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CODING

Analyzing CPT’s updates from radiology to the end

By Therese M. Jorwic, MPH, RHIA, CCS, CCS-P

In the past two issues, we covered CPT’s changes to the E/M codes and the surgery codes.

Here now are the rest of the changes. They start with radiology and end with the Category III codes.

Radiology

There are five newcomers here, all for nuclear medicine.

They begin with thyroid studies (78012-78014).

The first is for thyroid uptake where radioactive iodine is injected into the thyroid to show how it is processed. The test is often done for hyperthyroidism.

The second is for thyroid imaging, and the third is for imaging with uptake measurements.

The other two codes (78071-78072) are for planar imaging of the parathyroid, which is a gland around the thyroid. The first shows imaging with SPECT testing, and the second shows imaging with both SPECT and CT testing. SPECT is single photon emission computed tomography that provides three-dimensional views.

Path and lab

The path and lab section has 41 new codes.

They start with molecular pathology procedures (81201 through 81479) that analyze nucleic acid to detect gene variations, and they differ according to which gene is being analyzed.

Codes 81201 through 81326 apply to Tier 1 tests, which are somewhat common; code 81479 (unlisted procedure) is found with the Tier 2 tests, which apply to rare diseases and therefore are not often done.

Path and lab also has a new section for multianalyte assays with algorithmic analysis, which brings in nine new codes – 81500 through 81599.

And beyond that are new codes in chemistry, immunology, microbiology, and surgical pathology.

Medicine

VACCINES AND TOXOIDS

The medicine section saw 51 new codes this year.

They begin with vaccines and toxoids.

First is 90653 for intramuscular administration of adjuvanted flu vaccine. An adjuvant is an agent that stimulates the body’s immune system and thereby increases the effectiveness of the vaccine. This code has a lightening bolt beside it, which indicates it is awaiting FDA approval.

After that is 90672 for a quadrivalent intranasal flu vaccine that covers four strains of the virus.

And following that is 90739 for the new two-dose intramuscular hepatitis B vaccine, which is also awaiting FDA approval.

PSYCHIATRY

Since 1998, the psychiatry codes have remained relatively unchanged. Now, however, there are 12 new codes to reflect new ways of delivering psychiatric treatment. Mostly, they show the shift from treating just one disorder to managing a host of psychiatric and related medical conditions.

There are also lots of new guides at the beginning of the psychiatry section.

New code 90785 is an add-on for interactive complexity. It indicates an increased intensity of the service due to communication factors that complicate the treatment – things such as the patient’s anxiety or a caregiver’s inability to assist in the treatment.

Code 90791 is new for psychiatric diagnostic evaluation, and 90792 covers the same plus medical services. That second code would apply, for example, when the physician evaluates a psychiatric diagnosis and at the same time is concerned about a medical condition such as hypertension.

New codes 90832 through 90840 cover psychotherapy in both inpatient and outpatient settings. The site of service no longer counts. In addition, note that the time segments include time with family members, but only if the patient is present for part of the session.

These codes start with 30-minute psychotherapy sessions with patient and/or family (90832) followed by the same with an E/M service (90833). Then they continue along in the same pattern for 45-minute and 60-minute sessions. After each psychotherapy/E/M codes is a list of the E/M codes that can apply.

The last two new codes here are for psychotherapy for crises. They are 90839 for the first 60 minutes and 90840 for each additional 30 minutes.

Those codes are a new concept. They cover treatment for patients who are in high distress and require urgent attention. The problem is life-threatening or complex, such as depression with a plan for suicide.

Last is 90863 for pharmacologic management. It includes prescribing, reviewing, and changing medications. When the service is provided by a professional who can provide E/M services, it is an add-on to the E/M code. However, for a provider not authorized for E/M services, it is used with codes 90832, 90834, and 90837.

GASTROENTEROLOGY

There is just one new code here, and it is for gastrointestinal transit and pressure measurement that’s calculated by a capsule the patient swallows. It measures the digestive tract from stomach to colon.

The code is 91112, and it has moved up to CPT status after having been a Category III code (0242T).

CARDIOVASCULAR

The first group of new codes here (92920 to 92944) is for therapeutic coronary services and procedures. (Note that all these codes are out of sequence.)

It begins with codes for opening narrowed or occluded arteries in any of the five major vessels.

