2006 CPT codes - 1 of 7

  New CPT codes
  Deleted CPT codes

  Page Test Internet    
E & M Codes          
10000 Codes          
20000 Codes          
30000 Codes          
40000 Codes     Gastro Society  
New & Revised GI-codes in CPT 2006
   
50000 Codes          
60000 Codes          
70000 Codes          
80000 Codes          
90000 Codes          
Medicine - Audiology          
Medicine -           
Medicine -           
Medicine -           
Medicine - Conscious Sedation     http://www.aafp.org/x40152.xml

 

   
Medicine - Psych          
Medicine -           
Medicine -           
Medicine -           
Medicine -           
Medicine -           

2006_deleted_CPT CPT  codes deleted in 2006
   
   
   
   
   
   

 

1
New endovascular therapy codes 61630
New endovascular therapy codes 61635
New endovascular therapy codes 61640
New endovascular therapy codes - Add-On 61641
New endovascular therapy codes - Add-On 61642
10000 Codes15351 

15342-15351 being deleted. 15342 Deleted

New Graft Codes

These new codes are organized by type (epidermal, Dermal, body part, size of the graft and add-on codes)

The coder needs to carefully read all the codes in a category to be sure that the correct codes are reported.

15040 Harvest of skin for tissue culture skin autograft, 100 sq cm or less

15110 Epidermal autograft

15115 Epidermal autograft

15116 Epidermal autograft... each additional 100 sq cm.

Codes 15120 and 15121 were revised.

15130 Dermal autograft

15131 Dermal autograft

15135 Dermal autograft

15136 Dermal autograft. . . each additional 100 sq cm.

15150 Tissue cultured epidermal autograft, trunk, arms, legs; first 25 sq cm.

15151 Tissue cultured epidermal autograft, trunk, arms, legs; additional 1 sq cm to 75 cm.

15152 Tissue cultured epidermal autograft, trunk, arms, legs; each additional 100 sq. cm, or each additional one percent of body area of infants and children or part thereof.

15155 Tissue cultured epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm.

15156 Tissue cultured epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; additional 1 sq cm to 75 cm.

15157 Tissue cultured epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq. cm, or each additional one percent of body area of infants and children or part thereof.

Acellular Dermal Replacement

Acellular Dermal Placement Codes

Codes 15170 - 15176 for the trunk, arms, legs

Autograft/Tissue cultured Allogenic skin substitute

15300 - 15431 (total of 20 codes with 18 new codes)

15330 - 15331 Acellular dermal allograft 

15335 - 15336 Acellular dermal allograft

15340 - 15341 Tissue cultured allogenic skin substitute

15300 - 15321 Allograft skin for temporary wound closure

Xenograft

15400 - 15431 - Xenograft, skin dermal, for temporary wound closure and Acellular xenograft implant.

 

20000 Codes

Incision Codes

22010 and  Incision and drainage, open of deep abscess (subfascila), posterior spine; cervical thoracit or cervicothoracic

22015 same .... ; lumbar, sacral or lumbosacral.

 

22523

Percutaneous vertebral augmentation, including cavity creation using mechanical device, one vertebral body, unilateral or bilateral cannulation; thoracic
22524 ; lumbar
22525 ; each additional thoracic or lumbar vertebral body (Add-On Code)

 

30000 Codes

There are no new respiratory codes in 2006

See Coronary Artery Anomalies

Codes 33500 to 33506 are Revised.

New Code

33507 Repair of anomalous (e.g., intramular) aortic origin of coronary artery by unroofing or translocation.

33548 surgical ventriuclar restoration procedure, include prosthetic patch, when performed

Ventricular remodeling

 

SVR

 

SAVER

 

DOR

 

 

New Code

33768 Anastomosis, cavopulmonary, second superior vena cava (Add-On Code)

33880 Endovascular repair of descending thoracic aorta

To report radiological supervision and interpretation, use 75956 with 33880.

Codes 33880 - 33891

Placement of proximal extension prosthesis...

Placement of distal extention prosthesis

Open subclavian to carotid artery transposition 

Bypass graft, with other than vein, transcervical retropharyngeal carotid-carotid, ...


33925 Repair of pulmonary artery arborization anomalies by unifocalization; without cardiopulmonary bypass

33926 ; with cardiopulmonary bypass

Codes 33925, 33926 cannot be reported with 33697.


36598 Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report


2006 CPT has detailed guidelines for Transcatheter procedures 37184 - 37188.

Mechanical Thrombectomy

Arterial mechanical thrombectomy

Venous Mechanicqal thrombectomy

(page 143 in CPT Expert - Ingenix)


37718 Ligation, division, and stripping short saphenous vein. (replaces 37720

37722 Ligation, division, and stripping long (greater) saphaenous veins from saphenofemoral junction to the knee or below.

 

 

40000 Codes

Bariatric Surgery Codes

These procedures can include the stomach, duodenum, jejunum, and/or the ileum.

Band adjustments are included during the postoperating period after gastric restriction that utilize the adjustable gastric band technique, Band adjustment refers to changing the gastric band diameter by injection or aspiration of fluid through the subcutaneous port component.

