264 new 2014 complex chronic care coordination services ...• preparation of special reports (code...
TRANSCRIPT
-
2015Coding Changes
Gloria Kirkham CPC, CPC-I, COBGC317-454-7730
Fax317-261-2229
1
DisclaimerThe information contained in this presentation is intended solely for your personal reference. Such information is subject to change without notice, its accuracy is not guaranteed and it may not contain all material information concerning this topic. The Presenter makes no representation regarding, and assumes no responsibility or liability for, the accuracy or completeness of, or any errors or omissions in, any information contained herein.
2
264 new 143 deleted 134 revised
3
Evaluation and Management2014 Complex Chronic Care Coordination Services
– 99487 no face-to-face visit, first hour– 99488 one face-to-face visit, first hour– 99489 each additional 30 minutes
2015 Care Management Services— New Section heading— Two new subsections— Deletion of code 99488— Addition of code 99490
4
-
Evaluation and Management
• Why were the Chronic Care Management(CCM) Services Created?
• The goal was to recognize critical non-face-to-face time & services of advanced primary care.
• Payment is around $40.00-$43.00 (Not released yet)
5
Evaluation and Management• Not a per beneficiary/per month
payment (you must provide the service)• Coinsurance applies• In order to bill
– Practitioner must inform beneficiary– Obtain written agreement– Must provide beneficiary a copy of the
plan of care
6
Evaluation and ManagementPatients may be identified by practice-specific or other published algorithms that recognize:
– Multiple illnesses– Multiple medication use– Inability to perform activities of daily living– Requirement for a caregiver, and/or– Repeat admissions or ER visits
7
Evaluation and Management
CCM-Incident to– Modified the policy adopted in CY 2014– Allow incident to billing for CCM with
“general supervision” when services provided by clinical staff
– CFR 410.26
8
-
Evaluation and Management
Care Management Services– Provided by clinical staff, under the
direction of a physician or other QHP (Qualified Healthcare Provider)
– New code allows reporting for patients receiving at least 20 minutes of clinical staff time spent per calendar month.
• (Full Minutes, no ½)
9
Evaluation and Management
To patients who reside:– At home– Domiciliary– Rest home– Assisted living facility
10
Evaluation and ManagementManagement and support services may include:
– Establishing– Implementing– Revising– Monitoring– Coordinating the care of other professionals and
agencies– Educating the patient or caregiver about the
patient’s condition, care plan, and prognosis
11
Evaluation and Management
The Physician or QHP, provides or oversees the management and/or coordination of services, as needed, for all medical conditions, psychosocial needs, and is instrumental in the basic activities of daily living.
12
-
Evaluation and Management
A patient’s care plan is a comprehensive plan of care for all health problems, which is based on a physical, mental, cognitive, social, functional, and environmental assessment of the patient.
13
Evaluation and Management
Typically include/not all inclusive– Patient’s problem list, with expected outcome
and prognosis– Measurable treatment goals– Symptom management– Planned interventions– Medication management
14
Evaluation and Management
– Community and/or social services ordered, and how the services of agencies and specialists not connected to the practice will be directed and/or coordinated
– Identification of individuals responsible for each intervention
– Requirement for periodic review, and, when applicable, revision of the care plan
15
Evaluation and Management
CPT Codes 99487-99490 are reported only once per calendar month and may only be reported by the single physician or QHP who assumes the care management role with a particular patient for a the calendar month
16
-
Evaluation and Management
Codes 99487-99489 are not reported if chronic care management services are performed within the postoperative period of a reported surgery performed by the same individual.
17
Evaluation and Management• Determining the clinical staff time spent in
performance of CCM Services for the month– Face to face time
• Spent with the patient and/or family, caregivers, other professionals, and agencies
– Non-face to face timeRevising, documenting, and implementing the care plan
18
Evaluation and Management
• Only clinical staff can count time• When two or more clinical staff
members are meeting about the patient, only count the time of one clinical staff member.
19
Evaluation and Management
• On the first visit do not count that time
• On days that an E/M service is reported do not count that time– 99201-99215; 99324-99337; 99341-
99350
20
-
Evaluation and Management• The care management office/practice
must have the following capabilities:– Provide 24/7 access to physicians or other QHP or clinical
staff including providing patients and caregivers with a means to make contact with health care professionals in the practice to address urgent needs regardless of the time of day or day of the week
– Provide continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments
21
Evaluation and Management– Provide timely access and management
for follow-up after an ER visit or facility discharge
– Use an electronic health record system so that care providers have timely access to clinical information
– Use a standardized methodology to identify patients who require care management services
22
Evaluation and Management– Have an internal care management process
or function whereby a patient identified as meeting and requirements for these services starts receiving them in a timely manner
– Use a form and format in the medical record that is standardized within the practice
– Be able to engage and educate patients and caregivers as well as coordinate care among all service professionals, as appropriate for each patient
23
Evaluation and Management• Additional E/M services may be reported
separately by the same physician or QHP during the same calendar month by using the appropriate E/M codes).
• However the following services are integral to the performance of care management services (codes 99487-99490)
24
-
Evaluation and Management• Care plan oversight services (codes
99339, 99340, 99374-99380)• Prolonged services without direct
patient contact (codes 99358-99359) • Anticoagulant management (codes
99363, 99364)
25
Evaluation and Management• Medical team conference (codes 99366,
99368)• Education and training (codes 98960-
98962, 99071, 99078)• Telephone services (codes 98966-98968,
99441-99443)• On-line medical evaluation (codes 98969,
99444)
26
Evaluation and Management• Preparation of special reports (code 99080)• Analysis of data (code 99090, 99091)• Transitional care management services
(codes 99495, 99496)• Medication therapy management services
(codes 99605-99607)• End stage renal disease services (codes
90951-90970)
27
Evaluation and Management
• 99490 CCM services, at least 20 minutes of clinical staff time directed by a physician or other QHP, per month, with the following required elements:– Multiple (two or more) chronic conditions
expected to last at least 12 months, or until the death of the patient
28
-
Evaluation and Management– Chronic conditions place the patient at
significant risk of death, acute exacerbation/decompensation, or functional decline
– Comprehensive care plan established, implemented revised, or monitored
– If less than 20 minutes duration in a calendar month is spent, this service is not reported separately
29
Evaluation and Management• 99487 Complex Chronic Care Management
Services, required elements– Multiple (two or more) chronic conditions
expected to last at least 12 months, or until the death of the patient
– Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
30
Evaluation and Management• Establishment or substantial revision
of a comprehensive care plan• Moderate or high complexity medical
decision making• 60 minutes of clinical staff time
directed by a physician or QHP, per calendar month
31
Evaluation and Management
• +99489 Each additional 30 minutes of clinical staff time directed by a QHP per calendar month (List separately in addition to code for primary procedure)
• 99488 has been deleted. To report one or more face-to-face visits by the physician or QHP that are performed in the same month as 99487, use the appropriate E/M code
32
-
Evaluation and ManagementNOTE: Physicians or QHP may not report complex care management services if the care plan is unchanged or requires minimal change (eg. Only a medication is changed or an adjustment in a treatment modality is ordered)
33
Evaluation and ManagementTypical adult patients who receive complex chronic care management services are treated with three or more prescription medications and may be receiving other types of therapeutic interventions (eg, physical therapy, occupational therapy).
34
Evaluation and Management
Typical pediatric patients receive three or more therapeutic intervention (eg, medications, nutritional support, respiratory therapy).
35
Evaluation and Management99497 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of forms, when performed), by the physician or QHP; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate
36
-
Evaluation and Management
+99498 each additional 30 minutes (List separately in addition to code for primary procedure)
37
Evaluation and ManagementAdvance Care Planning; are used to report the face-to-face service between a physician or QHP and a patient, family member, or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms.
38
Evaluation and ManagementAn advance directive is a document appointing an agent and/or recording the wishes of a patient pertaining to his/her medical treatment at a future time should he/she lack decisional capacity at that time.
