Jan 13, 2015 | Uncategorized
The new CPT changes take effect January 1st. Understanding the new codes is crucial to obtaining the proper reimbursement for your services while also staying compliant with current coding and billing requirements. The changes for 2015 address a number of interrelated issues. Clinical practice has evolved and several issues required CPT clarification. CPT 2015 offers most changes in vascular and non-vascular interventional radiology as well as significant changes in breast imagining and radiation therapy.n
Changes to Modifier -59:
nModifier 59 is the most widely used modifier. This modifier is associated with considerable abuse and high levels of manual audit activity; leading to reviews, appeals and even civil fraud and abuse cases. This modifier often overrides the edit in the exact circumstance for which CMS created it in the first place. CMS believes that more precise coding options coupled with increased education and selective editing is needed to reduce the errors associated with this overpayment.nnFour (4) new modifiers have been established to define specific subsets of Modifier 59.n
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- XE: Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate EncounternEXAMPLE: The patient receives an outpatient infusion of antibiotics (CPT code 96365) at 8:00 AM, leaves the facility and returns at 8:00 PM for another infusion of the antibiotics. The second line item 96365 would require the -XE modifier.
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- XS: Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/StructurenEXAMPLE: A skin lesion of the arm was destroyed via laser surgery and reported with CPT code 17000 (Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (e.g., actinic keratoses); and another lesion is biopsied on the leg and reported with CPT code 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane including simple closure, unless otherwise listed; single lesion). CPT code 11100 would require the modifier – XS.
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- XP: Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different PractitionernEXAMPLE: A laparoscopic hernia repair (CPT code 49650) was performed in the morning by surgeon A; later in the day the patient developed acute abdominal pain and a laparoscopic appendectomy (CPT code 44970) was performed by surgeon B. The -XP modifier would be applied to CPT code 44970.
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- XU: Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main ServicenEXAMPLE: Two separate lesions are present that are within the same code set, and are excised separately – i.e. a 4 cm. lipoma is excised on the upper thigh (CPT code 27337 – excision tumor soft tissue thigh/knee subcutaneous greater than 3 cm) and a separate lipoma excised on the lower leg (CPT code 27327 – excision tumor soft tissue thigh/knee subcutaneous less than 3 cm). The -XU modifier would be applied to code 27327.
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nBecause of the detailed descriptions associated with these modifiers, it should be more evident as to why the provider is overriding the NCCI edit, and these modifiers will allow CMS to identify whether the edit was overridden appropriately. CMS will continue to recognize the -59 modifier, but notes that Current Procedural Terminology (CPT) instructions state that the -59 modifier should not be used when a more descriptive modifier is available.n
Highlights of the 2015 Changes:
n[vc_toggle title=”CHRONIC CARE MANAGEMENT AND TELEHEALTH” size=”sm” el_id=””]n
Beginning in 2015, CMS will pay $42.60 for a “one-per-month, per-patient CCM code.” Rather than using its proposed “G” code to report CCM services, the agency changed course in the final rule to allow physicians to utilize CPT code 99490 for CCM reporting purposes. CMS has finally given telehealth providers a glimpse of its plans to expand reimbursement for telehealth services provided to Medicare beneficiaries. This new CPT code can be bundled with the existing CPT code 99091 for collecting and reviewing patient data, which does not require the beneficiary to be present and pays an average monthly fee of $56.92 to the physician. The final rule also includes a provision that would cover remote-patient monitoring of chronic conditions using existing CPT code 99091 (with a monthly unadjusted, non-facility fee of $56.92). This provision will significantly broaden Medicare payments for remote patient monitoring of chronic conditions—while CPT code 99091 has been available for coverage of patient monitoring for many years, CMS traditionally has required (and will continue to require), that 99091 be billed in conjunction with evaluation and management (“E&M”) services (CPT codes 99201-99499), the most common of which are office visits. Yet, since the new CPT code 99490 is an E&M code and is intended for coverage of monitoring chronic conditions, the two services can now be combined as chronic care management and remote patient monitoring with a combined monthly fee of approximately $100.00. Notably, the 99490 and 99091 codes are available nationwide, as they are not considered by CMS as rural-only “telehealth” services. CMS also added seven new procedure codes for telehealth services, including annual wellness visits, psychotherapy services, and prolonged services in the office. Coverage under these new codes would begin in 2015.nnHistorically, Medicare has provided limited coverage for telehealth services, which has included coverage for interactive audio and video telecommunications that provide real-time communications between a practitioner and a Medicare beneficiary while the beneficiary is present at the encounter. Medicare only has covered the provision of telehealth services if the beneficiary is seen: (a) at an approved “originating site” (e.g., physician offices, hospitals, skilled nursing facilities); (b) by an approved provider (e.g., physicians, nurse practitioners, clinical psychologists); and (c) for a small defined set of services, including consultations, office visits, pharmacological management, and individual and group diabetes self-management training services.nn99490 Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: multiple chronic conditions expected to last at least 12 months, or until death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored.[/vc_toggle]nn[vc_toggle title=”BREAST IMAGING” size=”sm” el_id=””]nnThe current mammography codes do not include the added physician work or practice expense involved in digital breast tomosynthesis and, therefore, new codes were needed to describe these additional resources. Also, the existing code for breast ultrasound was deleted and two new codes have been introduced for limited and complete ultrasound. Although, limited versus complete has not been defined.nn76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; completenn76642 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limitednn77061 Digital breast tomosynthesis; unilateralnn77062 Digital breast tomosynthesis; bilateralnn77063 Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)nn[/vc_toggle]nn[vc_toggle title=”VERTEBRAL FRACTURE ASSESSMENT” size=”sm” el_id=””]nnVERTEBRAL FRACTURE ASSESSMENTnnThe existing code representing vertebral fracture assessment (VFA) has been deleted and 2 new codes have been introduced for 2015. One code represents VFA done as part of a bone density study and the other is for VFA alone. The deletion of code 77082 and establishment of two new codes to describe DXA and vertebral fracture assessment were requested for 2015.nn77085 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessmentnn77086 Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA)nn[/vc_toggle]nn[vc_toggle title=”NON–VASCULAR INTERVENTIONAL RADIOLOGY” size=”sm” el_id=””]n
JOINT PROCEDURES
nNew codes for joint aspiration and/or injection have been created to include ultrasound guidance. The existing codes were revised to state “not using ultrasound guidance”. However, one thing to keep in mind is that these procedures are sometimes done under fluoroscopic guidance which was not addressed with the new codes.nn20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reportingnn20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reportingnn20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reportingnn
ABLATION THERAPY
nThe existing code for radiofrequency bone ablation has been updated to include adjacent soft tissue and radiologic guidance. In addition, a new code has been added for cryoablation of bone tumors. A Category III* code has also been created for cryoablation of pulmonary tumors.nn20982 Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis),radiofrequency including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequencynn20983 Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; cryoablationnn0340T Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidancen
MYELOGRAPHY
nNew myelography codes were created which include the supervision and interpretation. The existing code for myelogram injection has been revised, but with the introduction of the new codes, there is some uncertainty on when would be an appropriate time to assign code 62284 as both seem to represent the injection portion of the procedure.nn62284 Injection procedure for myelography and/or computed tomography, spinal lumbar (other than C1-C2 and posterior fossa)nn62302 Myelography via lumbar injection, including radiological supervision and interpretation; cervicalnn62303 Myelography via lumbar injection, including radiological supervision and interpretation; thoracicnn62304 Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacralnn62305 Myelography via lumbar injection, including radiological supervision and interpretation; 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)n
nVERTEBROPLASTY/KYPHOPLASTY
nThe existing codes for vertebroplasty and kyphoplasty have been deleted for 2015 and new codes have been created to include all imaging guidance. Sacroplasty did not yet receive a new code, but the existing Category III* code has been revised to include all imaging guidance.nn22510 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracicnn22511 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracicnn22511 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacralnn22512 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure)nn22513 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracicnn22514 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbarnn22515 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)nn0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performednn0201T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performednn[/vc_toggle]nn[vc_toggle title=”VASCULAR INTERVENTIONAL RADIOLOGY” size=”sm” el_id=””]nnExisting codes for carotid stent placement have been revised to include angioplasty and radiologic supervision and interpretation. These codes should also be used for open or percutaneous approach, which is a change for 2015. Editorial revision of the cervical carotid artery stent codes 37215-37216 and 0075T-0076T (see Category III section below) will be made to differentiate