AAHAM Western Region December 2014.ppt · AAHAM Western Region December 11, 2014 Presented by...

AAHAM Western Region December 11, 2014

Presented by Terrance Wong and Associates 1

12/11/2014

Chargemaster Changes for 2015

AAHAM Western RegionDecember 11, 2014

Presented by:

Terrance WongTerrance Wong & AssociatesHealthcare Financial Consultants350 Augusta DrivePalm Desert, CA 92211(760) [email protected]

www.terrancewongandassociates.com

12/11/2014


The slides from this presentation are intended to be used in conjunction with the speaker’s oral presentation. Some slides may be designed to illustrate inappropriate or erroneous examples. Consequently, the use of these handouts by themselves could be misleading.

The slides in this presentation do not represent all of the CPT, HCPCS codes and Medicare OPPS changes for 2015, but rather a selection by the speaker for this presentation.

Current Procedural Terminology (CPT®) copyright2014 American Medical Association. All Rights Reserved

12/11/2014

2015 Review

Acute Care Hospital Chargemasters

Sources of Issues AMA CPT Code Book - 2015 AMA Changes/An Insider’s View – CPT 2015 Final Rules for OPPS Clinical Laboratory Fee Schedule (CLFS) Final

Determinations

Medi-Cal will not be adopting 2015 CPT and HCPCS code changes on January 1, 2015



12/11/2014

2015 Review

Two Handouts Copies of Slides 2015 Annual Update – Notes

Note number refers to our internal numbering Not all notes are in this document, only those selected for this

presentation

160 Notes

Note 004Arthrocentesis, Aspiration and/or Injection

Three CPT codes revised

Three CPT codes added

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Prior to 2015 CPT code 20600 = small joint or bursa CPT code 20605 = intermediate joint or bursa CPT code 20610 = major joint or bursa Any radiology guidance was reported in addition

For 2015 Existing CPT codes 20600, 20605 and 20610 revised

to specify without ultrasound guidance New CPT codes 20604, 20606 and 20611 specify with

ultrasound guidance and permanent recording and reporting

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CPT code 76942 – Ultrasound guidance should no longer be reported separately Instead, use new CPT code 20604, 20606 or 20611 as

appropriate

Fluoroscopic, CT and MRI guidance can still be reported separately Use with revised CPT code 20600, 20605 or 20610 as

appropriate

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Note 006Closed Treatment of Rib Fracture, Uncomplicated

CPT code deleted, not replaced

To report, use or include when factoring the selection of evaluation and management code.

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Note 012Laryngoscopy with Injection Into Vocal Cord(s)

HCPCS code C9742 added

CPT code 31575 is the basis for the search, but does not necessarily mean (most likely does not mean) a code change in the CDM



12/11/2014

Note 013 Implantable Defibrillators

Two Categories Transvenous implantable pacing cardioverter-

defibrillator (ICD) Subcutaneous implantable defibrillator (S-ICD)

Descriptor revisions for CPT codes in this note provides a contrast for new subcutaneouscodes in Note 014.

A table has been created in CPT 2015 to guide in the use of Pacemaker and Implantable Defibrillator codes

Note 014Subcutaneous Implantable Defibrillator Electrodes

Prior to 2015 CPT Category III codes used

Separate codes for insertion of S-ICD Separate codes for EP Evaluation, Interrogation

Device Evaluation and Programming Device Evaluation

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Note 014Subcutaneous Implantable Defibrillator Electrodes

Seven CPT Category III codes deleted Replaced with four CPT codes

33270 – addresses insertion or replacement of system and electrodes and evaluations and programming, when performed

33271 – addresses insertion (only) of electrode 33272 – addresses removal (only) of electrode 33272 – addresses repositioning (only) of electrode

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Note 022 Transcatheter Placement of Intravascular

Stent(s), Cervical Carotid Artery

Two CPT codes revised

Revised from just percutaneous to open or percutaneous

Revised to specify including angioplasty, when performed and radiological supervision and interpretation

“Open” is new “Angioplasty when performed” new “Radiological S&I” had been previously included

through parenthetical notes

12/11/2014

Note 035 Ablation Liver Tumor(s), Percutaneous,

Cryoablation

One CPT code added

Search by 47382, but does constitute a code change 47382 – Ablation liver tumor, percutaneous by

radiofrequency

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Note 042 Spine Myelography

Prior to 2015 Report injection procedure using surgical CPT code

62284 Report imaging procedure using radiology CPT code

(72240, 72255, 72265 or 77270)