39
Evaluation and ManagementExamples of written advance directives include, but are not limited to Health Care Proxy, Durable Power of Attorney for Health Care Living Will, and Medical Orders for Life-Sustaining Treatment (MOLST)
40
-
Evaluation and Management
When using codes 99497, 99498, no active management of the problem(s) is undertaken during the time period reported.
41
Evaluation and ManagementSpecific Modifiers for Distinct
Procedural Services http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8863.pdfMLN Matters® Number: MM8863
42
Evaluation and Management
• Release Date: August 15, 2014
• Effective Date: January 1, 2015
• Implementation Date: January 5, 2015
43
Evaluation and ManagementContractors shall use the following as the definition for the CR implementation date:
The implementation date identified in a change request is the date by which Medicare fee-for- service contractors shall apply all changes detailed in the business requirements, unless otherwise specified. It is the date when all necessary updates to infrastructure, business processes and/or supporting technology changes shall be completed and operational in order to execute new/modified policy and procedure.
Note: Implementation dates and effective dates are frequently not the same day. The Implementation date is the same for all business requirement(s) listed within a specific CR, unless otherwise specified.
Contractors shall use the following as the definition for CR effective date:
The effective date identified in a change request is the date on which any new rules, laws, processes and/or policies become active.
44
-
Evaluation and Management
(CMS) is establishing four new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.”
45
Evaluation and Management• The primary issue associated with the -59
modifier is that it is defined for use in a wide variety of circumstances, such as to identify:
• Different encounters; • Different anatomic sites; and • Distinct services.
46
Evaluation and Management• The -59 modifier is • Infrequently (and usually correctly) used to
identify a separate encounter; • Less commonly (and less correctly) used to
define a separate anatomic site; and • More commonly (and frequently incorrectly)
used to define a distinct service.
47
Evaluation and Management
CMS believes that more precise coding options coupled with increased education and selective editing is needed to reduce the errors associated with this overpayment.
48
-
Evaluation and Management• XE Separate Encounter, A Service That Is Distinct Because It
Occurred During A Separate Encounter, • XS Separate Structure, A Service That Is Distinct Because It
Was Performed On A Separate Organ/Structure, • XP Separate Practitioner, A Service That Is Distinct Because It
Was Performed By A Different Practitioner, and • XU Unusual Non-Overlapping Service, The Use Of A Service
That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service.
49
Evaluation and ManagementCMS 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. While CMS will continue to recognize the -59 modifier in many instances, it may selectively require a more specific - X{EPSU} modifier for billing certain codes at high risk for incorrect billing.
50
Evaluation and ManagementFor example, a particular NCCI PTP code pair may be identified as payable only with the -XE separate encounter modifier but not the -59 or other -X{EPSU} modifiers. The -X{EPSU} modifiers are more selective versions of the -59 modifier so it would be incorrect to include both modifiers on the same line.
51
Musculoskeletal System
20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes), without ultrasound guidance
20604 with ultrasound guidance, with permanent recording and reporting
– (Do not report 20600, 20604 in conjunction with 76942)
52
-
Musculoskeletal System
20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance
20606 with ultrasound guidance, with permanent recording and reporting.
– (Do not report 20605, 20606 in conjunction with 76942)
53
Musculoskeletal System20610 Arthrocentesis, aspiration and/or
injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance
20611 with ultrasound guidance, with permanent recording and reporting
– (Do not report 20610, 20611 in conjunction with 27370, 76942)
54
Musculoskeletal System21811 Open treatment of rib
fracture(s) with internal fixation includes thoracoscopic visualization when performed unilateral/ 1-3 ribs
21812 4-6 ribs21813 7 or more ribs
For bilateral procedure, report with modifier 50
55
Musculoskeletal System22510 Percutaneous vertebroplasty
(bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance cervicothoracic
22511 lumbosacral+22512each additional cerviothoracic or
lumbosacral vertebral body (List separately in addition to code for primary procedure)
56
-
Musculoskeletal System22513 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; thoracic
22514 lumbar+22515 each additional thoracic
or lumbar vertebral body (List separately in addition to code for primary procedure)
57
Musculoskeletal System27279 Arthrodesis, sacroiliac joint,
percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device
27280 Arthrodesis, open, sacroiliac joint, including obtaining bone graft, including instrumentation, when performed
For bilateral procedures report modifier 50
58
Cardiovascular System
Category III codes 0319T-0328T related to subcutaneous implantable defibrillator procedures have been deleted and replaced with 33270-33273
59
Cardiovascular System#33270 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 performed.
60
-
Cardiovascular System#33271 Insertion of subcutaneous
implantable defibrillator electrode#33272 Removal of subcutaneous
implantable defibrillator electrode#33273 Repositioning of previously
implanted subcutaneous implantable defibrillator electrode
61
Cardiovascular SystemNew subsection:Extracorporeal Membrane Oxygenation or Extracorporeal Life Support ServicesECMO and /or ECLS procedures
New Introductory guidelines
New Family of codes 33946-33989
62
Cardiovascular SystemCodes 33960 and 33961 were originally developed for use in the neonatal population for severe postpartum respiratory insufficiency, However this treatment has evolved and is now being provided to a variety of adults with severe influenza, pneumonia, and respiratory distress syndrome, as well as to pediatric patients.
63
Cardiovascular System
As a result, codes 33960, 33961, and 36822 have been deleted, and the Cardiac Assist guidelines have been revised to remove reference to deleted code 36822.
64
-
Cardiovascular System
ECMO/ECLS is a procedure that provides cardiac and/or respiratory support to the heart and/or lungs, which allows them to rest and recover when sick or injured.
65
Cardiovascular SystemECMO/ECLS supports the function of the heart and/or lungs by continuously pumping some of the patient’s blood out of the body to an oxygenator where oxygen is added to the blood, carbon dioxide is removed, and the blood is warmed before it is returned to the patient.
66
Cardiovascular SystemThere are two methods that can be used to accomplish ECMO/ECLS.One method is Venoarterialextracorporeal life support, which supports both the heart and the lungs. Venoarterial ECMO/ECLS requires that two cannulae are placed: one in a large vein and one in a large artery.
67
Cardiovascular SystemThe other method is Venovenousextracorporeal life support, Venovenous ECMO/ECLS is used for lung support only and requires one or two cannula(e), which are placed in a vein.
68
-
Cardiovascular SystemThe insertion, repositioning, and the removal of the cannula(e) are surgical procedures that can be performed percutaneously, open or by sternotomyor thoracotomy approach and are done on different days.
69
Cardiovascular System
Codes 33946-33989 will facilitate proper reporting of physician work and allow the appropriate professionals who are involved in the treatment of these complex patients to report their services.
70
Cardiovascular SystemCodes 33946 and 33947 describe the initial insertion of the cannulation of the ECMO/ECLS circuit and setting of parameters performed by the physician, which involves determining the necessary ECMO/ECLS device components, blood flow, gas exchange, and other necessary parameters to manage the circuit. For insertion of a cannulation for extracorporeal circulation, report codes 33951-33956
71
Cardiovascular SystemCodes 33948 and 33949 describe the daily management of the ECMO/ECLS circuit and monitoring parameters requiring physician oversight to ensure that specific features of the interaction of the circuit with the patient are met. ECMO therapy is very invasive and requires constant one-on-one monitoring, assessment, and adjustments.
72
-
Cardiovascular SystemIt would not be appropriate to append modifier 63 to 33946-33949. It would also not be appropriate to report the daily management codes 33948 and 33949 on the same day in conjunction with the initiation codes 33946 and 33947
73
Cardiovascular System
For more information on these codes see the manual provided.
74
Digestive SystemIn 2014 CPT code set, the Esophagus/Endoscopy section was restructured into three subsections: Esophagoscopy, Esophagogastroduodenoscopy (EGD), and Endoscopic Retrograde Cholangiopancreatography(ERCP). In those subsections, the codes were revised, deleted, and added to bundle services that were commonly performed together and to describe current practice more accurately.