Codes

43770 Laparoscopy, surgical gastric restrictive procedure; placement of adjustable gastric band
43771 ; revision of adjustable gastric band component only
43772 ; removal of adjustable gastric band component only
43773 ; removal and replacement of adjustable gastric band component only
43774 ; removal of adjustable gastric band and subcutaneous port components

 

43886 Gastric restrict procedure, open; revision of subcutaneous port component only

43887 ; removal of subcutaneous port component only

43888; removal and replacement of subcutaneous port only.

Codes 44132 - 44136 are non-covered services.


44180 Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion)
44186 Laparoscopy, surgical, jejunostomy, eg, for decompression or feeding.
44187 ; ileostomy or jejuostomy, non-tube
44188 Laparoscopy, surgical, colostomy or skin level cecostomy

Codes 44200 and 44201 are  deleted.


44213 Laparoscopy, surgical ..... Add-on code
44227 Laparoscopy, surgical, closure of enterostomy, large or small intestine, with resection and anastomosis

Laparoscopy Excision and Repair Codes

45395 Laparoscopy, surgical; proctectomy, complete, combined abdominoperineal, with colostomy
45397 ; proectectomy, combined  abdominoperineal, pull-through procedure... creation of J-pouch
45400 ; proctopexy (for prolapse)
45402 ; proctopexy (for prolapse), with sigmoid resection
45399 Unlisted laparoscopy procedure, rectum

Proctopexy codes 45540 to 45550 are Revised.

New code

45990 Anorectal exam, surgical , requiring anesthesia, diagnostic.

46505 Chemodenervation of internal anal sphincter.


46710 Repair of anal fistual with fibrin glue.

46712 ; combined transperineal and transabdominal approach.


5000 Codes

50250 Renal Excision Ablation, Open, One or More Renal Mass Lesion(s), Cryosurgical, Including Intra . . .
50382 Renal Transplantation - Internal Dwellling Removal (Via Snare/capture) and Replacement of Internally Dwelling Ureteral Stent . . .
50384 Renal Transplantation - Internal Dwellling Removal (Via Snare/capture) of Internally Dwelling Ureteral Stent via Percutaneous . . .
50387 Renal Transplantation - External Accessible Removal and Replacement of Externally Accessible Transnephric Ureteral Stent . . .
50389 Renal Transplantation - External Accessible Removal of Nephrostomy Tube, Requiring Fluoroscopic Guidance (Eg, with Concurrent . . .


50592  Endoscopy Other Ablation, One or More Renal Tumor(s), Percutaneous, Unilateral, Radiofrequency
     
     


57295 Vagina, Repair Revision (Including Removal) of Prosthetic Vaginal Graft, Vaginal Approach
58110 Corpus Uteri, Excision Endometrial Sampling (Biopsy) Performed in Conjunction with Colposcopy . . .
     
     
     

 

 


6000 Codes    

These codes include:

  1. Endocrine
  2. Nervous System
  3. Eye
  4. Auditory System

 


Nervous System Codes - 2006

61630 Endovascular Therapy Balloon Angioplasty, Intracranial (Eg, Atherosclerotic Stenosis), Percutaneous
61635   Transcatheter Placement of Intravascular Stent(s), Intracranial (Eg, Atherosclerotic . . .  See Notes  
61640   Balloon Dilatation of Intracranial Vasospasm, Percutaneous; Initial Vessel
61641   Balloon Dilatation of Intracranial Vasospasm, Percutaneous; Each Additional Vessel . . . Add-On
61642   each additional vessel in different vascular family   Add-On

Codes 61630 - 61635 include:

  1. All selective vascular cath
  2. All Dx imaging for arteriograph of the the target vascular family
  3. All radiological supervision and interpretation

Note: Some carriers may not cover 61630 - 61641 (UT-MCD 2006 Non-Covered List)


There are no  New   Eye Codes in 2006


There are no   New  Auditory System codes in 2006



7000 Codes - Radiology    

Diagnostic Radiology - Transcatheter Procedures


75956   Endovascular repair of descending thoracic aorta
75957   ; not involving coverage of left subclavian artery origin, ...
75958   Placement of proximal extension prosthesi for endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurys, dissection, prentraing ulcer, intramular hematoma, otraumatic disruption), radiological supervision and interp
75959   Placement of distal extension prosthesis after endovascular repair of descending thoracic aorta as needed, to level of celiac origin, radiological supervision and interpretation
     


76376   3D rendering with interp and reporting of CT, Magnetic resonance imaging, ultrasound or other tomographic modality; not requiring image postprocessing on an independent workstation.
76377   ; requiring image postprocessing on an independent workstation.
12-2-05   http://www.medicaid.alabama.gov/news/Alerts/2005/1B-4a-34_ALERT_12-2-05%20_Modifier%2059.pdf
     
     

Radiation Treatment Delivery Codes 77401 - 77416. Report for the technical level and Energy Levels

77412 - 77416   Radiation treatment delivery three or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam ; (Revised Codes)
     
77421   Stereoscopic X-ray guidance for localizaiton of target volume for the delivery of radiation therapy.
77422   High Energy 
77423   ; 1 or more isocenter(s) with coplanar or noncoplanar geometry

     
     
     
     
     


     
     
     
     
     

 

 


   
   
   
   
   

 

 


   
   
   
   
   

 

 


   
   
   
   
   

 

 

 

 

American Medical  Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein.  Applicable FARS/DFARS restrictions apply to government use.

