CPT Code Updates


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Integumentary and
Musculoskeletal Systems
   Respiratory and
Cardiovascular Systems
   Digestive, Urinary and
Reproductive Systems
    Nervous, Ocular And
Auditory SystemS
    Category III, Appendices, Evaluation
and Management And Hopps Changes


 

 

Integumentary and Musculoskeletal Systems

For 2023 in general, there were 225 new CPT codes added, 75 deleted and 93 revised. In this post, we will also include category III procedures as they pertain to the body system procedures discussed. Although they are not located in the surgery section, many of the category III additions involve surgical procedures.

Integumentary

There was three added codes and one code revision. 15778, Implantation of absorbable mesh or other prosthesis for delayed closure of defect(s) (i.e., external genitalia, perineum, abdominal wall) due to soft tissue infection or trauma was added. There are several manufacturers, and some are porcine acellular dermal matrix derived. Note that this is for DELAYED closure of defects, OR soft tissue infection, not for implants during a procedure that uses mesh such as hernia repairs. Revised code 15851 Removal of sutures or staples REQUIRING anesthesia (i.e., general, moderate sedation) and new add on codes ✚15853 Removal of sutures or staples not requiring anesthesia ✚ 15854 Removal of sutures AND staples not requiring anesthesia (List separately in addition to E/M) were needed. 15850 was deleted. Coders most likely will see these done in the clinic, MD office or possibly ER. The key is if anesthesia is required or not, and if both sutures and staples are removed, or one or the other. These things drive the code selection.

Musculoskeletal

The guidelines for using ADD ON drug delivery codes +20700-20705 have been revised to give better instructions on the intent, and to list what surgical procedures they are performed with.
  • Clarifies correct reporting based on if infection addressed by the drug delivery device was eradicated or not.
  • Clarifies that if additional work is needed to address injuries not healed, to see specific repairs such as flap, fusion, complex repair, etc.
  • Report deep drug delivery device removal such as intramedullary when the infection is eradicated, and it is the only procedure performed to 20680, removal of deep hardware.

Also addresses reporting insertion of drug delivery device into deep tissue when a spacer is also inserted, implant removal after failed drug delivery device, and partial replacement after infection eradicated with removal drug delivery device.

Arthrodesis Codes

Some arthrodesis codes were updated to reflect changes made last year. Not all codes were updated last year so they corrected that for 2023.   Codes 22630 and 22633 were revised to be parent codes. The term “and segment” was removed from some codes and it now states “each additional interspace.”

Exclusionary and parenthetical notes revised for 22634, 63035 and 63044 to include vertebral SEGMENTS. (“on the same spinal interspace(s)” changed to “on the same spinal interspace(s) and vertebral segment(s)” For codes 22633 and others changed “level” to “Interspace” Although decompression codes 63052, 63053 are in the neurology section, these are frequently coded with PLIF. Language has been updated to reflect “vertebral segment.” A vertebral segment means motion segment. Decompression is usually coded per motion segment or interspace. L2-L3 is one (63047 or 63052) and L4-L5 would be the second one if done (63047, 63048 OR 63052, 63053). The decompression of the existing nerve root is performed in the interspace between the two laminae. So L2-L3 decompression is coded 63047 or 63052. L2, L3, L4 vertebra with associated interspaces when looked at closely defines two motion segments: L2-3 =63047 L3-4= 63048 x 1 unit.

Code 22847 was revised for total disc arthroplasty on single interspace lumbar. New code 22860 is for second lumbar interspace. If more than two interspaces, use unlisted code 22899. New Category III code 0719T was created for Posterior vertebral joint replacement, including bilateral facetectomy, laminectomy, and radical discectomy, including imaging guidance, lumbar spine, single segment (THIS IS NOT FACET JOINT ARTHROPLASTY 0202T). This procedure can be an improvement over spinal fusion, and is just now starting to be performed in the USA. MOTUS is one example.

New code 0737T Xenograft implantation into the articular surface uses a xenograft scaffold that helps regenerate osteochondral bone. It is a donor usually from pig or mouse tissue. Usually used on knee joints.

New code 0775T Arthrodesis, sacroiliac joint, percutaneous, with image guidance, includes placement of intra articular implant(s) (eg, bone allograft[s], synthetic device[s])(may be called minimally invasive).

It is important that coders know that this DISTRACTS the joint, meaning it is pulling the joint open. This is different from 27279 and 27280 which TRANSFIX the joint with pins.

