Room 33419 TCAT MITRAL VALVE REPAIR ADDL PROSTHESIS Operating Room 34839 PLNNING PT SPEC FENEST VISCERAL AORTIC GRAFT Operating Room 66179 AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT Operating Room 66184 REVJ SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT Operating Room 0345T TRANSCATH MITRAL VALVE REPAIR VIA CORONARY SINUS Operating Room 0375T TOTAL DISC ARTHRP ANT APPR W/DISCECTOMY CRV 3+ Operating Room 0376T ANT SEGMENT INSERT DRAIN W/O RESERVOIR EA ADDL Operating Room

Surgery CPT Deletions

120

2014 CPT Code Description Department Replacement 2015 CPT Code 21800 CLOSED TX RIB FRACTURE UNCOMPLICATED EACH Operating Room None 21810 TX RIB FRACTURE EXTERNAL FIXATION FLAIL CHEST Operating Room 21899 29020 APPLICATION TURNBUCKLE JACKET BODY ONLY Operating Room None 29025 APPLICATION TURNBUCKLE JACKET BODY W/HEAD Operating Room None 29715 REMOVAL/BIVALVING TURNBUCKLE JACKET Operating Room None 33472 VALVOTOMY PULM VALVE OPEN HRT W/INFLOW OCCLUSION Operating Room 92990 42508 PAROTID DUCT DIVERSION BI W/EXC 1 SUBMNDBLR GLND Operating Room None 61334 EXPL ORBIT TRANSCRANIAL W/RMVL FOREIGN BODY Operating Room None 61440 CRANIOTOMY SECTION TENTORIUM CEREBELLI SPX Operating Room None 61470 CRANIECTOMY SUBOCCIPITAL MEDULLARY TRACTOTOMY Operating Room None 61490 CRANIOTOMY LOBOTOMY W/CINGULOTOMY Operating Room None 61542 CRANIOTOMY TOTAL HEMISPHERECTOMY Operating Room None 61609 TRNSXJ/LIGATION CAROTID ARTERY SINUS W/O REPAIR Operating Room None 61875 CRNEC IMPLTJ NSTIM ELTRD CEREBELLAR SUBCORTICAL Operating Room None 62116 RDCTJ CRANIOMEGALIC SKULL W/SIMPLE CRANIOPLASTY Operating Room None 64752 TRANSECTION/AVULSION VAGUS NRV TRANSTHORACIC Operating Room None 64761 TRANSECTION/AVULSION PUDENDAL NERVE Operating Room None 64870 ANASTOMOSIS FACIAL‐PHRENIC Operating Room None 66165 FSTLJ SCLERA GLAUCOMA IRIDENCLEISIS/IRIDOTASIS Operating Room None

Surgery CPT Deletions

121

2014 CPT Code Description Department Replacement 2015 CPT Code 69400 EUSTACHIAN TUBE NFLTJ TRANSNSL CATHJ Operating Room 69799 69401 EUSTACHIAN TUBE NFLTJ TRANSNSL W/O CATHJ Operating Room None 69405 EUSTACHIAN TUBE CATHJ TRANSTYMPANIC Operating Room 69799 0092T TOT DISC ARTHRP ANT APPR DSKC PREP CRV EA NTRSPC Operating Room 0375T 0245T OPEN TX RIB FRACTURE W/INT FIX UNI 1‐2 RIBS Operating Room 21811, 21812, 21813 0246T OPEN TX RIB FRACTURE W/INT FIX UNI 3‐4 RIBS Operating Room 21811, 21812, 21813 0247T OPEN TX RIB FRACTURE W/INT FIX UNI 5‐6 RIBS Operating Room 21811, 21812, 21813 0248T OPEN TX RIB FRACTURE W/INT FIXATION UNI 7/> RIBS Operating Room 21811, 21812, 21813 0334T STABLJ SI JOINT FOR ARTHRODESIS PERQ/MIN INVAS Operating Room 27279

Surgery CPT Revisions

122

2015 CPT Code Description Department 22856 TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV Operating Room 66180 AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W/GRAFT Operating Room 66185 REVJ AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/GRAFT Operating Room 67399 UNLISTED PROCEDURE EXTRAOCULAR MUSCLE Operating Room 0253T INSERT ANT SGM DRAINAGE DEV W/O RESERVR INT APPR Operating Room

