January 2014 Jean C. Russell, MS, RHIT [email protected]@epochhealth.com Richard...

January 2014

Jean C. Russell, MS, RHIT [email protected]

Richard Cooley, BA, CCS [email protected]

Matthew H. Lawney MSPT, MBA, CHC, [email protected]

518-430-1144

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Agenda• Breast Biopsy Procedures• Pacemaker, Cardiac Defibrillators• Angiography• Vascular Embolism and Occlusion• Questions and Discussion

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Increased Packaging for Imaging Guidance

CMS is considering conditionally packaging all imaging services performed with a surgical procedure

Comments have been requestedThis is also an increasing pattern under CPT

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Pre-Op Needle Localization• The following codes are deleted:

– 19290 – Preoperative needle placement, breast

– 19291 – Each additional– 77031 - Stereotactic guidance for breast

bx or needle placement, each lesion– 77032 – Mammo guidance for needle

placement, each lesion

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Pre-Op Needle Localization• The following codes are not deleted, but cannot

be reported for breast biopsy guidance:– 76942 – US guidance for needle placement or

biopsy– 77021 – MRI guidance for needle placement

of biopsy

• The following codes are not deleted, but cannot be reported for breast biopsy specimen exams:– 76098 – Radiologic exam of surgical

specimen– 76999 – US exam of surgical specimen

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Placement of Localization Devices w/o the Biopsy

The following codes are new in 2014:19281 – Placement of localization device (e.g., clip, wire), first

lesion, using mammographic guidance 19282 – Each additional lesion

19283 – Placement of localization device (e.g., clip, wire), first lesion, using stereotactic guidance 19284 – Each additional

19285 – Placement of localization device (e.g., clip, wire), first lesion, using ultrasound guidance 19286 – Each additional

19287 – Placement of localization device (e.g., clip, wire), first lesion, using MRI guidance 19288 – Each additional

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Pre-Op Needle Localization Breast Bx

• 19125 and 19126+, excision breast lesion identified by pre-op needle loc, open, have not been changed

• Pre-op needle placement (19290/19291) has been replaced:– 19281/19282, stereotactic guidance replaces

19290/19291/19295/77032• 19283/19284, ultrasound guidance replaces

19290/19291/19295/77031• 19285/19286, MRI guidance replaces

19290/19291/77021

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Breast Bx Under Guidance• The following codes are deleted:

– 19102 – Bx of breast, needle core, using imaging

– 19103 – Bx of breast, vacuum assisted, using imaging

– 19295 – Image guided placement of a clip during breast bx/aspiration, report in addition to primary procedure

– 77031 - Stereotactic guidance for breast bx or needle placement, each lesion

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Breast Bx Under Guidance• The following codes are not deleted, but cannot be

reported for breast biopsy guidance:– 76942 – US guidance for needle placement or

biopsy– 77021 – MRI guidance for needle placement of

biopsy

• The following codes are not deleted, but cannot be reported for breast biopsies:– 76098 – Rad exam of surgical specimen– 76999 – Us exam of surgical specimen

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Breast Bx Under Guidance• The following codes are new in 2014 (19102/19103):

– 19081 – Bx breast, w/ placement of localization device (e.g., clip), and imaging of the biopsy specimen, first lesion, using stereotactic guidance• 19082 – Each additional lesion

– 19083 – Bx breast, w/ placement of localization device (e.g., clip), and imaging of the biopsy specimen, first lesion, using ultrasound guidance• 19084 – Each additional

– 19085 – Bx breast, w/ placement of localization device (e.g., clip), and imaging of the biopsy specimen, first lesion, using MRI guidance• 19086 – Each additional

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Breast Bx Under GuidanceNew codes include:

Image guided biopsyPlacement of localization deviceGuidance – whether stereotactic, US, or MRIPlacement of post-op clip (19295)Imaging of the biopsy specimen (76098)

If more than one imaging is performed, report the additional procedure for each additional modality

If an open, incisional biopsy is performed after image guided biopsy, report 19101, bx breast, open, incisional

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Breast Bx Without GuidanceBreast biopsies without image guidance are still

reported with:19000, breast bx; percutaneous, needle core, not

using imaging (separate procedure)19101, … open/incisional

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Bx Under GuidanceModified NCCI Policy:

“If a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with mammographic guidance (e.g., 19281,19282), the physician should not separately report a post procedure mammography code (e.g., 77051, 77052, 77055-77057, G0202-G0206) for the same patient encounter.

The radiologic guidance codes include all imaging by the defined modality required to perform the procedure.”

