CPT Changes for 2005

1
CPT Changes for 2005

• Julie A. Leu, CPC December 16, 2004
• 930 1130 a.m.

2
Overview of Changes for 2005

• One new symbol
• Indicates a code which typically includes
  conscious sedation
• Category I code changes
• 130 codes added
• 26 codes deleted
• 60 code descriptors revised

3
Overview of Changes for 2005

• Category II code changes
• 11 codes deleted
• 14 codes added
• Category III Codes
• 27 codes added
• 9 codes deleted
• 1 code descriptor revised

4
Overview of Changes for 2005

• No modifiers deleted or revised
• Four new appendices
• Appendix F - Summary of CPT Codes Exempt from
  Modifier 63
• Appendix G - Summary of CPT Codes which Include
  Conscious Sedation
• Appendix H - Alphabetic Index of Performance
  Measures by Clinical Condition or Topic
• Appendix I - Genetic Testing Code Modifiers
• Apply to pathology/laboratory codes only

5
Evaluation and Management

• Critical Care Services
• Change in guidelines for the section with
  reference to the age of the patient
• Neonate 28 days of age or less
• Infant 29 days through 24 months of age
• Formerly CPT utilized 30 days of age or less, and
  31 days through 24 months
• 99293, 99294 revised to include 29 days through
  24 months of age
• 99295, 99296 revised to include 28 days of age
  or less

6
Anesthesia

• Guidelines revised in conjunction with creation
  of Appendix G
• If sedation is provided by the surgeon, CPT codes
  99141, 99142 are to be reported.
• If sedation/anesthesia is provided by another
  physician (or under their supervision), the
  anesthesia codes are to be reported.
• CPT codes listed in Appendix G include the
  provision of sedation by the operating physician.

7
Anesthesia

• One new code
• 00561 Anesthesia for procedures on heart,
  pericardial sac, and great vessels of chest with
  pump oxygenator, under one year of age.

8
Surgery Integumentary System

• Four new codes in the Skin, Subcutaneous and
  Accessory Structures Codes
• 11004 Debridement of skin, subcutaneous tissue,
  muscle and fascia for necrotizing soft tissue
  infection external genitalia and perineum
• 11005 abdominal wall, with or w/o fascial
  closure
• 11006 external genitalia, perineum and abdominal
  wall, with or w/o fascial closure
• 11008 Removal of prosthetic material or mesh,
  abdominal wall for necrotizing soft tissue
  infection

9
Surgery Integumentary System

• One revised, three new Breast codes
• 19160 Mastectomy,partial (eg, lumpectomy,
  tylectomy, quadrantectomy, segmentectomy)
• 19296 Placement of radiotherapy afterloading
  balloon catheter into the breast for interstitial
  radioelement application following partial
  mastectomy, includes imaging guidance on date
  separate from partial mastectomy
• 19297 concurrent with partial mastectomy

10
Surgery Integumentary System

• One revised, three new Breast codes
• 19298 Placement of radiotherapy afterloading
  brachytherapy catheters . . . into the breast for
  interstitial radioelement application following
  (at the time of or subsequent to) partial
  mastectomy, includes imaging guidance
• New guidelines at the beginning of Breast
  Excision subsection

11
Surgery Musculoskeletal System

• Five new codes
• Two new codes in the Femur subsection
• 27412 Autologous chondrocyte implantation, knee
• 27415 Osteochondral allograft, knee, open

12
Surgery Musculoskeletal System

• Three new codes in the Arthroscopy subsection
• 29866 Arthroscopy, knee, surgical osteochondral
  autografts (eg, mosaicplasty) (includes
  harvesting of the autograft)
• 29867 osteochondral allograft
• 29868 meniscal transplantation, (includes
  arthrotomy for meniscal insertion), medial or
  lateral