For 2015 Existing CPT codes intact Four CPT codes added for myelography CPT codes 62302, 62303, 62304 and 62305 includes

both injection and radiological supervision and interpretation designed for when the same physician performs both the

injection procedure and the radiological supervision and interpretation



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Note 042 Spine Myelography

For myelography procedure performed by two separate physicians, use 2014 protocol: 62284 for injection procedure, lumbar 72240, 72255, 72265 or 72270, as appropriate, for

radiological supervision and interpretation

Search by 72240, 72255, 72265 and 72270 does not necessarily constitute code changes

12/11/2014

Note 050 Vertebroplasty, Vertebral Augmentation & Sacral

Augmentation

Vertebroplasty Three surgical CPT codes deleted Two radiology CPT codes deleted Three CPT codes added

Includes imaging guidance Anatomic regions revised

Vertebral Augmentation Three surgical CPT codes deleted Two radiology CPT codes deletes (same as above) Three CPT codes added

Includes imaging guidance

12/11/2014

Note 050 Vertebroplasty, Vertebral Augmentation & Sacral

Augmentation

Sacral Augmentation (Sacroplasty) Two radiology CPT codes deleted (same as before) Two CPT Category III codes revised

Includes imaging guidance when performed



12/11/2014

Note 052 Ultrasound - Breast

One CPT code deleted Had previously indicated unilateral or bilateral

Two CPT codes added Both codes represent unilateral only One represents complete

study of all four quadrants study of retroareolar region study of axilla, if performed

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Note 052 Ultrasound - Breast

One represents limited a focused ultrasound exam study of one or more, but not all elements of complete

exam study axilla, if performed

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Note 056 Teletherapy Isodose Plan

Three CPT codes deleted Had previously indicated simple, intermediate &

complex Previous protocol called for basic dosimetry

calculations to be reported separately using CPT code 77300.

Two CPT codes added Simple (1 or 2 unmodified ports directed to a single

area of interest) Complex (multiple treatment areas, tangential ports,

the use of wedges, blocking, rotational beam, or special beam considerations)

Both include basic dosimetry calculations



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Note 056 Teletherapy Isodose Plan

CPT code 77300 (basic dosimetry calculations) should not be reported with 77306 or 77307

Need to redefine the teletherapy isodose plancharges based on new code definitions

12/11/2014

Note 057 Brachytherapy Isodose Plan

Three CPT codes deleted Previous protocol called for basic dosimetry

calculations to be reported separately using CPT code 77300.

Three CPT codes added New codes include basic dosimetry calculations

CPT code 77300 (basic dosimetry calculations) should not be reported with 77316, 77317 or 77318

12/11/2014

Note 059Radiation Treatment Delivery

Nine CPT codes deleted Previously represented delivery criteria Previously used various energy levels (MeV)

Four CPT codes revised Assigned complexity level (defined by delivery

criteria) Any energy level one MeV or greater



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Complexity Levels

Simple – All of the following criteria are met (and none of the complex or intermediate criteria are met): single treatment area, one or two ports, and two or fewer simple blocks

Intermediate – All of the following criteria are met (and none of the complex criteria are met):2 separate treatment areas, 3 or more ports on a single treatment area, or 3 or more simple blocks

12/11/2014


Complex – 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, field-in-field or other tissue compensation that does not meet IMRT guidelines, or electron beam

Complexity levels similar to previous delivery criteria, but not exact.

12/11/2014

Note 060 Intensity Modulated Radiation Treatment (IMRT)

Delivery

One CPT code and one CPT Category III code deleted

Two CPT codes added Based on two complexity levels

Simple – Any of the following: prostate, breast, and all sites using physical compensator based IMRT

Complex – Includes all other sites if not using physical compensator based IMRT



12/11/2014

Note 061 Imaging Guidance for Target Volume for Delivery

of Radiation Treatment Therapy

Two CPT codes and one CPT Category III code deleted

One CPT code added Non-specific as to modality of guidance

12/11/2014

Notes 063, 064 & 084Laboratory – Drug Assays

Drug Assays Presumptive Drug Class Definitive Drug Class

Therapeutic Drug Assays

Chemistry

12/11/2014

Note 063Presumptive Drug Class Screening

Five CPT codes deleted Only two had been previously used by Medicare

Five CPT codes added None of which will be used by Medicare



12/11/2014


Characteristics of New CPT codes Drug Class

From Drug Class List A From Drug Class List B

Methodology within Drug Class Non-TLC ( non-thin layer chromatography) TLC (thin layer chromatography)

