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CPT update from path/lab to Categories II and III

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

The path and lab updates

There are more than 100 new codes for molecular pathology, or studies to detect variances in genes.

They are divided into two tiers. The Tier 1 codes  (81383) are for the tests that are done relatively often such as genetic testing for colon or breast cancer, cystic fibrosis, and Tay-Sachs disease.

The Tier 2 codes (81400 through 81408) are for genetic testing for rare disease.

The codes in Tier 1 are listed in alphabetical order.

The medicine updates

VACCINES AND TOXOIDS: New code 90654 is interesting in that it covers simply flu vaccine. It’s for all preservative-free flu vaccines.

The code for the H1N1 vaccine has been deleted because it’s no longer used, and all flu vaccines are now covered by just the one code.

PSYCHIATRY: The one new code here is 90869 for motor threshold determination by TMS, or transcranial magnetic stimulation. TMS is a new treatment for psychiatric conditions, including severe depression that doesn’t respond to medication.

Codes and coverage for flu and pneumococcal vaccines

Medicare has laid out an outline on coding flu and pneumococcal vaccines. It’s not new, but it is clear.

seasonal flu vaccines

diagnosis code: V04.81

administration code: G0008

coverage: one per influenza season, fall or winter, plus additional vaccinations if medically necessary

pneumococcal vaccines

diagnosis code: V03.82

administration code: G0009

coverage: one per lifetime plus additional vaccinations based on risk

seasonal flu and pneumococcal vaccines given at the same visit

diagnosis code: V06.6

administration codes: G0008 (flu) and

coverage: same as for the two separately

Q & A plus two notes

• Does the Part B deductible or coinsurance apply to immunizations?

No. And neither does the deductible or coinsurance apply to hepatitis B vaccines.

• Will Medicare pay for flu vaccinations given more than once in a 12-month period?

Yes, but only if the patient is getting the vaccine for two different flu seasons. For example, a patient might get the vaccine for the 2011-2012 season in January and then get the 2012-2013 season vaccine in November of the same year.

• Does Medicare pay for a pneumococcal vaccination if the patient isn’t sure about getting it in the past?

Yes. If the patient is uncertain about vaccinations during the past five years, Medicare covers it. However, if the patient is sure of having had it, revaccination is not covered unless the patient is at highest risk.

• Does Medicare cover the hepatitis B vaccine for all patients?

No. Only patients at intermediate to high risk for hepatitis B are covered. For the most part, those are health care professionals who have frequent contact with blood or blood-derived body fluids, patients with end-stage renal disease, and patients who live with HBV carriers.

• When a patient receives both flu and pneumococcal vaccines at the same visit, does the office use a separate administration code for each one?

Yes. Even though there is only one diagnosis code (V06.6), Medicare pays for both administration codes (G0008 for flu and G0009 for pneumococcal).

  • Note #1: All offices have to accept assignment on flu and pneumococcal vaccines.
  •  Note #2: Both the vaccine and the administration are covered by Part B, not by Part D.

An electromagnetic coil is placed against the front of the scalp, and electric currents stimulate nerve cells in the area of the brain that controls mood and depression. There is a small risk of seizure during the treatment.

OPTHALMOLOGY: The new codes (92071 and 92072) are for fitting contact lenses to treat disease.

The first shows treatment of ocular surface conditions such as corneal abrasion, and the second shows treatment or keratoconus, which is a degeneration of the cornea. Those procedures are obviously more detailed than fitting an ordinary vision-correcting lens and so warranted separate codes.

OTORHINOLARYNGOLOGIC SERVICE: New here is 92558 for evoked otoacoustic emissions, which is a comprehensive analysis of hearing function.

That’s followed by 92618, an add-on code showing additional 30-minute periods evaluating a noon speech-generating communication device, which is a device such as a communication board or a texting mechanism that communicates without sound.

Not that 92618 is out of sequence. It is used with code 92605, which covers the first hour of the evaluation.

NONINVASIVE VASCULAR STUDIES: New code 93998 is for unlisted vascular studies that are noninvasive.

It is the only code in a new subsection for other noninvasive vascular diagnostic studies. That subsection was set up for studies that don’t fit into a new Category III code (0286T) for reporting near infrared spectroscopy studies of wounds in the lower extremities.

PULMONARY: The first new codes (94726-94729) are for four pulmonary function tests to determine lung capacity and airway resistance.

The other new codes (94780 and 94781) are for car seat testing.

The seat testing is often done before a premature or high risk infant is discharged from the hospital, and the purpose is to ensure the structure of the seat won’t hamper the baby’s breathing.

NEUROLOGY: The updates begin with extensive new guides for sleep testing, though there aren’t any new codes in that area.

The new codes begin with 95885-95887 for needle electromyography, a test of the electric activity produced by the muscles. The first two are for the skeletal muscles of the extremities, and the other is for the nonextremity muscles.

The last two new medicine codes are 95938 and 95939 for evoked potential studies, which measure electrical signals going to the brain.

the Category II updates

The Category II codes are quality codes. They are not required, though many of them are used in quality reporting.

The new codes here cover things such as smoking status and smoke exposure, the presence of dementia, and the assessment of asthma, heart failure, and depression.

They also show counseling on patient safety.

the Category III updates

The Category III codes are for new procedures and technologies, and they are required. Their purpose is to see how often the new procedures are performed. They remain on the list for five years. If they are used during that time, they are turned into regular CPT codes. If not, they are dropped.

This year’s new ones include procedures such as hypothermia induction in neonates, implantation of cardiac devices to treat hypertension and heart failure, asthma procedures, pain management, and cancer evaluation testing.

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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