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

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.

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).