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2014 Coding Changes

2014 Coding Changes. AAPC Richmond Va. chapter January 2014. Overview & Objectives. Identify coding changes for the upcoming year (HIGHLIGHTS) CPT ® HCPCS What's new for 2014- over 330 coding changes. 175 New Codes 47 deleted codes 107 revised codes. CPT ®. Evaluation & Management.

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2014 Coding Changes

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  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

  3. 175 New Codes 47 deleted codes 107 revised codes CPT® AAPC Richmond Va. Chapter - January 2014

  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

  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

  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

  7. Integumentary - Lund-Browder (No more “Rule of Nines” in CPT) AAPC Richmond Va. Chapter - January 2014

  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

  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

  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

  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

  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

  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

  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

  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

  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

  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

  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

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

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

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

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

  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

  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

  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

  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

  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

  28. Next Steps • 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 AAPC Richmond Va. Chapter - January 2014

  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

  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

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