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CPT%20Changes%20for%202005

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Title: CPT%20Changes%20for%202005


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
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