New code 0778T Surface mechanomyography ( sMMG ) with concurrent application of inertial measurement unit (IMU) sensors for measurement of multi joint range of motion, posture, gait, and muscle function. Purpose of technology is to increase accuracy of measuring and recording joint motion of the axial and appendicular skeleton, to record muscle function in standardized fashion and to decrease variability and bias of recording.

These two new codes will be important to look for in shoulder procedures. New code 0717T Autologous adipose-derived regenerative cell (ADRC) therapy for partial thickness rotator cuff tear; adipose tissue harvesting, isolation and preparation of harvested cells, including incubation with cell dissociation enzymes, filtration, washing, and concentration of ADRCs and new code 0718T injection into supraspinatus tendon including ultrasound guidance, unilateral. Note that one code is for the prep and the other for the injection. It helps to repair the supraspinatus tendon which is part of the rotator cuff.


 

 

Respiratory And Cardiovascular Systems

There are significant additions, deletions and changes for the cardiovascular system this year. In this part, I will discuss the respiratory and cardiovascular surgery sub-section changes, the Medicine section cardiovascular changes and the Category III respiratory and cardiovascular code changes. I will cover each under separate title below. 

Respiratory System Surgery

New code 30469 was created for repair of nasal valve collapse with low energy, temperature controlled (radiofrequency) subcutaneous/submucosal remodeling. A radiofrequency wand is inserted into the nose through the nostril using direct vision. It is inside the nose, not outside. No endoscope used. The wand is pressed against the nasal mucosa and a lesion created. This creates a “scar” in place which will help improve the obstruction.

Category III codes 0781T Bronchoscopy, rigid or flexible, with insertion of esophageal protection device and circumferential radiofrequency destruction of the pulmonary nerves, including fluoroscopic guidance when performed; bilateral mainstem bronchi and 0782T unilateral mainstem bronchus. Thermal energy can help bronchial tubes open up. COPD sufferers undergo this procedure the most.   The indirect radiofrequency involve NERVES not bronchial tissue. Report the code ONCE regardless of number of treatments per bronchus.

Cardiovascular System Surgery

We start this with codes added for percutaneous pulmonary artery stent revascularization
  • 33900 Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, unilateral
  • 33901 normal native connections, bilateral
  • 33902 abnormal connections, unilateral
  • 33903 abnormal connections, bilateral

✚ ● 33904 Percutaneous pulmonary artery revascularization by stent placement, each additional vessel or separate lesion, normal or abnormal connections (List separately in addition to code for primary procedure).

Note that the codes are divided by NORMAL connections and ABNORMAL connections. Examples of abnormal connections are Blalock-Taussig shunt, Glenn shunt, Sano shunt and Fontan procedure. Coders should NOT report cardiac catheterization for roadmapping, and only report it for diagnostic purposes that are well documented.

Before this year there was no way to determine if angiography was of pulmonary ARTERIES or pulmonary VEINS when done during cardia catheterization procedures.   Also, no way to report angiography on major aortopulmonary collateral arteries (MAPCAs) during cardiac catheterization procedures. Revised and new codes are as follows:

93563 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective coronary angiography during congenital heart catheterization (List separately in addition to code for primary procedure)   (Parent Code)
✚▲93568 for nonselective pulmonary arterial angiography (List separately in addition to code for primary procedure)
✚ ● 93569 for selective pulmonary arterial angiography, unilateral (List separately in addition to code for primary procedure)
#✚ ● 93573 for selective pulmonary arterial angiography, bilateral (List separately in addition to code for primary procedure)
#✚ ● 93574 for selective pulmonary venous angiography of each distinct pulmonary vein during cardiac catheterization (List separately in addition to code for primary procedure)
#✚ 93575 for selective pulmonary angiography of major aortopulmonary collateral arteries (MAPCAs) arising off the aorta or its systemic branches, during cardiac catheterization for congenital heart defects, each distinct vessel (List separately in addition to code for primary procedure)

Coder will need to be careful to identify if the catheter selects a pulmonary ARTERY or VEIN, and if unilateral or bilateral angiography is performed.   If a right and left heart catheterization for congenital heart defects was done and selective right pulmonary artery angiography performed, then the codes assigned would be 93596 and 93569.