ECMO CPT Additions

123 2015 CPT Code Description Department 33946 ECMO/ECLS INITIATION VENO‐VENOUS ECMO/Operating Room 33947 ECMO/ECLS INITIATION VENO‐ARTERIAL ECMO/Operating Room 33948 ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO‐VENOUS ECMO/Operating Room 33949 ECMO/ECLS DAILY MANAGEMENT EA DAY VENO‐ARTERIAL ECMO/Operating Room 33951 ECMO/ECLS INSJ OF PRPH CANNULA BIRTH‐5 YRS PERQ ECMO/Operating Room 33952 ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ ECMO/Operating Room 33953 ECMO/ECLS INSJ OF PRPH CANNULA BIRTH‐5 YRS OPEN ECMO/Operating Room 33954 ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN ECMO/Operating Room 33955 ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH‐5 YRS ECMO/Operating Room 33956 ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER ECMO/Operating Room 33957 ECMO/ECLS REPOS PERIPH CANNULA PERQ BIRTH‐5 YRS ECMO/Operating Room 33958 ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER ECMO/Operating Room 33959 ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH‐5 YRS ECMO/Operating Room

ECMO CPT Additions

124

2015 CPT Code Description Department 33962 ECMO/ECLS REPOS PERPH CANNULA OPEN 6 YRS & OLDER ECMO/Operating Room 33963 ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH‐5YRS ECMO/Operating Room 33964 ECMO/ECLS ECLS REPOS CENTRAL CNULA 6YRS & OLDER ECMO/Operating Room 33965 ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH‐5 YRS ECMO/Operating Room 33966 ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER ECMO/Operating Room 33969 ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH‐5 YRS ECMO/Operating Room 33984 ECMO/ECLS RMVL PRPH CANNULA OPEN 6 YRS & OLDER ECMO/Operating Room 33985 ECMO/ECLS REMOVAL OF CENTRAL CANNULA BIRTH‐5 YRS ECMO/Operating Room 33986 ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER ECMO/Operating Room 33987 ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS ECMO/Operating Room 33988 INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS ECMO/Operating Room 33989 RMVL LEFT HEART VENT BY THORACIC INCIS ECMO/ECLS ECMO/Operating Room

ECMO CPT Deletions

125

2014 CPT Code Description Department Replacement 2015 CPT Code 33960 PROLONGED EXTRACORPOREAL CIRCULATION INIT DAY ECMO/Operating Room 33946‐33989 33961 PROLONGED EXTRACORPOREAL CIRCULATION EA ADDL DAY ECMO/Operating Room 33946‐33989 36822 INSJ CANNULA PROLNG XC‐CIRCJ ECMO SPX ECMO/Operating Room 33946‐33989

Clinic CPT Additions

126

2015 CPT Code Description Department 90630 INFLUENZA VACC IIV4 SPLIT VIRUS PRSRV FREE ID Clinic 90651 HUMAN PAPILLOMA VIRUS NONAVALENT HPV 3 DOSE IM Clinic 91200 LIVER ELASTOGRAPHY W/O IMAG W/I&R Clinic 99188 APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP Clinic 0341T QUANT PUPILLOMETRY W/INTERP&REPORT UNILAT/BILAT Clinic 0342T THERAPEUTIC APHERESIS W/SELECTIVE HDL DELIP Clinic 0346T ULTRASOUND ELASTOGRAPHY Clinic 0358T BIA WHOLE BODY SUPINE POSTION WITH I&R Clinic

Clinic CPT Deletions

127

2014 CPT Code Description Department Replacement 2015 CPT Code 36469 1/MLT NJXS SCLRSG SLNS SPIDER VEINS FACE Clinic None

Clinic CPT Revisions

128

2015 CPT Code Description Department 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US Clinic 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US Clinic 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US Clinic 90654 INFLUENZA VACC IIV3 SPLIT VIRUS PRSRV FREE ID Clinic 90721 DTAP/HIB VACCINE INTRAMUSCULAR Clinic 90723 DTAP‐HEPB‐IPV VACCINE INTRAMUSCULAR Clinic 90734 MENINGOCOCCAL CONJ VACCINE QUADRAVALENT IM Clinic