13
Surgery Respiratory System

• Two new codes in the Larynx/Endoscopy subsection
• 31545 Laryngoscopy, direct, operative, with
  operating microscope or telescope, with
  submucosal removal of non-neoplastic lesion(s) of
  vocal cord reconstruction with local tissue
  flap(s)
• 31546 reconstruction with graft(s) (includes
  obtaining autograft)

14
Surgery Respiratory System

• Four new codes, two revised codes in the Trachea
  and Bronchi/Endoscopy subsection
• 31620 Endobronchial ultrasound (EBUS) during
  bronchoscopic diagnostic or therapeutic
  intervention(s)
• 31630 Bronchoscopy, rigid or flexible, with or
  without fluoroscopic guidance with
  tracheal/bronchial dilation or closed reduction
  of fracture
• 31631 with placement of tracheal stent(s)
  

15
Surgery Respiratory System

• Trachea and Bronchi/Endoscopy subsection
• 31636 Bronchoscopy, rigid or flexible, with or
  without fluoroscopic guidance with placement of
  bronchial stent(s) (includes tracheal/bronchial
  dilation as required), initial bronchus
• 31637 each additional major bronchus stented
• 31638 with revision of tracheal or bronchial
  stent inserted at previous session

16
Surgery Respiratory System

• Lungs and Pleura
• One new code in the Incision subsection
• 32019 Insertion of indwelling tunneled pleural
  catheter with cuff

17
Surgery Respiratory System

• Lungs and Pleura, cont.
• One revised and two new codes in the Lung
  Transplantation subsection
• 32850 Donor pneumonectomy (including cold
  preservation), from cadaver donor
• 32855 Backbench standard preparation of cadaver
  donor lung allograft prior to transplantation,
  including dissection of allograft from
  surrounding soft tissues to prepare pulmonary
  venous/atrial cuff, pulmonary artery, and
  bronchus unilateral
• 32856 bilateral

18
Surgery Cardiovascular System

• Heart and Pericardium
• Two new codes, two revised codes in Heart/Lung
  Transplantation subsection
• 33930 Donor cardiectomy-pneumonectomy (including
  cold preservation)
• 33933 Backbench standard preparation of cadaver
  donor heart/lung allograft prior to
  transplantation, including dissection of
  allograft from surrounding soft tissues to
  prepare aorta, superior vena cava, inferior vena
  cava, and trachea for implantation

19
Surgery Cardiovascular System

• Two new codes, two revised codes in Heart/Lung
  Transplantation subsection
• 33940 Donor cardiectomy (including cold
  preservation)
• 33944 Backbench standard preparation of cadaver
  donor heart allograft prior to transplantation,
  including dissection of allograft from
  surrounding soft tissues to prepare aorta,
  superior vena cava, inferior vena cava, pulmonary
  artery, and left atrium for implantation

20
Surgery Cardiovascular System

• Arteries and Veins
• Eight new codes, three deleted, one revised
• 34803 Endovascular repair of infrarenal
  abdominal aortic aneurysm or dissection using
  modular bifurcated prosthesis ( two docking
  limbs)
• Codes 35161 and 35162 have been deleted. A
  parenthetical note has been added to instruct
  that code 37799 should be reported for direct
  aneurysm repair of other arteries, not otherwise
  specified.
• Code 35582 has been deleted due to a confusing
  redundancy of codes in the section.

21
Surgery Cardiovascular System

• Arteries and Veins, cont.
• 36475 Endovenous ablation therapy of incompetent
  vein, extremity, inclusive of all imaging
  guidance and monitoring, percutaneous,
  radiofrequency first vein treated
• 36476 second and subsequent veins treated in a
  single extremity, each through separate access
  sites (List separately in addition to code for
  primary procedure)

22
Surgery Cardiovascular System

• Arteries and Veins, cont.
• 36478 Endovenous ablation therapy of incompetent
  vein, extremity, inclusive of all imaging
  guidance and monitoring, percutaneous, laser
  first vein treated
• 36479 second and subsequent veins treated in a
  single extremity, each through separate access
  sites (List separately in addition to code for
  primary procedure)