 

New codes were created for PERCUTANEOUS AV fistula creation for hemodialysis depending on if a SINGLE access site is used or SEPARATE access sits are used. To join the vessels, the surgeon uses ultrasound guidance to make a small puncture in a superficial vein. They insert a wire into the vein and move it toward the hand until the wire punctures the radial artery. In some instances, TWO small punctures may be needed. Ellipsys® Vascular Access System and the WavelinQ™ EndoAVF System are two such systems
  • 36836 Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures(eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation.
▶(For percutaneous AV fistula creation other than upper extremity use 37799)◀  
  • 36837 Percutaneous arteriovenous fistula creation, upper extremity, separate access sites for the peripheral artery and peripheral vein, including fistula maturation procedures(eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation.

Cardiovascular Category III Section Codes

It is easier to discuss the cat III CV codes here since they are similar, just not yet Section I codes.

New code ✚●0715T Percutaneous transluminal coronary lithotripsy (List separately in addition to code for primary procedure) was added for when calcified plaques are lithotripsied as part of another separately reported procedure. Code it is reported with are in the code book notation.

New code ✚0716T Cardiac acoustic waveform recording with automated analysis and generation of coronary artery disease risk score. A noninvasive sensor is placed on patient's chest to assess for coronary artery disease risk.

New code ✚●0742T Absolute quantitation of myocardial blood flow (AQMBF), single photon emission computed tomography (SPECT), with exercise or pharmacologic stress, and at rest, when performed (List separately in addition to code for primary procedure). AQMBF detects reduced coronary flow reserve and helps to identify patients who may have high-risk coronary artery disease. Imaging cameras, and software is used.

New code ●0744T Insertion of bioprosthetic valve, open, femoral vein, including duplex ultrasound imaging guidance, when performed, including autogenous or non-autogenous patch graft (eg, polyester, ePTFE , bovine pericardium), when performed, includes imaging guidance using duplex ultrasound. The valve is a single use valve and permanently implanted to support the blood flow from the lower extremities in the absence of native deep venous valve function. Treats reflux in the deep venous system, leg ulcers, and chronic deep venous insufficiency.

Several new codes were added for cardiac focal ablation using radiation therapy:

  • 0745T Cardiac focal ablation utilizing radiation therapy for arrhythmia; noninvasive arrhythmia localization and mapping of arrhythmia site (nidus), derived from anatomical image data (eg, CT, MRI, or myocardial perfusion scan) and electrical data (eg, 12-lead ECG data), and identification of areas of avoidance
▶(For catheter-based electrophysiologic evaluation, see 93609, 93619, 93620, 93621, 93622)◀
  • 0746T conversion of arrhythmia localization and mapping of arrhythmia site (nidus) into a multidimensional radiation treatment plan
  • 0747T delivery of radiation therapy, arrhythmia
Coders must keep in mind that cardiac radioablation is a new noninvasive treatment that uses functional radioablation in combination with mapping and targeting of the abnormal myocardium. Treats arrhythmias such as ventricular tachycardia.

 

Digestive, Urinary and Reproductive Systems

Let's explore the digestive, urinary and reproductive system CPT changes.

Digestive System

Several new codes were created in the digestive system. The first involves EGD with deployment or removal of intragastric bariatric balloon(s):

Parent code 43235, Esophagogastroduodenoscopy, flexible, transoral;

  • 43290 with deployment of intragastric bariatric balloon
  • 43291 with removal of intragastric bariatric balloon(s)

Balloon used to treat morbid obesity and aid in weight loss.

The codes for ANTERIOR abdominal hernias have totally been revamped. This is because the older codes were a bit confusing and did not reflect current surgical techniques.

First we have the deletion of anterior hernia repair codes 49560-49561, 49565-49566, 49570, 49572, 49580, 49582, 49585, 49587, 49590, 49652-49657 (anterior hernias are ventral, epigastric, umbilical, spigelian, incisional)

Next we have the addition of 15 codes:

  • 49591-49596<– For initial repair of a reducible, incarcerated, or strangulated anterior abdominal hernia <3 cm to >10 cm
  • 49613-49618 – For recurrent repair of a reducible, incarcerated, or strangulated anterior abdominal hernia <3 cm to >10 cm
  • 49621-49622 –For initial or recurrent repair of a reducible, incarcerated, or strangulated parastomal hernia
  • 49623 –For removal of total or near total non-infected mesh or other prosthesis during anterior abdominal or parastomal hernia repair (For removal of INFECTED mesh, use 11008.)
  • Code 49568 for implantation of mesh was deleted.
  • New hernia repair codes (49591-49622) include implantation of mesh or other prosthesis.
  • Inguinal, femoral, lumbar, omphalocele and/or parastomal hernia repair may be separately reported when performed during same session as anterior abdominal hernia repairs.

