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2010 Procedure Code Updates

2010 Procedure Code Updates

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2010 Procedure and Service Code Updates

Audio Seminar/Webinar
December 3, 2009

Practical Tools for Seminar Learning
© Copyright 2009 American Health Information Management Association. All rights reserved.

Disclaimer
The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service. CPT® five digit codes, nomenclature, and other data are copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein. As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments.

AHIMA 2009 Audio Seminar Series • http://campus.ahima.org/audio American Health Information Management Association • 233 N. Michigan Ave., 21st Floor, Chicago, Illinois

i

Faculty
Margi Brown, RHIA, CCS, CCS-P, CPC, CCDS Margi Brown is director at Precyse Solutions, specializing in clinical documentation improvement, audits, education, and RAC services. She is a frequent speaker on coding, documentation, and compliance topics. Ms. Brown has over 25 years of experience in the HIM field covering hospital outpatient, inpatient, surgical centers, physician office, clinic, law firms, consulting, and third-party carrier areas. Karen Scott, MEd, RHIA, CCS-P, CPC Karen Scott is the owner of Karen Scott Seminars and Consulting, through which she teaches seminars on coding, reimbursement, medical terminology, and management. She has been an educator for many years, and has two AHIMA publications: Coding and Reimbursement for Hospital Inpatient Services and Medical Coding for the Non-Coder: Understanding Coding and Reimbursement in Today’s Healthcare Society.

AHIMA 2009 Audio Seminar Series

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Table of Contents
Disclaimer ..................................................................................................................... i Faculty ......................................................................................................................... ii Objectives of this Seminar............................................................................................... 1 Change Statistics............................................................................................................ 1 Resequencing ................................................................................................................ 2 Resequenced Codes ....................................................................................................... 2 Evaluation and Management ........................................................................................... 3 Consultation Codes: CPT vs. CMS .................................................................................... 3 Evaluation and Management ........................................................................................... 4 Concurrent Care ............................................................................................................. 4 Transfer of Care ............................................................................................................. 5 Transfer of care vs. Consultation ..................................................................................... 5 Consultation ............................................................................................................... 6-7 Nursing Facility Care ....................................................................................................... 8 Prolonged Services ...................................................................................................... 8-9 Anesthesia and (Humerus) .............................................................................................10 Fine Needle Aspiration ...................................................................................................10 Adjacent Tissue Transfer (ATT) ......................................................................................11 Integumentary ..............................................................................................................11 Other Flaps and Grafts...................................................................................................12 Destruction ...................................................................................................................12 Localization Clip ............................................................................................................13 Musculoskeletal ........................................................................................................ 13-14 Musculoskeletal Additions and Revisions ..................................................................... 15-20 Musculoskeletal Revisions ......................................................................................... 20-24 Respiratory ...................................................................................................................25 Respiratory Revisions ....................................................................................................25 Bronchoscopy Revisions .................................................................................................26 Respiratory Revisions ............................................................................................... 26-27 Bronchoscopy Additions .................................................................................................28 Chest Tube ...................................................................................................................28 Fibrinolysis ...................................................................................................................29 Cardiovascular Revisions ................................................................................................29 Cardiovascular Additions ................................................................................................30 Ventricular Assist Device Additions ..................................................................................30 Arteriovenous Shunt for Dialysis .....................................................................................31 Cardiovascular Revisions ................................................................................................31 Ligation of Perforator Veins ............................................................................................32 Laparoscopy Additions ...................................................................................................32 Digestive Additions ........................................................................................................33 Digestive Revisions........................................................................................................34

(CONTINUED) AHIMA 2009 Audio Seminar Series

Table of Contents
Hemorrhoidectomy Revisions .................................................................................... 34-35 Digestive Revisions........................................................................................................35 Urodynamics Additions and Revisions..............................................................................36 Urinary Revisions and Additions ......................................................................................36 Male Genital System Revisions........................................................................................37 Female Genital System ..................................................................................................37 Maternity Care and Delivery Revisions .............................................................................38 Nervous System Additions ..............................................................................................38 Paravertebal Spinal Nerves and Branches Additions ..........................................................39 Other Surgery Modifications ...........................................................................................39 Radiology .....................................................................................................................40 New Codes GI Tract ......................................................................................................41 Heart .......................................................................................................................41 New Cardiac MRI Codes .................................................................................................42 Two More Cardiac MRI Codes .........................................................................................42 Vascular Procedures ......................................................................................................43 Radiation Oncology .......................................................................................................43 Nuclear Medicine ...........................................................................................................44 Path/Lab ......................................................................................................................44 Pathology and Laboratory ......................................................................................... 45-46 Organ Panels ................................................................................................................46 More Chemistry.............................................................................................................47 Immunology New Codes ................................................................................................47 Tissue Typing ...............................................................................................................48 Microbiology .................................................................................................................48 Micro New Codes ..........................................................................................................49 Guidance for 87260-87999 .............................................................................................49 New Codes ...................................................................................................................50 Two More New Lab Codes..............................................................................................50 Medicine Section ...........................................................................................................51 Vaccines .......................................................................................................................52 ENT Services ................................................................................................................52 Audiologic Function Tests New Codes .............................................................................53 Implantable and Wearable Cardiac Device Evaluations......................................................53 New Definitions .............................................................................................................54 Echocardiography..........................................................................................................54 Noninvasive Physiologic Studies ......................................................................................55 Pulmonary ....................................................................................................................55 Nerve Conduction Tests .................................................................................................56 Hydration, Injections/Infusions .......................................................................................56 Facility Hierarchy...........................................................................................................57 Category II Codes .................................................................................................... 57-58

(CONTINUED) AHIMA 2009 Audio Seminar Series

Table of Contents
New Patient Management Codes ....................................................................................58 Patient History ..............................................................................................................59 Physical Exam ...............................................................................................................59 Screening/Diagnostic Results..........................................................................................60 More Screening/Diagnostic Results ............................................................................ 60-61 Therapeutic and Preventive Interventions........................................................................61 Category III Codes ........................................................................................................62 References ..................................................................................................................62 Thank You ..................................................................................................................63 Audio Seminar Discussion ..............................................................................................63 Become an AHIMA Member Today! .................................................................................64 Audio Seminar Information Online ..................................................................................64 Upcoming Audio Seminars ............................................................................................65 Thank You/Evaluation Form and CE Certificate (Web Address) ..........................................65 Appendix ..................................................................................................................66 CE Certificate Instructions

AHIMA 2009 Audio Seminar Series

2010 Procedure and Service Code Updates

Notes/Comments/Questions

Objectives of this Seminar
Identify the additions and changes to CY10 CPT that impact physician/hospital reporting Review new techniques used in procedures and surgeries Summarize changes by chapter Page numbers provided will follow CPT 2010 – Professional Edition
1

Change Statistics
Per the AMA, the CPT code changes for 2010 includes:
• • • •

225 new codes 155 revised codes 77 deleted codes Refer to Appendix B – summary of additions, deletions, and revisions

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Resequencing
The “#” symbol will precede the code References are inserted where the code would have been numerically which directs to the current subsection of the resequenced location The instructions are more detailed Refer to (new) Appendix N
3