75
Digestive SystemIn the 2015 CPT code set, changes have been made to the Intestines and Rectum Endoscopy subsections for the same purposes. A Colonoscopy decision tree has been added to help users select the appropriate colonoscopy code.
76
-
Decision to undergo
Colonoscopy
Diagnostic Procedure
Does Not Reach Splenic Flexure
Flexible Sigmoidoscopy
(45330)
Beyond Splenic Flexure, But Not To the Cecum
Colonoscopy (45378; Modifier
53)
To Cecum
Colonoscopy (45378, No Modifier)
Therapeutic Procedure
Does Not Reach Splenic Flexure
Flexible Sigmoidoscopy (45331‐45347)
Beyond Splenic Flexure, But Not To the Cecum
Colonoscopy (45379‐45398; Modifier 52)
To Cecum
Colonoscopy (45379‐45398; No Modifier)
77
Digestive SystemDefinition of Colonoscopy –RevisedColonoscopy Is the examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum or small intestine proximal to an anastomosis
78
Digestive SystemDefinition of Colonoscopy through StomaColonoscopy through Stoma is now defined as the examination of the colon, from the colostomy stoma to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis
79
Digestive System
Definition of ProctosigmoidoscopyProctosigmoidoscopy is the examination of the rectum and may include examination of a portion of the sigmoid colon
80
-
Digestive System
Definition of SigmoidoscopySigmoidoscopy is the examination of the entire rectum, sigmoid colon and may include examination of a portion of the descending colon.
81
Digestive System2014 CPT Code
2015 HCPCS Code
Long Descriptor
44383 G6018 Ileoscopy, through stoma; with transecdoscopic stent placement (includes predilation)
44393 G6019 Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
44397 G6020 Colonoscopy through stoma; with transendoscopicstent placement (includes predilation)
44799 G6021 Unlisted procedure, intestine
82
Digestive System2014 CPT Code
2015 HCPCS Code
Long Descriptor
45339 G6022 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
45345 G6023 Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation)
45383 G6024 Colonoscopy, flexible, proximal to splenic
45387 G6025 Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)
83
Digestive System2014CPT Code
2015 HCPCS Code
Long Descriptor
0226T G6025 Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed
0227T G6027 Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); with biopsy(ies)
84
-
Digestive SystemIf the patient is Medicare (Original, Medicare Advantage), and :
– If the code has not changed from 2014 to 2015
– Physicians report the CPT code
– If the code has changed from 2014 to 2015
– Physicians report the G code
– If the code is new for 2015– Physicians report the CPT code
85
Digestive SystemStent placement:New codes include pre- and post-dilation and guide wire passage.Use 74360 if fluoroscopic guidance is performed.
86
Digestive SystemStent Placement OLD NEW
Colonoscopy through Stoma
44397 44402
Flexible Sigmoidoscopy
45345 45347
Colonoscopy 45387 45389
87
Digestive SystemEndoscopic Mucosal Resection
Not separately reportable with biopsy, submucosal injection, snare, or band ligation for the same lesion. (Now included)
88
-
Digestive SystemBalloon Dilation of multiple strictures can be reported with modifier 59 for each additional stricture dilatedUse 74360 if fluoroscopic guidance is performed(Not separately reportable with ablation or stent placement procedures)
89
Digestive SystemBottom line: If 2 or more procedures are reported together 75% of the time it is likely they are or will be bundled.
Review this section in detail
90
Digestive SystemEffective January 1, 2015, Anesthesia professionals who furnish a separately payable anesthesia service in conjunction with a colorectal cancer screening test should include the 33 modifier on the claim line with the anesthesia service.(At the time of preparing this presentation a Change Request (CR) has not been released. Please watch for it).
91
Urinary System
52441Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant
+52442 each additional permanent adjustable transprostaticimplant (List separately in addition to code for primary procedure)
92
-
Nervous System4 new bundled codes have been added for myelography procedures 62302 Myelography via lumbar injection,
including radiological supervision and interpretation; cervical
62302 thoracic62304 lumbosacral62305 2 or more regions (eg,
lumbar/lhoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)
93
Nervous SystemThe existing injection and radiological supervision and interpretation codes for myelography (77240, 77255, 77265, and 72270) have been retained.These procedures are occasionally performed by two physicians; one performs the contrast injection and the second provides the radiological supervision and interpretation.
94
Nervous System4 codes have been established to report administration of local anesthetic for postoperative pain control and abdominal wall analgesia, including imaging guidance when performed.
95
Nervous System64486 Transverus abdominis plane (TAP)
block (abdominal plane block, rectus sheath block) unilateral by injection(s) i(includes imaging guidance, when performed)
64487 by continuous infusion(s) (includes imaging guidance when performed)
64488 Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral, by injections (includes imaging guidance, when performed)
64489 by continuous infusions (includes imaging guidance, when performed)
96
-
Nervous SystemBecause more than 50% of the time these services are typically performed bilaterally, codes 64486 and 64487are intended to report the transversusabdominis plane (TAP) block performed unilaterally, and codes 64488 and 64489 are intended to report bilateral services
97
Radiology/Diagnostic UltrasoundCode 76641 is intended to describe a complete ultrasound examination of all four quadrants of the breast, the retroareolar region, and the axilla when performed.
98
Radiology/Diagnostic Ultrasound
Code 76642 is intended to describe a focused ultrasound examination of the breast, with a limited assessment of one or more of the elements included in code 76641, but not all, and of the axilla when performed.
99
Radiology/Diagnostic Ultrasound
Codes 76641 and 76642 should be reported only once per breast per session.
100
-
Radiology/Diagnostic Ultrasound
Mamography77061, 77062, and 77063 have been established to report diagnostic and screening breast tomosynthesis, unilateral and bilateral procedure.
101
Radiology/Diagnostic UltrasoundBreast tomosynthesis is a digital tomographic, technique performed using multiple low-dose X-ray exposures, which are obtained as the X-ray tube swings in an arc around the compressed breast. The resulting image-data are reconstructed using standard computer algorithms to produce a series of sequential stacked slices through the breast.
102
Radiology/Diagnostic Ultrasound77061 Digital breast tomosynthesis;
unilateral77062 bilateral+77063 Screening digital breast
tomosynthesis, bilateral (List separately in addition to code for primary procedure)(Use 77063 in conjunction with 77057)
103
Radiology/Diagnostic Ultrasound77080 and 77082 has been identified as being reported 75% of the time. As a result, code 77082 has been deleted and new code 77085, which bundles the bone density study and vertebral fracture assessment, was created, In addition, code 77086 was created to report vertebral fracture assessment via DXA.
104
-
Rad
iolo
gy/D
iagn
ostic
Ultra
soun
d
In r
espo
nse
to t
he a
naly
sis
iden
tifie
ngth
ese
code
s ar
e fr
eque
ntly
rep
orte
d to
geth
er, th
e fa
mily
of
tele
ther
apy
and
brad
hyth
erap
yis
odos
epl
anni
ng c
odes
ha
s be
en u
pdat
ed t
o re
flect
the
cu
rren
t pr
actic
e
105
Rad
iolo
gy/D
iagn
ostic
Ultra
soun
dN
ew c
odes
77306 a
nd 7
7307 h
ave
been
es
tabl
ishe
d to
rep
ort
com
bine
d te
leth
erap
yis
odos
ew
ith b
asic
dos
imet
ry c
alcu
latio
n(s)
.
Sec
ondl
y, n
ew c
odes
77316, 77317, 77318
have
bee
n es
tabl
ishe
d to
rep
ort
com
bine
d br
achy
ther
apy
isod
ose
plan
ning
with
bas
ic
dosi
met
ry c
alcu
latio
n(s)
.
