Volume 5, #1

February 2008

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CPT and HCPCS Code Changes for 2008

Ann Florer, RN, CCS-P
Corporate Compliance Analyst

The American Medical Association (AMA) held its annual symposium November 14-16th in Chicago Illinois. This conference provided detailed information regarding significant changes to CPT 2008 codes and descriptors as well as 2008 payment policy and relative value (RVU) changes to the Medicare physician fee schedule. In addition, the Centers for Medicare & Medicaid Services (CMS) recently released in HCPCS code set for 2008. Following is a discussion of Current Procedural Terminology (CPT^®)and Healthcare Common Procedure Coding System (HCPCS) changes pertinent to Emergency Departments (ED).

Parenthetical additions to CPT sections, subsections, headings, and appendices pertinent to Emergency Department coding

Introduction—results, testing, interpretation, and report

• Results _ technical components of a service.
• Testing leads to results.
• Results lead to interpretation.
• Reports are the work product of interpretation of test results.
• Certain procedures have a technical component (e.g. tests) which produce results (e.g. images, data, slides).

• Some CPT descriptors specifically require interpretation to report the code.

• For clinical use, some of results require interpretation.

For professional assignment of interpretation and reports of X-rays, Ultrasounds and EKGs there must be an interpretation of test finding in addition to the reporting of findings.

Hydration, therapeutic, prophylactic, and diagnostic injections and infusions

• These codes are not intended to be a report by the physician in the facility setting.
• When these codes are reported by the facility, the initial code should be selected using a hierarchy whereby chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services which are primary to hydration services. Infusion are primary to pushes, which are primary to injections.

Medicine/cardiology

• Codes 93040-93042 are appropriate when an order for the test is triggered by an event.
• It is not appropriate to used these codes for reviewing the telemetry monitor strips taken from a monitoring system.
• There must be a specific order for an electrocardiogram or rhythm strip followed by a separate, signed, written, and retrievable report.
• The need for an electrocardiogram or rhythm strips should be supported by documentation in the patient medical record.

2008 code additions

Below are the CPT/HCPCS changes that will affect ED professional and facility coding on January 1, 2008. Contact your Coding Operations Manager or LYNX Support Services with Chargemaster changes. Chargemaster changes can be made at any time due to the "effective date" functionality in E/Code^™. This information could significantly impact revenue opportunities in 2008. Discontinued 2008 codes will not be reimbursed for dates of service after December 31, 2007.

Certain codes addressed below have specific payer and/or chargemasters issues (e.g. payer crosswalk) related to them. These issues are described below in italicized text.

Professional ED code changes

CPT Code Book LYNX recommended additions

Evaluation and management non-face-to-face services codes (Washington state clients only):

99441 Telephone call-5-10 minutes

99442 11-20 minutes

99443 21-30 minutes

These codes will be used by the Washington State Department of Labor and Industries for reporting the service of telephone communication between providers and employers regarding industrial accident claimants' healthcare). These codes are not appropriate for follow up phone calls after an ED encounter.

Evaluation and management behavioral change interventions, individual codes:

99406 Smoking and Tobacco use cessation counseling visit; intermediate greater than 3 minutes up to 10 minutes

99407 intensive, greater than 10 minutes

99408 Alcohol and/or substance abuse (other than tobacco) structural screening (e.g. AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes

The service for code 99408 requires a minimum of 15 minutes in duration separate from the ED evaluation and management (E/M) services. Any E/M service reported on the same day must be distinct, and time spent providing these services may not be used as a basis for the E/M code selection. A SBI requires a significant amount of time and additional acquire skills to deliver beyond that required for provision of general advice. SBI techniques are discrete, clearly distinguishable clinical procedures that are effective in identifying problematic alcohol or substance use.

Surgery/musculoskeletal-fracture and/or dislocation codes:

27267 Closed treatment of femoral fracture, proximal end, head; without manipulation.

27768 with manipulation.

Surgery/respiratory-lungs and pleura removal codes:

32421 Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent.

32422 Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure).

32551 Tube thoracostomy, includes water seal (e.g., for abscess, hemothrox, empyema), when performed (separate procedure).

Surgery/cardiovascular-arteries and veins

36591 #$ Collection of blood from a completely implantable venous access device.

36592 #$ Collection of blood using established central or peripheral catheter venous, not otherwise specified.

36593 # Declotting by thrombolytic agent of implanted vascular access device or catheter.