these codes from 37218 and to make them consistent with all other endovascular bundled coding. Codes 37215 and 37216 will be revised to specify “open or percutaneous” and to specify “including angioplasty, when performed, and radiological supervision and interpretation.nn37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, open orpercutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protectionnn37216 Transcatheter placement of intravascular stent(s), cervical carotid artery, open orpercutaneous, including angioplasty, when performed, and radiological supervision and interpretation; without distal embolic protectionnnPreviously a Category III* code, there is now a CPT code for placement of intrathoracic common carotid or innominate artery stent. This code includes angioplasty and imaging.nn37218 Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretationnn[/vc_toggle]nn[vc_toggle title=”PACEMAKER AND IMPLANTABLE DEFIBRILLATOR” size=”sm” el_id=””]nnPACEMAKER AND IMPLANTABLE DEFIBRILLATORnnFour new codes were developed for subcutaneous implantable defibrillators. These devices differ from transvenous implantable pacing cardioverter-defibrillators in that subcutaneous defibrillators do not provide antitachycardia pacing or chronic pacing. Revisions were made to CPT codes 33215 – 33220, 33223 – 33225, 33240 – 33264, 33243 – 33249 (# – Resequenced) regarding the phrase “pacing cardioverter-defibrillator”. The new language is “implantable defibrillator”. Review the new introductory language of the CPT book for pacemakers and implantable defibrillators. Examples of new language:n
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- 2014 – 33243 – Removal of single or dual chamber pacing cardioverter-defibrillator electrode(s); by thoracotomy
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- 2015 – 33243 – Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy
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n33270 Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performednn33271 Insertion of subcutaneous implantable defibrillator electrodenn33272 Removal of subcutaneous implantable defibrillator electrodenn33273 Repositioning of previously implantable defibrillator electrodenn[/vc_toggle]nn[vc_toggle title=”IMPLANTABLE AND WEARABLE CARDIAC DEVICE EVALUATIONS” size=”sm” el_id=””]nnIMPLANTABLE AND WEARABLE CARDIAC DEVICE EVALUATIONSnnChanges have been added to the introductory language for implantable and wearable device evaluations. These changes were added to replace implantable cardioverter-defibrillator with implantable defibrillator and language to accommodate the two new codes for subcutaneous defibrillator into the coding guidelines.33418 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesisnn93260 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 analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead defibrillator systemnn93261 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillatornn[/vc_toggle]nn[vc_toggle title=”ADVANCE CARE PLANNING” size=”sm” el_id=””]nnADVANCE CARE PLANNINGnnThese codes are used to report the face-to-face service between a physician or other qualified health care professional and a patient, family member, or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms. When using these codes, no active management of the problem(s) is undertaken during the time period reported. The Final Rule states “For CY 2015, we are assigning a PFS status indicator of ‘I’ (Not valid for Medicare purposes. Medicare uses another code for the reporting and payment of these services.) to CPT codes 99497 and 99498 for CY 2015. However, we will consider whether to pay for CPT codes 99497 and 99498 after we have had the opportunity to go through notice and comment rulemaking.”nn99497 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogatenn99498 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (list separately in addition to code for primary procedure)nn[/vc_toggle]nn[vc_toggle title=”RADIATION THERAPY” size=”sm” el_id=””]nnRadiation therapy codes underwent significant changes for 2015. Teletherapy isodose planning and brachytherapy codes now include the basic dosimetry calculation and IMRT codes now include guidance and tracking. Also radiation treatment delivery codes were deleted in 2015.nn77306 Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)nn77307 Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)nn77316 Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)nn77317 Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s)nn77318 Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s)nn77385 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simplenn77386 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complexnn77387 Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performednn[/vc_toggle]nn[vc_toggle title=”OTHER PROCEDURES” size=”sm” el_id=””]nnNew Category III* codes have been introduced for radiostereometric analysis.nn0348T Radiologic examination, radiostereometric analysis (RSA); spine, (includes cervical, thoracic and lumbosacral, when performed)nn0349T Radiologic examination, radiostereometric analysis (RSA); upper extremity(ies), (includes shoulder, elbow, and wrist, when performed)nn0350T Radiologic examination, radiostereometric analysis (RSA); lower extremity(ies), (includes hip, proximal femur, knee, and ankle, when performed)nn*Category III codes are temporary codes created for emerging technology, services, and procedures. Use of these Category III codes allow data collection for these services and procedures.nn[/vc_toggle]nn[vc_toggle title=”CPT ADDITIONS” size=”sm” el_id=””]nnThe