106
-
2015
CPT
Cod
ing
Upd
ates
Glo
ria K
irkha
m C
PC, C
PC-I,
CO
BG
C
gkirk
ham
@is
man
et.o
rg
Indi
ana
Sta
te M
edic
al A
ssoc
iatio
n 32
2 C
anal
Wal
k In
dian
apol
is In
dian
a 46
202
-
Tabl
e of
Con
tent
s
Eval
uatio
n an
d M
anag
emen
t ....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.... 1
M
uscu
losk
elet
al S
yste
m ..
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
. 3
Car
diov
ascu
lar
Sys
tem
.....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
4
Dig
estiv
e Sys
tem
.....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
... 6
U
rinar
y Sys
tem
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
8
Ner
vous
Sys
tem
.....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.....
8 Ey
e an
d O
cula
r A
ndex
a ...
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
. 8
Rad
iolo
gy/D
iagn
ostic
Ultr
asou
nd ..
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.....
9 Pa
thol
ogy
and
Labo
rato
ry ...
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.. 10
M
edic
ine .
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.. 15
-
CP
T
CO
DI
NG
U
PD
AT
ES
2
01
5
1
Eval
uatio
n an
d M
anag
emen
t
# 9
9490 C
hron
ic c
are
man
agem
ent
serv
ices
, at
lea
st 2
0 m
inut
es o
f cl
inic
al s
taff
tim
e di
rect
ed b
y a
phys
icia
n or
oth
er q
ualif
ied
heal
th c
are
prof
essi
onal
. Pe
r ca
lend
ar m
onth
, w
ith t
he f
ollo
win
g re
quire
d el
emen
ts.
Mul
tiple
(tw
o or
mor
e) c
hron
ic c
ondi
tions
exp
ecte
d to
last
at
leas
t 12 m
onth
s, o
r un
til t
he d
eath
of
the
patie
nt;
C
hron
ic
cond
ition
s pl
ace
the
patie
nt
at
sign
ifica
nt
risk
of
deat
h,
acut
e ex
acer
batio
n/de
com
pens
atio
n, o
r fu
nctio
nal d
eclin
e;
C
ompr
ehen
sive
car
e pl
an e
stab
lishe
d, im
plem
ente
d, r
evis
ed,
or m
onito
red.
(C
hron
ic c
are
man
agem
ent se
rvic
es o
f le
ss tha
n 20 m
inut
es d
urat
ion,
in a
cal
enda
r m
onth
, ar
e no
t re
port
ed s
epar
atel
y)
Cod
es 9
9487,
99489,
99490 a
re r
epor
ted
only
onc
e pe
r ca
lend
ar m
onth
and
may
onl
y be
re
port
ed b
y th
e si
ngle
phy
sici
an o
r ot
her qu
alifi
ed h
ealth
car
e pr
ofes
sion
al w
ho a
ssum
es t
he c
are
man
agem
ent
role
with
a p
artic
ular
pat
ient
for
the
cal
enda
r m
onth
.
Car
e m
anag
emen
t se
rvic
es a
re m
anag
emen
t an
d su
ppor
t se
rvic
es p
rovi
ded
by c
linic
al s
taff
, und
er
the
dire
ctio
n of
a p
hysi
cian
or
othe
r qu
alifi
ed h
ealth
car
e pr
ofes
sion
al,
to a
pat
ient
res
idin
g at
ho
me
or in
a d
omic
iliar
y, r
est
hom
e, o
r as
sist
ed li
ving
fac
ility
.
Do
not
coun
t an
y cl
inic
al s
taff
tim
e on
a d
ay w
hen
the
phys
icia
n or
qua
lifie
d he
alth
car
e pr
ofes
sion
al r
epor
ts a
n E/
M s
ervi
ce.
-
CP
T
CO
DI
NG
U
PD
AT
ES
2
01
5
2
9
9487 C
ompl
ex c
hron
ic c
are
man
agem
ent
serv
ices
, w
ith t
he f
ollo
win
g re
quire
d el
emen
ts:
Mul
tiple
(tw
o or
mor
e) c
hron
ic c
ondi
tions
exp
ecte
d to
last
at
leas
t 12 m
onth
s,
or u
ntil
the
deat
h of
the
pat
ient
;
Chr
onic
co
nditi
ons
plac
e th
e pa
tient
at
si
gnifi
cant
ris
k of
de
ath,
ac
ute
exac
erba
tion/
deco
mpe
nsat
ion,
or
func
tiona
l dec
line;
Com
preh
ensi
ve c
are
plan
est
ablis
hed,
impl
emen
ted,
rev
ised
, or
mon
itore
d.
M
oder
ate
or h
igh
com
plex
ity m
edic
al d
ecis
ion
mak
ing
60 m
inut
es o
f cl
inic
al s
taff
tim
e di
rect
ed b
y a
phys
icia
n or
oth
er q
ualif
ied
heal
ca
re p
rofe
ssio
nal,
per
cale
ndar
mon
th
+
99489 e
ach
addi
tiona
l 30 m
inut
es o
f cl
inic
al s
taff
tim
e di
rect
ed b
y a
phys
icia
n or
oth
er q
ualif
ied
heal
th c
are
prof
essi
onal
, pe
r ca
lend
ar m
onth
(Li
st s
epar
atel
y in
ad
ditio
n to
cod
e fo
r pr
imar
y pr
oced
ure)
(Rep
ort
99489 in
con
junc
tion
with
99487)
AD
VA
NC
E C
ARE
PLA
NN
ING
99497 A
dvan
ce c
are
plan
ning
incl
udin
g th
e ex
plan
atio
n an
d di
scus
sion
of
adva
nce
dire
ctiv
es s
uch
as s
tand
ard
form
s (
with
com
plet
ion
of f
orm
s, w
en p
erfo
rmed
), b
y th
e ph
ysic
ian
or Q
HP;
firs
t 30 m
inut
es,
face
-to-
face
with
the
pat
ient
, fa
mily
m
embe
r(s)
, an
d/or
sur
roga
te
+99498
ea
ch a
dditi
onal
30 m
inut
es (
List
sep
arat
ely
in a
dditi
on t
o co
de f
or p
rimar
y pr
oced
ure)
-
CP
T
CO
DI
NG
U
PD
AT
ES
2
01
5
3
Mus
culo
skel
etal
Sys
tem
TRIG
GER
PO
INT IN
JEC
TIO
N
20600 A
rthr
ocen
tesi
s, a
spira
tion
and/
or inj
ectio
n, s
mal
l jo
int
or b
ursa
(eg
, fing
ers,
toe
s),
with
out
ultr
asou
nd g
uida
nce
20604 W
ith u
ltras
ound
gui
danc
e, w
ith p
erm
anen
t re
cord
ing
and
repo
rtin
g
(D
o no
t re
port
20600, 20604 in
con
junc
tion
with
76942)
20605
Art
hroc
ente
sis,
as
pira
tion
and/
or
inje
ctio
n,
inte
rmed
iate
jo
nt
or
burs
a (e
g,
tem
poro
man
dibu
lar,
wris
t, e
lbow
or
ankl
e, o
lecr
anon
bur
sa); w
ithou
t ul
tras
ound
gui
danc
e
20606 W
ith u
ltras
ound
gui
danc
e, w
ith p
erm
anen
t re
cord
ing
and
repo
rtin
g.