Deleted Codes

E & M

Codes Descriptors Now reported by:
99261-99263 Follow-up inpatient consultation codes Report with subsequent hospital visit and subsequent nursing facility codes
99271-99275 Confirmatory consultation codes Report using visit codes appropriate to setting & type of service
99301-99303 Nursing Facility Assessment Replaced with codes 99304-99306 & 99318
99311-99313  Subsequent Nursing Facility Care Replaced with codes 99307-99310
99321-99323 Domiciliary or Rest Home Visit, New Replaced with codes 99324-99328
99331-99333 Domiciliary or Rest Home Visit, Estab. Replaced with codes 99334-99337

Intravenous infusion for therapy/diagnosis*

90780-90781 Intravenous infusion for therapy/diagnosis See codes 90760-90761 & codes 90765-90768
90782-90784 Therapeutic, prophylactic or diagnostic injections See codes 90772-90774
90788 Intramuscular injection of antibiotic See code 90772
90799 Unlisted therapeutic injection See code 90779

 *Note: Chemotherapy codes have undergone changes as well

Conscious Sedation

 
99141-99142 Conscious Sedation Replaced with codes 99143-99145


Medicine Special Services

 
99052 Services requested between 10pm and 8am See codes 99053 or 99050
99054   Services requested on Sundays or holidays See codes 99050 or 99051


New Codes

E & M

 
99300  Subsequent Intensive care, per day, for the E & M of the recovering infant (present body weight of 2501-5000 grams)
99304-99306 Initial nursing facility care,per day 
99307-99310 Subsequent nursing facility care, per day
99318  Annual nursing facility assessment
99324-99328 Domiciliary or Rest Home(eg, Boarding Home), or Custodial Care Services, guidelines now state including assisted living facility, new patient
99334-99337 Domiciliary or Rest Home(eg, Boarding Home), or Custodial Care Services, guidelines now state including assisted living facility,established
99339-99340 Domiciliary, Rest Home (eg, Assisted Living Facility), or Home Care Plan Oversight Services (similar to care plan oversight codes for home health/hospice)


Pathology & Laboratory/Chemistry

82271   Blood, occult, by peroxidase activity (eg, guaiac), qualitative; by other sources
82272   Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, single specimen (eg, from digital rectal exam)
83037  Hemoglobin, glycosylated (A1C) by device cleared by FDA for home use


Injections & Infusions*

90760-90761 Intravenous infusion, hydration
90765-90768  Intravenous infusion, therapeutic, prophylactic or diagnostic
90772-90775 Therapeutic, prophylactic or diagnostic injections
90779 Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion


 Vaccines

90649  Human Papilloma virus (HPV) vaccine, types 6,11,16,18 (quadrivalent), 3 dose schedule for intramuscular use
90714  Tetanus and Diphtheria toxoids (Td) adsorbed, preservative free, individuals 7 or older, intramuscular use
90736  Zoster (shingles) vaccine, live, for subcutaneous injection


 Medicine Special Services

99051 Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service
99053 Service(s) provided between 10:00pm and 8:00am at 24-hour facility, in addition to basic service
99060 Service(s) provided on an emergency basis, out of the office, which disrupts other scheduled office services, in addition to basic service


Codes with new or revised text

Pathology and Laboratory

82270 Blood occult, by peroxidase activity (guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided three cards or single triple card for consecutive collection)


Vaccines

90680  Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use
90713  Poliovirus vaccine, inactivated, (IPV), for subcutaneous or intramuscular use
90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), for use in individuals 7 years or older, for intramuscular use


Medicine Special Services

99050  Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to basic service
99056 Service(s) typically provided in the office, provided out of the office at request of patient, in addition to basic service 
 99058 Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service

Current Procedural Terminology ©  2006 American Medical Association. All rights reserved.

 


New Moderate Sedation Codes Set for 2006 Fee Schedule

The 2006 Medicare Fee Schedule posted on the Centers for Medicare & Medicaid Services (CMS) website last week, and scheduled to be released in the Federal Register later this month, included several new moderate sedation codes effective Jan. 1, 2006, with CPT 2006. Six new codes for reporting moderate sedation services will replace former conscious sedation codes 99141 and 99142. The six new codes no longer differentiate between route of administration, but are rather categorized into two separate families, distinguished by provision of services by a single physician and a trained observer (99143-99145), or two physicians (other than an anesthesiologist), and a trained observer (99148-99150). Incorporated into each family of codes are both time and patient age. Refer to your 2006 CPT manual for a complete description of new codes 99143-99150 and the associated instructional guidelines. Also be sure to look for the January/February 2006 issue of AAOMS Today for more detail on these new codes.



CPT 2006


 gastroenterologists. These changes will take effect in January 2006 and are published in the new 2006 CPT book.