Resequenced Codes
Musculoskeletal System 21552 21554 23071 23073 24071 24073 25071 25073 26111 26113 27043 27045 27059 27329 27337 27339 27632 27634 28039 28041
Digestive System

46946 46947
Urinary System

46220 46320 46945

51797
Pathology and Laboratory

82652
4

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Evaluation and Management
Revisions to the guidelines
• • •

“Extensive” in the consultations “Editorial” to the nursing facility services “Additional” to the prolonged services and direct (face-to-face) patient contact subsection

5

Consultation Codes: CPT vs. CMS
As stated in the PFS final rule, Medicare will not cover consultation codes
• •

Inpatient and office/outpatient Except for telehealth consultation G-codes

Instead, use the E/M appropriate codes Modifier - should be applied to the “admitting” physician’s E/M initial code guidelines will be published
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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Evaluation and Management
Changes in the guidelines:
• • •

Concurrent care Unit/floor time Instructions for selecting a E/M level

Category and subcategory

Refer to subsection “opener” in CPT, p 1-3

Patient admitted from the office/outpatient setting – see notes for initial hospital inpatient care or nursing facility 7

Concurrent Care
“Concurrent care is the provision of similar services to the same patient by more than one physician on the same day” “No special reporting is required”

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Transfer of Care
“Transfer of care is the process whereby the physician who is proving management for some or all of a patient’s problems relinquishes this responsibility to another physician who explicitly agrees to accept this responsibility and who from the initial encounter is not providing consultative services. The physician transferring care is then no

longer providing care for these problems

though he/she may continue providing care for other conditions when appropriate”.
9

Transfer of Care vs. Consultation
“Consultation codes should not be reported by the physician who has agreed to accept transfer of care before an initial evaluation But are appropriate to report if the decision to accept transfer of care cannot be made Until after the initial consultation evaluation, regardless of the service”
(CPT, p 4) 10

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Consultation
A consultation is an:
“E/M service provided by a physician at the request of another physician or appropriate source (not the patient and/or family) to • either recommend care for a specific condition or problem or • to determine whether to accept responsibility for ongoing management of the • patient’s entire care or for the care of a specific condition or problem”

(CPT, p 16-19)

11

Consultation
Documentation requirements in the medical record
1.

Request – either written or verbal

By either the consulting or requesting physician or appropriate source

2. 3.

The consultant’s opinion and any services ordered or performed Communication back (written) to the requesting physician or appropriate source

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AHIMA 2009 Audio Seminar Series

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Consultation
Inpatient consultation code range

99251 - 99255

Physician consultations provided to
Hospital inpatients, residents of nursing facilities, or in a partial hospital setting • ONE per admission

Instruction
Do not use both an inpatient and outpatient consult for services related to the same stay • CPT, p 18-19

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Consultation
Instructions

Use subsequent codes 99231 - 99233 or 99307 - 99310 for:
Subsequent services during same admission • Transfer of care services

See concurrent care and transfer of care

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Nursing Facility Care
Language change:
• • •

Initial: 99304 - 99306 Subsequent: 99307 - 99310 Physician’s typically spend xx minutes “at the bedside and on the patient’s facility floor or unit”

Revised from “with the patient and/or family or caregiver” 15

Prolonged Services
Prolonged Physician Service without direct (face-to-face) patient contact

“before and/or after direct (face-to-face) patient care;

1st hour = 99358
– – –

Use only once per date Regardless of the place of service Add-on status (+) removed

Each additional 30 minutes = + 99359 16

AHIMA 2009 Audio Seminar Series

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Prolonged Services
Prolonged Physician Service without direct (face-to-face) patient contact
• •

“Beyond the usual non face-to-face component of physician service time” Report using the total duration of non face-to-face time spent, even if not continuous, on that date A typical time for the primary service need not be established within CPT code set

17

Prolonged Services
Prolonged Physician Service without direct (face-to-face) patient contact
• •

Report in relation to other physician services including E/M services at any level May report on a different date than the primary service to which it is related
• •

Extensive medical record review Must relate to a service or patient where direct (face-toface) care has occurred or will occur and relate to ongoing patient management Instruction to not report with time spent with other non face-to-face services that have more specific codes and an no upper time limit May report when related to other non face-to-face service codes that have a published max time (ex: telephone services)

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Anesthesia and (Humerus)
Due to low reporting volume, the code (set) for radical resection of bone tumor proximal humerus was deleted
• • •

23221 – with autograft and 23222 – with prosthetic replacement 01632 – anesthesia

Cross reference notes present

(use 01630, 01638)

19

Fine Needle Aspiration
A cross reference note following 10022 – (FNA with imaging guidance) was revised to use 19295

for percutaneous placement of a localization clip during breast biopsy

20

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Adjacent Tissue Transfer (ATT)
New codes for adjacent tissue transfer (ATT) or rearrangement, any area;
• •

14301 – Defect 30.1 sq cm to 60.0 sq cm + 14302 – each additional 30.0 sq cm or part thereof

List separately with 14301

Guidelines expanded

21

Integumentary
The instruction guideline for closure of defects with benign and malignant lesions now includes the new codes 14301-2 (ATT) Reminder to code separately:
Intermediate or complex closure • Reconstruction

Reminder that lesion excision is included in the adjacent tissue transfer (ATT) codes 14000 – 14302 Refer to closure guidelines in CPT, p 64
22

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Other Flaps and Grafts
Cross reference notes for ATT flaps expanded to include the new codes New introductory guidelines added to define other flaps and grafts such as:
• •

15740 – Cutaneous flap – island pedicle 15750 – Neurovascular pedicle

23

Destruction
Instruction cross reference note: “for laser treatment for inflammatory skin disease, see 96920 – 22”

24

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Localization Clip
Cross reference note was revised to include the clip placement during the FNA with imaging guidance – 10022 Code + 19295

Image guided placement, metallic localization clip, percutaneous, during breast biopsy/aspiration

25

Musculoskeletal
Biggest section of changes
• • • •

41 new codes 53 revised codes 7 deleted codes New parenthetical and instructional notes

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AHIMA 2009 Audio Seminar Series

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Musculoskeletal
Many revisions

Introductory guidelines to:

Excision of:
subcutaneous soft tissue tumors and – fascial or subfascial soft tissue tumors and

Radical resection of:
soft tissue tumors – bone tumors

New codes to complete different anatomic sites
27

Musculoskeletal
Reasons for changes due to the “confusion” of:
• •

Malignant skin tumors vs. radical soft tissue tumors Radical excisions vs. debridements vs. benign tumors

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AHIMA 2009 Audio Seminar Series

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Musculoskeletal Additions and Revisions
Excision tumor, soft tissue of Face or scalp
Sub-Q Radical Resection Subfascial of Tumor
(eg, malignant neoplasm)

< 2 cm 2 cm or greater

• •

21011 21012

• •

21013 21014

21015
(revision)

21016
29

Musculoskeletal Additions and Revisions
Excision tumor, soft tissue of Neck or anterior thorax
Sub-Q
< 3 cm 3 cm or greater < 5 cm 5 cm or greater
• •

Subfascial

Radical Resection of Tumor
(eg, malignant neoplasm)

21555 #21552 21556 #21554

21557 21558

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Musculoskeletal Additions and Revisions
Excision tumor, soft tissue of Back or flank
Sub-Q < 3 cm 21930 Subfascial Radical Resection of Tumor
(eg, malignant neoplasm)