(Do
not
repo
rt 2
0605, 20606 in
con
junc
tion
with
76942)
20610 A
rthr
ocen
tesi
s, a
spira
tion
and/
or in
ject
ion,
maj
or jo
int
or b
ursa
(eg
, sh
ould
er,
hip,
kn
ee, su
bacr
omia
l bur
sa);
with
out
ultr
asou
nd g
uida
nce
20611 W
ith u
ltras
ound
gui
danc
e, w
ith p
erm
anen
t re
cord
ing
and
repo
rtin
g
(D
o no
t re
port
20610, 20611 in
con
junc
tion
with
27370, 76942)
OTH
ER P
RO
CED
URES
20982 A
blat
ion
ther
apy
for
redu
ctio
n or
era
dica
tion
of 1
or
mor
e bo
ne t
umor
s (e
g,
met
asta
sis)
incl
udin
g ad
jace
nt s
oft
tissu
e w
hen
invo
lved
by
tum
or e
xten
sion
, pe
rcut
aneo
us, in
clud
ing
imag
ing
guid
ance
whe
n pe
rfor
med
, ra
diof
requ
ency
20983
Cry
obla
tion
FRA
CTU
RE
AN
D/O
R D
ISLO
CA
TIO
N
21811 O
pen
trea
tmen
t of
rib
fra
ctur
e(s)
with
inte
rnal
fix
atio
n in
clud
es t
hora
cosc
opic
vi
sual
izat
ion
whe
n pe
rfor
med
uni
late
ral/
1-3
rib
s
21812
4-6
rib
s
21813
7 o
r m
ore
ribs
PERC
UTA
NEO
US V
ERTEB
RO
PLA
STY
AN
D V
ERTEB
RA
L A
UG
MEN
TA
TIO
N
22510 P
ercu
tane
ous
vert
ebro
plas
ty (bo
ne b
iops
y in
clud
ed w
hen
perf
orm
ed), 1
ver
tebr
al b
ody,
un
ilate
ral o
r bi
late
ral i
njec
tion,
incl
usiv
e of
all
imag
ing
guid
ance
cer
vico
thor
acic
22511
lum
bosa
cral
+
22512
each
add
ition
al c
ervi
otho
raci
c or
lum
bosa
cral
ver
tebr
al b
ody
(Lis
t se
para
tely
in
addi
tion
to c
ode
for
prim
ary
proc
edur
e)
22513 P
ercu
tane
ous
vert
ebra
l aug
men
tatio
n, in
clud
ing
cavi
ty c
reat
ion
(fra
ctur
e re
duct
ion
and
bone
bio
psy
incl
uded
whe
n pe
rfor
med
) us
ing
mec
hani
cal d
evic
e (e
g, k
ypho
plas
ty(, 1
ver
tebr
al
body
, un
ilate
ral o
r bi
late
ral c
annu
latio
n, in
clus
ive
of a
ll im
agin
g gu
idan
ce; th
orac
ic
22514
lum
bar
+22515
each
add
ition
al t
hora
cic
or lu
mba
r ve
rteb
ral b
ody
(Lis
t se
para
tely
in a
dditi
on t
o co
de f
or p
rimar
y pr
oced
ure)
ARTH
RO
DES
IS
27279 A
rthr
odes
is, sa
croi
liac
join
t, p
ercu
tane
ous
or m
inim
ally
inva
sive
(in
dire
ct v
isua
lizat
ion)
, w
ith im
age
guid
ance
, in
clud
es o
btai
ning
bon
e gr
aft
whe
n pe
rfor
med
, an
d pl
acem
ent
of
tran
sfix
ing
devi
ce
-
CP
T
CO
DI
NG
U
PD
AT
ES
2
01
5
4
Car
diov
ascu
lar Sys
tem
PA
CEM
AKER
OR IM
PLA
NTA
BLE
DEF
IBRIL
IATO
R
#33270 In
sert
ion
or r
epla
cem
ent
of p
erm
anen
t su
bcut
aneo
us im
plan
tabl
e de
fibril
lato
r sy
stem
, w
ith s
ubcu
tane
ous
elec
trod
e, in
clud
ing
defib
rilla
tion
thre
shol
d ev
alua
tion,
indu
ctio
n of
ar
rhyt
hmia
, ev
alua
tion
of s
ensi
ng f
or a
rrhy
thm
ia t
erm
inat
ion,
and
pro
gram
min
g or
rep
rogr
amm
ing
of s
ensi
ng o
r th
erap
eutic
par
amet
ers,
whe
n pe
rfor
med
.
#33271 In
sert
ion
of s
ubcu
tane
ous
impl
anta
ble
defibr
illat
or e
lect
rode
#33272 R
emov
al o
f su
bcut
aneo
us im
plan
tabl
e de
fibr
illat
or e
lect
rode
#33273 R
epos
ition
ing
of p
revi
ousl
y im
plan
ted
subc
utan
eous
impl
anta
ble
defibr
illat
or e
lect
rode
EXTRA
CO
RPO
REA
L M
EMBRA
NE
OX
YG
ENA
TIO
N O
R E
XTRA
CO
RPO
REA
L LI
FE
SU
PPO
RT S
ERV
ICES
Ex
trac
orpo
real
mem
bran
e ox
ygen
atio
n (E
CM
O)/ex
trac
orpo
real
life
sup
port
(EC
LS) pr
ovid
ed b
y ph
ysic
ian;
initia
tion;
ven
o-ve
nous
33947
initi
atio
n, v
eno-
arte
rial
33948
daily
man
agem
ent,
eac
h da
y, v
eno-
veno
us
33949
daily
man
agem
ent,
eac
h da
y, v
eno-
arte
rial
33951
inse
rtio
n of
per
iphe
ral (
arte
rial a
nd/o
r ve
nous
) ca
nnul
a(e)
, pe
rcut
aneo
us,
birt
h th
roug
h 5 y
ears
of
age
(incl
udes
flu
oros
copi
c gu
idan
ce, w
hen
perf
orm
ed)
33952
inse
rtio
n of
per
iphe
ral (
arte
rial a
nd/o
r ve
nous
) ca
nnul
a(e)
, pe
rcut
aneo
us,
6 y
ears
an
d ol
der
(incl
udes
flu
oros
copi
c gu
idan
ce, w
hen
perf
orm
ed)
33953
inse
rtio
n of
per
iphe
ral (
arte
rial a
nd/o
r ve
nous
) ca
nnul
a(e)
, op
en,
birt
h th
roug
h 5
year
s of
age
33954
inse
rtio
n of
per
iphe
ral (
arte
rial a
nd/o
r ve
nous
) ca
nnul
a(e)
, op
en,
6ye
ars
and
olde
r
33955
inse
rtio
n of
cen
tral
can
nula
(e)
by s
tern
otom
y or
tho
raco
tom
y, b
irth
thro
ugh
5
year
s of
age
33956
inse
rtio
n of
cen
tral
can
nula
(e)
by s
tern
otom
y or
tho
raco
tom
y, 6
yea
rs a
nd o
lder
33957
repo
sitio
n pe
riphe
ral (
arte
rial a
nd/o
r ve
nous
) ca
nnul
a(e)
, pe
rcut
aneo
us,
birt
h th
roug
h 5 y
ears
of
age
(incl
udes
flu
oros
copi
c gu
idan
ce, w
hen
perf
orm
ed)
33958
repo
sitio
n pe
riphe
ral (
arte
rial a
nd/o
r ve
nous
) ca
nnul