Duodenal motility (manometric) study
Duodenal motility 91022, as the name implies, describes the placement of a motility probe into the duodenum with its tip distal to the ligament of Treitz. Motility changes are then measured in both fasting and fed states, and with and without prokinetic agents. This code is distinct from the existing code 91020 describing gastric motility. If an endoscopy is performed for tube placement, 43235 should be used, and if fluoroscopy is performed, 76000 should be used with 91022.

Stool guaiac
There has been an editorial revision to code 82270, which now calls for 1-3 "consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided three cards or single triple card for consecutive collection)." New code 82271 is for an occult blood determination from "other sources," and new code 82272 describes the stool guaiac during digital rectal exam. Code 82273 has been deleted.

Infusion services and chemotherapy administration codes
Codes 90760-90761 are intended to report a hydration IV infusion to consist of a pre-packaged fluid and electrolytes (e.g., normal saline, D5-½ normal saline+30mEq KCl/liter), but are not used to report infusion of drugs or other substances. Hydration IV infusions typically require direct physician supervision for purposes of consent, safety oversight or intra-service supervision of staff. Typically, such infusions require little special handling to prepare or dispose of, and staff who administer these hydration infusions do not typically require advanced practice training. After initial set-up, infusion typically entails little patient risk and thus little monitoring. Code 90760 is, "Intravenous infusion, hydration; initial, up to 1 hour," and code 90761 is "…each additional hour, up to 8 hours (List separately in addition to code for primary procedure)." Code 90761 should be reported for hydration infusion intervals of greater than 30 minutes beyond one-hour increments.

A therapeutic, prophylactic, or diagnostic IV infusion or injection (codes 90765-90799), other than hydration, is for the administration of substances/drugs. The fluid used to administer the drug(s) is incidental hydration and is not separately reportable. These services typically require direct physician supervision for any or all purposes of patient assessment, provision of consent, safety oversight and intra-service supervision of staff. Typically, such infusions require special consideration to prepare, dose or dispose of, require practice training and competency for staff who administer the infusions, and require periodic patient assessment with vital sign monitoring during the infusion. Code 90765 is, "Intravenous infusion, for therapy, prophylaxis, or diagnosis, (specify substance or drug); initial, up to 1 hour." Code 90766 is "…each additional hour, up to 8 hours (List separately in addition to code for primary procedure)." Code 90767 is "…additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure)." Code 90772 is "Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular." One should not report 90772 for injections given without direct physician supervision; to report, use code 99211.

The preamble to chemotherapy administration codes 96401-96549 has been changed to include "substances such as monoclonal antibody agents, and other biologic response modifiers." In addition, these services can be provided by any physician. This will allow more equitable reimbursement for infusion of agents such as infliximab using new infusion codes for 2006:

96413, "Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug,"

96417, "…each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)", and

96415 "…each additional hour, up to 8 hours (List separately in addition to code for primary procedure)."
Follow-up consultation codes and confirmatory consultation codes
All of the follow-up consultation codes (99261-99263) and all of the confirmatory consultation codes (99271-99275) have been deleted from the CPT book in 2006. The services should be coded using subsequent hospital care codes (99231-99233) and/or the appropriate E/M service code.

Category II Codes/Appendix H
Category II codes are supplemental tracking codes that can be used for performance measurement. Pay-for-performance initiatives may bring more attention to this set of codes. Category II codes are arranged in eight categories: composite measures; patient management; patient history; physical examination; diagnostic/screening processes or results; therapeutic, preventive or other interventions; follow-up or other outcomes; and patient safety. New code 4017F is a performance measure of gastrointestinal prophylaxis with NSAID use.

Category III Codes
Although there is a new Category III code for treatment of gastroesophageal reflux disease via delivery of submucosal injection of a polymer into the intramuscular portion of the lower esophageal sphincter, the FDA has notified gastroenterologists to stop injecting the Enteryx® polymer. Code 0133T includes the upper GI endoscopy procedure and was to be reported only once, regardless of the number of injections. However, Boston Scientific, the company that currently manufactures Enteryx® Procedure kits and Enteryx Single Pack Injectors, has issued a voluntary recall of the product. The ACG, ASGE and AGA have helped the FDA notify gastroenterologists to stop injecting Enteryx® immediately.

Conscious Sedation/Appendix G
Appendix G describes procedures where the administration of conscious or moderate sedation is inherent to the procedure when provided by the physician performing the procedure. Procedure codes 43237, 43238, and 45392 that were accidentally omitted from the appendix in 2005 have been added to the conscious sedation appendix G for 2006.

Moderate (conscious) sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patient airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. Codes 99141-99142 have been deleted, and have been replaced by six new codes to describe moderate sedation services. Since the services in Appendix G include moderate sedation, it is not appropriate for the same physician to report both the service and the sedation codes 99143-99145. It is expected that if conscious sedation is provided to the patient as part of one of these services, it is provided by the same physician who is providing the service

In the unusual event when a second physician other than the healthcare professional performing the diagnostic or therapeutic services, provides moderate sedation in the facility setting for the procedures listed in Appendix G, the second physician can report codes 99148-99150. However, for the circumstance in which these services are performed by the second physician in the non-facility setting, codes 99148-99150 would not be reported. Moderate sedation does not include minimal sedation ("anxiolysis"), deep sedation, or monitored anesthesia care (codes 00100-01999).

