CPT / HCPCS Changes for 2014

The Current Procedural Terminology, Fourth Edition, (CPT-4) code set for 2014 includes a few updates of interest to ob-gyns. As in previous years, extensive new instructions and guidelines have been added to the CPT manual to help clarify coding in a variety of situations. CPT continues to modify code descriptions, instructions, and guidelines to increase provider neutrality language. This new guidance is in addition to new, revised and deleted CPT codes for 2014. These changes take effect January 1, 2014.

HIPAA requires insurers to accept new procedure codes beginning on January 1st.

The American Medical Association CPT Editorial Panel approved these changes for 2014.

 
GUIDELINES
Appendix C
The clinical examples in Appendix C have been updated to clarify guidance to providers on identifying and reporting the most appropriate Evaluation and Management codes from the Office or Other Outpatient Services, Hospital Inpatient Services, Consultations, Critical Care, Prolonged Services and Care Plan Oversight sections of CPT.
 

NEW, REVISED, AND DELETED CODES

Evaluation and Management
Interprofessional Telephone/Internet Assessment and Management Service
For 2014, CPT has introduced new codes for non-face-to-face interprofessional telephone/Internet Consultations. It is uncertain at this time whether payers will reimburse for these codes. 

99446   Interprofessional telephone/internet assessment and management service   provided by a consultative physician including a verbal and written report to the patient’s treating /requesting physician or other qualified healthcare professional; 5-10 minutes of medical consultative discussion and review.
99447   11-20 minutes of medical consultative discussion and review
99448   21-30 minutes of medical consultative discussion and review
99449        31 minutes or more of medical consultative discussion and review

Complex Chronic Care Coordination and Transitional Care Management
Introductory guidelines have been extensively updated to provide clarifying guidance and reporting instructions for both Complex Chronic Care Coordination and Transitional Care Management codes.

Integumentary System
Introduction and Removal
New code 10030 (Image guided fluid collection drainage by catheter (e.g. abscess, hematoma, seroma, lymphocele, cyst, soft tissue (e.g., extremity, abdominal wall, neck), percutaneous) has been introduced to report image guided fluid drainage by catheter as a bundled service. As a result, abscess drainage codes 49021, 49041, and 49061 have been deleted.

Excision
Six new codes have been added to describe breast biopsies with image guidance. These codes were developed to report services that were frequently reported together.  As a result, codes 19102-19203, 19290-19291, 19295 and imaging codes 77031-77032 have been deleted for 2014.

The new codes to report these services are as follows:

19081   Biopsy breast with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance
+19082   each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure)
19083   Biopsy breast with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance
+19084     each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)
19085   Biopsy breast with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance
+19086     each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure)

Introduction
Image guided placement of localization devices are reported with the following new codes:

19281   Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds) percutaneous; first lesion, including mammographic guidance
+19282     each additional lesion, including mammographic guidance (List separately in addition to code for primary procedure)
19283   Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds) percutaneous; first lesion, including stereotactic guidance
+19284     each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure)
19285   Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds) percutaneous; first lesion, including ultrasound guidance
+19286     each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)
19287   Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds) percutaneous; first lesion, including magnetic resonance guidance
+19288     each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure)

 
DIGESTIVE SYSTEM

Abdomen, Peritoneum, and Omentum
Incision
New codes were added to describe image guided fluid collection drainage by catheter of viscera.

49405   Image guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst) visceral (e.g., kidney, liver, spleen, lung/mediastinum), percutaneous
49406     ; peritoneal or retroperitoneal, percutaneous
49407     ; peritoneal or retroperitoneal, transvaginal or transrectal

 
FEMALE GENITAL SYSTEM

Ovary
Incision
Code 58823 (Drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous (e.g., ovarian, pericolic)) has been deleted due to the introduction of new codes for image guided fluid collection drainage by catheter (e.g. 10030, 49405-49407).

 
MEDICINE

Vaccine, Toxoids
Influenza Vaccine Codes
Several new influenza vaccine codes have been added to CPT for 2014:

90673   (Influenza virus vaccine, trivalent, derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use)
90686   (Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use)
90688   (Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use)

 
HCPCS Influenza Codes
Q2033 joins the list of brand specific HCPCS codes that replaced the use of CPT code 90658 when reporting the influenza virus vaccine for Medicare patients.

The current list of influenza virus vaccine codes for Medicare is as follows:
Q2033 (Flublock)
Q2034 (Agriflu)
Q2035 (Afluria),
Q2036 (Flulaval),
Q2037 (Fluvirin),
Q2038 (Fluzone) and
Q2039 (not otherwise specified)

CPT codes for other vaccine formulations would be reported if provided.

Category III Code(s)

0336T   Laparoscopy, surgical, ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring, radiofrequency

 
New HCPCS IUD Code (Skyla)

The HCPCS code set is updated on a quarterly basis.  Effective January 1, 2014, code J7301  (Levonorgestrel-Releasing Intrauterine Contraceptive System (SKYLA), 13.5 mg) was introduced to provide another alternative for IUD placement. Skyla is a hormone-releasing IUD (intrauterine device) that is considered very effective and continuously prevents pregnancy for up to 3 years.