23
Surgery Cardiovascular System

• Arteries and Veins, cont.
• 36818 Arteriovenous anastomosis, open, by upper
  arm cephalic vein transposition
• 37205 Transcatheter placement of an
  intravascular stent(s), (except coronary,
  carotid, and vertebral vessel), percutaneous,
  initial vessel
• 37215 Transcatheter placement of intravascular
  stent(s), cervical carotid artery, percutaneous
  with distal embolic protection
• 37216 without distal embolic protection

24
Surgery Digestive System

• 18 new codes, five revised codes
• 43257 Upper gastrointestinal endoscopy . . .
  with delivery of thermal energy to the muscle of
  lower esophageal sphincter and/or gastric cardia,
  for treatment of gastroesophageal reflux disease
• 43644 Laparoscopy, surgical, gastric restrictive
  procedure with gastric bypass and Roux-en-Y
  gastroenterostomy (roux limb 150 cm or less)
• 43645 with gastric bypass and small intestine
  reconstruction to limit absorption

25
Surgery Digestive System

• 43845 Gastric restrictive procedure with partial
  gastrectomy, pylorus-preserving duodenoileostomy
  and ileoileostomy (50 to 100 cm common channel)
  to limit absorption (biliopancreatic diversion
  with duodenal switch)
• 43846 Gastric restrictive procedure with gastric
  bypass for morbid obesity with short limb (150
  cm or less) Roux-en-Y gastroenterostomy

26
Surgery Digestive System

• Guidelines added to the Intestines/Excision
  subsection to address intestinal
  allotransplantation.
• 44137 Removal of transplanted intestinal
  allograft, complete
• 44715 Backbench standard preparation of
  cadaver or living donor intestine allograft
  prior to transplantation, including mobilization
  and fashioning of the superior mesenteric artery
  and vein
• 44720 Backbench reconstruction of cadaver or
  living donor intestine allograft prior to
  transplantation venous anastomosis, each
• 44721 arterial anastomosis, each

27
Surgery Digestive System

• 45391 Colonoscopy, flexible, proximal to
  splenic flexure with endoscopic ultrasound
  examination
• 45392 with transendoscopic ultrasound
  guided intramural or transmural fine needle
  aspiration/biopsy(s)
• 46947 Hemorrhoidopexy (eg, for prolapsing
  internal hemorrhoids), by stapling
• New Liver Transplantation subsection
• 47133 and 47140 revised
• Five new codes (47143 47147)

28
Surgery Digestive System

• 48550 Donor pancreatectomy (including cold
  preservation), with or without duodenal segment
  for transplantation
• 48551 Backbench standard preparation of
  cadaver donor pancreas allograft prior to
  transplantation, . . .
• 48552 Backbench reconstruction of cadaver
  donor pancreas allograft prior to
  transplantation, venous anastomosis, each

29
Surgery Urinary System

• Seven new codes, five deleted, five revised
• New Renal Transplantation subsection guidelines
• Codes 50300, 50320, and 50360 were revised
• New codes 50323 and 50325 report standard
  backbench services performed on living or
  cadaver donor renal allograft prior to
  transplantation.
• New codes 50327, 50328, and 50329 report
  backbench reconstruction procedures performed
  on living or cadaver donor renal allograft prior
  to transplantation.

30
Surgery Urinary System

• 50391 Instillation of therapeutic agent into
  renal pelvis and/or ureter through established
  nephrostomy, pyelostomy or ureterostomy tube (eg,
  anticarcinogenic or antifungal agent)
• Codes 50559, 50578, 50959, and 50978 have been
  deleted and can be reported utilizing the
  radiation oncology codes (eg, 77778)
• 52234 Cystourethroscopy, with fulguration . . .
  SMALL bladder tumor(s) (0.5 up to 2.0 cm)
• 52402 Cystourethroscopy with transurethral
  resection or incision of ejaculatory ducts