Introductory notes updated to explain that new codes 49591-49618 include all anterior abdominal hernias ventral, epigastric, umbilical, spigelian, incisional.

The new codes are by ANY APPROACH (i.e., open, laparoscopic, robotic).

New codes are reported ONCE per DEFECT SIZE for ONE OR MORE anterior abdominal hernias measured as the maximal craniocaudal or transverse distances between the outer margins of all defects repaired.

If more than one hernia, one reducible, one incarcerated/strangulated, code to incarcerated/strangulated.

Surgeons need to be informed of the measuring technique and to document the sizes repaired.

Notes added for unilateral vs bilateral hernias and when to use -50 modifier.

Coders will need to review all of the introductory notes, and look at the photos on page 390 of the CPT Professional Edition. ***Surgeon must measure hernia defect(s) BEFORE opening the hernia defect, otherwise during repair fascia will retract giving a falsely elevated measurement. For example, one 2 cm reducible initial incisional hernia and one 4 cm incarcerated initial incisional hernia separated by 2 cm would be reported as an initial incarcerated hernia repair with a maximum craniocaudal distance of 8 cm (49594).

If the defects are NOT contiguous and separated by greater than or equal to of intact fascia, then add the sum of the length of EACH defect together and report that code. See photos on page 390 of CPT Professional Edition.

New category III codes:

  • 0723T Quantitative magnetic resonance cholangiopancreatography (QMRCP), including data preparation and transmission, interpretation and report, obtained without diagnostic magnetic resonance imaging (MRI) examination of the same anatomy (eg, organ, gland, tissue target structure) during the same session.
  • +0724T Quantitative magnetic resonance cholangiopancreatography (QMRCP), including data preparation and transmission, interpretation and report, obtained WITH diagnostic magnetic resonance imaging (MRI) examination of the same anatomy (eg, organ, gland, tissue target structure) during the same session.
  • 0736T Colonic lavage, 35 or more liters of water, gravity fed, with induced defecation, including insertion of rectal catheter. This is done to clear patients for colonoscopy. Patients can go and get this done instead of doing the normal colonoscopy prep. Clinical staff perform this under physician supervision.
  • 0748T Injections of stem cell product into perianal peri-fistular soft tissue, including fistula preparation (eg, removal of setons, fistula curettage, closure of internal openings) This is done for refractory fistulas in Crohn’s disease patients. Darvadstrocel (Alofisel) is one example of stem cell product.
  • 0779T Gastrointestinal myoelectrical activity study, stomach through colon, with interpretation and report
No scope involved. This study is a noninvasive procedure that assesses motility in the GI tract from the stomach through the colon. The study may be performed over several days. Usually, this assessment is performed for GI symptoms such as gastrointestinal pain, bloating, and distension.
  • 0780T Instillation of fecal microbiota suspension via rectal enema into lower gastrointestinal tract. Material is shipped to center, thawed and used.   No scope involved.   To treat relapsing Clostridium difficile.

Urinary System

Codes 50080 and 50081 have been revised. Prior to 2023, codes 50080 and 50081 described percutaneous nephrostolithotomy or pyelostolithotomy with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction. The terms “nephrostolithotomy” and “pyelostolithotomy” are no longer used in current clinical practice. In addition, the terminology describing some of the components of the procedure (ie, dilation, endoscopy, stenting, basket extraction) no longer accurately describe how these procedures are performed.

Nephrolithotomy is the surgical removal of stones from the kidney, and pyelolithotomy is the surgical removal of stones from the renal pelvis. This section of the guidelines refers to the removal of stones from the kidney or renal pelvis using a percutaneous antegrade approach. Code 50081 now states it is for complex stones > 2 cm, branching stones, stones in multiple locations, ureter stones, or complicated anatomy.

Also, coders can now report 50080 or 50081 with 50436 Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed; and 50437 including new access into the renal collecting system if they are performed.

There is new code 55867 Laparoscopy, surgical prostatectomy, simple subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy), includes robotic assistance, when performed. Coders must keep in mind that radical prostatectomy laparoscopic approach is coded 55866, open is coded 55840.

