Becker's ASC Review

63 Coding & Billing 2014 CPT Code & Medicare List Updates: What Do ASC Leaders Need to Know? By Carrie Pallardy T he American Medical Association re- leased its 2014 Current Procedural Ter- minology code set in fall 2013. The new code set, which includes 335 changes, now applies to all claims filed on or after Jan. 1. Stephanie Ellis, RN, CPC, president of Ellis Medi- cal Consulting, explains some of the most signifi- cant changes affecting ambulatory surgery center specialties. CPT Code Changes and Additions General surgery Breast biopsy codes have undergone significant changes, largely in relation to imaging used in these procedures. New codes and add-on codes include: • Codes 19081-19806 • Codes 19281-19288 Several of the add-on codes refer to treatment of additional lesions. "Medicare has gotten very re- strictive on payment for add-on codes in ASCs," says Ms. Ellis. Gastroenterology Approximately 25 percent of the 2014 CPT code changes affect the field of GI, according to the American Medical Association. The additions below cover esophagoscopy, esophagogastroduo- denoscopy, endoscopic retrograde cholangiopan- creatography and image-guided fluid collection drainage by catheter. • Codes 43191-43918 • Codes 43211-43214 • Code 43229 • Code 43233 • Codes 43253-43254 • Code 43266 • Code 43270 • Codes 43274-43278 • Codes 49405-49407 "Code 4327, which can be used for the ablation in Barrett's esophagus cases, is a good addition," says Ms. Ellis. "Medicare pays $550 for it." Neurology Chemodenervation has undergone a number of significant changes, including new codes and add- on codes. Additions include: • Codes 64616-64617 • Codes 64642-64647 "This is an opportunity for new reimbursement if you perform the procedure on one area, but if you perform the procedure on multiple areas (where an add-on code would be used), the codes are packaged and not covered by Medicare," says Ms. Ellis. Ophthalmology Code 0192T has been deleted and replaced by code 66183, which refers to the insertion of an an- terior segment aqueous drainage device without an extraocular reservoir. This code has an average Medicare payment of $1,651. Orthopedics New orthopedics codes relate to removal of for- eign bodies, prosthesis removal and knee proce- dures. The new codes include: • Code 23333-23335 • Code 27415 • Code 27524 "Code 27415 for open osteochondral allograft, knee, open, is an existing CPT code, which is newly-added to the Medicare ASC list for 2014 with an average Medicare payment of $2,242," says Ms. Ellis. Important changes include arthroscopic knee synovectomy codes 29875 and 29876. "Medi- care no longer allows either of these codes to be billed when any other arthroscopic procedure is performed on the same knee in the same surgical case, due to strict enforcement of the CCI edits," says Ms. Ellis. Strict CCI edit enforcement has also extended to include codes involving some ar- throscopic shoulder procedures. Urology Code 52356 is new to urology. The code covers cystourethroscopy, with ureteroscopy and/or py- eloscopy; with lithotripsy including insertion of indwelling ureteral stent, says Ms. Ellis. Medicare pays an average of $1,796. This new code com- bines previous codes for standard lithotripsy and stent insertion, as these procedures are common- ly performed together. Category III CPT Code Additions There are several new category III CPT codes. Specialties of note include gynecology and spine and pain management. Gynecology "Category III code 0336T is a new code for lapa- roscopy, surgical, ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring, radiofrequency which has been added to the Medicare ASC List for 2014 with an average Medicare payment of $4,671," says Ms. Ellis. Spine and pain management Two category III codes have been added to the Medicare ASC list in the areas of spine and pain management. • Code 0334T • Code 0335T The codes cover sacroiliac joint stabilization for arthrodesis and extra-osseous joint implant for talotarsal stabilization, respectively. Medicare pays $3,537 for code 0334T and $1,094 for code 0335T. HCPCS Drug Code Additions ASCs do not frequently bill for these codes, but there are a few that Medicare pays for. For exam- ple, code J1602 refers to an injection of Golimum- ab, 1 mg. This code has been added to the Medi- care ASC list and generates an average Medicare payment of $24. "Be sure to read the code descrip- tor carefully," says Ms. Ellis. "If a code descriptor says 1 mg and you are giving 3 mg., be sure to increase the number of units billed to three." Medicare ASC List Deletions There are several ASC list deletions, including HCPCS and CPT codes. "Many of these deletions are related to new CPT codes being made for procedures," says Ms. Ellis. "For examples codes 64613 and 64614 were both for chemodenerva- tion of the neck muscles. These have been deleted and replaced with new codes." Medicare ASC List Packaged Codes Medicare has taken a number of commonly used add-on codes and translated them into packaged procedures. "The biggest change to the Medicare list this year has been the drastic expansion of packaged procedures," says Ms. Ellis. These add- on codes will no longer be reimbursed separately. Pain management is the specialty most affected by the increase in packaged procedures. n CPT Copyright 2014 American Medical Associa- tion. 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