First is 92920 for percutaneous transluminal coronary angioplasty, single major artery or branch, followed by 92921 for each additional branch of a major coronary artery.

With angioplasty, a catheter is threaded through an artery such as the femoral artery, and a balloon attached to the end is inflated to stretch the vessel and relieve the obstruction.

The other codes follow along in much the same pattern, with each procedure growing in intensity.

Code 92924 is for atherectomy, for example where a catheter with a blade on the end removes the plaque obstructing the artery. And 92925 is for each additional branch of a major coronary artery. Those codes include angioplasty, if it is performed.

Next in intensity are codes 92928 for transcatheter placement of stents and 92929, again for each additional branch. And angioplasty is included.

Next is 92933 for percutaneous transluminal coronary atherectomy with stent (with 93934 for each additional branch). This too includes angioplasty.

Next come 92937 and 92938 for resuming blood flow through a coronary artery bypass graft. They include angioplasty, atherectomy, and stents.

After those comes 92941 for revascularization of an acute occlusion during a heart attack. It applies to an artery or a bypass graft and includes angioplasty, atherectomy, stent, and clot removal.

The final codes here are 92943 and 92944 for revascularization of a chronic total occlusion. They apply to artery, branch, or bypass graft and include angioplasty, atherectomy, and stent. The second code is, again, for each additional artery, branch, or graft.

From there, the new codes go to 93653-93657 for electrophysiological procedures for heart rhythm problems.

Code 93653 is for treatment of supraventricular tachycardia by ablation. Tachycardia is a heart rate that is too rapid, usually more than 100 beats per minute, and destroying the tissue shocks the heart back into normal rhythm. The code includes the evaluation plus the ablation.

Code 93654 is for treatment of ventricular tachycardia as opposed to supraventricular tachycardia, which occurs in the upper chambers of the heart.

Code 93655 is an add-on for an additional effort at ablation. It can be used with 93653, 93654, or with the next code, 93656.

Code 93656 encompasses both 93653 and 93654 but is for atrial fibrillation, which is an irregular heart beat as opposed to tachycardia.

The last code here (93657) is an add-on for additional ablation efforts for fibrillation. It can be used only with 93656.

ALLERGY AND CLINICAL IMMUNOLOGY

There are two new codes here for allergy testing.

Code 95017 is for testing with venoms, or toxins produced by animals. And 95018 is for testing with drugs. The distinction has been made because there is a significant cost difference between the two.

Following those are two newcomers for ingestion testing to detect food allergies such as peanuts or shellfish. Code 95076 is for the first 120 minutes, and 95079 is for each additional 60 minutes.

For a test of less than 61 minutes use the appropriate E/M code; for 61 to 120 minutes use 95076.

NEUROLOGY

The newcomers here start with sleep testing for children younger than six years old (95782-95783). Both require the attendance of a technologist, and the second code includes a continuous positive airway pressure or CPAP mask, which produces a mild air pressure to keep the airways open.

Next are 95907-95913 for nerve conduction studies.

The first is for up to two studies, and the others continue on up to 13 or more studies.

Conduction studies are usually done to detect the extent of nerve injury. They stimulate the nerve to see if it conducts the message.

After those come 95940-95941 for monitoring nerve function during surgery, particularly brain and spinal surgery.

Code 95940 is for monitoring just one patient within the operating room, each 15-minute segment, while 95941 is for monitoring from outside the operating room or for monitoring more than one patient within the operating room, each 60-minute segment.

The next new code is 95924 for adrenergic function testing where the patient is placed on a tilt table to see how the autonomic nervous system reacts when the angle of the table is changed. And following that is 95943 for adrenergic testing without a tilt table.

Categories II and III

There are seven new Category II codes, all relating to inflammatory bowel disease, or IBD. The Category II codes are quality codes, many of which are used in Medicare’s quality reporting. They are optional.

After those are 28 new Category III codes. These are temporary codes for new technologies, and unlike Category II, they are mandatory. Their purpose is to collect data on how often a technology is used. If use is significant, the code moves up to CPT status. If there’s little use or if the technology becomes obsolete, it is dropped.

Therese M. Jorwic, MPH, RHIA, CCS, CCS-P, is assistant professor of health information management at the University of Illinois at Chicago and senior consultant for MC Strategies in Atlanta.

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