Male Reproductive System

New codes category III codes:

  • 0714T Transperineal laser ablation of benign prostatic hyperplasia, including imaging guidance. This procedure is an alternative to surgical excision and describes a minimally invasive intervention that includes imaging guidance. Treats benign prostatic obstruction.
  • 0738T Treatment planning for magnetic field induction ablation of malignant prostate tissue, using data from previously performed magnetic resonance imaging (MRI) examination
  • 0739T Ablation of malignant prostate tissue by magnetic field induction, including all intraprocedural, transperineal needle/catheter placement for nanoparticle installation and intraprocedural temperature monitoring, thermal dosimetry, bladder irrigation, and magnetic field nanoparticle activation.

Coders must not report 0738T in conjunction with 0739T on the same date of service.


 

Nervous, Ocular And Auditory Systems

Let’s explore the nervous, ocular and auditory systems CPT changes.

Nervous System

Codes 64400-64489 for injection of anesthetic/steroid into the somatic nervous system have been updated to reflect that ►Imaging guidance and localization may be reported separately for 64400, 64405, 64408, 64420, 64421, 64425, 64430, 64435, 64449,64450. Imaging guidance and any injection of contrast are inclusive components of 64415, 64416, 64417, 64445, 64446, 64447, 64448, 64451, 64454.◄ Coders will have to look carefully at the codes and not report imaging guidance for separately for above bolded codes. The codes themselves now have “including imaging guidance, when performed” as part of the description.

Also, for facet joint injection codes 64490, 64491, 64492, 64493, 64494, 64495 the notes were updated to describe the introduction/injection of a diagnostic or therapeutic agent into the paravertebral facet joint or into the nerves that innervate that joint by level. When determining a level, count the number of facet joints injected, not the number of nerves injected. Therefore, if multiple nerves of the same facet joint are injected, it would be considered as a single level. So count the number of JOINTS injected, not the nerves. Use -50 if bilateral. When the procedure is performed on the left side at one level and the right side at a different level in the same region, report one unit of the primary procedure and one unit of the add-on code. There are other updates as well to the introductory notes so be sure to read them before assigning these codes. SEE CHART ON PAGE 479 OF CPT PROFESSIONAL BOOK.

New code 0720T, Percutaneous electrical nerve field stimulation, cranial nerves, without implantation

The intent of this procedure involves placement of a noninvasive device that delivers percutaneous electrical nerve field stimulation (PENFS) to the external ear. Stimulation is applied to the cranial nerve region on the ventral/dorsal side of the ear lobe. After visualization of the cranial and occipital neurovascular bundles, needle arrays are placed behind the patient’s ear, activated, and secured in place with adhesives.

New add-on code +0735T Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with primary craniotomy (List separately in addition to code for primary procedure) Code 0735T was added to report the preparation of a cavity left by the removal of a tumor for placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) that is performed concurrently with a craniotomy. It is done immediately following tumor removal.

New codes: 0766T Transcutaneous magnetic stimulation by focused low frequency electromagnetic pulse, peripheral nerve, initial treatment, with identification and marking of the treatment location, including noninvasive electroneurographic localization (nerve conduction localization), when performed; first nerve

✚●0767T each additional nerve (List separately in addition to code for primary procedure)

0768T Transcutaneous magnetic stimulation by focused low frequency electromagnetic pulse, peripheral nerve, subsequent treatment, including noninvasive electroneurographic localization (nerve conduction localization), when performed; first nerve

✚●0769T each additional nerve (List separately in addition to code for primary procedure) This new modality treats chronic nerve pain. The injured nerve is localized using magnetic stimulation at the time of the initial treatment, the skin is marked (with photographic record) to facilitate rapid localization of the correct site for subsequent treatments. Unlike electrical stimulation, magnetic stimulation does not need a traverse of electric current through electrodes, skin, and tissue interface. Nerve conduction may be used for guidance. Coders will have to pay attention to assess if it is initial or subsequent treatment to assign the correct codes.

New code 0776T, Therapeutic induction of intra brain hypothermia, including placement of a mechanical temperature-controlled cooling device to the neck over carotids and head, including monitoring ( eg , vital signs and sport concussion assessment tool 5 [SCAT5]), 30 minutes of treatment. Used in sports medicine more so in patients with concussions.