The inclusion of a procedure in Appendix G does not prevent separate reporting of an associated anesthesia procedure/service (codes 00100-01999) when performed by a physician other than the healthcare professional performing the diagnostic or therapeutic procedure. In such cases, the person providing anesthesia services shall be present for the purpose of continuously monitoring the patient and shall not act as a surgical assistant. When clinical conditions of the patient require such anesthesia services, or in the circumstances when the patient does not require sedation, the operating physician is not required to report the procedure as a reduced service using modifier 52.


CPT Code Descriptor Global Period
 43237 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination limited to the esophagus 0
 43238 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), esophagus (includes endoscopic ultrasound examination limited to the esophagus) 0
 45392 Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s) 0
 82270 Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided three cards or single triple card for consecutive collection) XXX
  • 82271
Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources XXX
  • 82272
Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, single specimen (eg, from digital rectal exam)

(82273 has been deleted. To report, use 82271)
XXX
  • 91022
Duodenal motility (manometric) study

(If gastrointestinal endoscopy is performed, use 43235)

(If fluoroscopy is performed, use 76000)

(If gastric motility study is performed, use 91020)
0
  • 96413
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug XXX
  • + 96415
Chemotherapy administration, intravenous infusion technique; each additional hour, 1 to 8 hours (List separately in addition to code for primary procedure)

(Use 96415 in conjunction with 96413)

(Report 96415 for infusion intervals of greater than 30 minute beyond 1-hour increments)

(Report 90761 to identify hydration, or 90766, 90767, 90775 to identify therapeutic, prophylactic, or diagnostic drug infusion or injection, if provided as a secondary or subsequent service in association with 96413)
ZZZ
  • + 96417
Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)

(Use 96417 in conjunction with 96413)

(Report only once per sequential infusion. Report 96415 for additional hour(s) of sequential infusion)
ZZZ
  • 4017F
Gastrointestinal prophylaxis for NSAID use prescribed NA
  • 0133T
Upper gastrointestinal endoscopy, including esophagus, stomach, and either the duodenum and/or jejunum as appropriate, with injection of implant material into and along the muscle of the lower esophageal sphincter (eg, for treatment of gastroesophageal reflux disease) NA

 




  

 

 

50000 Codes

 

 

60000 Codes

 

 

70000 Codes

 

 

80000 Codes

80000 Codes New and Revised Lab and Pathology Codes

80195: Sirolimus
82271: Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources (this code replaces code 82273)

82272: Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, single specimen (eg, from digital rectal exam)
83037: Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use
83631: Lactoferrin, fecal; quantitative
83695: Lipoprotein (a)
83700: Lipoprotein, blood; electrophoretic separation and quantitation (this code replaces code 83715)

83701: Lipoprotein, blood; high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (eg, electrophoresis, ultracentrifugation) (this code replaces CPT code 83716

83704: Lipoprotein, blood; quantitation of lipoprotein particle numbers and lipoprotein particle subclasses (eg, by nuclear magnetic resonance spectroscopy)

83900: Molecular diagnostics; amplification of patient nucleic acid, multiplex, first two nucleic acid sequences)

83907: Molecular diagnostics; lysis of cells prior to nucleic acid extraction (eg, stool specimens, paraffin embedded tissue)

83908: Molecular diagnostics; signal amplification of patient nucleic acid, each nucleic acid sequence

83909: Molecular diagnostics; separation and identification by high resolution technique (eg, capillary electrophoresis)

83914: Mutation identification by enzymatic ligation or primer extension, single segment, each segment (eg, oligonucleotide ligation assay (OLA), single base chain extension (SBCE), or allele-specific primer extension (ASPE))

86200: Cyclic citrullinated peptide (CCP), antibody

86355: B cells, total count (this is a renumbering of DELETED code 86064)

86357: Natural killer (NK) cells, total count (this is a renumbering of DELETED code 86379)

86367: Stem cells (ie, CD34), total count (this is a renumbering of DELETED code 86587)

86480: Tuberculosis test, cell mediated immunity measurement of gamma interferon antigen response

87209: Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites

87900: Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics

REVISED CODES

Revised language is shown in bold type.

82270: Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided three cards or single triple card for consecutive collection)

83036: Hemoglobin; glycosylated (A1C)

83898: Molecular diagnostics; amplification of patient nucleic acid, each nucleic acid sequence

83901: Molecular diagnostics; amplification of patient nucleic acid, multiplex, each additional nucleic acid sequence (List separately in addition to code for primary procedure)

87904: Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; each additional drug tested (List separately in addition to code for primary procedure)

2. New and Revised Lab and Pathology Codes on the Medicare Physician Fee Schedule

Payment amounts for the following new and revised codes will be published in mid-November as part of the 2006 Medicare Physician Fee Schedule.

New Pathology Codes

88333: Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), initial site

88334: Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), each additional site

88384: Array-based evaluation of multiple molecular probes; 11 through 50 probes (this new code will include both technical and professional components)

88385: Array-based evaluation of multiple molecular probes; 51 through 250 probes (this new code will include both technical and professional components)

88386: Array-based evaluation of multiple molecular probes; 251 through 500 probes (this new code will include both technical and professional components)

89049: Caffeine halothane contracture test (CHCT) for malignant hyperthermia susceptibility, including interpretation and report.