3 cm or • 21931 greater < 5 cm 5 cm or greater
• •

21932 21933

21935

21936 31

Musculoskeletal Additions and Revisions
Excision tumor, soft tissue of Abdominal wall
Sub-Q < 3 cm 3 cm or greater < 5 cm 5 cm or greater
• •

Subfascial

(eg, malignant neoplasm)

Radical Resection of Tumor

22902 22903 22900
• • •

22904 22905 32

22901

AHIMA 2009 Audio Seminar Series

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Musculoskeletal Additions and Revisions
Excision tumor, soft tissue of Shoulder area
Sub-Q
< 3 cm 3 cm or greater < 5 cm 5 cm or greater
• •

Subfascial

(eg, malignant neoplasm)

Radical Resection of Tumor

23075 #23071 23076 #23073 23077

23078 33

Musculoskeletal Additions and Revisions
Excision tumor, soft tissue of Upper arm or elbow
Sub-Q
< 3 cm 24075 3 cm or • #24071 greater < 5 cm 5 cm or greater

Subfascial

(eg, malignant neoplasm)

Radical Resection of Tumor

24076 #24073

24077

24079 34

AHIMA 2009 Audio Seminar Series

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Musculoskeletal Additions and Revisions
Excision tumor, soft tissue of Forearm and/or wrist area
Sub-Q
< 3 cm 25075

Subfascial
25076 #25073

(eg, malignant neoplasm)

Radical Resection of Tumor 25077

3 cm or • #25071 greater

25078

35

Musculoskeletal Additions and Revisions
Excision, tumor or vascular malformation, soft tissue of Hand or finger

Sub-Q < 1.15 cm 26115

Subfascial 26116

Radical Resection of Tumor
(eg, malignant neoplasm)

1.15 cm • #26111 or greater < 3 cm 3 cm or greater

#26113 26117

26118 36

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Musculoskeletal Additions and Revisions
Excision tumor, soft tissue of Pelvis and hip area
Sub-Q
< 3 cm 27047

Subfascial

(eg, malignant neoplasm)

Radical Resection of Tumor

3 cm or • #27043 greater < 5 cm 5 cm or greater

27048 #27045

27049 #27059 37

Musculoskeletal Additions and Revisions
Excision tumor, soft tissue of Thigh or knee area
Sub-Q
< 3 cm 27327

Subfascial

(eg, malignant neoplasm)

Radical Resection of Tumor

3 cm or • #27337 greater < 5 cm 5 cm or greater

27328 #27339

#27329

27364 38

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Musculoskeletal Additions and Revisions
Excision tumor, soft tissue of Leg or ankle area
Sub-Q
< 3 cm 27618 3 cm or • #27632 greater < 5 cm 5 cm or greater

Subfascial

(eg, malignant neoplasm)

Radical Resection of Tumor

27619 #27634

27615

27616 39

Musculoskeletal Revisions
CODE 21015 21555 21556 21557 21930 21935 2009 CPT
Radical resection of tumor (eg, malignant neoplasm), soft tissue of face or scalp Excision tumor, soft tissue of neck or thorax; subcutaneous Excision tumor, soft tissue of neck or thorax; deep, subfascial, intramuscular Radical resection of tumor (eg, malignant neoplasm), soft tissue of neck or thorax Excision, tumor, soft tissue of back or flank Radical resection of tumor (eg, malignant neoplasm), soft tissue of back or flank

2010 CPT
Radical resection of tumor (eg, malignant neoplasm), soft tissue of face or scalp;

less than 2 cm

Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than

3 cm

Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cm Radical resection of tumor (eg, malignant neoplasm), soft tissue of neck or anterior thorax; less than 5 cm Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm Radical resection of tumor (eg, malignant neoplasm), soft tissue of back or flank;

less than 5 cm

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Musculoskeletal Revisions
CODE 22900 23075 23076 23077 23200 23210 23220 2009 CPT
Excision, abdominal wall tumor, subfascial (eg, desmoid) Excision, soft tissue tumor, shoulder area; subcutaneous Excision, soft tissue tumor, shoulder area; deep, subfascial or intramuscular Radical resection of tumor (eg, malignant neoplasm), soft tissue of shoulder area Radical resection for tumor; clavicle Radical resection for tumor; scapula Radical resection of bone tumor, proximal humerus

2010 CPT
Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); less than 5 cm Excision, tumor, soft tissue of shoulder area, subcutaneous; less

than 3 cm

Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); less than 5 cm Radical resection of tumor (eg, malignant neoplasm), soft tissue of shoulder area; less than 5 cm Radical resection of tumor; clavicle Radical resection of tumor; scapula Radical resection of tumor, proximal humerus

41

Musculoskeletal Revisions
CODE 24075 24076 2009 CPT
Excision, tumor, soft tissue of upper arm or elbow area; subcutaneous Excision, tumor, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular) Radical resection of tumor (eg, malignant neoplasm), soft tissue of upper arm or elbow area Radical resection for tumor, shaft or distal humerus; Radical resection for tumor, radial head or neck;

2010 CPT
Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less

than 3 cm

Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, intramuscular); less than 5 cm Radical resection of tumor (eg, malignant neoplasm), soft tissue of upper arm or elbow area; less than 5

24077

cm

24150 24152

Radical resection of tumor, shaft or distal humerus Radical resection of tumor, radial head or neck

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Musculoskeletal Revisions
CODE 25075 25076 25077 25170 26115 26116 26117 2009 CPT
Excision, tumor, soft tissue of forearm and/or wrist area; subcutaneous Excision, tumor, soft tissue of forearm and/or wrist area; deep (subfascial or intramuscular) Radical resection of tumor (eg, malignant neoplasm), soft tissue of forearm and/or wrist area Radical resection for tumor, radius or ulna Excision, tumor or vascular malformation, soft tissue of hand or finger; subcutaneous Excision, tumor or vascular malformation, soft tissue of hand or finger; deep (subfascial or intramuscular) Radical resection of tumor (eg, malignant neoplasm), soft tissue of hand or finger

2010 CPT
Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less than 3 cm Excision, tumor, soft tissue of forearm and or wrist area, subfascial (eg, intramuscular); less

than 3 cm

Radical resection of tumor (eg, malignant neoplasm), soft tissue of forearm and/or wrist area; less than 3 cm Radical resection of tumor, radius or ulna Excision, tumor or vascular malformation, soft tissue of hand or fingers, subcutaneous; less

than 1.5 cm

Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); less than 1.5 cm Radical resection of tumor (eg, malignant neoplasm), soft tissue of hand or finger; less

than 3 cm

43

Musculoskeletal Revisions
CODE 26250 26260 26262 27047 27048 27049 2009 CPT
Radical resection, metacarpal; (eg, tumor) Radical resection, proximal or middle phalanx of finger (eg, tumor) Radical resection, distal phalanx of finger (eg, tumor) Excision, tumor, pelvis and hip area; subcutaneous tissue Excision, tumor, pelvis and hip area; deep, subfascial, intramuscular Radical resection of tumor, soft tissue of pelvis and hip area