31
Surgery Female Genital System

• Five new codes, one revised
• 57267 Insertion of mesh or other prosthesis for
  repair of pelvic floor defect, each site
  (anterior, posterior compartment), vaginal
  approach
• 57282 Colpopexy, vaginal extra-peritoneal
  approach (sacrospinous, iliococcygeus)
• 57283 intra-peritoneal approach (uterosacral,
  levator myorrhaphy)

32
Surgery Female Genital System

• 58356 Endometrial cryoablation with ultrasonic
  guidance, including endometrial curettage, when
  performed
• 58565 Hysteroscopy, surgical with bilateral
  fallopian tube cannulation to induce occlusion by
  placement of permanent implants
• 58956 Bilateral salpingo-oophorectomy with
  total omentectomy, total abdominal hysterectomy
  for malignancy

33
Surgery Nervous System

• Three new codes, three revised
• 63050 Laminoplasty, cervical, with decompression
  of the spinal cord, two or more vertebral
  segments
• 63051 with reconstruction of the posterior bony
  elements (including the applica-tion of bridging
  bone graft and non-segmental fixation devices
  (eg, wire, suture, mini-plates), when performed)

34
Surgery Nervous System

• 63295 Osteoplastic reconstruction of dorsal
  spinal elements, following primary intraspinal
  procedure
• Codes 61685, 63685, and 64590 all were revised to
  include the replacement of stimulation or drug
  delivery devices.

35
Surgery Eye and Ocular Adnexa

• One new code, one revised
• 66710 Ciliary body destruction
  cyclophotocoagulation, transscleral
• 66711 cyclophotocoagulation, endoscopic

36
Radiology Code Changes

• Thirteen new codes, 14 revised, 11 deleted
• Introductory guidelines for the subsections
  related to selective catheterization imaging
• Aorta and Arteries
• Veins and Lymphatics
• Transcatheter Procedures
• 75960 revision to the cross reference only

37
Radiology Code Changes

• 76075 Dual energy x-ray absorptiometry (DXA),
  bone density study, one or more sites axial
  skeleton (eg, hips, pelvis, spine)
• 76077 vertebral fracture assessment
• 76510 Ophthalmic ultrasound, diagnostic B-scan
  and quantitative A-scan performed during the same
  patient encounter
• 76511 quantitative A-scan only
• 76512 B-scan (with or without superimposed
  nonquantitative A-scan)

38
Radiology Code Changes

• 76820 Doppler velocimetry, fetal umbilical
  artery
• 76821 middle cerebral artery
• 76827 Doppler echocardiography, fetal, pulsed
  wave and/or continuous wave with spectral
  display complete
• Guidelines added for Non-Obstetrical
  Ultrasounds
• 77750 Infusion or instillation of
  radioelement solution (includes three
  months follow-up care)
• 78267 Urea breath test, C-14 (isotopic)
  acquisition for analysis

39
Radiology Code Changes

• Code descriptors for 78464 and 78465 were
  revised to include attenuation correction, when
  performed, for myocardial perfusion single
  photon emission computed tomography (SPECT).
• Code 78810 has been eliminated and six new
  codes, 78811- 78816, added for reporting tumor
  imaging by positron emission tomography
  (PET).
• Code 78990 has been deleted. HCPCS Level II
  codes may be used to report the diagnostic
  radiopharmaceuticals used.

40
Radiology Code Changes

• 79005 Radiopharmaceutical therapy, by oral
  admninistration
• 79101 Radiopharmaceutical therapy, by
  intravenous administration
• 79200 Radiopharmaceutical therapy, by
  intracavitary administration
• 79300 Radiopharmaceutical therapy, by
  interstitial radioactive colloid administration
• 79440 Radiopharmaceutical therapy, by
  intra-articular administration
• 79445 Radiopharmaceutical therapy, by
  intra-arterial particulate administration