Pharmacy CPT Additions

129

HCPCS Code Short Descriptor SI 2015 Payment Rate C9025 Injection, ramucirumab G $54.06 C9026 Injection, vedolizumab G $17.03 C9027 Injection, pembrolizumab G $45.75 C9136 Factor viii (eloctate) G $2.10 C9349 Fortaderm, fortaderm antimic G $109.18 C9442 Injection, belinostat G $31.80 C9443 Injection, dalbavancin G $31.59 C9444 Injection, oritavancin G $25.62 C9446 Inj, tedizolid phosphate G $1.25 C9447 Inj, phenylephrine ketorolac G $418.70 J0153 Adenosine inj 1mg N J0571 Buprenorphine oral 1mg E J0572 Buprenorphin/nalox up to 3mg E J0573 Buprenorph/nalox 3.1 to 6mg E J0574 Buprenorph/nalox 6.1 to 10mg E

Pharmacy CPT Additions

130

HCPCS Code Short Descriptor SI 2015 Payment Rate J0575 Buprenorph/nalox over 10mg E J0887 Epoetin beta esrd use N J0888 Epoetin beta non esrd N J1071 Inj testosterone cypionate N J1322 Elosulfase alfa, injection G $222.13 J1439 Inj ferric carboxymaltos 1mg G $1.05 J2274 In morphine preservativ free N J2704 Inj, propofol, 10 mg N J3121 Inj testostero enanthate 1mg N J3145 Testosterone undecanoate 1mg G $1.15 J7181 Factor xiii recomb a-subunit G $13.69 J7182 Factor viii recomb novoeight E J7200 Factor ix recombinan rixubis G $1.22 J7201 Factor ix fc fusion recomb G $3.02 J7327 Monovisc inj per dose K $977.92 J7336 Capsaicin 8% patch K $2.65

Pharmacy CPT Additions

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HCPCS Code Short Descriptor SI 2015 Payment Rate J9267 Paclitaxel injection N J9301 Obinutuzumab inj G $54.27 Q4150 Allowrap ds or dry 1 sq cm N Q4151 Amnioband, guardian 1 sq cm N Q4152 Dermapure 1 square cm N Q4153 Dermavest 1 square cm N Q4154 Biovance 1 square cm N Q4155 Neoxflo or clarixflo 1 mg N Q4156 Neox 100 1 square cm N Q4157 Revitalon 1 square cm N Q4158 Marigen 1 square cm N Q4159 Affinity1 square cm N Q4160 Nushield 1 square cm N

Pharmacy CPT Deletions

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Deleted HCPCS Code Short Descriptor Suggested HCPCS Code C9021 Injection, obinutuzumab J9301 C9022 Injection, elosulfase alfa J1322 C9023 Inj testosterone undecanoate J3145 C9133 Factor ix recombinant J7200 C9134 Factor xiii a-subunit recomb J7181 C9135 Factor ix (alprolix) J7201 J0150 Injection adenosine 6 mg J0153 J0151 Inj adenosine diag 1mg J0153 J0900 Testosterone enanthate inj J3121 J1060 Testosterone cypionate 1 ml J1071 J1070 Testosterone cypionat 100 mg J1071 J1080 Testosterone cypionat 200 mg J1071 J2271 Morphine so4 injection 100mg J2270 J2275 Morphine sulfate injection J2274 J3120 Testosterone enanthate inj J3121 J3130 Testosterone enanthate inj J3121 J3140 Testosterone suspension inj TBD J3150 Testosteron propionate inj TBD J7335 Capsaicin 8% patch J7336 J9265 Paclitaxel injection J9267 Q9970 Inj ferric carboxymaltos 1mg J1439 Q9972 Epoetin beta esrd use J0887 Q9973 Epoetin beta non esrd J0888 Q9974 Morphine epidural/intratheca J2274

Pain Management CPT Additions

• These CPT code include the imaging guidance

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2015 CPT Code Description Department 64486 TAP BLOCK UNILATERAL BY INJECTION(S) Pain Management 64487 TAP BLOCK UNILATERAL BY CONTINUOUS INFUSION(S) Pain Management 64488 TAP BLOCK BILATERAL BY INJECTION(S) Pain Management 64489 TAP BLOCK BILATERAL BY CONTINUOUS INFUSION(S) Pain Management

