January 13, 2016
Nancy Clark, CPC, COC, CPB, CPMA, CPC-I
Current Procedural Terminology (CPT®) procedure codes have been revised for 2016. According to the American Medical Association, there are 365 changes, including:
- 140 new codes,
- 134 revised codes, and
- 91 deleted codes
The highest volume of code changes can be found in the Surgery section, with 48 new codes and 22 deleted codes. The new codes are concentrated in the digestive and the urinary system subsections. Many of these code descriptions identify new technology approaches, some of which are either less invasive or more specific to the procedure.
In the Auditory system, there is new code 69209, which identifies removal of impacted cerumen, or ear wax, using irrigation or lavage techniques. This is in addition to a frequently audited code, 69210, that only applied to removal of cerumen with instrumentation. Providers who perform this procedure should adhere to the related documentation changes.
The Radiology section replaces some of the old descriptors of “film” to the new term “image,” indicating that digital or saved images are appropriate for these procedures. There are 25 deleted codes in this category, the most of any section. Some deletions are due to codes not being utilized or being misvalued.
In the Medicine section, most of the vaccine codes have been updated to include the Advisory Committee on Immunization Practices’ abbreviations. Many of the codes representing obsolete vaccine products have been deleted. Several new codes, including certain meningococcal vaccines, have been added.
Also of note, the Ophthalmology section now bundles certain minor procedures with eye exams. Optometric physicians should pay careful attention to the parenthetical notes in this section.
There are 2 new and 2 revised evaluation and management codes. The new codes (99415, 99416) identify prolonged services by clinical staff, including physician assistants and nurse practitioners. The revised codes (99354, 99355) now allow for reporting of prolonged service time for outpatient psychotherapy services.
CPT® Category III codes, temporary codes for emerging technology, services, and procedures, have increased by 43. Some Category III codes have now been replaced by permanent CPT® codes, while others have been deleted or “sunset” due to lack of substantial use after 5 years.
The Pathology and Laboratory section also has substantial changes, including additions and revisions to the Molecular Pathology Tier subsections. There are no changes to the CPT® modifiers located in Appendix A for this year.
Ensure that your practice reviews all relevant changes and additions to CPT® for the current year. Update the encounter form, chargemaster and other forms to accurately reflect only current CPT® codes. Deleted CPT® codes will no longer be reimbursed for dates of service January 1 and after. Verify that the new codes are loaded into the software and practice management systems. A thorough review now may prevent costly errors during the year.