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Dec 9, 2016

It is that time of year, again.  No, not the holidays; it’s time for new CPT® code updates.  Here, we review some of the changes to the code set. Moderate (conscious) sedation is no longer included in any procedures.  This is the single largest change in CPT®, affecting 441 codes.  Most of these procedures are endoscopies, which previously had the “bullseye” symbol appended in the CPT® manual to identify the inclusion of moderate sedation. According to CMS, these codes were initially intended to be used when the performing provider administered moderate sedation.  In recent years, a distinct anesthesiologist has predominantly been responsible for this administration.  This unfairly values the procedure, which previously included relative value units for the anesthesia administration.  The 2017 distinct sedation codes ensure that only providers who administer moderate sedation are reimbursed for this service.

Another significant change is the addition of telemedicine codes.   Telemedicine allows health care professionals to provide clinical services from a distance to those who have geographic barriers to medical services.   2017 introduces Modifier 95, Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.  There are 79 CPT® codes, including evaluation and management services, which can be appended with this modifier.  These services are now identified with a “star” symbol and listed in the new Appendix P.  Medicare has specific requirements for telemedicine services, including the use of interactive audiovisual telecommunications equipment in real time, and that the individual receiving the service must be located in an approved telehealth originating site.

The surgery section has the largest number of code changes this year.  In orthopedics, spinal instrumentation is now defined in greater specificity; and treatments for spinal stenosis with stabilization or distraction devices are now represented by CPT® codes.  In the respiratory section, there are changes to laryngoplasty codes, which now include several procedure methods and identification of congenital or acquired stenosis. 

There are new codes for dialysis circuits, which are designed for easy and repetitive access to perform hemodialysis.  The circuits are broken down into the peripheral and central dialysis segments.  Also in the cardiovascular section, the transluminal balloon angioplasty codes are streamlined to include radiological supervision and interpretation, which will enable the service to be coded with one CPT® code.

The range of new spinal injections differentiates between spinal region and whether or not imaging guidance is used.  In radiology, a code representing fluoroscopic guidance for needle placement is added.  Mammography codes have been condensed and now include computer-aided detection (CAD).  Additionally, nine influenza vaccine codes have changed and are now reported by dosage instead of patient age.   Physical and occupational therapy evaluation codes are overhauled this year, and now require specific components similar to evaluation and management codes.  New athletic training evaluation codes have also been added.

As always, there are some codes worth mentioning just for their uniqueness.   Code 97602, used to identify debridement of devitalized tissue within a wound, now includes the use of larval therapy, where maggots are added to the wound.  The maggots will selectively remove the necrotic tissue while not harming the healthy tissue.  An old-time treatment becomes a newly revised CPT® code. The CPT code manual is published by the American Medical Association and available for purchase from several vendors.

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Nancy Clark

Nancy Clark is a Senior Manager in the Health Care Consulting Group. Her expertise focuses on coding and documentation audits, which includes chart review and report compilation.

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