Ocular System

Codes 66174 Transluminal dilation of aqueous outflow canal (eg, canaloplasty); without retention of device or stent and 66175 with retention of device or stent were revised to show that they include canaloplasty. This had been confusing as coders were not sure if canaloplasty was the same. Canaloplasty is a highly effective, minimally invasive, surgical technique indicated for the treatment of open-angle glaucoma that works by restoring the function of the eye's natural outflow system. CPT Assistant, September 2019, Volume 29, Issue 9, page 11

Code 92065 Orthoptic; performed by a physician or other qualified health care professionalrevised and new code 92066 under supervision of a physician or other qualified health care professional added to show this can be done under supervision. Orthoptic training is the treatment of defective visual habits, defects of binocular vision, and muscle imbalance (strabismus) by re-education of visual habits, exercise, and visual training.

New code 95919 Quantitative pupillometry with physician or qualified health care professional interpretation and report, unilateral or bilateral has been added. This code has been structurally placed in the CPT code set to precede code 95921, which involves the rapid, noninvasive measurement of autonomic nervous system function. Quantitative pupillometry is the objective measurement of pupil size and reactivity through the use of an automatic, portable device that emits a standard light-emitting diode light source and records pupil reaction.

One new category III code was added:

0730T Trabeculotomy by laser, including optical coherence tomography (OCT) guidance This laser procedure is without incision. Therefore, the code descriptor does not include the terms “ab interno or ab externo” used for incisional surgeries. This treats open angle glaucoma, pseudoexfoliative glaucoma, and ocular hypertension. Laser trabeculotomy is a minimally invasive technique in which an excimer laser is used to excise tissue with extraordinary precision, opening a canal that allows for improved outflow of intraocular fluids. This technique allows for tissue to be removed from the inner wall of the canal without causing scarring, which is the body’s natural healing response. This scarring would cause the canal, clinically known as Schlemm’s canal, to narrow again and interfere with the proper drainage of fluids.

 

Auditory System

Parent code is 69714 Implantation, osseointegrated implant, skull; with percutaneous attachment to external speech processor remains the same.

Revised code 69716 - with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or resulting in removal of less than 100 sq mm surface area of bone deep to the outer cranial cortex

New code added 69729 with magnetic transcutaneous attachment to external speech processor, outside of the mastoid and resulting in removal of greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex

Code 69716 was revised and 69729 added to differentiate between temporal bone implant WITHIN the mastoids or OUTSIDE the mastoid with/or removal bone amounts noted above. Processor.

We also have:

Revised code 69717 Revision or Replacement (including removal of existing device), osseointegrated implant, skull; with percutaneous attachment to external speech processor (Parent code)

Revised code 69719 with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or involving a bony defect less than 100 sq mm surface area of bone deep to the outer cranial cortex

New code 69730 with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex

Revised code 69726 Removal, entire osseointegrated implant, skull; with percutaneous attachment to external speech processor (To report partial removal of the device [ie, abutment only], use appropriate evaluation and management code)

Revised code 69727 with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or involving a bony defect less than 100 sq mm surface area of bone deep to the outer cranial cortex

New code 69728 with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex Sophono®, a passive transcutaneous skin-drive bone-conduction device.

New Category III codes added:

  • 0725T Vestibular device implantation, unilateral
  • 0728T Removal of implanted vestibular device, unilateral
  • 0727T Removal and replacement of implanted vestibular device, unilateral
  • 0728T Diagnostic analysis of vestibular implant, unilateral; with initial programming
  • 0729T with subsequent programming A VESTIBULAR implant is designed to restore the motion detection in the ear by providing electrical stimulation in the labyrinth. Helps balance and addresses Bilateral Vestibular Hypofunction (BVH). A cochlear implant, in contrast, is designed to produce auditory sensations by providing electric stimulation in the cochlea, not the labyrinth.

 

 

Category III, Appendices, Evaluation And Management and Hopps Changes

For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.

Category III Codes

Category III CPT codes are released semi-annually, in January and July. There are 70 new, 23 deleted and 1 revised Category III codes. Review pages 879-929 of CPT book which indicate the new codes delineated by a red circle. Many of the Category III codes not already discussed in the previous parts of this post involve more diagnostic and testing procedures across all specialties.