a(e)
, pe
rcut
aneo
us,
6 y
ears
an
d ol
der
(incl
udes
flu
oros
copi
c gu
idan
ce, w
hen
perf
orm
ed)
33959
repo
sitio
n pe
riphe
ral (
arte
rial a
nd/o
r ve
nous
) ca
nnul
a(e)
, op
en,
birt
h th
roug
h 5
year
s of
age
(in
clud
es f
luor
osco
pic
guid
ance
, w
hen
perf
orm
ed)
#33962
repo
sitio
n pe
riphe
ral (
arte
rial a
nd/o
r ve
nous
) ca
nnul
a(e)
, op
en, 6 y
ears
and
old
er
(incl
udes
flu
oros
copi
c gu
idan
ce,
whe
n pe
rfor
med
)
#33963
repo
sitio
n of
cen
tral
can
nula
(e)
by s
tern
otom
y or
tho
raco
tom
y, b
irth
thro
ugh
5
year
s of
age
(in
clud
es f
luor
osco
pic
guid
ance
, w
hen
perf
orm
ed)
#33964
repo
sitio
n of
cen
tral
can
nula
(e)
by s
tern
otom
y or
tho
raco
tom
y,
6 y
ears
and
ol
der
(incl
udes
flu
oros
copi
c gu
idan
ce,
whe
n pe
rfor
med
)
#33965
rem
oval
of
perip
hera
l (ar
tria
l and
/or
veno
us)
cann
ula(
e),
perc
utan
eous
, bi
rth
thro
ugh
5 y
ears
of
age
#33966
rem
oval
of
perip
hera
l (ar
tria
l and
/or
veno
us)
cann
ula(
e),
perc
utan
eous
, 6 y
ears
an
d ol
der
-
CP
T
CO
DI
NG
U
PD
AT
ES
2
01
5
5
#33969
rem
oval
of
perip
hera
l (ar
teria
l and
/or
veno
us)
cann
ula(
e),
open
, bi
rth
thro
ugh
5
year
s of
age
#33984
rem
oval
of
perip
hera
l (ar
teria
l and
/or
veno
us)
cann
ula(
e),
open
, 6 y
ears
and
old
er
#33985
rem
oval
of
cent
ral c
annu
la(e
) by
ste
rnot
omy
or t
hora
coto
me,
birt
h th
roug
h 5
year
s of
age
#33986
rem
oval
of
cent
ral c
annu
la(e
) by
ste
rnot
omy
or t
hora
coto
my,
6 y
ears
and
old
er
#+
33987 A
rter
ial e
xpos
ure
with
cre
atio
n of
gra
ft c
ondu
it (e
g, c
him
ney
graf
t) t
o fa
cilit
ate
arte
rial
perf
usio
n fo
r EC
MO
/EC
LS (Li
st s
epar
atel
y in
add
ition
to
code
for
prim
ary
proc
edur
e)
#33988 In
sert
ion
of le
ft h
eart
ven
t by
tho
raci
c in
cisi
on (eg
, st
erno
tom
y, t
hora
coto
my)
for
EC
MO
/EC
LS
#33989 R
emov
al o
f le
ft h
eart
ven
t by
tho
raci
c in
cisi
on (eg
, st
erno
tom
y, t
hora
coto
my)
for
EC
MO
/EC
LS
-
CP
T
CO
DI
NG
U
PD
AT
ES
2
01
5
6
Dig
estiv
e Sys
tem
EN
DO
SC
OPY
, STO
MA
4438
0 Ile
osco
py, t
hrou
gh s
tom
a; d
iagn
ostic
, inc
ludi
ng c
olie
ctio
n of
spe
cim
en(s
) by
brus
hing
or
was
hing
, whe
n pe
rfor
med
(se
para
te P
roce
dure
#44
381
w
ith tra
nsen
dosc
opic
bal
loon
dila
tion
#44
401
Col
onos
copy
thr
ough
sto
ma;
with
abl
atio
n of
tum
or(s
), p
olyp
(s), o
r ot
her le
sion
(s)
(incl
udes
pre
-and
pos
t-di
latio
n an
d gu
ide
wire
pas
sage
, w
hen
perf
orm
ed)
4440
2 w
ith e
ndos
copi
c st
ent p
lace
men
t (in
clud
ing
pre-
and
post
-dila
tion
and
guid
e w
ire
pass
age,
whe
n pe
rfor
med
)
4440
3 w
ith e
ndos
copi
c, m
ucos
al res
ectio
n
4440
4 w
ith d
irect
ed s
ubm
ucos
al in
ject
ion(
s), an
y su
bsta
nce
4440
5 w
ith tra
nsen
dosc
opic
bal
loon
dila
tion
4440
6 w
ith e
ndos
copi
c ul
tras
ound
exa
min
atio
n, lim
ited
to t
he s
igm
oid,
des
cend
ing,
tr
ansv
erse
, or
asc
endi
ng c
olon
and
cec
um a
nd a
djac
ent st
ruct
ures
4440
7 w
ith t
rans
endo
scop
ic u
ltras
ound
gui
ded
intr
amur
al o
r tr
ansm
ural
fin
e ne
edle
as
pira
tion/
biop
sy(s
), in
clud
es en
dosc
opic
ul
tras
ound
ex
amin
atio
n lim
ited
to th
e si
gmoi
d,
desc
endi
ng, tr
ansv
erse
, or as
cend
ing
colo
n an
d ce
cum
and
adj
acen
t st
ruct
ures
4440
8 w
ith de
com
pres
sion
(for
pa
thol
ogic
di
sten
tion)
(e
g, vo
lvul
us,
meg
acol
on),
incl
udin
g pl
acem
ent of
dec
ompr
essi
on tub
e, w
hen
perf
orm
ed
-
CP
T
CO
DI
NG
U
PD
AT
ES
2
01
5
7
#
45346 S
igm
oido
scop
y, f
lexi
ble;
with
abl
atio
n of
tum
or(s
), p
olyp
(s),
or
othe
r le
sion
(s)
(incl
udes
pre
-and
pos
t-di
latio
n an
d gu
ide
wire
pas
sage
, w
hen
perf
orm
ed)
45347
with
pla
cem
ent
of e
ndos
copi
c st
ent
(incl
udes
pre
- an
d po
st-
dila
tion
and
guid
e w
ire p
assa
ge,
whe
n pe
rfor
med
)
45349
with
end
osco
pic
muc
osal
res
ectio
n
45350
with
ban
d lig
atio
n(s)
(eg
, he
mor
rhoi
ds)
45388
Col
onos
copy
, fle
xibl
e; w
ith a
blat
ion
of t
umor
(s),
pol
yp(s
), o
r ot
her
lesi
on(s
) (in
clud
es p
re-a
nd p
ost-
dila
tion
and
guid
e w
ire p
assa
ge,
whe
n pe
rfor
med
)
45389
with
end
osco
pic
sten
t pl
acem
ent
(incl
udes
pre
-and
pos
t-di
latio
n an
d gu
ide
wire
pas
sage
, w
hen
perf
orm
ed)
#
45390
w
ith e
ndos
copi
c m
ucos
al r
esec
tion
45393
with
dec
ompr
essi
on (
for
path
olog
ic d
iste
ntio
n) (
eg,
volv
ulus
, m
egac
olon
),
incl
udin
g pl
acem
ent
of d
ecom
pres
sion
tub
e, w
hen