following codes have been added:nn20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reportingnn20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reportingnn20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reportingnn20983 Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; cryoablationnn22510 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracicnn22511 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacralnn22512 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure)nn22513 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracicnn22514 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbarnn22515 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)nn37218 Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty when performed, and radiological supervision and interpretation.nn52241 Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implantnn52442 Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; each additional angioplasty, when performed, and radiological supervision and interpretationnn62302 Myelography via lumbar injection, including radiological supervision and interpretation; cervicalnn62303 Myelography via lumbar injection, including radiological supervision and interpretation; thoracicnn62304 Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacralnn62305 Myelography via lumbar injection, including radiological supervision and interpretation; 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)nn64486 Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)nn64487 Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) unilateral; by continuous infusion(s) (includes imaging guidance, when performednn64488 Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)nn64489 Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) bilateral; by continuous infusions (includes imaging guidance, when performed)nn76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; completenn76642 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limitednn77061 Digital breast tomosynthesis; unilateralnn77062 Digital breast tomosynthesis; bilateralnn77063 Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)nn77085 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessmentnn77086 Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA)nn77306 Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)nn77307 Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)nn77316 Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)nn77317 Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s)nn77318 Brachytherapy isodose plan; complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s)nn77385 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simplenn77386 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complexnn77387 Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performednn90630 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal usenn90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (HPV), 3 dose schedule, for intramuscular usenn91200 Liver elastography, mechanically induced shear wave without imaging, with interpretation and reportnn92145 Corneal hysteresis determination, by air impulse stimulation, unilateral or bilateral, with interpretation and reportnn93355 Echocardiography, TEEnn0340T Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidancenn0348T Radiologic examination, radiostereometric analysis (RSA); spine, (includes cervical, thoracic and lumbosacral, when performed)nn0349T Radiologic examination, radiostereometric analysis (RSA); upper extremity(ies), (includes shoulder, elbow, and wrist, when performed)nn0350T Radiologic examination, radiostereometric analysis (RSA); lower extremity(ies), (includes hip, proximal femur, knee, and ankle, when performed)[/vc_toggle]nn[vc_toggle title=”CPT DELETIONS” size=”sm” el_id=””]nnThe following codes have been deleted:nn00452 Anesthesia for procedures on clavicle and scapula; radical surgerynn00622 Anesthesia for procedures on thoracic spine and cord; thoracolumbar sympathectomynn00634 Anesthesia for procedures in lumbar region; chemonucleolysis3nn22520 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracicnn22521 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; lumbarnn22522 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)nn22523 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracicnn22524 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); lumbarnn22525 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)nn72291 Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under fluoroscopic guidancenn72292 Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under CT guidancenn74291 Cholecystography, oral contrast; additional or repeat examination or multiple day examinationnn76645 Ultrasound, breast(s) (unilateral or bilateral), real time with image documentationnn76950 Ultrasonic guidance for placement of radiation therapy fieldsnn77082 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; vertebral fracture assessmentnn77305 Teletherapy, isodose plan (whether hand or computer calculated); simple (1 or 2 parallel opposed unmodified ports directed to a single area of interest)nn77315 Teletherapy, isodose plan (whether hand or computer calculated); complex (mantle or inverted Y, tangential ports, the use of wedges, compensators, complex blocking, rotational beam, or special beam considerations)nn77326 Brachytherapy isodose plan; simple (calculation made from single plane, 1 to 4 sources/ribbon application, remote afterloading brachytherapy, 1 to 8 sources)nn77327 Brachytherapy isodose plan; intermediate (multiplane dosage