 

Medicine Codes

 

Moderate (Conscious) Sedation

99143-99145 Moderate sedation services provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status
99148-99150 Moderate sedation services provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports

 

 

E & M Codes

 

 

The AMA has just announced that the 2006 CPT® code set will have 281 new codes, ... The 2006 CPT® Professional is the official list of codes

The 2006 CPT codes will be effective January 1, 2006. HIPAA mandates that there will be no grace period for adoption of the new codes. Providers should update their billing systems to include all new and revised codes.

 

New Orthotic Codes

97504 Orthotic training
97520 prosthetic training
97703 prosthetic checkout

90000 Medicine Codes
95251: Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for up to 72 hours; physician interpretation and report

Revised Code

88175: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision.

3. New Blood Bank Codes

86923: Compatibility test each unit; electronic

86960: Volume reduction of blood or blood product (eg, red blood cells or platelets), each unit.

4. Deleted Codes

The following codes will not be valid after January 1, 2006.

82273: Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources.  (Use new code 82271 after Jan 1, 2006)

83715: Lipoprotein, blood; electrophoretic separation and quantitation (Use new code 83700 after Jan 1, 2006)

83716: Lipoprotein, blood; fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (eg, electrophoresis, nuclear magnetic resonance, ultracentrifugation) (Use new code 83704 after Jan 1, 2006)

86064: B cells, total count (Use new code 86355 after Jan 1, 2006)

86379: Natural killer (NK) cells, total count (Use new code 86357 after Jan 1, 2006)

86587: Stem cells (ie, CD34), total count (Use new code 86367 after Jan 1, 2006)

86585: Skin test, tuberculosis, tine test (Obsolete code)


Medicine - 2006 Audiology Code Changes (926xx - 

The 2006 American Medical Association (AMA) Current Procedural Terminology (CPT) code set includes a number of important changes for audiologists and speech-language pathologists.

These additions and revisions are the culmination of two years of work by the ASHA Health Care Economics Committee and ASHA's advisors to the AMA CPT Editorial Panel

There are four new procedures for reporting auditory rehabilitation. The first two,

92626 and "Evaluation of auditory rehabilitation status; first hour"

92627, "Evaluation of auditory rehabilitation status; "each additional 15 minutes."

The other two codes are
92630 "Auditory rehabilitation; pre-lingual hearing loss"

92633 "Auditory rehabilitation; post-lingual hearing loss."

The new codes created a need for revision of the descriptors of two long-standing codes: 92506 and 92507.

Reference to aural rehabilitation in both of those procedures is DELETED for 2006.

CPT 92506 will read, "Evaluation of speech, language, voice, communication, and/or auditory processing.

"Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual" will be the new 92507.

Another audiology code was revised for 2006. Audiologists had reported problems with 92568, "Acoustic reflex testing," and 92569, "Acoustic reflex decay." Third party payers denied reimbursement for 92569 stating that is was bundled in 92568. The payers were not persuaded that they were incorrect when contacted by the audiologists or ASHA.

The 2006 CPT should resolve the payers' misinterpretation because of the new and more specific descriptor for 92568, "Acoustic reflex testing; threshold."

There is a change of note for speech-language pathologists who evaluate and treat patients with voice disorders. CPT 92520 will more specifically describe what is involved with laryngeal function studies.

The descriptor for 2006 will read "Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)." Please note the "i.e." is not an "e.g." so that 92520 is restricted to reporting either aerodynamic testing or acoustic testing.

There are four new procedures for reporting auditory rehabilitation. The first two, 92626 and 92627, are for reporting "Evaluation of auditory rehabilitation status; first hour" and for "each additional 15 minutes."

The other two codes are 92630 "Auditory rehabilitation; pre-lingual hearing loss" and 92633 "Auditory rehabilitation; post-lingual hearing loss."

The new codes created a need for revision of the descriptors of two long-standing codes: 92506 and 92507. Reference to aural rehabilitation in both of those procedures is DELETED for 2006. CPT 92506 will read, "Evaluation of speech, language, voice, communication, and/or auditory processing. "Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual" will be the new 92507.


Medicine - Respiratory Therapists (989xx - 

New CPT Codes Hold Interest for Respiratory Therapists Performing Patient Education

2006 CPT codebook was released and includes some codes of special interest to respiratory therapists.

New codes in the patient education area may be useful for respiratory therapists providing patient education. Specifically the new codes are:

Education and Training for Patient Self-Management - Respiratory therapy

* 98960 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes, individual patient.
* 98961 2-4 patients
* 98962 5-8 patients

"The purpose of these codes is to teach self-management of a patient's illness or disease, or delay disease comorbidity" said Rinaldo-Gallo after looking through the AMA's CPT 2006 manual and the CPT Changes, 2006, An Insider's View. "Asthma was an example given where patient education could be provided."

The curriculum used in patient education must be recognized by a physician society or by a nonphysician healthcare professional society/association, such as the AARC.

Note: Some of the old CPT codes correspond to more than one G-code. Also, there are codes that will allow physicians to bill for services that previously did not have a code or were bundled into other services. 

