1. 2014 Coding Changes AAPC RICHMOND VA. CHAPTER JANUARY 2014

2. Overview & Objectives  Identify coding changes for the upcoming year (HIGHLIGHTS)  CPT ®  HCPCS  What's new for 2014- over 330 coding changes AAPC Richmond Va. Chapter - January 2014 2

3. CPT ® 175 NEW CODES 47 DELETED CODES 107 REVISED CODES AAPC Richmond Va. Chapter - January 2014 3

4. Evaluation & Management  Interprofessional Telephone/Internet Consultations (99446 - 99449) four new codes  Time-based!!  must document a minimum of 5 minutes to report 99446  Time includes review of medical record, diagnostic test, verbal & written communication  Request from treating physician to consultant for opinion and/or treatment advice to assist in the diagnosis and/or management of the patient  no face to face w/ patient  Complex and/or urgent situations where a timely face-to-face service with the consultant may not be feasible  New patient to consultant or Established patient with new problem or exacerbation of an existing patient  No face-to-face with consultant last 14 days or next 14 days  Report only once in a seven day period AAPC Richmond Va. Chapter - January 2014 4

5. Evaluation & Management (cont.)  Complex Chronic Care Coordination Services (99487 - 99489)  Codes did not change  Guidelines revised to detail:  Typical adult patients  Typical pediatric patients  Requirements for care coordination offices/practices  Requirements:  Provide 24/7 access to clinical staff  Use standardized methodology to identify CCCC patients  Internal process whereby identified patients being receiving treatment in a timely manner  Standardized medical record form and format  Engage and educate patients and caregivers and coordinate care among all service professionals AAPC Richmond Va. Chapter - January 2014 5

6. Evaluation & Management (cont.)  Transitional Care Management Services (99495 - 99496)  Codes did not change/ just revised  Can report for new or established patients  Separately reported E&M cannot be reported on the same day  Discharge service may not be used as required face-to-face visit AAPC Richmond Va. Chapter - January 2014 6

7. Integumentary - Lund-Browder (No more “Rule of Nines” in CPT) AreaBirth-1yr1-4 Yrs5-9 Yrs10-14 Yrs15 YrsAdult Head1917131197 Neck222222 Trunk*13 Buttock*2.5 Genitalia111111 U Arm*444444 L Arm*333333 Hand*2.5 Thigh*2.56.588.599.5 Leg*555.566.57 Foot*3.5 AAPC Richmond Va. Chapter - January 2014 7

8. Integumentary - Breast Procedures  New biopsy with localization codes:  Include localization devices, when performed  Include imaging of the biopsy specimen, when performed  Differ based on type of guidance  Stereotactic(19081, +19082)  Ultrasound(19083, +19084)  MRI(19085, +19086) AAPC Richmond Va. Chapter - January 2014 8

9. Integumentary - Breast Procedures (cont.)  New introduction codes for localization devices  Differ based on type of guidance  Mammographic (19281, +19282)  Stereotactic (19283, +19284)  Ultrasound (19285, +19286)  MRI (19287, +19288) AAPC Richmond Va. Chapter - January 2014 9

10. Musculoskeletal  Tumor resections  Changed terminology from: Malignant neoplasm to sarcoma  New and revised codes for removal of foreign body and removal of prosthesis  Specifically describes what is removed foreign body or prosthesis AAPC Richmond Va. Chapter - January 2014 10

11. Respiratory  Pleural catheter & thoracentesis  Parenthetical notes revised to state not to report in conjunction when performed on the same side of the chest AAPC Richmond Va. Chapter - January 2014 11

12. Cardiovascular  Pacemaker or Pacing Cardioverter Defibrillator  Guidelines revised  Relocation of skin pocket: requires creation of a new skin pocket  Revision of skin pocket, not reported separately  Subcutaneous implantable defibrillator system  TAVI/TARI new code for transapical exposure AAPC Richmond Va. Chapter - January 2014 12

13. Cardiovascular (cont.)  New codes  Fenestrated Endovascular Repair of the Visceral and Infrarenal Aorta (34841 - 34848)  Transcather placement of an intravascular stent(s) (37217, 37236 - 37239)  Vascular Embolization and Occlusion (37241 - 37244) AAPC Richmond Va. Chapter - January 2014 13

14. Digestive - BIG CHANGES  Endoscopy codes: specifically rigid and flexible esophagoscopy= significant changes  13 new codes  Description revision for nearly all remaining codes  New parenthetical instructions AAPC Richmond Va. Chapter - January 2014 14

15. Digestive - BIG CHANGES  Esophagoscopy (43191 - 43232)  Esophagogastroduodenoscopy (43233 - 43259)  Endoscopic Retrograde Cholangiopancreatography - ERCP (43260 - 43278)  Abdomen, Peritoneum, and Omentum - Introduction, Revision, and Removal AAPC Richmond Va. Chapter - January 2014 15

16. Digestive (cont.)  Esophagoscopy  Cricopharyngeus muscle (upper esophageal sphincter) to and including the gastoesophageal junction  Includes examination of the proximal region of the stomach via retroflexion when performed  Selecting code need to know if a rigid or flexible scope is used  Reason for separating the code is the different types of anesthesia used AAPC Richmond Va. Chapter - January 2014 16