2010 CPT
Radical resection of tumor, metacarpal Radical resection of tumor, proximal or middle phalanx of finger Radical resection of tumor, distal phalanx of finger Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; less

than 3 cm

Excision, tumor, soft tissue of pelvis and hip area, subfascial (eg, intramuscular); less than 5 cm Radical resection of tumor (eg, malignant neoplasm), soft tissue of pelvis and hip area; less than 5 cm

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Musculoskeletal Revisions
CODE 27075 27076 27077 27078 27327 27328 27329 2009 CPT
Radical resection of tumor or infection; wing of ilium, one pubic or ischial ramus or symphysis pubis Radical resection of tumor or infection; ilium, including acetabulum, both pubic rami, or ischium and acetabulum Radical resection of tumor or infection; innominate bone, total Radical resection of tumor or infection; ischial tuberosity and greater trochanter of femur Excision, tumor, thigh or knee area; subcutaneous Excision, tumor, thigh or knee area; deep, subfascial, or intramuscular Radical resection of tumor (eg, malignant neoplasm), soft tissue of thigh or knee area

2010 CPT
Radical resection of tumor; wing of ilium, 1 pubic or ischial ramus or symphysis pubis Radical resection of tumor; ilium, including acetabulum, both pubic rami, or ischium and acetabulum Radical resection of tumor; innominate bone, total Radical resection of tumor; ischial tuberosity or greater trochanter of femur Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 cm Excision, tumor, soft tissue of thigh or knee area, subfascial (eg, intramuscular); less

than 5 cm

Radical resection of tumor (eg, malignant neoplasm), soft tissue of thigh or knee area;

less than 5 cm

45

Musculoskeletal Revisions
CODE 27365 27615 27618 27619 2009 CPT
Radical resection of tumor, bone, femur or knee Radical resection of tumor (eg, malignant neoplasm), soft tissue of leg or ankle area Excision, tumor, leg or ankle area; subcutaneous tissue Excision, tumor, leg or ankle area; deep, subfascial or intramuscular

2010 CPT
Radical resection of tumor, femur or knee Radical resection of tumor (eg, malignant neoplasm), soft tissue of leg or ankle area; less than 5 cm Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than

3 cm

Excision, tumor, soft tissue of leg or ankle area, subfascial (eg, intramuscular); less than 5 cm

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Musculoskeletal Revisions
CODE 27640 2009 CPT
Partial excision (craterization, saucerization, or diaphysectomy) bone, (eg, for osteomyelitis or exostosis); tibia Partial excision (craterization, saucerization, or diaphysectomy) bone, (eg, for osteomyelitis or exostosis); fibula Radical resection of tumor, bone; tibia Radical resection of tumor, bone; fibula Radical resection of tumor, bone; talus or calcaneus

2010 CPT
Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); tibia Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); fibula Radical resection of tumor; tibia Radical resection of tumor; fibula Radical resection of tumor; talus or calcaneus

27641

27645 27646 27647

47

Musculoskeletal Revisions
CODE 28043 28045 28046 28171 28173 28175 2009 CPT
Excision, tumor, foot; subcutaneous tissue Excision, tumor, foot; deep, subfascial, intramuscular Radical resection of tumor (eg, malignant neoplasm), soft tissue of foot Radical resection for tumor, bone; tarsal (except [talus or calcaneus]) Radical resection for tumor, bone; metatarsal Radical resection for tumor, bone; phalanx of toe

2010 CPT
Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm Excision, tumor, soft tissue of foot or toe, subfacial (eg, intramuscular); less

than 1.5 cm

Radical resection of tumor (eg, malignant neoplasm), soft tissue of foot or toe; less than 3 cm Radical resection of tumor; tarsal (except talus or calcaneus) Radical resection of tumor; metatarsal Radical resection of tumor; phalanx of toe

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Respiratory
For the Nose, excision:

The instructional note to use

30140 – 52 for “reduction” of turbinates was deleted

The cross reference note was revised regarding closure and reconstruction with the appropriate integumentary code ranges
49

Respiratory Revisions
CODE 2009 CPT
Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; superficial

2010 CPT
Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery,

30801

radiofrequency ablation, or tissue volume reduction); superficial
Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, submucosal)

30802

Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; intramural

radiofrequency ablation, or tissue volume reduction); intramural (ie,

Radiofrequency is inherent to the ablation. Both codes also include reduction of the turbinates. 50

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Bronchoscopy Revisions
The bronchoscopy main term was changed to:

Bronchoscopy, rigid or flexible,

“including fluoroscopic guidance, when performed”

From “with or without fluoroscopic guidance”
From “with or without cell washing”

“with cell washing, when performed”

51

Respiratory Revisions
The bronchoscopy family of codes 31641 – 31656 codes are revised with the new heading of the parent code 31622

52

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Notes/Comments/Questions

Respiratory Revisions
CODE 2009 CPT Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing (separate procedure) 2010 CPT

including fluoroscopic guidance, when performed;
diagnostic, with cell washing, when performed (separate procedure)

Bronchoscopy, rigid or flexible,

31622

53

Respiratory Revisions
CODE 2009 CPT
Bronchoscopy (rigid or flexible);
with destruction of tumor or relief of stenosis by any method other than [excision] (eg, laser therapy, cryotherapy) with placement of catheter(s) for intracavitary radioelement application with therapeutic aspiration of tracheobronchial tree, initial (eg, drainage of lung abscess) with therapeutic aspiration of tracheobronchial tree, subsequent with injection of contrast material for segmental bronchography

2010 CPT
including fluoroscopic guidance, when performed;
with destruction of tumor or relief of stenosis by any method other than excision (eg, laser therapy, cryotherapy) same

Bronchoscopy, rigid or flexible,

31641 31643 31645 31646 31656

same same with injection of contrast material for segmental bronchography (fiberscope

only)

54

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Notes/Comments/Questions

Bronchoscopy Additions
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed;
• •

31626: with placement of fiducial markers, single or multiple +31627: with computer-assisted imageguided navigation

Notes added to
– –

Includes 3D reconstruction Use in conjunction with codes …..

55

Chest Tube
New codes:
• •

32552: Removal of indwelling tunneled pleural catheter with cuff 32553: Placement of interstitial device(s) for radiation therapy guidance (eg-fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple

Instructional notes added 56

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Notes/Comments/Questions

Fibrinolysis
Lungs, pleura – Destruction: installation of a fibrolytic agent Revised code:

New codes:

32560: Chemical pleurodesis (eg, for recurrent or persistent pneumothorax) to • Instillation, via chest tube/catheter, agent for pleurodesis (eg, talc, for recurrent or persistent pneumothorax) Instillation(s) via chest tube/catheter, agent for fibrinolysis (eg-fibrinolytic agent for break up of multiloculated effusion) • 32561: Initial day

All 3 codes have instructional notes for chest tube insertion, to use 32551

32562: Subsequent day

Report only x1

57

Cardiovascular Revisions
CODE 2009 CPT
Insertion of a transvenous electrode; single chamber (one electrode) permanent pacemaker or single chamber pacing cardioverter-defibrillator Insertion of a transvenous electrode; dual chamber (two electrodes) permanent pacemaker or dual chamber pacing cardioverter-defibrillator Revision of skin pocket for single or dual chamber pacing cardioverterdefibrillator

2010 CPT
Insertion of a single transvenous electrode, permanent pacemaker or cardioverter-defibrillator

33216

33217

Insertion of 2 transvenous electrodes permanent pacemaker or cardioverterdefibrillator