Infusions

Infusions that were previously reported under CPT code 90780 (non-chemotherapy infusion, 1st hour) will be billed under one of three G-codes. The first hour of a hydration infusion will be billed under G0345. The first hour of infusion of a non-chemotherapy drug other than hydration will be billed under G0347.

The first hour of infusion of anti-neoplastic agents provided for treatment of non-cancer diagnoses or substances such as monoclonal antibody agents and other biologic response modifiers will be billed under G0359.

A monoclonal antibody is any of a class of antibodies produced in the laboratory by identical offspring of a hybridoma -- a cell hybrid in which a tumor cell forms one of the original source cells.

Monoclonal_Antibodies

List of therapeutic monoclonal antibodies

Empire Carrier Policy on monoclonal antibodies

Physicians may now bill several infusion codes in one day for a single patient. For example, physicians may bill an antibiotic infusion (G0347) AND a hydration infusion (G0345); or an infusion of one antibiotic (G0347) AND the infusion of a second drug concurrently (G0350) or sequentially (G0349).

If a combination of chemotherapy (monoclonal antibodies, biological response modifiers), non-chemotherapy drugs, and/or hydration is administered by infusion sequentially, the initial code that best describes the service should always be billed irrespective of the order in which the infusions occur.

Physicians also may bill for an evaluation and management (E&M) service on the same day as an infusion, if a separate service was performed. Be sure to use a modifier 25 when doing so.

Services that were previously reported under CPT code 90781 (non-chemotherapy infusion, each additional hour) will be billed under one of four G-codes.

Each additional hour of a hydration infusion will be billed under G0346. Each additional hour of a non-chemotherapy infusion will be billed under G0348. Currently, if a second (or other subsequent) non-chemotherapy drug is administered sequentially, the physician would bill code 90781 for the additional hour of infusion.

Under the new G-codes, the physician will bill G0349, the sequential administration of a second or subsequent non-chemotherapy drug. In addition, each additional hour of the infusion of anti-neoplastic agents for the treatment of non-cancer diagnoses or substances, such as monoclonal antibodies and other biological modifiers, is billed under G0360.

Under the new infusion coding structure, if a drug such as amphotericin is given and takes more than one hour to infuse, the physician should bill using G0347 for an initial one hour drug infusion and G0348 for the subsequent hours of infusion. (CMS has now agreed to define second hour and subsequent hours of infusion as more than 30 minutes.)

The codes for hydration (G0345 and G0346 in the table) are for reporting hydration intravenous (IV) infusions consisting of a prepackaged fluid and electrolytes. These codes are not used to report infusion of drugs or other substances.


Injections
Under prior CPT codes (90782-90788) (therapeutic, prophylactic or diagnostic injections), payment for injections was bundled unless they were the only service billed by the physician for the patient that day.

This is no longer the case. The new G codes G0351 - G0354 may be separately paid even if another physician fee schedule service is billed for the same patient that day.

Injections that were previously billed under CPT code 90782 will now be billed under HCPCS code G0351. Physicians should continue to use CPT code 90783 for intra-arterial injections (this is incorrectly reported in the final rule, and CMS has said it will issue a clarification). Non-chemotherapy drugs administered by IV push (currently using CPT code 90784) should now be billed under HCPCS code G0353. The CPT book does not currently contain a code for physicians to bill a second (or other subsequent) non-chemotherapy drug administered by IV push. The CPT Editorial Panel created a new code for each additional non-chemotherapy drug administered by IV push. For 2005, the physician should bill HCPCS code G0354.

The CPT coding system will be deleting code 90788 (Intramuscular injection of antibiotic) in 2006. CMS is maintaining CPT code 90788 as an active code until it is changed in the CPT coding system and instructions are provided on the code to bill in its place beginning January 1, 2006.

Add-on Codes
CMS created the following new add-on G-codes: G0346, G0348, G0349, G0350, and G0354.

As indicated above, add-on codes must be billed with other codes, and the CMS payment reflects the incremental resources associated with providing the additional service. For two add-on codes (G0350, G0354), the table above has an "N/A" listed in the "Old CPT" column, meaning there were no CPT codes that existed explicitly for these services. These services will now be billable under the new coding system. For instance, CPT will be establishing a code G0350 for a "concurrent infusion." A concurrent infusion refers to the simultaneous infusion of two non-chemotherapy drugs. HCPCS code G0354 is a new code for each additional sequential non-chemotherapy drug administered by IV push.


E & M Code Changes


2006 introduces a new family of Nursing Home Codes.

CPT codes 99301-99303 and 99311-13 have been DELETED.

They are replaced by three new codes (99304-306) for the initial assessment; four new codes for the subsequent visits (99307-99310); and a new code for the annual nursing facility assessment (99318).

Discharge codes 99315 and 99316 were unchanged.

CPT includes three codes for Comprehensive Nursing Facility Assessments: an annual assessment (99301); an assessment for a major permanent change of status (99302); and, an assessment at the time of admission (99303).