# No Work or Practice Expense RVUs for facility based providers on Medicare Physician Fee Schedule (MPFS). Other payers may reimburse.

$ Only paid if no other service payable on the on the same date of service by the provider; otherwise service is bundled on the MPFS. Other payers may reimburse.

Codes represent professional service performed by ED physician/NPP; not ED facility staff (e.g., nursing).

Surgery/urinary system-bladder codes:

51100 Aspiration of bladder; by needle.

51101 by trocar or intracatheter.

51102 with insertion of suprapubic catheter.

Laboratory point-of-service testing CLIA waived tests:

82272* Blood, occult, by peroxidase activity (e.g. guaiac), qualitative, feces, 1-3 simultaneous determination, performed for other than colorectal neoplasm screening.

*This code has no RVUs per the MPFS, some payers may reimburse. Professional code represents testing and interpretation performed by the physician/NPP; not ED facility staff. This is not a new code for 2008; but its descriptor was revised to indicate it is for other than colorectal screening.

HCPCS level II codes recommended additions

The following two codes are similar to CPT codes 99406 and 99406 but is for assessment services rather than for screening and both codes require an intervention in addition to the assessment. Codes 99406 and 99407 are not paid by CMS under the MPFS. Whereas the following two codes will be paid by CMS when performed for alcohol and substance abuse assessment and intervention services that are not screening services but are performed in the context of the diagnosis or treatment of illness or injury and appropriately documented.

G0396 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes

G0397 greater than 30 minutes.

The following professional codes are deleted for dates of service January 1, 2008 forward.

CPT Code Book required deletions:

32000 Thoracentesis

32002 Thoracentesis with tube placement

32020 Tube Thoracostomy

36540 Collection of blood specimen from a completely implantable venous access device

36550 Declotting by thrombolytic agent of implanted vascular access device or catheter

51000 Aspiration of bladder by needle

51010 with insertion of suprapubic catheter

99371**Telephone call, simple

99372** intermediate

99373** complex or lengthy

* * These codes were used by the Washington State Department of Labor and Industries for reporting the service of communicating between providers and employers regarding an industrial accident claimants' healthcare.

HCPCS Code 2008 professional deletions (see CPT^® code descriptors 99406 and 99407):

G0375 Smoke/tobacco counseling 3-10

G0376 Smoke/tobacco counseling >10

Facility ED code changes

CPT Code recommended additions

Evaluation and management codes:

99406 Smoking and Tobacco use cessation counseling visit; intermediate greater than 3 minutes up to 10 minutes.

99407 intensive, greater than 10 minutes.

99408 Alcohol and/or substance abuse (other than tobacco) abuse structural screening (e.g. AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes.

99409 greater than 30 minutes.

Codes 99408 and 99409 are not paid under the CMS OPPS -see HCPCS II codes G0396 and G0397.

Surgery/musculoskeletal-fracture and/or dislocation codes:

27267 Closed treatment of femoral fracture, proximal end, head; without manipulation.

27767 Closed treatment of posterior malleolus fracture; without manipulation.

27768 with manipulation.

Surgery/respiratory-lungs and pleura removal codes:

32421 Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent.

32422 Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure).

32551 Tube thoracostomy, includes water seal (e.g., for abscess, hemothrox, empyema), when performed (separate procedure).

Surgery/cardiovascular-arteries and veins

36591 Collection of blood from a completely implantable venous access device.

Code 36591 is paid under the CMS OPPS only when a specific payment criterion is met - status indicator "Q" for 2008 (criteria is usually that no other separately payable OPPS service is reported on the same day- OPPS code status indicator S, T, X or V). If the criterion is not met payment is always packaged. LYNX recommends this code always be reported when performed [except when bundled with another service per the Outpatient Code Editor _ (OCE)] as this is a new code with a temporary APC assignment (comment indicator NI), and is a conditionally packaged service. Future payment rate and or a separate APC assignment for this code may be evaluated and adjusted based on code assignment reporting.

36592 Collection of blood using established central or peripheral catheter venous, not otherwise specified.

Code 36592 is a packaged service under CMS OPPS for 2008; no separate payment will be made _status indicator "N". LYNX recommends this code always be reported when performed (except when bundled with another service per the OCE) as this is a new code with a temporary APC assignment (comment indicator NI). This code however is an unconditionally packaged service. Future APC payment rate and separate APC assignment may be evaluated and adjusted based on code reporting.

36593 Declotting by thrombolytic agent of implanted vascular access device or catheter.

Surgery/urinary system-bladder codes:

51100 Aspiration of bladder; by needle.

51101 by trocar or intracatheter.