41
Pathology Code Changes

• Chemistry Section six new codes and three
  revised
• 82045 Albumin ischemia modified
• 82656 Elastase, pancreatic (EL-1), fecal,
  quantitative or semi-quantitative.
• 83009 Helicobacter pylori, blood test
  analysis for urease activity, non-radioactive
  isotope

42
Pathology Code Changes

• 83013 Helicobacter pylori, breath test
  analysis for urease activity, non-radioactive
  isotope.
• 83014 Helicobacter pylori, drug administration
• 83630 Lactoferrin, fecal, qualitative
• 84163 Pregnancy-associated plasma protein-A
  (PAPP-A)

43
Pathology Code Changes

• 84165 Protein electrophoretic fractionation
  and quantitation
• 84166 Protein electrophoretic fractionation
  and quantitation, other fluids with
  concentration (eg, urine, CSF)
• Genetic Testing Modifiers (Appendix I) for use
  with molecular diagnostic procedures, CPT codes
  83890 through 83912.

44
Pathology Code Changes

• Hematology and Coagulation section one revised
  code
• 85046 Blood count reticulocytes, automated,
  including one or more cellular parameters (eg,
  reticulocyte hemoglobin content, immature
  reticulocyte fraction, reticulocyte volume, RNA
  content), direct measurement

45
Pathology Code Changes

• Immunology section, four new codes and one
  revised code
• 86064 B cells, total count
• 86379 Natural killer (NK) cells, total count
• 86587 Stem cells (ie, CD34), total count

46
Pathology Code Changes

• Immunology section, four new codes and one
  revised code
• 86334 Immunofixation electrophoresis serum
• other fluids with concentration (eg, urine,
  CSF)

47
Pathology Code Changes

• Microbiology section, one new code and one
  revised code
• 87046 Culture, bacterial stool, aerobic,
  additional pathogens, isolation and
  presumptive identification of isolates, each
  plate
• 87807 Infectious agent antigen detection by
  immunoassay with direct optical observation
  repiratory syncytial virus.

48
Pathology Code Changes

• Cytopathology section, one deleted code (88180)
  and five new codes
• 88184 Flow cytometry, cell surface,
  cytoplasmic, or nuclear marker, technical
  component only first marker
• 88185 each additional marker
• 88187 Flow cytometry, interpretation 2 to
  8 markers
• 88188 9 to 15 markers
• 88189 16 or more markers

49
Pathology Code Changes

• Cytogenetic Studies Section
• Genetic Testing Modifiers (Appendix I) for use
  with cytogenetic studies procedures, CPT codes
  88230 through 88299.

50
Pathology Code Changes

• Surgical pathology section, three new codes and
  two revised codes
• 88360 Morphometric analysis, tumor
  immunohistochemistry (eg, Her-2/neu, estrogen
  receptor/progesterone receptor), quantitative or
  semiquantitative, each antibody manual
• 88361 using computer assisted technology
• Surgical Pathology section

51
Pathology Code Changes

• 88365 In situ hybridization (eg, FISH), each
  probe
• 88367 Morphometric analysis, in situ
  hybridization, (quantitative or
  semi- quantitative), each probe using computer
  assisted technology
• 88368 manual
• Surgical Pathology section

52
Pathology Code Changes

• Reproductive Medicine Procedures, one revised
  code
• 89346 Storage, (per year) oocyte(s)

53
Medicine Section Changes

• 90465 Immunization administration under 8
  years of age (includes percutaneous,
  intradermal, subcutaneous or intramuscular
  injections), when the physician counsels the
  patient/family first injection (single or
  combination vaccine/toxoid), per day
• 90466 each additional injection, per day
• 90467 Immunization administration under age 8
  years (includes intranasal or oral routes of
  administration.) . . . . first administration
  (single or combination vaccine/toxoid), per day
• 90468 each additional administration, per
  day

54
Medicine Section Changes

• 90656 Influenza virus vaccine, split virus,
  preservative free, for use in individuals 3
  years and above, for intramuscular use
• 90700 Diphtheria, tetanus toxoids, and
  acellular pertussis vaccine (DTaP), for use in
  individuals younger than 7 years, for
  intramuscular use