In 2005 there were only three levels of service for established patients in the Subsequent Nursing Facility Care subsection of CPT, and that the highest level of service is restricted to a detailed interval history and a detailed examination. This is inconsistent with current clinical practice. To correct this problem, a new fourth level of service code has been added in 2006 to permit the reporting of a comprehensive level of service.

There is a new code in a new subsection (Other Nursing Facility Care) to allow the reporting of a comprehensive annual assessment.

"This is a service that is unique to the NF setting and the extent of history and examination and the complexity of medical decision making are not well described by the other E & M codes in this section."

New Nursing Facility Codes

New descriptors for the redefined Nursing Facility Code family.

CPT Codes

 

99301-

99304

99302

99305

99303

99306

No Code

 

 

 

Subsequent Nursing Facility Care:

 

 

99307

99311

99308

99312

99309

99313

99310

 

 


99304 Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components:

a detailed or comprehensive history;
a detailed or comprehensive examination; and
medical decision making that is straightforward or of low complexity.
Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.

Usually, the problem(s) requiring admission are of low severity.

99305 Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components:

a comprehensive history;
a comprehensive examination; and
medical decision making of moderate complexity.
Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.

Usually, the problem(s) requiring admission are of moderate severity.

99306 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these three key components:

a comprehensive history;
a comprehensive examination; and
medical decision making of high complexity.
Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.

Usually, the problem(s) requiring admission are of high severity.

There are now 4 codes for Subsequent Nursing Facility Care:

99307 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components:

a problem focused interval history;
a problem focused examination;
straightforward medical decision making.
Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.

Usually, the patient is stable, recovering, or improving.


 

99308 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components:

an expanded problem focused interval history;
an expanded problem focused examination;
medical decision making of low complexity.
Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.

Usually, the patient is responding inadequately to therapy or has developed a minor complication.

99309 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components:

a detailed interval history;
a detailed examination;
medical decision making of moderate complexity.
Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.

Usually, the patient has developed a significant complication or a significant new problem.


99310 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components:

a comprehensive interval history;
a comprehensive examination;
medical decision making of high complexity.
Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.

The patient may be unstable or may have developed a significant new problem requiring immediate physician attention.

The Discharge Codes have remained the same:

99315 99315 Nursing facility discharge day management; 30 minutes or less
99316 99316 Nursing facility discharge day management; more than 30 minutes

This is the new annual assessment code:

99318 Evaluation and management of a patient involving an annual nursing facility assessment, which requires these three key components:

a detailed interval history;
a comprehensive examination; and
medical decision making that is of low to moderate complexity.
Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.

Usually, the patient is stable, recovering, or improving.

The Domiciliary Care Services family (99341 - 99350) have updated descriptors and vignettes.

The AMA has a downloadable file of the new and revised 2006 CPT codes, which go into effect January 1, 2006.

The downloadable file is available for purchase at https://catalog.ama-assn.org/Catalog/product/product_detail.jsp?productId=prod620035?checkXwho=done

 

www.amda.com/federalaffairs/feeschedule2006.htm

 

http://www.apa.org/monitor/feb05/codes.html


Medicine - Psychology Codes gains new CPT testing codes for 2006 (691xx - 

CPT, testing codes
96100
96115
96117
--with an expanded series of codes beginning in 2006

In 2003, the AMA's reimbursement committee determined that it was unable to assign professional work values to the current testing codes because they do not distinguish aspects of the service performed by a professional from those performed by a technician or computer. In response, the APA Practice Organization successfully sought the 2006 testing and assessment codes, which make such a distinction.

The new codes

The new testing and assessment codes will capture the same types of services as the current codes. Yet the codes that take effect in 2006 will clearly establish whether the test administration portion of the service is done by a psychologist, or instead by a technician or computer. Interpretation and report by a psychologist will remain a key component of all the new codes.

While the new descriptors and code numbers will not be finalized until the 2006 CPT manual is ready for publication, a general overview is provided below. Importantly, the current codes (96100, 96115, and 96117) remain in effect through 2005. Ultimately, Medicare decides whether to assign professional work values to the codes based on the recommendations of the reimbursement committee.

o Psychological testing. Code 96100 will be DELETED and replaced by three new codes.

The first will capture psychological testing when entirely administered, interpreted and reported by a psychologist.

The second will be used when a technician administers the test and the psychologist does the interpretation and report.
The third code will be billed when a computer is used for test administration and the psychologist does the interpretation and report.

o Neuropsychological testing. Code 96117 also will be DELETED and replaced by three new codes. Similar to the psychological testing codes, the three new codes will also distinguish among the three different forms of test administration. Selection of a particular code will depend upon whether the psychologist, a technician or a computer administers the test. All three new codes will include interpretation and report by the psychologist.

o Neurobehavioral Status Exam. Code 96115 will be DELETED and replaced by one new code that will reflect the administration of the neurobehavioral status exam, along with interpretation and report, by a psychologist. Unlike the codes above, the psychologist is responsible for all facets--administration, interpretation and report--of the service when this code is selected.

Under the new codes effective in 2006, psychologists will continue to bill for the entire testing and assessment service, including when a technician or computer has administered the test. Any professional work value presumably would capture the extent of the professional's direct involvement (i.e., whether the psychologist actually administers the test or just provides the interpretation and report).


 

 

 

 

 

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