perf
orm
ed
#
45398
w
ith b
and
ligat
ion(
s) (
eg,
hem
orrh
oids
)
LAPA
RO
SC
OPY
#
45399 U
nlis
ted
proc
edur
e, c
olon
AN
US
46601 A
nosc
opy;
dia
gnos
tic, w
ith h
igh
reso
lutio
n m
agni
ficat
ion
(HRA
0 (eg
, co
lpos
cope
, op
erat
ing
mic
rosc
ope)
and
che
mic
al a
gent
enh
ance
men
t, in
clud
ing
colle
ctio
n of
spe
cim
en(s
) by
br
ushi
ng o
r w
ashi
ng, w
hen
perf
orm
ed
46607 w
ith h
igh-
reso
lutio
n m
agni
ficat
ion
(HRA
) (e
g, c
olpo
scop
e, o
pera
ting
mic
rosc
ope)
and
ch
emic
al a
gent
enh
ance
men
t, w
ith b
iops
y, s
ingl
e or
mul
tiple
LIV
ER/O
TH
ER P
RO
CED
URES
47383 A
blat
ion,
1 o
r m
ore
liver
tum
or(s
), p
ercu
tane
ous,
cry
oabl
atio
n
Decisio
n to
unde
rgo
Colono
scop
y
Diagno
stic
Proced
ure
Does Not Reach
Splenic Flexure
Flexible
Sigm
oido
scop
y (45330)
Beyond
Splen
ic
Flexure, But Not
To th
e Ce
cum
Colono
scop
y (45378;
Mod
ifier 53)
To Cecum
Colono
scop
y (45378, N
o Mod
ifier)
Therapeu
tic
Proced
ure
Does Not Reach
Splenic Flexure
Flexible
Sigm
oido
scop
y (45331
‐45347)
Beyond
Splen
ic
Flexure, But Not
To th
e Ce
cum
Colono
scop
y (45379
‐45398;
Mod
ifier 52)
To Cecum
Colono
scop
y (45379
‐45398;
No Mod
ifier)
-
CP
T
CO
DI
NG
U
PD
AT
ES
2
01
5
8
Urin
ary
Sys
tem
V
ESIC
AL
NEC
K A
ND
PRO
STA
TE
52441 C
ysto
uret
hosc
opy,
with
inse
rtio
n of
per
man
ent
adju
stab
le t
rans
pros
tatic
impl
ant;
si
ngle
impl
ant
+52442
each
add
ition
al p
erm
anen
t ad
just
able
tra
nspr
osta
tic im
plan
t (L
ist
sepa
rate
ly in
add
ition
to
code
for
prim
ary
proc
edur
e)
Ner
vous
Sys
tem
IN
JEC
TIO
N, D
RA
INA
GE,
OR A
SPI
RA
TIO
N
62302 M
yelo
grap
hy v
ia lu
mba
r in
ject
ion,
incl
udin
g ra
diol
ogic
al s
uper
visi
on a
nd
inte
rpre
tatio
n; c
ervi
cal
62302
thor
acic
62304
lum
bosa
cral
62305
2 o
r m
ore
regi
ons
(eg,
lum
bar/
lhor
acic
, ce
rvic
al/t
hora
cic,
lum
bar/
cerv
ical
, lu
mba
r/th
orac
ic/c
ervi
cal)
INTRO
DU
CTIO
N/IN
JEC
TIO
N O
F A
NES
TH
ETIC
AG
ENT (N
ERV
E BLO
CK
),
DIA
GN
OSTIC
OR T
HER
APE
UTIC
64486 T
rans
veru
s ab
dom
inis
pla
ne (
TA
P) b
lock
(ab
dom
inal
pla
ne b
lock
, re
ctus
she
ath
bloc
k) u
nila
tera
l by
inje
ctio
n(s)
i(in
clud
es im
agin
g gu
idan
ce,
whe
n pe
rfor
med
)
64487 b
y co
ntin
uous
infu
sion
(s)
(incl
udes
imag
ing
guid
ance
whe
n pe
rfor
med
)
64488 T
rans
vers
us a
bdom
inis
pla
ne (
TA
P) b
lock
(ab
dom
inal
pla
ne b
lock
, re
ctus
she
ath
bloc
k) b
ilate
ral,
by in
ject
ions
(in
clud
es im
agin
g gu
idan
ce, w
hen
perf
orm
ed)
64489 b
y co
ntin
uous
infu
sion
s (in
clud
es im
agin
g gu
idan
ce,
whe
n pe
rfor
med
)
Eye
and
Ocu
lar A
ndex
a
AQ
UEO
US S
HU
NT
66179 A
queo
us s
hunt
to
extr
aocu
lar
equa
toria
l pla
te r
eser
voir,
ext
erna
l app
roac
h;
with
out
graf
t
66185
with
gra
ft
-
CP
T
CO
DI
NG
U
PD
AT
ES
2
01
5
9
Rad
iolo
gy/D
iagn
ostic
Ultr
asou
nd
CH
EST
76641 U
ltras
ound
, br
east
, un
ilate
ral,r
eal t
ime
with
imag
e do
cum
enta
tion,
incl
udin
g ax
illa
whe
n pe
rfor
med
; co
mpl
ete
76642
limite
d
BREA
ST,
MA
MM
OG
RA
PHY
77061 D
igita
l bre
ast
tom
osyn
thes
is;
unila
tera
l
77062
bila
tera
l
+
77063 S
cree
ning
dig
ital b
reas
t to
mos
ynth
esis
, bi
late
ral (
List
sep
arat
ely
in a
dditi
on t
o co
de f
or p
rimar
y pr
oced
ure)
(U
se 7
7063 in
con
junc
tion
with
77057)
RA
DIA
TIO
N T
REA
TM
ENT D
ELIV
ERY
#77385 In
tens
ity m
odul
ated
rad
iatio
n tr
eatm
ent
deliv
ery
(IMRT),
incl
udes
gui
danc
e an
d tr
acki
ng,
whe
n pe
rfor
med
; si
mpl
e
#77386
com
plex
#77387 G
uida
nce
for
loca
lizat
ion
of t
arge
t vo
lum
e fo
r de
liver
y of
rad
iatio
n tr
eatm
ent
deliv
ery,
incl
udes
intr
afra
ctio
n tr
acki
ng,
whe
n pe
rfor
med
BO
NE/
JOIN
T S
TU
DIE
S
#770
85 D
ual-e
nerg
y X
-ray
abs
orpt
iom
etry
(D
XA
), b
one
dens
ity s
tudy
, 1 o
r m
ore
site
s; a
xil
skel
eton
(eg
, pe
lvis
, sp
ine)
, in
clud
ing
vert
ebra
l fra
ctur
e as
sess
men
t
#770
86 V
erte
bral
fra
ctur
e as
sess
men
t vi
a du
al-e
nerg
y X
-ray
abs
orpt
iom
etry
(D
XA
)
MED
ICA
L RA
DIA
TIO
N P
HY
SIC
S, D
OSIM
ETRY
, TREA
TM
ENT D
EVIC
ES,
AN
D
SPE
CIA
L SER
VIC
ES
7730
6 Te
leth
erap
y is
odos
e pl
an; si
mpl
e (1
or
2 un
mod
ified
por
ts d
irect
ed t
o a
sing
le a
rea
of
inte
rest
,) in
clud
es b
asic
dos
imet
ry c
alcu
latio
n(s)
7730
7
com
plex
(m
ultip
le tr
eatm
ent
area
s, ta
ngen
tial
prot
s, th
e us
e of
w
edge
s,
bloc
king
, ro
tatio
nal
beam
, or
sp
ecil
beam
co
nsid
erat
ions
).