33223

Revision of skin pocket for cardioverter-defibrillator

58

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Notes/Comments/Questions

Cardiovascular Additions
Transposition of the great vessels new codes:

Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (eg-Nikaidoh procedure);

33782: without coronary ostium reimplantation

Note included to restrict the use with other cardiac repairs

33783: with reimplantation of 1 or both coronary ostia

59

Ventricular Assist Device Additions
Replacement of ventricular assist device - VAD –

33981: extracorporeal, single or biventricular, pump(s); single or each pump 33982: pump(s); implantable intracorporeal, single ventricle without cardiopulmonary bypass 33983: with cardiopulmonary bypass
60

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Notes/Comments/Questions

Arteriovenous Shunt for Dialysis
Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula);

• •

36147: Initial access with complete radiological evaluation of dialysis access, including fluoroscopy , image documentation, and report (includes access of shunt, injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow, including the inferior or superior vena cava) Do not report in addition 75791 36148: additional access for therapeutic intervention

List separately in addition to code for primary procedure)

61

Cardiovascular Revisions
CODE 2009 CPT 2010 CPT

36481

Percutaneous portal vein catheterization by any method

Same – includes the moderate sedation symbol

37183

Revision of TIPS – transvenous intrahepatic portosystemic shunt(s)….

Same – includes the moderate sedation symbol

62

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Notes/Comments/Questions

Ligation of Perforator Veins
Ligation of perforator …

37760: veins, subfascial, radical (Linton type), including skin graft, when performed, open, 1 leg (revised code for

unilateral)

37761: vein(s), open including ultrasound guidance when performed, 1 leg (new code) Instructional notes present to apply modifier 50 for bilateral or use 37500 if endoscopic 63

Laparoscopy Additions
Laparoscopy surgical, repair of paraesophageal hernia, includes fundoplasty when performed;
• •

43281: without implantation of mesh 43282: with implantation of mesh

Instructional notes

64

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Notes/Comments/Questions

Digestive Additions
43775: Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy

(sleeve gastrectomy) 45171: not including muscularis propria

Excision of rectal tumor, transanal approach;
• •

(partial thickness) (full-thickness)

45172: including muscularis propria

46707: Repair of anorectal fistula with plug

(Porcine small intestine submucosa (SIS))

65

Digestive Additions
49411: Placement of interstitial device(s) for radiation therapy guidance, (eg-fiducial markers, dosimeter), percutaneous, intra-abdominal, intrapelvic, (except prostate), and/or retroperitoneum, single or multiple

Instructional notes:
For imaging guidance • Report supply of device separately • For percutaneous placement of … for intrathoracic,… use 32553

66

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Notes/Comments/Questions

Digestive Revisions
CODE 42894 2009 CPT
Resection of pharyngeal wall requiring closure with myocutaneous flap Repositioning of the gastric feeding tube, through the duodenum for enteric nutrition Fissurectomy, with or without sphincterotomy Papillectomy or excision of single tag, anus (separate procedure) Hemorrhoidectomy, by simple ligature (eg, rubber band) Excision of external hemorrhoid tags and/or multiple papillae

2010 CPT
Resection of pharyngeal wall requiring closure with myocutaneous or fasciocutaneous flap or free muscle, skin, or fascial flap with microvascular anastomosis Repositioning of a naso- or oro- gastric feeding tube, through the duodenum for enteric nutrition Fissurectomy, including sphincterotomy, when performed Excision of single external papilla or tag, anus Hemorrhoidectomy, internal by rubber band ligation(s) Excision of multiple external papillae or tags, anus

43761 46200 #46220 46221 46230

67

Hemorrhoidectomy Revisions
CODE 46250 46255 2009 CPT
Hemorrhoidectomy, external,

2010 CPT
Hemorrhoidectomy, external, 2 or

complete

more columns/groups

Hemorrhoidectomy internal and external, simple; Hemorrhoidectomy internal and external, simple; with fissurectomy Hemorrhoidectomy internal and external, simple; with fistulectomy, with or without fissurectomy

Hemorrhoidectomy internal and external, single column/group; Hemorrhoidectomy internal and external, single column/group; with fissurectomy Hemorrhoidectomy internal and external, single column/group; with fistulectomy, including

46257

46258

fissurectomy, when performed

Note: The “simple” is changed to single column/group” and the “complete” is changed to “2 or more columns/groups”.

68

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Notes/Comments/Questions

Hemorrhoidectomy Revisions
CODE 46260 2009 CPT
Hemorrhoidectomy, internal and external, complex or extensive; Hemorrhoidectomy, internal and external, complex or extensive; with fissurectomy Hemorrhoidectomy, internal and external, complex or extensive; with fistulectomy, with or without fissurectomy

2010 CPT
Hemorrhoidectomy, internal and external, 2 or more

columns/groups;

46261

Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fissurectomy Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fistulectomy, including fissurectomy, when performed

46262

Note: The “complex or extensive” is changed to “2 or more columns/groups”.

69

Digestive Revisions
CODE 46275 2009 CPT
Surgical treatment of anal fistula (fistulectomy, fistulotomy); submuscular Surgical treatment of anal fistula (fistulectomy, fistulotomy); complex or multiple, with or without placement of seton Enucleation or excision of external thrombotic hemorrhoid Ligation of internal hemorrhoids; single procedure Ligation of internal hemorrhoids; multiple procedures

2010 CPT
Surgical treatment of anal fistula (fistulectomy, fistulotomy); intersphincteric Surgical treatment of anal fistula (fistulectomy, fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or multiple, including placement of seton, when performed Excision of thrombosed hemorrhoid, external Hemorrhoidectomy, internal by other than rubber band; single hemorrhoid column/group Hemorrhoidectomy, internal by other than rubber band; 2 or more hemorrhoid columns/groups

46280

#46320 #46945 #46946

70

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Notes/Comments/Questions

Urodynamics Additions and Revisions
“Urodynamics (51725 – 51792) lists procedures that may be used separately or in varied combinations” Complex cystometrogram (ie, calibrated electronic equipment):
• • • •

51726 – (revised - now a parent code to the following new codes) 51727: with urethral pressure profile studies (ieurethral closure pressure profile), any technique 51728: with voiding pressure studies (ie-bladder voiding pressure), any technique 51729: with voiding pressure studies (ie-bladder voiding pressure) and urethral pressure profile studies (ie-urethral closure pressure profile), any technique

71

Urinary Revisions and Additions
CODE 2009 CPT
Voiding pressure studies (VP); intra-abdominal voiding pressure (AP) (rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure)

2010 CPT
Voiding pressure studies; intraabdominal (ie, rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure)

#+51797

52282

Cystourethroscopy, with insertion of urethral stent

Cystourethroscopy, with insertion of permanent urethral stent

New code 53855: Insertion of a temporary prostatic urethral stent, including urethral measurement 72

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Notes/Comments/Questions

Male Genital System Revisions
CODE 2009 CPT Cryosurgical ablation of the prostate (includes ultrasonic guidance for 2010 CPT Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring)

55873

interstitial cryosurgical probe placement)

55876

Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple

Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous prostate, single or multiple

73

Female Genital System
New code:

57426: Revision (including removal) of prosthetic vaginal graft, laparoscopic approach

Revisions of cross reference notes to include reference to this code

74

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Notes/Comments/Questions

Maternity Care and Delivery Revisions
CODE 2009 CPT Unlisted fetal invasive procedure, including ultrasound guidance 2010 CPT Unlisted fetal invasive procedure, including ultrasound guidance, when

59897

performed

75

Nervous System Additions
Spinal neurostimulator electrode
• • • •

63661: Removal of … percutaneous array(s), … 63662: Removal of … plate/paddle(s) via laminotomy or laminectomy, … 63663: Revision including replacement, when performed, … percutaneous array(s), … 63664: Revision including replacement, when performed, … plate/paddle(s) via laminotomy or laminectomy, … All … including fluoroscopy, when performed 76

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Notes/Comments/Questions

Paravertebral Spinal Nerves and Branches Additions
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance, fluoroscopy or CT,

Cervical or thoracic
• • •

64490: single level +64491: 2nd level +64492: 3rd and any additional level(s)

Do not use more than once per day

Lumbar or sacral
• • •

64493: single level +64494: 2nd level +64495: 3rd and any additional level(s)

Do not use more than once per day

77

Other Surgery Modifications
Conscious sedation not separately reportable bullseye added to codes 22520, 22521, 36481, 37183, 47382, 47525, 50200, 77371

78

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Notes/Comments/Questions

Radiology
Defined “special report” in guidelines “Service that is rarely provided, unusual, variable or new may require special report” Include

“adequate” definition/description of
• • •

Nature Extent Need for procedure

Time, effort, equipment needed to perform

79

Radiology
CODE 2009 CPT
Radiological supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation including cavity creation, per vertebral body; under fluoroscopic guidance Radiological supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation including cavity creation, per vertebral body; under CT guidance Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, pravertebral facet joint nerve, or sacroiliac joint), including neurolytic agent destruction

2010 CPT
Radiological supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance Radiological supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under CT guidance Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, or sacroiliac joint), including neurolytic agent destruction

72291

72292

77003

80

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Notes/Comments/Questions

New Codes GI Tract
74261 CT colonography, Diagnostic including image postprocessing, without contrast 74262 with contrast including noncontrast images if done 74263 CT colonography, screening, including image postprocessing Watch “do not report” notes
81

Heart
Cardiac magnetic resonance imaging Different from regular MRI because can give physiologic eval of cardiac function
Flow and velocity assessment for valves and intracardiac shunts • Function and morphologic eval

Performed at rest and/or during stress testing Most codes are one per session Inclusive of most testing performed at same time so read notes carefully

82

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Notes/Comments/Questions

New Cardiac MRI Codes
75565 add on code for velocity flow mapping 75571 CT heart, without contrast, with quantitative eval of coronary calcium 75572 CT Heart with contrast for eval cardiac structure/morphology

Includes 3D image postprocessing, assessment cardiac function, eval venous structures (if done)

83

Two More Cardiac MRI
75573 CT heart with contrast for eval of cardiac structure/morphology in congenital heart disease
• •

Includes 3D postprocessing Assess LV cardiac function, RV structure/function/eval of venous structures if done 75574 CT angiography, heart, coronary arteries and bypass grafts when present, with contrast

Includes 3D postprocessing: eval cardiac structure/morphology/function, eval venous structures if done

84

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Notes/Comments/Questions

Vascular Procedures
75791 Angiography
• •

Arteriovenous shunt
• •

Dialysis patient fistula or graft Fluoro, image doc and report

Complete eval of dialysis access
Injections of contrast, all necessary imaging from arterial anastomosis, adjacent artery through entire venous outflow including inferior or superior vena cava

And Rad S&I

Can code catheter intro • Must be done through already existing access not direct puncture of shunt • See surgery code for shunt procedure 85

Radiation Oncology
New code 77338
• •

Multi-leaf collimator MCL For intensity modulated radiation therapy (IMRT) design and construction per IMRT plan

Not more than once per IMRT plan

Revised code 77371

Rad tx delivery, stereotactic radiosurgery complete course of tx cranial lesion(s) 1 session; multi-source Cobalt 60 based

86

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Notes/Comments/Questions

Nuclear Medicine
Cardiovascular system new codes
• •

Myocardial perfusion and cardiac blood pool imaging studies done at rest or with stress 78451 SPECT single study at rest or stress

78452 multiple studies, at rest and/or stress and/or redistribution and/or rest reinjection

78453 Planar, includes qual or quan wall motion, EF by first pass or gated technique, add quantification, when performed, single study at rest or stress

78454 multiple studies at rest and/or stress and/or redistribution and/or rest reinjection

87

Path/Lab
Table of Drugs/Appropriate Qualitative Screening, Confirmatory and Quantitative Codes Just before Guidelines

88

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Notes/Comments/Questions

Pathology and Laboratory
CODE 2009 CPT
Obstetric panel THIS PANEL MUST INCLUDE THE FOLLOWING: Syphilis test; qualitative (eg, VDRL, RPR, ART) (86592)

2010 CPT
Obstetric panel THIS PANEL MUST INCLUDE THE FOLLOWING: Syphilis test non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) (86592) Vitamin D; 25 hydroxy, includes fraction(s), if performed 1, 25-dihydroxy, includes fraction(s), if performed Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each Gammaglobulin (immunoglobulin); IgE Gammaglobulin (immunoglobulin); immunoglobulin subclasses, (eg, IgG1, 2, 3, or 4), each

80055

82306 82652 82784 82785 82787

Calcifediol (25-OH Vitamin D-3) Dihydroxyvitamin D, 1, 25Gammaglobulin; IgA, IgD, IgG, IgM, each Gammaglobulin; IgE Gammaglobulin; immunoglobulin subclasses, (IgG1, 2, 3, or 4), each

89

Pathology and Laboratory
CODE 83516 2009 CPT
Immunoassay for analyte other than [infectious agent antibody or infectious agent antigen], qualitative or semiquantitative; multiple step method Immunoassay for analyte other than [infectious agent antibody or infectious agent antigen]; qualitative or semiquantitative, single step method (eg, reagent strip)

2010 CPT
Immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or semiquantitative; multiple step method Immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or semiquantitative; single step method (eg, reagent strip) Quantitative; by radioimmunoassay (eg, RIA) Quantitative; not otherwise specified pH, body fluid, not otherwise specified

83518

83519 83520 83986

Immunoassay, analyte, quantitative;
by radiopharmaceutical technique (eg, RIA) not otherwise specified

Immunoassay, analyte, quantitative;
pH, body fluid, except [blood]

90

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Notes/Comments/Questions

Pathology and Laboratory
CODE 86592 86593 87149 2009 CPT
Syphilis test; qualitative (eg, VDRL, RPR, ART) Syphilis test; quantitative Culture typing; identification by nucleic acid probe Special stains (List separately in addition to code for primary service); Group I for microorganisms (eg, Gridley, acid fast, methenamine silver), each Special stains (List separately in addition to code for primary service); Group II, all other (eg, iron, trichrome), except immunocytochemistry and immunoperoxidase stains, each

2010 CPT
Syphilis test non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) Syphilis test non-treponemal antibody; quantitative Culture typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each organism probed Special stains; Group I for microorganisms (eg, Gridley, acid fast, methenamine silver), including interpretation and report, each