55
Medicine Section Changes

• Gastroenterology Subsection
• 91034 Esophagus, gastroesophageal reflux
  test with nasal catheter pH elecrode(s)
  placement recording, analysis and
  interpretation
• 91035 with mucosal attached telemetry pH
  electrode placement, recording, analysis and
  interpretation

56
Medicine Section Changes

• 91037 Esophageal function test,
  gastroesophageal reflux test with nasal
  catheter intraluminal impedance electrode(s)
  placement, recording, analysis and
  interpretation
• 91038 prolonged (gt1 hr, up to 24 hrs)
• 91040 Esophageal balloon distension
  provocation study
• 91120 Rectal sensation, tone, and compliance
  test

57
Medicine Section Changes

• Special Otorhinolaryngologic Services
• 92620 Evaluation of central auditory
  function, with report initial 60 minutes
• 92621 each additional 15 minutes
• 92625 Assessment of tinnitus (includes
  pitch, loudness matching, and masking)

58
Medicine Section Changes

• 93741 Electronic analysis of pacing
  cardioverter-defibrillator . . . single chamber
  or wearable cardioverter-defibrillator system,
  without reprogramming
• 93742 single chamber or wearable
  cardioverter-defibrillator system, with
  reprogramming.
• 93745 Initial set-up and programming by a
  physician of wearable cardioverter-defibrillator
  includes initial programming of system,
  establish- ing baseline electronic ECG,
  transmission of data to data repository, patient
  instruction in wearing system and patient
  reporting of problems or events

59
Medicine Section Changes

• Noninvasive Vascular Diagnostic Studies
• 93890 Transcranial Doppler study of the
  intracranial arteries vasoreactive study
• 93892 emboli detection without intravenous
  microbubble injection
• 93893 emboli detection with intravenous
  microbubble injection

60
Medicine Section Changes

• 94060 Bronchodilation responsiveness,
  spirometry as in 94010, pre- and
  post- bronchodilator administration
• 94070 Bronchospasm provocation evaluation,
  multiple spirometric determinations as in 94010,
  with administered agents (eg, antigen(s), cold
  air, methacholine)
• 94452 High altitude simulation test (HAST),
  with physician interpretation and report
• 94453 with supplemental oxygen titration

61
Medicine Section Changes

• 95928 Central motor evoked potential study
  (transcranial motor stimulation) upper limbs
• 95929 lower limbs

62
Medicine Section Changes

• 95978 Eletronic analysis of implanted
  neurostimulator pulse generator system . .
  complex deep brain neurostimulator pulse
  generator/transmitter, with initial or
  subsequent programming first hour
• 95979 each additional 30 minutes after
  first hour
• Codes 95971, 95972, and 95973 have been revised
  to exclude brain stimulation

63
Medicine Section Changes

• 96111 Developmental testing extended
  (includes assessment of motor, language,
  social, adaptive and/or cognitive functioning by
  standardized developmental instruments) with
  interpretation and report

64
Medicine Section Changes

• Physical Medicine and Rehabilitation
• One code deleted (97601) and four added (97597,
  97598, 97605, 97606) to the Active Wound Care
  Management subsection
• Accupuncture
• Two codes deleted (97780, 97781) and four
  added ( 97810, 97811, 97813, 97814) to this new
  subsection.

65
Category II Codes

• For 2005, all of the 2004 Category II codes
  have been deleted and renumbered.
• Four new codes have been added to represent
  Maternity Care Management.
• Eight new categories of codes have been added
  to accommodate the addition and organization of
  the existing and future Category II codes.

66
Category III Codes

• Eight Category II codes have been deleted and
  converted to Category I codes for 2005.
• Twenty-seven Category III codes were added for
  2005, including a code for online evaluation and
  management service with guidelines specifically
  to instruct for appropriate coding (0074T)
• One Category III code, revised