Number of Drug Classes Any number Single

Service Unit Per date of service Each procedure

12/11/2014


Medicare will continue using HCPCS codes G0431 – Drug screen, qualitative; multiple drug

classes by high complexity test method, per patient encounter

G0434 – Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter

To replace deleted CPT code 80102, Medicare will adopt new HCPCS code G6058 – Drug confirmation, each procedure

12/11/2014

Note 064 Definitive Drug Testing

27 CPT codes deleted

58 CPT codes added None of which will be used by Medicare



12/11/2014


Characteristics of New CPT codes Move from specific drugs to drug classes Most based on the number of reported analytes Code can be reported only once per date of service

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Medicare will not be using the new structure and new CPT codes for Definitive Drug Testing

Medicare will continue using a structure based on specific drug or existing drug class

For each of the 27 deleted CPT codes, Medicare has created a new Level II HCPCS code (G-code)

12/11/2014

Note 065 - 083 Specific Definitive Drug Testing Codes

Notes 065 through 083 crosswalk deleted CPT codes to

Revamped Drug Class CPT code(s) (in most cases there is more than one CPT code from which to choose, based on the number of analytes

New Level II HCPCS codes used by Medicare



12/11/2014

Notes 084 – 086Therapeutic Drug Assays

Six CPT codes deleted Replacement CPT codes addressed in Definitive Drug

Testing section

Medicare will continue using existing and new CPT codes for TDA

12/11/2014


Used to monitor clinical responses to known prescribed medication

Specimen for procedure is whole blood, serum, plasma, or cerebral spinal fluid

Reporting of digoxin (note 084) and valporic acid (note 085) revised Existing codes revised to represent total A CPT code added for each to represent free

12/11/2014


Gabapentin was revised to reflect whole blood, serum and plasma as the only specimens allowed when using this code (note 86)



12/11/2014

Note 098 Column Chromatography/Mass Spectrometry

Four CPT codes revised Codes represent a methodology of an analyte not

elsewhere specified Text was added to specify non-drug analyte Text revision is a product of the Drug Assay codes

being revamped Parenthetical notes added referring the use of Drug

Assay codes and/or specific analyte codes in Chemistry for drug analytes

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Note 109 Volatiles

One CPT code revised Removed as parenthetical examples are

Carbon tetrachloride Dichlorethane Dichlomethane Isopropyl alcohol Methanol

Text revision is a product of the Drug Assay codes being revamped

12/11/2014

Note 109 Volatiles

Use existing CPT code 82441 – Chlorinated hydrocarbons, screen for Carbon tetrachloride Dichlorethane Dichlomethane

CPT payers use new CPT code 80320 – Alcohols for Isopropyl alcohol Methanol

Medicare continues to use CPT code 84600



12/11/2014

Note 112 Infectious Agent Detection by Nucleic Acid for

Influenza Virus

Three CPT codes revised 87501 – descriptor revised so that the use of reverse

transcription is included when performed

87502 & 87503 – descriptors revised to clarify that amplified probe technique is also multiplex

12/11/2014

Note 114Human Papillomavirus (HPV)

Three CPT codes deleted Based on technique

Direct probe technique Amplified probe technique Quantification

Three CPT codes added Based on risk type

Low-risk type (e.g. 6, 11, 42, 43, 44) High-risk type (e.g. 16, 18, 31, 33, 35, 39, 45, 51, 52, 56,

58, 59, 68) Types 16 and 18 only, and includes 45, if performed

12/11/2014

Note 114Human Papillomavirus (HPV)

If both low- and high-risk HPV types are performed in a single assay, only one code should be reported, 87624, the high risk code



12/11/2014

Note 115 Infectious Agent Detection by Nucleic Acid for

Respiratory Virus

Three CPT codes revised 87631, 87632 & 87633 – descriptor revised so that

the use of reverse transcription is included when performed

87631, 87632 & 87633 – descriptors revised to clarify that amplified probe technique is also multiplex

12/11/2014

Note 120Morphometric Analysis, Tumor

Immunocytochemistry

Two codes revised

88360 & 88361 revised from each antibody to per specimen, each single antibody stain procedure

Technology allows for multiple antibodies to be tested per specimen Only one unit of service should be reported per specimen Likely requires restructuring of price of any current charge