88312

88313

Special stains; Group II, all other (eg, iron, trichrome), except immunocytochemistry and immunoperoxidase stains, including interpretation and report, each Special stains; histochemical staining with frozen section(s), including interpretation and report (List separately in addition to code for primary service)

Special stains (List separately in addition

+88314

histochemical staining with frozen section(s)

to code for primary service);

91

Organ Panels
New instructions
Don’t report two or more panel codes that include any of same constituent tests performed from same patient collection • If group tests overlaps panels, report the panel incorporates greater number of tests to fulfill code definition • Report remainder of tests using individual test codes • Example: don’t use 80047 and 80053 together

92

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Notes/Comments/Questions

More Chemistry
83986 revised pH body fluid NOS New Codes:

83987 exhaled breath condensate

84145 Procalcitonin PCT 84431 Thromboxane metabolite(s) including thromboxane if performed, urine
93

Immunology New Codes
86305

Human epididymis protein 4 (HE4) Cellular function assay involving stimulation (mitogen or antigen) and detection of biomarker (such as ATP) Treponema pallidum
94

86352

86780

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Notes/Comments/Questions

Tissue Typing
New Codes 86825 Human leukocyte antigen crossmatch, noncytotoxic, first serum sample or dilution 86826 each additional serum sample/sample dilution

Add on code
95

Microbiology
Presumptive id of microorganisms defined

“id by colony morphology, growth on selective media, gram stains, or up to three tests” Definitive id “id to the genus or species level requires additional tests”

Notes to show which codes can be used together
96

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Notes/Comments/Questions

Micro New Codes
87150

Id by nucleic acid probe, amplified probe technique, per culture/isolate, each organism probed Id by nucleic acid sequencing method each isolate

87153

97

Guidance for 87260-87999
Note above 87260 Codes to be used for primary source only Other rules included regarding selection of most specific code possible Separate results reported for different species/strains, each coded separately Use -59 when separate results reported for diff species described by same code
98

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Notes/Comments/Questions

New Codes
87493 Clostridium difficile, toxin gene(s) amplified probe technique 88387

Macroscopic exam, dissection, prep tissues for non-microscopic analytical studies

Nucleic-based molecular studies

Each tissue prep

88388

In conjunction with touch imprint, intraop consult, or frozen section

Each tissue prep
• •

Example: single lymph node Add on code, use with 88329-88334

99

Two More New Lab Codes
In Vivo Procedures 88738

Hemoglobin (Hgb) quantitative, transcutaneous Unlisted reproductive medicine lab procedure
100

89398

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Notes/Comments/Questions

Medicine Section
CODE 90378 90669 2009 CPT
Respiratory syncytial virus immune globulin (RSV-IgM), for intramuscular use, 50 mg, each

2010 CPT
Respiratory syncytial virus monoclonal antibody, recombinant, for intramuscular use, 50 mg, each

polyvalent, when administered to children younger than 5 years, for intramuscular
use Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; Bioimpedance, thoracic, electrical Sleep study, simultaneous recording of

Pneumococcal conjugate vaccine,

Pneumococcal conjugate vaccine, 7 valent, for intramuscular use Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; Bioimpedance-derived physiologic cardiovascular analysis Sleep study, unattended, simultaneous recording of heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)

9327993287 93701 95806

ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, unattended by a technologist
Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); … (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and esophagus)

+96570 +96571

Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); … (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract)

101

Medicine
New Heading

Immune globulins, serum or recombinant products
• • • • •

Not new codes Instructions on usage of codes Coded in conjunction with admin codes Do not use mod 51 90379 deleted 102

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Notes/Comments/Questions

Vaccines
90670 new code

Pneumococcal conjugate vaccine, 13 valent for IM use

90738 Japanese encephalitis virus vaccine, inactivated, for intramuscular list revised to show now on FDA approved list
103

ENT Services
92540 Basic vestibular eval

Includes spontaneous nystagmus test with eccentric gaze fixation nystagmus

Recording, positional nystagmus test, min 4 positions, with recording optokinetic nystagmus test Bidirectional foveal/peripheral stimulation Recording, oscillating tracking test with recording “Do Not Report with” notes 104

• • •

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Notes/Comments/Questions

Audiologic Function Tests New Codes
92550 Tympanometry and reflex threshold measurements 92570 Acoustic immittance testing, includes tympanometry
• • •

Impedance testing Acoustic reflex threshold testing Acoustic reflex decay testing
105

Implantable and Wearable Cardiac Device Evaluations
New instructions and information on how to use codes In person vs. remote Technical/professional physician Service center practice Some are once per 90 days/30 days/10 days
106

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Notes/Comments/Questions

New Definitions
Electrocardiographic rhythm derived elements

Include heart rhythm, rate, ST analysis, heart rate variability, T-wave alternans Of implantable device such as

Interrogation device evaluation

Pacemaker, implantable cardioverter-defibrillator, implantable cardiovascular monitor, implantable loop recorder

Programming device eval

In person programming

107

Echocardiography
Instructions and definitions

• •

Complex transthoracic echo includes two dimensional and selected M-Mode exam of left/right atria, ventricles, aortic, mitral tricuspid valves, pericardium, adjacent portions of aorta if performed If an element cannot be visualized, it must be documented Stress echo done with stress test use one code only
108

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Notes/Comments/Questions

Noninvasive Physiologic Studies
New code 93750

Interrogation of ventricular assist device (VAD) in person
• • • •

With physician analysis of device parameters Review of device function With programming, if performed Report

109

Pulmonary
Measurement
• •

94011 spirometric forced expiratory flows in infant/child to two yrs. 94012 spirometric forced expiratory flows, before and after bronchodialator, infant/child to age two 94013 lung volumes infant/child to age two
Include functional residual capacity • Forced vital capacity • Expiratory reserve volume

110

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Notes/Comments/Questions

Nerve Conduction Tests
Instructions on specificity of what is included and that tests are individualized to patient’s anatomy 95905 New code

Motor/sensory nerve conduction
Using preconfigured electrode array(s) • Amplitude/latency/velocity study, each limb • Only once per limb • Don’t use with other nerve conduction study codes 111

Hydration, Injections/Infusions
Updated instructions regarding hierarchy for multiple services
• •

Physician Hierarchy Dependent on physician knowledge of clinical conditions and treatments
• •

Initial = best describes primary reason for encounter Does not matter what order they are given 112

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Notes/Comments/Questions

Facility Hierarchy
Chemo Therapeutic services Hydration Infusions primary to pushes Pushes primary to hydration Hierarchy rules supersedes instructions in the book regarding add on code usage
113

Category II Codes
CODE 0519F 2009 CPT
Planned chemotherapy regimen, including at a minimum: drug(s) prescribed, dose, and duration, documented prior to course of treatment (ONC)1

2010 CPT
Planned chemotherapy regimen, including at a minimum: drug(s) prescribed, dose, and duration, documented prior to initiation of a new treatment regimen (ONC)1 Radiation dose limits to normal tissues established prior to the initiation of a course of 3D conformal radiation for a minimum of two tissues/organs (ONC)1 Plan of care to address pain documented (COA)2 (ONC)1 1 of the following diagnostic imaging studies ordered: chest X-ray, CT, ultrasound, MRI, PET, or nuclear medicine scans (ML)5 Oral antiplatelet therapy prescribed (CAD)1