51102 with insertion of suprapubic catheter.

Medicine/therapeutic, prophylactic, and diagnostic injections and infusions codes:

90776 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure).

(Do not report 90776 for a push performed within 30 minutes of a reported push of the same substance or drug.)

(90776 may be reported by facilities only.)

Code 90776 is a packaged service under CMS OPPS for 2008; no separate payment will be made _status indicator "N". LYNX recommends this code always be reported when performed (except when bundled with another service per the OCE) as this is a new code with a temporary APC assignment (comment indicator NI). However, this code is an unconditionally packaged service. Future APC payment rate and separate APC assignment may be evaluated and adjusted based on code reporting.

See below for Code Descriptor Revision related to infusion and injection coding.

HCPCS level II codes recommended additions

The following two codes are similar to CPT codes 99406 and 99406 but is for assessment services rather than for screening and both codes require an intervention in addition to the assessment. Codes 99406 and 99407 are not paid by CMS under OPPS whereas the following two codes will be paid when appropriate performed and documented.

G0396 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes.

G0397 greater than 30 minutes.

The following codes are deleted for dates of service January 1, 2008 forward.

CPT Code required deletions:

32000 Thoracentesis

32002 Thoracentesis with tube placement

32020 Tube Thoracostomy

36540 Collection of blood specimen from a completely implantable venous access device

36550 Declotting by thrombolytic agent of implanted vascular access device or catheter

43750 Percutaneous placement of gastrostomy tube, without imaging or endoscopic guidance

51000 Aspiration of bladder by needle

51010 with insertion of suprapubic catheter

86586 Unlisted antigen, each

HCPCS Code 2008 deletions (see CPT codes 99406 and 99407):

G0375 Smoke/tobacco counseling 3-10 minutes

G0376 greater than 10 minutes

Additional ED or Outpatient Facility Clinic codes LYNX recommended CDM deletions; not deleted from the CPT code book:

Evaluation and management codes - office consultations:

99241-99245 Office or Other Outpatient Consultations codes (99241-99245) will no longer be paid under OPPS in 2008. Instead providers are instructed to build consult services into their internal clinic coding guidelines for reporting the clinic new or established office codes 99201-99205 or 99211-99215

2008 CPT Code descriptor revisions

Deleted language within revised codes appears with a strikethrough , new text appears underlined. New parenthetical language or cross-references appear in green font.

Surgery/musculoskeletal-fracture and/or dislocation

24670 Closed treatment of ulnar fracture, proximal end (e.g., olecranon or coronoid process[es]); without manipulation

24675 with manipulation

27808 Closed treatment of bimalleolar ankle fracture (including Potts e.g., lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation

27810 with manipulation

43760 Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance

43761 Repositioning of gastric feeding tube, any method, through the duodenum for enteric nutrition

57500 Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure)

80048 Basic metabolic panel (Calcium, total)

82272 Blood, occult, by peroxidase activity (e.g. guaiac), qualitative, feces, single specimen (e.g. from digital rectal exam) 1-3 simultaneous determination, performed for other than colorectal neoplasm screening

Medicine/hydration

90760 Intravenous infusion, hydration, initial, up to 1 31 minutes to 1 hour

(Do not report 90760 if performed as a concurrent infusion service)

90761 each additional hour (list separately in addition to code for primary procedure)

(Use 90761 in conjunction with 90760)

(Report 90761 to identify hydration infusion intervals of greater than 30 minutes beyond 1 hour increments)

(Report 90761 to identify hydration if provided as a secondary or subsequent service after a different initial service [90760, 90765, 90774, 96409, 96413] is provided administered through the same IV access)

(Do not report intravenous infusion for hydration of 30 minutes or less)

Medicine/therapeutic, prophylactic, and diagnostic injections and infusions

90767 additional sequential infusion, up to 1 hour (List separately in addition to code for primary procedure)

(Report 90767 in conjunction with 90765, 90774, 96409, 96413 if provided as a secondary or subsequent service after a different initial service is administered through the same IV access. Report 90767 only once per sequential infusion of same infusate mix)

90768 concurrent infusion (List separately in addition to code for primary procedure)

(Report 90768 in conjunction with 90765, 90766, 96413, 96415, 96416)

90775 each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)

(Report 90775 to identify intravenous push of a new substance/drug if provided as a secondary or subsequent service after a different initial service is provided administered through the same IV access)