New year, new CPT modifications

Another year has come and gone and we are now entering into the most exciting time of year. Yes, that’s right, it’s CPT additions, deletions and modifications time!   Each year, coders across the United States eagerly await our new CPT books. Mine is still leaving paper dust all over my desk as I turn each newly printed page to see the updates.

Because the CPT manual puts the E&M codes in the front, I’ll list those changes first.

Prolonged service with direct patient contact has been reportable in addition to psychotherapy code 90837 with direction in a parenthetical note under code 90837. However, we now have that direction specifically stated in the Prolonged Services section of the CPT book. There is an additional modification to that section that guides us to use new CPT codes 99415 Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour and 99416, each additional 30 minutes, when the prolonged services is provided by clinical staff rather than a physician or other qualified healthcare provider. These add-on codes are to be used secondarily to the appropriate E&M code and require direct supervision. Be sure to read the entire section directions to ensure you are reporting properly.

There are a few updates to section directions within the E&M chapter, but no other changes. No changes to the Anesthesia section, Integumentary Surgery section and one change to Musculoskeletal Surgery section — deletion of code 21805 Open treatment of rib fracture without fixation, each.

The Respiratory Surgery section gets three new codes and code 31620 has been deleted. New for 2016 are:

31652 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies], one or two mediastinal and/or hilar lymph node stations or structures

31653, three or more mediastinal and/or hilar lymph node stations or structures

+31654, with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic interventions(s) for peripheral lesion(s). List separately in addition to code for primary procedure(s).

Codes 31652 and 31653 are complete procedures, but 31654 is an add-on procedure with a parenthetical note advising which codes are appropriate as parent code to 31654.

In the Cardiovascular Surgery section, Pacemaker or Implantable Defibrillator section, we have added direction about how to code services associated with a leadless cardiac pacemaker system using Category III codes 0387T-03891T. Like other device codes, these new codes include radiological supervision and interpretation. This section also gets a new code: 33477 Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed. Please refer to the Pulmonary Valve section of the chapter for full guidance when reporting this service, also known as TPVI.

Code 37202 has been deleted with direction to code for intracranial arterial mechanical thrombectomy and/or infusion for thrombolysis with 61645. This update moves intracranial thrombectomy treatment from the Cardiovascular system section to the Nervous system section.

Codes 37250 and 37251, describing intravascular ultrasound, have been deleted and new codes 37252-37253 have been created for the same service including the supervision and interpretation.

And code 39400 has been deleted and two new codes added to separate biopsy of mediastinal mass from lymph node biopsy.

39401 Mediastinoscopy: includes biopsy(ies) of mediastinal mass (eg. lymphoma), when performed

39402 with lymph node biopsy(ies) (eg. Lung cancer staging)

In the Digestive System surgery section, we see the trend continue of deleting component codes and creating new bundled codes. Codes 47500-47530 have been deleted and new codes 47531-47544 created. A new introduction is available in the Biliary Tract section of the chapter with direction on reporting these services. Please refer to this section for complete instructions on reporting these procedures.

Next month, look for a second blog regarding the rest of CPT changes for 2016. We’ve got some learning ahead of us!

Rebecca Caux-Harry, CPC, is the CodeRyte product specialist for cardiology with 3M Health Information Systems.

Want to test your ICD-10 coding skills?  Try coding these scenarios from our top ICD-10 scenarios eguide.

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