Incl
udes
ba
sic
dosi
met
ry
calc
ulat
ion(
s)
7731
6 Br
achy
ther
apy
isod
ose
plan
; sim
ple
(cal
cula
tion(
s) m
ade
from
1 to
4 s
ourc
es, o
r rem
ote
afte
rload
ing
brad
ythe
rapy
, 1
chan
nel),
incl
udes
bas
ic d
osim
etry
cal
cula
tion(
s)
7731
7
inte
rmed
iate
(ca
lcul
atio
n(s)
mad
e fr
om 5
to 1
0 so
urce
s, o
r rem
ote
afte
rload
ing
brac
hyth
erap
y, 2
-*12
cha
nnel
(s), in
clud
es b
asic
dos
imet
ry c
alcu
latio
n(s)
7731
8
com
plex
(ca
lcul
atio
n(s)
mad
e fr
om o
ver
10 s
ourc
es o
r re
mot
e af
terlo
adin
g br
achy
ther
apy,
ove
r 12
cha
nnel
(s) in
clud
es b
asic
dos
imet
ry c
alcu
latio
n(s)
-
CP
T
CO
DI
NG
U
PD
AT
ES
2
01
5
10
Path
olog
y an
d La
bora
tory
PR
ESU
MPT
IVE
DRU
G C
LASS S
CREE
NIN
G
#80300 D
rug
scre
en ,
any
num
ber
of d
rug
clas
ses
from
Dru
g C
lass
Lis
t A
; an
y nu
mbe
r of
non
-TLC
dev
ices
or
proc
edur
es,
(eg
imm
unoa
ssay
) ca
pabl
e of
bei
ng#
rea
d by
dire
ct o
ptic
al o
bser
vatio
n, in
clud
ing
inst
rum
ente
d-as
sist
ed w
hen
perf
orm
ed (
eg,
dips
ticks
, cu
ps,
card
s, c
artr
idge
s),
per
date
of
serv
ice
#80301
sing
le d
rug
clas
s m
etho
d, b
y in
stru
men
ted
test
sys
tem
s (e
g, d
iscr
ete
mul
ticha
nnel
che
mis
try
anal
yzer
s ut
ilizi
ng im
mun
oass
ay o
r en
zym
e as
say)
, pe
r da
te o
f se
rvic
e
# 8
0302 D
rug
scre
en,
pres
umpt
ive,
sin
gle
drug
cla
ss f
rom
Dru
g C
lass
Lis
t B,
by
imm
unoa
ssay
(eg
, EL
ISA
) or
non
-TLC
chr
omat
ogra
phy
with
out
mas
s sp
ectr
omet
ry (
eg,
GC
, H
PLC
), e
ach
proc
edur
e
#80303 D
rug
scre
en,
any
num
ber
of d
rug
clas
ses,
pre
sum
ptiv
e, s
ingl
e or
mul
tiple
dru
g cl
ass
met
hod;
thi
n la
yer
chro
mat
ogra
phy
proc
edur
e(s)
(TLC
) (e
gm a
cid,
neu
tral
, al
kalo
id
plat
e),
per
date
of
serv
ice
#80304
not
othe
rwis
e sp
ecifi
ed p
resu
mpt
ive
proc
edur
e (d
g, T
OF,
MA
LDI,
LDTD
, D
ESI,
DA
RT),
eac
h pr
oced
ure
DEF
INIT
IVE
DRU
G T
ESTIN
G
#80320 A
lcoh
ols
#80321 A
lcoh
ol b
iom
arke
rs;
1 o
r 2
#80322
3 o
r m
ore
#80323 A
lkal
oids
, no
t ot
herw
ise
spec
ified
#80324 A
mph
etam
ines
; 1 o
r 2
#80325
3 o
r 4
#80326
5 o
r m
ore
#80327 A
nabo
lic s
tero
ids;
1 o
r 2
#80328
3 o
r m
ore
#80329 A
nage
sics
, no
n-op
iod;
1 o
r 2
#80330
3-5
#80331
6 o
r m
ore
#80332 A
ntid
epre
ssan
ts,
sero
tone
rgic
cla
ss;
1 o
r 2
#80333
3-5
#80334
6 o
r m
ore
#80335 A
ntid
epre
ssan
ts,
tric
yclic
and
oth
er c
yclic
als;
1 o
r 2
#80336
3-5
#80337
6 o
r m
ore
#80338 A
ntid
epre
ssan
ts,
not
othe
rwis
e sp
ecifi
ed
#80339 A
ntie
pile
ptic
s, n
ot o
ther
wis
e sp
ecifi
ed;
1-3
#80340
4-6
#80341
7 o
r m
ore
#80342 A
ntip
sych
otic
s, n
ot o
ther
wis
e sp
ecifi
ed;
1-3
#80343
4-6
#80344
7 o
r m
ore
#80345 B
arbi
tura
tes
-
CP
T
CO
DI
NG
U
PD
AT
ES
2
01
5
11
#80346 B
enzo
diaz
epin
es;
1-1
2
#80347
13 o
r m
ore
#80348 B
upre
norp
hine
#80349 C
anna
bino
ids,
syn
thet
ic,
1-3
#80350 C
anna
bino
ids,
syn
thet
ic;
1-3
#80351
4-6
#80352
7 o
r m
ore
#80353 C
ocai
ne
#80354 F
enta
nyl
#80355 G
abap
entin
, no
n-bl
ood
#80356 H
eroi
n m
etab
olite
#80357 K
etam
ine
and
nork
etam
ine
#80358 M
etha
done
#80359 M
ethy
lene
diox
yam
phet
amin
es (
MD
A,
MD
EA,
MD
MA
)
#80360 M
ethy
lphe
nida
te
#80361 O
piat
es,
1 o
r M
ore
#80362 O
piod
s an
d op
iate
ana
logs
, 1 o
r 2
#80363
3 o
r 4
#80364
5 o
r m
ore
#80365 O
xyco
done
#80366 P
rega
balin
#80367 P
ropo
xyph
ene
#80368 S
edat
ive
hypn
otic
s (n
on-b
enzo
diaz
epin
es)
#80369 S
kele
tal m
uscl
e re
laxa
nts;
1 o
r 2
#80370
3 o
r m
ore
#80371 S
timul
ants
, sy
nthe
tic
#80372 T
apen
tado
l
#80373 T
ram
adol
#80374 S
tere
oiso
mer
(en
antio
mer
) an
alys
is,
sing
le d
rug
clas
s
#80375 D
rug(
s) o
r su
bsta
nce(
s),
defin
itive
, qu
alita
tive
or q
uant
itive
, no
t ot
herw
ise
spec
ified
; 1-3
#80376
4-6
#80377
7 o
r m
ore
TH
ERA
PEU
TIC
DRU
G A
SSA
YS
80163 D
igox
in;
free
#80165 V
alpr
oic
acid
(di
prop
ylac
etic
aci
d);
free
MO
LEC
ULA
R P
ATH
OLO
GY
81246 F
LT3 (
fms-
rela
ted
tyro
sine
kin
ase
3)
(eg,
acu
te m
yelo
id le
ukem
ia),
gen
e an
alys
is;
tyro
sine
kin
ase
dom
ain
(TK
D)
varia
nts
(eg,
D835,
I836)
#81288 M
LH1 (
mut
L ho
mal
og 1
, co
lon
canc
er,
nonp
olyp
osis
typ
e 2)
(eg,
her
edita
ry
non-
poly
posi
s co
lore
ctal
can
cer,
Lyn
ch s
yndr
ome)
gen
e an
alys
is;
prom
oter
met
hyla
tion
anal
ysis
81313 P
CA
3/K
LK3 (
pros
tate
can
cer
antig
en 3
[no
n-pr
otei
n co
ding
]/ka
llikr
ein-
rela
ted
pept
ides
3 [
pros
tate
spe
cific
ant
igen
]) r
atio
(eg
, pr
osta
te c
ance
r)
-
CP
T
CO
DI
NG
U
PD
AT
ES
2
01
5
12
GEN
OM
IC S
EQU
ENC
ING
PRO
CED
URES
AN
D O
TH
ER M
OLE
CU
LAR M
ULT
IAN
ALY
TE
ASSA
YS
81410 A
ortic
dys
func
tion
or d
ilatio
n (e
g, M
arfa
n sy
ndro
me,
Loe
ys D
ietz
syn
drom
e,
Ehle
r D
anlo
s sy
ndro
me
type
IV,
arte
rial t
ortu
osity
syn
drom
e);
geno
mic
seq
uenc
e an
alys
is p
anes
, m
ust
incl
ude
sequ
enci
ng o
f at
leas
t 9 g
enes
, in
clud
ing
FBN
1,
TG
FBR1,
TG
FBR2,
CO
L3A
1,
MY
H1,
AC
TA
2,
SLC
2A
10,
SM
AD
3,
and
MY
LK
81411
du
plic
atio
n/de
letio
n an
alys
is p
anel
, m
ust
incl
ude
anal
yses
for
TG
FBR1,
TG
FBR2,
MY
H11,
and
CO
L3A
1
81415 E
xom
e (e
g, u
nexp
lain
ed c
onst
itutio
nal o
r he
ritab
le d
isor
der
or s
yndr
ome0
; se
quen
ce a
naly
sis
+81416
sequ
ence
ana
lysi
s, e
ach
com
para
tor
exom
e (e
g, p
aren
ts,
sibl
ings
) (li
st
sepa
rate
ly in
add
ition
to
code
for
prim
ary
proc
edur
e)
81417
re-e
valu
atio
n of
pre
viou
sly
obta
ined
exo
me
sequ
ence
(eg
, up
date
d kn
owle
dge
or u
nrel
ated
con
ditio
n/sy
ndro
me)