Of note are the following new category III codes that may be of interest to coders:

  • 0721T-0722T Quantitative computed tomography tissue characterization
  • 0731T Augmentative AI-based facial phenotype analysis
  • 0732T Immunotherapy administration with electroporation, intramuscular
  • 0740T-0741T Remote algorithm recommendation for insulin dose
  • 0742T AQMBF absolute quantitation of myocardial blood flow
  • 0743T, 0749T-50T Bone strength/fracture risk bone mineral density analysis.
  • +0751T, thru +0763T Digitization of glass microscope slides different types
  • +0764T-0765T Assistive algorithmic electrocardiogram risk-based assessing
  • +0770T-0774T Virtual reality technology/procedures
  • +0777T Real time pressure sensing epidural guidance
  • 0783T Transcutaneous auricular neurostimulation, set up, etc.

Please review to make sure your facility does not report these other Category III codes. They are also hard to find in an encoder so please remember to look at this section in the actual CPT tabular.

Radiology

For radiology there are 1 new codes, 0 deleted, and 9 revised. 76883 was added for ultrasound of nerves and accompanying structures

Medicine

For this section there are 38 new codes, 0 deleted, and 4 revised Medicine CPT Codes. A summary:
  • New COVID-19 vaccines 0003A-0112A, 91305-91310
  • New Dengue vaccine code; New RSV vaccine code
  • Be behaviour management codes
  • Remote monitoring code changes and addition
  • New COVID-19 vaccines 0003A-0112A, 91305-91310

Laboratory and Pathology

There are 12 new codes, 0 deleted and 4 revised codes. Most of the new codes and revisions involve new drug assays and oncology lab tests. Since many of these codes are inputted in the pathology or laboratory departments via chargemaster, the hospital will want to be sure the chargemaster is up to date and personnel in these departments are aware of the updates.

Appendices

Two appendices have been created to help the coder: Appendix S – Artificial Intelligence Taxonomy for Medical Services and Procedures
  • This taxonomy provides guidance for classifying various artificial intelligence (AI) applications for medical services and procedures, in three categories:
    • Assistive
    • Augmentative
    • Autonomous
Appendix T – CPT Codes That Can Be Used For Synchronous Real-Time Interactive Audio-Only Telemedicine Services
  • Listing of all these codes that also get modifier -93 for audio only.

Evaluation and Management

Office and Other Outpatient E/M for FY2023: The Time or MDM as the determinant for leveling of office and other outpatients continues. There were updates made to the table of risk. They involve defining acute illnesses and reporting of tests and interpretation to include dipstick UA, quick strep and CBC, among other changes. See the AMA website for a complete description of the Table of Risk updates here on page 6: https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

Remaining E/M codes have been revised to utilize Time or MDM to determine level. Here are the E/M codes that have been updated to reflect time or MDM as determinant of E/M level, just like we have for office and other outpatient E/M codes:
  • Hospital Inpatient and Observation Care Services
  • Consultations
  • Emergency Department services (MDM only, not Time)
  • Nursing Facility Services
  • Home and Domiciliary Services
  • Prolonged Services
Some key changes include:
  • Deletion of observation CPT codes (99217-99220, 99224-99226) and merged into the existing hospital care CPT codes (99221-99223, 99221-99233, 99238-99239). Editorial revisions to the code descriptors to reflect the code structure approved in the office visit revisions.
  • For consultations, there deletion of confusing guidelines including the definition of “Transfer of care.” Deletion of lowest level office (99241) and inpatient (99251) consultation codes to align with four levels of MDM.
  • For ER’s Time cannot be used as the key criterion to determine the level, only MDM.
  • Keep in mind some of the times have changed for many of these codes.
  • Coders should review all the technical changes carefully in the Evaluation and Management section of the CPT book.

Conversion Factor for Physician Services CY2022

December 31, 2022 - $34.61 January 1, 2023 - $33.06 January 1, 2023 – A $1.55 decrease from CY2022

See final rule for specific changes.
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched
https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule

Conversion Factor for HOPPS Hospitals CY2023

Overall INCREASE of payment rates of 3.8% for 2023 (4.1% increase reduced by 0.3 percentage point for the productivity adjustment)
Two conversion factors for CY 2022 For hospitals that meet the outpatient quality reporting (OQR) requirements, the 2023 conversion factor increases to $85.585 which is up from $84.177 from CY 2022.
Reduction of 2.0% in 2023 for those that fail to meet Hospital OQR requirement ($83.934)

Status Indicator C procedures

  • See Addendum E from final rule for a list of these.
  • Removed eleven codes from the IP only list: 21141, 21142, 21143, 21194, 21196, 21255, 21347, 21366, 21422, 22632, 47550.
  • Adding eight new CPT codes 15778, 22860, 49596, 49616, 49617, 49618, 49621, 49622.

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