Ophthalmology CPT Additions

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2015 CPT Code Description Department 92145 CORNEA HYSTERESIS DETERMIN IMPULSE STIMJ UNI/BI Ophthalmology 0356T INSERT DRUG IMPLANT INTO LACRIMAL CANAL FOR IOP Ophthalmology 0378T VISUAL FIELD ASSESSMENT PHYS REVIEW AND REPORT Ophthalmology 0379T VISUAL FIELD ASSESSMENT TECH SUPPORT W/INSTRUCT Ophthalmology 0380T COMP ANIMATION RETINA IMAGE TIME SERIES ANALYSIS Ophthalmology

Ophthalmology CPT Deletions

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2014 CPT Code Description Department Replacement 2015 CPT Code 0181T CORNEAL HYSTERESIS AIR IMPULSE STIMJ BI W/I&R Ophthalmology 92145

Ophthalmology CPT Revisions

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2015 CPT Code Description Change Department 0191T ANT SEGMENT INSERTION DRAINAGE W/O RESERVOIR INT R Ophthalmology

Mental Health CPT Additions

137

2015 CPT Code Description Department 96127 BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT Mental Health 0359T BEHAVIORAL IDENTIFICATION ASSESSMENT Mental Health 0360T OBSERVATIONAL BEHAV ASSESSMENT FIRST 30 MIN Mental Health 0361T OBSERVATIONAL BEHAV ASSESSMENT ADDL 30 MIN Mental Health 0362T EXPOSURE BEHAV ASSESSMENT FIRST 30 MIN Mental Health 0363T EXPOSURE BEHAV ASSESSMENT ADDL 30 MIN Mental Health 0364T ADAPTIVE BEHAVIOR TX BY PROTOCOL FIRST 30 MIN Mental Health 0365T ADAPTIVE BEHAVIOR TX BY PROTOCOL ADDL 30 MIN Mental Health 0366T GROUP BEHAVIOR TREATMENT FIRST 30 MIN Mental Health 0367T GROUP BEHAVIOR TREATMENT ADDL 30 MIN Mental Health 0368T BEHAVIOR TX WITH MODIFICATION FIRST 30 MIN Mental Health 0369T BEHAVIOR TREATMENT WITH MODIFICATION ADDL 30 MIN Mental Health 0370T FAMILY BEHAVIOR TREATMENT GUIDANCE Mental Health 0371T MULTIPLE FAMILY GROUP BEHAV TREATMENT GUIDANCE Mental Health 0372T BEHAVIOR TREATMENT SOCIAL SKILLS TRAINING GROUP Mental Health 0373T EXPOSURE BEHAVIOR TREATMENT FIRST 60 MIN Mental Health 0374T EXPOSURE BEHAVIOR TREATMENT ADDL 30 MIN Mental Health

Mental Health CPT Revisions

138

2015 CPT Code Description Department 96110 DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM Mental Health

Other CPT Additions

139

2015 CPT Code Description Department 93702 BIS EXTRACELLULAR FLUID ALYS LYMPHEDEMA ASSMNT Vascular Studies 93895 CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI Vascular Studies 97607 NEG PRESSURE WOUND THERAPY NON DME </= 50 SQ CM Wound Care 97608 NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM Wound Care 99184 INITIAT SELECTIVE HEAD/BODY HYPOTHERMIA NEONATE Neonatology

Other CPT Deletions

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2014 CPT Code Description Department Replacement 2015 CPT Code 99481 TOT BODY SYSTEMIC HYPOTHERMIA CRITICAL NEONATE Neonatology 99184 99482 SELECTIVE HEAD HYPOTHERMIA CRITICAL NEONATE Neonatology 99184 0199T PHYSIOL REC TRMR W/ACCEL & GYRO FREQ&AMPL & I&O Vascular Studies 95999 0239T BIOIMPEDANCE SPECTROSCOPY LIMB DIFFERENCES Neurology 93702

Other CPT Revisions

• 97605 and 97606 to be used for Negative pressure wound therapy

using DME only

141

2015 CPT Code Description Department 95972 ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR Neurology 97605 NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM Wound Care 97606 NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM Wound Care

Wrap up and Question/ Answers

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Presenter Information

Mike Kovar 410-916-0824 Mike.Kovar@WeiserMazars.com

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