calculations, application involving 5 to 10 sources/ribbons, remote afterloading brachytherapy, 9 to 12 sources)nn77328 Brachytherapy isodose plan; complex (multiplane isodose plan, volume implant calculations, over 10 sources/ribbons used, special spatial reconstruction, remote afterloading brachytherapy, over 12 sources)nn77403 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 6-10 MeVnn77404 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 11-19 MeVnn77406 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 20 MeV or greaternn77408 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks; 6-10 MeVnn77409 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks; 11-19 MeVnn77411 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks; 20 MeV or greaternn77413 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 MeVnn77414 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 MeVnn77416 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 MeV or greaternn77418 Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment sessionnn77421 Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapynn[/vc_toggle]nn[vc_toggle title=”CPT REVISIONS” size=”sm” el_id=””]CPT REVISIONSnnThe following code descriptions have been revised:nn20600 Arthrocentesis, aspiration and/or injection; small joint or bursa (eg, fingers, toes), without ultrasound guidancenn20605 Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa), without ultrasound guidancenn20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), without ultrasound guidancenn20982 Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis), radiofrequency including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequencynn37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protectionnn37216 Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; without distal embolic protectionnn37236 Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial arterynn37237 Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; each additional arterynn62284 Injection procedure for myelography and/or computed tomography, spinal lumbar (other than C1-C2 and posterior fossa)nn77401 Radiation treatment delivery, superficial and/or ortho voltage, per daynn77402 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; up to 5 MeV; 1MeV, simplenn77407 Radiation treatment delivery, up to 5 MeV; intermediatenn77412 Radiation treatment delivery, up to 5 MeV; complexnn0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performednn0201T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed[/vc_toggle]n
CLICK HERE TO DOWNLOAD 2015 CPT CODE CHANGES
Hospitals will have to speed up changes in how well they treat Medicare patients or face lower payments under plans announced Monday by the Department of Health and Human Services.nnHHS hopes to tie 30% of traditional Medicare payments to quality or value through what are known as “alternative payment models” by the end of 2016, up from 20%. These models include accountable care organizations, which are groups of doctors, hospitals and other health care providers responsible for the health of a group of patients.nnThe plans include “bundled payments,” which are groups of payments for treatments for the same issue, such as an injury. By the end of 2018, HHS hopes to link 50% of payments to these arrangements.nn”Today’s announcement is about improving the quality of care we receive when we are sick, while at the same time spending our health care dollars more wisely,” HHS Secretary Sylvia Burwell said in a news release. “We believe these goals can drive transformative change, help us manage and track progress and create accountability for measurable improvement.”nnHealth care, including for Medicare patients, has traditionally used the “fee for service” model that pays providers for each individual treatment rather than for the overall treatment of a patient or group of patients. That is, they are paid for making people better; not just for trying.nnFor consumers, the end result of HHS’ push should be better health care, but it may not seem that way to some.nn
“Burdens are being placed on doctors who have to explain that more care isn’t always the best care,” says physician Lisa Bielamowicz, chief medical officer and executive director at the Advisory Board, which provides health care research and consulting. Americans have believed for years “that another test and another prescription is always better, but clinical evidence shows that isn’t always the case.”nnHHS’ Center for Medicare and Medicaid Services set a goal of tying 85% of all traditional Medicare payments to quality or value by 2016 and 90% by 2018 through programs such as its “value-based purchasing” and readmission reduction programs. These programs reward or penalize hospitals depending on their quality, which is sometimes defined as whether patients need to be readmitted within 30 days of being discharged.nnThis is the first time HHS has set goals for alternative payment models for Medicare.n
About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners
Z68.35 — Body mass index (BMI) 35.0-35.9, adultnR03.0 — Elevated blood-pressure reading, without diagnosis of hypertensionnF17.210 — Nicotine dependence, cigarettes, uncomplicatednF10.129 — Alcohol abuse with intoxication, unspecifiednnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to 
UnitedHealthcare is an operating division of 
S32.2XXA — Fracture of coccyxnW00.0XXA — Fall due to slipping on icenY93.H1XA — Shoveling snownY92.014 — Place of occurrence, drivewaynnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to 
CAQH ProView™ is Coming in February 2015.