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Modified GuidelinesRevision of a skin pocket is included in 33206-33249,

33262-33264Pocket revisions that include I&D of hematoma/wound

infection or debridement may be separately reportedRelocation of a skin pocket – when performed as part

of an explant of an existing generator followed by replacement with a new generator, the pocket relocation is reported separately33222 – Revision/relocation of skin pocket, pacemaker33223 - … ICD

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Subcutaneous ICDsCategory III codes 0319T-0328TThese are for subcutaneous ICDs (S-ICDs)FDA recently approved a new type “A subcutaneous implantable defibrillator system

is an implantable technology that uses a subcutaneous pulse generator attached to a single subcutaneous electrode to treat ventricular tachy-arrhythmias.”

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Angiography ChangesCPT is moving to bundled imaging codes for

angiography when the procedures are performed under guidance more than 75% of the time

The codes for endovascular revascularization were previously bundled with the guidance when performed on peripheral vessels in the lower extremity

The new change is for intravascular stenting of vessels other than the lower extremity, cervical carotid, intracranial, intracoronary, extracranial or intrathoracic

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Lower Extremity Revascularization

New combination codes created in 2011:37220-37235

Reported for lower extremity revascularization services performed for occlusive disease

Built on progressive hierarchy with more intensive services inclusive of less intensive services

Includes: accessing/selectively catheterizing the vessel, traversing the lesion, radiology S&I directly related, embolic protection, closure of the arteriotomy, imaging to document completion

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Transcatheter Stent Placement Changes

The following codes have been deleted:37205 – Transcath placement of a stent,

percutaneous, initial vessel37206 – Each additional37207 – Transcath placement of a stent, open,

initial vessel37208 – Each additional75960 – Guidance of stent placement

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The following codes have been added:37236 – Transcath placement of a stent, open

or percutaneous, initial artery, including imaging and angioplasty within the same vessel

37237 – Each additional37238 – Transcath placement of a stent, open

or percutaneous, initial vein, including imaging and angioplasty within the same vessel

37239 – Each additional

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Code selection based on:Arterial versus venousInitial “vessel” versus additional “vessel”

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The new codes not for areas where other, more specific codes exist

Report just one code when there is more than one stent in a single vessel

New codes include:PTA [percutaneous angioplasty] in the treated vesselAny pre-dilationPost dilationRadiological S&IClosure by pressure or closure device or suture

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New codes do not include:PTA in a separate vesselBoth selective and non-selective vascular

catheterizationExtensive repair of a artery (e.g., 35228,

35286)US guidance for vascular access (e.g., 76937)Initial dx angiography (as defined by CPT)

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Vascular Embolization and Occlusion

The following code has been deleted:37204 – Tranacath occlusion/embolization (e.g, tumor

destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, an method, non-central nervous system, non-head / neck

Was frequently reported with these codes:75894 - Transcatheter therapy, embolization, any

method, radiological supervision and interpretation75898 - Angiography through existing catheter for

follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis

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37204 is now bundled with 75894 and 75898Head/neck embolization remains the same:

61626 - Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; non-central nervous system, head or neck (extracranial, brachiocephalic branch)

7589475898

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New Codes:37241-Vascular embolization or occlusion, inclusive of all

radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) - AV access branch embolization

37242 - … arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms) – translumbar AAA sac coil embolization or splenic artery aneurysm embolization

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New Codes37243- Vascular embolization or occlusion, inclusive of

all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction (e.g., uterine fibroid embolization, tumor embolization, chemoembolization)

37244 - …for arterial or venous hemorrhage or lymphatic extravasation (e.g., embolization of vessel perforation or GI bleeding source embolization)

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Embolization includes:All radiological S&IIntra-procedural guidance and road mapping

necessary to document completion of the procedureEmbolization does not include:

Selective and non-selective vascular catheterization(s)US guidance for vascular access (76937)Intravascular ultrasound (37250, 37251)Initial dx angiography (as defined by CPT)

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Stenting and Embolization for Aneurysm Treatment:When stent is placed for providing a latticework for

deployment of embolization coils (e.g., aneurysm embolization), the embolization code is reported rather than the stent code

If a covered stent is deployed as the sole management of an aneurysm, extra-vascularisation, then he stent deployment code should be reported rather than the embolization code

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Contact UsRichard Cooley

Phone: 518-430-1144

Email: [email protected]

Matthew LawneyPhone: 845-642-6462


Jean RussellPhone: 518-369-4986


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http://www.EpochHealth.com/

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DisclaimerInformation and opinions included in this presentation are provided based on our interpretation of current available regulatory resources. No representation is made as to the completeness or accuracy of the information. Please refer to your payer or specific regulatory guidelines as necessary.

January 2014 Jean C. Russell, MS, RHIT [email protected]@epochhealth.com Richard...

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