0520F

Normal tissue dose constraints established within 5 treatment days from the initiation of a course of 3D conformal radiation for a minimum of one tissue/organ (ONC)1
Plan of care to address pain documented (ONC)1

0521F 3319F

One of the following diagnostic imaging studies ordered: chest X-ray, CT, ultrasound, MRI, PET, or nuclear medicine scans (ML)5
Oral antiplatelet therapy prescribed

4011F

(eg, aspirin, clopidogrel/Plavix, or combination of aspirin and dipyridamole/Aggrenox) (CAD)1

4158F

Patient education regarding risk of alcohol consumption performed (HEP-C)1

Patient counseled about risks of alcohol use (HEP-C)1

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Category II Codes
CODE
4180F 4200F 4201F

2009 CPT
Adjuvant chemotherapy prescribed or previously received for Stage IIIA through Stage IIIC colon cancer (ONC)1 External beam radiotherapy to prostate only (PRCA)1 External beam radiotherapy for prostate cancer to region(s) other than prostate only (PRCA)1 Active warming used intraoperatively for the purpose of maintaining normothermia, OR at least one body temperature equal to or greater than 36 degrees Centigrade (or 96.8 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 30 minutes immediately after anesthesia end time (CRIT)1 Treatment summary report communicated to physician(s) managing continuing care within 1 month of completing treatment (ONC)1 All elements of maximal sterile barrier technique including: cap AND mask AND sterile gown AND sterile gloves AND a large sterile sheet AND hand hygiene AND 2% chlorhexidine for cutaneous antisepsis, followed (CRIT)1

2010 CPT
Adjuvant chemotherapy referred, prescribed or previously received for Stage IIIA through Stage IIIC colon cancer (ONC)1 External beam radiotherapy as primary therapy to prostate with or without nodal radiation (PRCA)1 External beam radiotherapy with or without nodal irradiation as adjuvant or salvage therapy for prostate cancer patient (PRCA)1

4250F

Active warming used intraoperatively for the purpose of maintaining normothermia, OR at least one body temperature equal to or greater than 36 degrees Centigrade (or 96.8 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (CRIT)1

5020F

Treatment summary report communicated to physician(s) managing continuing care and to the patient within 1 month of completing treatment (ONC)1 All elements of maximal sterile barrier technique followed including: cap AND mask AND sterile gown AND sterile gloves AND a large sterile sheet AND hand hygiene AND 2% chlorhexidine for cutaneous antisepsis, (or acceptable alternative antiseptics, per current guideline) (CRIT)1

6030F

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New Patient Management Codes
0528F-0575F

Recommended follow up repeat colonoscopy

At least 10 years documented

• • • •

3 or more years since patient last colonoscopy Dyspnea mgmt plan of care Glucocorticoid mgmt plan HIV RNA control plan of care
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Patient History
New codes 1150F-1220F
patient high risk for death within 1 year patient is not at high risk of death within 1 year • Advanced disease diagnosis
• •

Goals: comfort Goals don’t prioritize comfort

• • • • • • • •

Advanced disease diagnosis

Advance care plan present in health record Discussion of advance care plan documented Medication list documented Review of medications Functional status assessment Thromboembolic risk factors documented Screening for depression

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Physical Exam
2050F Documentation of wound
• • •

Size Nature Drainage amount

Prior to debridement

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Screening/Diagnostic Results
3016F
• •

Screening for alcohol use/abuse

3018F
Colonoscopy documentation • Risk assessment, depth of insertion • Prep quality • Findings: details of polyps found

Location, size, morphology

• •

Recommendations Specimen site

3250F
More than just location of primary tumor

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More Screening/Diagnostic Results
3321F AJCC cancer stage 0/1A Melanoma 3322F Melanoma >Stage 0/1A 3370F-3390F

Staging of breast and colon cancer

3450F-3452F Dyspnea screening 3455F TB screening and results prior to tx 3470F-3476F Rheumatoid arthritis screening 3490F-3503F HIV screening and cell counts

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More Screening/Diagnostic Results
3510F TB Test Screening 3511F-3512F STD screening 3513F-3515F Hepatitis screening 3550F-3552F Thromboembolism screening 3555F INR performed 3570F Bone scintigraphy study 3572F-3573F Risk assessment for fracture

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Therapeutic and Preventive Interventions
Hepatitis Vaccine given Patient counseling for alcohol risks/screening for drug abuse Chemotherapy for Stage III Colon Cancer Status of patient getting/not getting types of therapy (glucocorticoid, arthritis drugs) Radiotherapy Wound tx HIV therapy Immunizations given such as flu, Hep B Foot care

122

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Category III Codes
Note in guidelines explaining usage of the alphanumeric codes New Codes 0197T-0207T
• • • • • • • • •

Patient tracking during radiation therapy Ocular blood flow measurement Tremor recording Sacroplasty with injections Vertebral joint arthroplasty Sleep Studies IV catheter based coronary vessel spectroscopy Analysis of EKG data with computer probability assessment Evacuation meibomian glands using heat/pressure unilateral 123

References
CPT® 2010 Professional Edition, American Medical Association CPT® 2010 Changes; An Insider’s View, American Medical Association CPT® Coding Symposium November 11-13, 2009, American Medical Association
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Audio Seminar Discussion
Following today’s live seminar Available to AHIMA members at
www.AHIMA.org
Click on Communities of Practice (CoP) – icon on top right AHIMA Member ID number and password required – for members only

Join the Coding Community from your Personal Page under Community Discussions, choose the Audio Seminar Forum You will be able to: • Discuss seminar topics • Network with other AHIMA members • Enhance your learning experience

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Notes/Comments/Questions

Become an AHIMA Member Today!
To learn more about becoming a member of AHIMA, please visit our website at ahima.org/membership to Join Now!

AHIMA Audio Seminars
Visit our Web site http://campus.AHIMA.org for information on the 2009 seminar schedule. While online, you can also register for seminars or order CDs, pre-recorded Webcasts, and *MP3s of past seminars.
*Select audio seminars only

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2010 Procedure and Service Code Updates

Notes/Comments/Questions

Upcoming Seminars
2010 Procedure and Service Code Updates (Rebroadcast) December 8, 2009 CY10 CMS OPPS Update December 10, 2009 Advanced Coding Scenarios: An Expert Review December 15, 2009

Thank you for joining us today!
Remember − sign on to the AHIMA Audio Seminars Web site to complete your evaluation form and receive your CE Certificate online at:
http://campus.ahima.org/audio/2009seminars.html Each person seeking CE credit must complete the sign-in form and evaluation in order to view and print their CE certificate Certificates will be awarded for AHIMA Continuing Education Credit

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Appendix
CE Certificate Instructions

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To receive your

CE Certificate
Please go to the AHIMA Web site click on the link to “Sign In and Complete Online Evaluation” listed for this seminar. You will be automatically linked to the CE certificate for this seminar after completing the evaluation.
Each participant expecting to receive continuing education credit must complete the online evaluation and sign-in information after the seminar, in order to view and print the CE certificate.

http://campus.ahima.org/audio/2009seminars.html

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