AH123 Intermediate Medical Coding
April 28, 2013
CPT Codes Paper
Evaluation and Management Codes
The evaluation and management (E/M) codes were extensively revised to include other qualified healthcare professionals. For example, these changes affect all of the codes for office and outpatient visits (99201-99215). New codes were established for complex chronic care coordination services rendered to high-risk patients in a noninstitutional setting (99487-99489) and for transitional care management at the time a patient transitions from a facility to a community setting (99495-99496). Additionally, new codes 99485-99486 were created for supervision of interfacility transport of critically ill or critically injured pediatric patients 24 months of age or younger. Surgery Changes
In the integumentary section, the code for island pedicle flap (15740) was revised to require identification and dissection of “an anatomically named axial vessel.” In the Musculoskeletal section, new code 22586 was created for L5-S1 arthrodesis by presacral interbody technique. New codes were also added for revision of total shoulder arthroplasty (23473-23474) and total elbow arthroplasty (24370-24371). In the respiratory section, new codes were created for bronchial valve procedures (31647-31651) and bronchial thermoplasty (31660-31661). Both of these procedures were previously reported with Category III codes. The codes for bronchography were deleted as this procedure is obsolete. New codes were established for thoracentesis and pleural drainage (32554-32557), and tube thoracostomy code 32551 was revised so that it applies only to open procedures. Finally, new code 32701 was established for target delineation for stereotactic body radiotherapy. In the Cardiovascular section, a new line was added to the table on pacemaker and cardioverter-defibrillator procedures to cover conversion of an existing system to biventricular. The code for left ventricular lead insertion (33225) was revised and a note added to clarify the reporting of pocket revision. A new section and guidelines were added for “Heart (Including Valves) and Great Vessels.” New codes were established for transcatheter aortic valve replacement (33361-33369) and percutaneous ventricular assist device procedures (33990-33993), both of which were previously reported with Category III codes. New codes were established for head and neck arteriograms (36221-36228) that include both the catheter placement and the imaging. New comprehensive codes were also established for transcatheter thrombolysis (37211-37214) and transcatheter foreign body retrieval (37197). Finally, the revascularization guidelines have been revised to clarify the reporting hierarchy. In the Hemic and Lymphatic Systems section, a new section heading and guidelines were created for bone marrow and stem cell transplants, along with one new code to report HPC boost (38243) and three revised codes. In the Digestive section, new codes were added for endoscopic microscopy (43206, 43252), and preparation of specimen for fecal transplant (44705). Also, the code for simple primary upper GI endoscopy (43234) was deleted and this procedure is now assigned to code 43235. In the Urinary section, a new code (52287) was established for chemodenervation of the bladder. In the Nervous System section, the neurolysis subsection was retitled to reflect that it also includes chemodenervation, and the coding guidelines were revised. Facial nerve chemodenervation (64612) was revised to indicate that it is a unilateral procedure. Notes were added to neck muscle and extremity chemodenervation (64613, 64614) to indicate that these codes should be reported only once per session. Finally, a new code was established for chemodenervation to treat chronic migraine (64615). Radiology Changes
The “Supervision and Interpretation” (S&I) section of the guidelines was revised to reflect...