S93.421A — Ankle sprainnW18.49XA — Slipping, tripping, or stumblingnY93.41 — DancingnR78.0 — Finding of alcohol in bloodnY92.252 — Dance hall as the place of occurrencennIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to 
From all of us at Welter Healthcare Partners –nnWe wish you all the joys of the holiday season and happiness and prosperity throughout the coming year!nn 
S30.0XXA — Contusion of buttocksnW55.32XA — Struck by reindeernY92.89 — Santa’s driveway as the place of occurrencennIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to 
Saturday night, in a rare weekend session, the so-called “Cromnibus” federal funding bill, “HR 83 – Consolidated and Further Continuing Appropriations Act, 2015” passed the US Senate without any amendments delaying ICD-10, after passing the House of Representatives late in the evening on Thursday, December 11. Selected physician groups had attempted to insert a two-year ICD-10 delay into the bill.nnThe Centers for Medicare & Medicaid Services has estimated that the last delay, enacted April 1 through a legislative act of Congress, has cost the healthcare industry approximately $6.8 billion in lost investments, not including the cost associated with missed opportunities for better health data to improve quality of care and patient safety.n
S68.011A — Complete traumatic amputation of right thumbnW01.118A — Fall with striking against sharp bladenV00.211A — Fall from ice-skatesnY92.330 — Ice skating rink as place of occurrencennIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to 
Provider Enrollment Application Fee Amount for CY 2015
Recently, physicians requested Congress delay ICD-10 until 2017.nnThe most recent delay of the code sets has already cost the healthcare industry approximately 6.8 billion dollars.nnWe cannot afford another delay. 
C43.31 — Malignant melanoma of nosenC43.11 — Malignant melanoma of right eyelid, including canthusnC43.22 — Malignant melanoma of left ear and external auricular canalnC43.52 — Malignant melanoma of skin of breastnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to 
J00 — Common coldnT48.4X1A — Poisoning by expectorants, accidental (unintentional)nT48.3X5A — Adverse effect of antitussivesnT48.5X6A — Underdosing of other anti-common-cold drugs
R29.4 — Clicking hipnH93.12 — Objective tinnitus, left earnR01.0 — Benign and innocent cardiac murmursnR19.12 — Hyperactive bowel soundsnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to 
ICD-10 preparation is still lagging as providers continue to worry about testing, revenue, and productivity.
Despite the optimism from many organizations, there remains a significant gap between the well-prepared and the lost at sea. Familiar challenges such as clinical documentation improvement, coder productivity, and the scope of financial investment still top the list of worries as the industry moves closer to compliance.
M17.0 — Bilateral primary osteoarthritis of kneenM16.7 — Other unilateral secondary osteoarthritis of hipnM25.662 — Stiffness of left knee, not elsewhere classifiednM25.551 — Pain in right hip
BALTIMORE — The ordinary looking office building in a suburb of Baltimore gives no hint of the high-tech detective work going on inside. A $100 million system churns through complicated medical claims, searching for suspicious patterns and posting the findings on a giant screen.
Fraud and systematic overcharging are estimated at roughly $60 billion, or 10 percent, of Medicare’s costs every year, but the administration recovered only about $4.3 billion last year. The Centers for Medicare and Medicaid Services, which is responsible for overseeing the effort, manually reviews just three million of the estimated 1.2 billion claims it receives each year.