12/11/2014

Note 121 In Situ Hybridization

One CPT code revised 88365 revised from each probe to per specimen;

initial single probe stain procedure

Two CPT codes added

88364 as add-on code for each additional single probe stain procedure

88366 for each multiplex probe stain procedure



12/11/2014

Note 122 Morphometric Analysis,

In-Situ Hybridization, Computer-Assisted Technology



Two CPT codes added



12/11/2014

Note 123 Morphometric Analysis,

In-Situ Hybridization, Manual



Two CPT codes added



12/11/2014

Note 126Human Papillomavirus Vaccine

One CPT code added For HPV types 6, 11, 16, 18, 31, 33, 45, 52, 58,

nonavalent, 3 dose schedule

Pending FDA approval



12/11/2014

Note 127Influenza Vaccine

One CPT code revised 90654 revised from non-specific to trivalent (IIV3)

One CPT code added 90630 added for quadrivalent (IIV4) Pending FDA approval Intended to replace last season’s vaccine

12/11/2014

Note 135 Implantable Defibrillator Evaluations

Two Categories Transvenous implantable pacing cardioverter-

defibrillator (ICD) Subcutaneous implantable defibrillator (S-ICD)

Descriptor revisions for CPT codes in this note provides a contrast for new subcutaneouscodes in Note 136.

12/11/2014

Note 136 Subcutaneous Implantable Defibrillator

Evaluations

Three CPT Category III codes deleted Three CPT codes added

In support of CPT codes being added specific to insertion, removal and repositioning of a subcutaneous implantable defibrillator (note 14) CPT codes added for programming, interrogation and electrophysiologic evaluation of a subcutaneous implantable defibrillator



12/11/2014

Note 139 Echocardiography, Transesophageal (TEE)

One CPT code added 93355 for transesophageal echocardiography during

interventional cardiac procedures

Existing TEE codes should not be used in conjunction with interventional cardiac procedures

12/11/2014

Note 145Negative Pressure Wound Therapy

Two Level II HCPCS codes deleted G0456 & G0457 for procedures using a mechanically-

powered device, not durable equipment

Two CPT codes revised Existing CPT codes 97605 & 97606 revised to

represent utilizing durable medical equipment (DME)

Two CPT codes added 97607 & 97608 added to represent utilizing

disposable, non-durable medical equipment

Note 146Hyperbaric Oxygen

One HCPCS code deleted One HCPCS code added

Exchange HCPCS code C1300 for G0277 Exact same descriptor, including time element of per 30 minutes.

12/11/2014



Note 146Hyperbaric Oxygen

CPT code 99183 continues to exist for CPT payers (per session)

Level III HCPCS codes continue to exist for Medi-Cal Z7606 – 1st 15 minutes Z7608 – subsequent 15 minutes

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Note 150Drug Codes – Deleted & Replaced

Temporary codes replaced with a more permanent new HCPCS code

Some codes include a change in reporting dose Note change in dose for codes shaded in

note box

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Note 151Drugs/Biologicals Added

Codes added for drugs and biologicals not elsewhere noted



12/11/2014

Note 154Biologicals Added

Codes added for biologicals not elsewhere noted

12/11/2014

Note 156Status Indicator Changes - Favorable

Favorable Light Packaged (N) to Payable (A, F, G, K and L) Non-reportable (B, E and M) to Payable (A,

F, G, K and L) Non-reportable (B, E and M) to Packaged

(N)

See extended note page

12/11/2014

Note 157Status Indicator Changes – Unfavorable

Unfavorable Light Payable (A, F, G, K and L) to Non-reportable

(B, E and M) Packaged (N) to Non-reportable (B, E and

M) Payable (A, F, G, K and L) to Packaged (N)

See extended note page



12/11/2014

Note 160Medicare – Modifier 59 Subsets

59 - Distinct Procedural Service Four subsets of Modifier 59 created

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

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XP – Separate Encounter, a service that is distinct because it was performed by a different practitioner

XU – Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service

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Use in place of 59, not in addition to 59

Modifier 59 can still be reported by itself, but subset modifiers provide a better explanation



12/11/2014


Reference: CMS Transmittal 1422, dated August 14, 2014

http://www.cms.gov/Regulations‐and‐Guidance/Guidance/Transmittals/Downloads/R1422OTN.pdf

12/11/2014

Medi-Cal Reminder

2015 CPT and HCPCS codes adds, revisions and deletions not applicable to Medi-Cal.

2014 CPT and HCPCS codes still in effect for Medi-Cal for services on or after 01-01-15.

12/11/2014


AAHAM Western RegionDecember 11, 2014

Presented by:

Terrance WongTerrance Wong & AssociatesHealthcare Financial Consultants350 Augusta DrivePalm Desert, CA 92211(760) [email protected]

www.terrancewongandassociates.com

AAHAM Western Region December 2014.ppt · AAHAM Western Region December 11, 2014 Presented by...

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