17. Digestive (cont.)  Esophagogastroduodenoscopy (AKA: Upper GI)  Cricopharyngeus muscle (upper esophageal sphincter) to and including the duodenum  Consistent terminology  Explanation of proper modifier use  Duodenum deliberately not examined  Modifier 52 - Repeat examination not planned  Modifier 53 - Repeat examination planned AAPC Richmond Va. Chapter - January 2014 17

18. Digestive (cont.)  ERCP  Requires visualization of one or more of the ductal systems  Pancreatic  Biliary  Altered postoperative anatomy  Unlisted codes (47999 or 48999) for ERCP via gastrostomy or via Roux-en-Y AAPC Richmond Va. Chapter - January 2014 18

19. Digestive (cont.)  New codes for image-guided fluid collection draining by catheter (abdomen, peritoneum, and omentum)  49405Visceral Percutaneous  49406Peritoneal or Retroperitoneal, Percutaneous  49407Peritoneal or Retroperitoneal, Transvaginal or Transrectal AAPC Richmond Va. Chapter - January 2014 19

20. Urinary  One new code  Combination code  52356Cystourethroscopy with ureteroscopy with lithotripsy including insertion of indwelling ureteral stent(eg, Gibbons or double-J type) AAPC Richmond Va. Chapter - January 2014 20

21. Nervous  New Codes in the Chemodenervation Section - Somatic Nerves  64616Neck muscle(s) excluding larynx (unilateral)  64617Larynx, unilateral, percutaneous includes needle EMG guidance  64642One extremity; 1 -4 muscles  +64643Each additional extremity, 1 - 4 muscles  64644One extremity; 5+ muscles  +64645Each additional extremity, 5+ muscles  64646Trunk muscles; 1 - 5 muscles  64647Trunk muscles; 6+ muscles AAPC Richmond Va. Chapter - January 2014 21

22. Eye & Ocular Adnexa  One new code - Anterior Sclera - Aqueous Shunt  66183Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach  Replaces the category III code 0192T AAPC Richmond Va. Chapter - January 2014 22

23. Auditory System  Guideline for cerumen removal 69210  Clarifies that an instrument is required  Revised to report unilateral procedure (continue to use modifier 50 for bilateral procedures)  Added guidance from CPT ® Assistant AAPC Richmond Va. Chapter - January 2014 23

24. Radiology  Radiologic exam of spine 72040 now specifies “2 or 3 views instead of “3 or less”  Revisions to guidance codes and parenthetical references based on codes for which guidance is now included:  Transcatheter Procedures- supervision included in new codes 37236-37239  Fluoroscopic Guidance  Magnetic Resonance Guidance  Revisions to radiation oncology simulation guidelines: inappropriately described as “simulation”, more appropriately labeled as “planning” AAPC Richmond Va. Chapter - January 2014 24

25. Pathology & Laboratory  New Molecular Pathology Table  Expansion of molecular pathology parenthetical lists of included items  10 New Therapeutic Drug Assay Codes AAPC Richmond Va. Chapter - January 2014 25

26. Medicine  Vaccines - New Flu Codes  Includes four strains (two type A and two type B)  Patients age determines the code  Special Otorhinolaryngologic Services  New speech related codes  Repair of Structural Heart Defects  Two new percutaneous transcatheter repair codes  Intracardiac Electrophysiological Procedures/Studies  3 revised codes - all for comprehensive electrophysiologic evaluations AAPC Richmond Va. Chapter - January 2014 26

27. Medicine (cont.)  Intraoperative Neurophysiology  Guidelines revised to define specifically what the time monitoring and time in the OR includes  Monitoring - Time to set up, record, and interpret the baseline studies, and to remove electrodes at the end of the procedure  OR - Time is cumulative and only includes time physically present in the room; may begin prior to incision  Active Wound Care Management  One new code - low frequency non-contact non-thermal US for wound assessment (per day) AAPC Richmond Va. Chapter - January 2014 27

28. Next Steps AAPC Richmond Va. Chapter - January 2014 28  Review all new codes, guidelines, and parenthetical  Highlight the changes for your specialty  New guidelines/parenthetical printed in green.  Look in the index for any changes.  Update coding cheat sheets with the new codes  Make sure super bills, charge masters are updated with the new codes  Load new codes into software  Educate staff on changes

29. Questions? & Reminders…  Current 2014 CPT  2014 CPT® Errata  2014 CPT® Changes: An Insider’s View  CPT Assistant  AHA Coding Clinic AAPC Richmond Va. Chapter - January 2014 29

30. Contact Information  Presentation Prepared by- Chandra Stephenson, CPC, CPC-H, CPCO, CPMA, CPC-I, CANPC, CEMC, CFPC, CIMC, COSC  Presentation Presented by- Colleen Mescall, MHA/E, CPC, CPMA, CPC-I, 2014 RAC President, 2013-2015 National Advisory Board Member AAPC Richmond Va. Chapter - January 2014 30