GI, Neurology, Ophthalmology, Urology Surgery CPT Codes Changes

<div dir="ltr" style="text-align: justify;" trbidi="on">Learn surgery CPT code changes in Gastroenterology (GI), Neurology, Ophthalmology and Urology specialties.<br /> <br /> Current Procedural Terminology (CPT) 2015 update by American Medical Association (AMA) includes 276 new codes. There are a total of 129 revised codes and 137 deleted codes. <br /> <br /> New Surgery CPT Codes were added to the Gastroenterology (Digestive System subsection), Neurology (Nervous System subsection), Ophthalmology (Eye and Ocular Adnexa subsections), Urology (Urinary System subsection), Musculoskeletal System and Cardiovascular System subsections. <br /> <br /> Additional changes noted in the CPT Surgical Package Definition appear in the Surgical Guidelines to include the new language "or other qualified health care professional who performs the surgery" in the descriptor of provider of services.<br /> <br /> <div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2015/04/gi-neurology-ophthalmology-cptcodeschanges.html"><img alt="GI, Neurology, Ophthalmology, Urology Surgery CPT Codes Changes" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhex7KfDofGzqEq7073gAz0oU8yqBjgQiu3bI15HcbmXhmufYW-2AZg8-n10QZJVZEhn6Ns8lJv8gpewoyBtG0KOa_Syvc13cix2zED__AFsqeI3If2ShkUOkX9FmXYCpA7t07luhJ0Vtw/s1600/cpt-code-changes-updates2015.jpg" /></a></div><style>.table td { border:dotted 0px #e0e0e0; padding:0px 2px 5px 2px; vertical-align:top; }</style><br /> We have already covered all <a href="http://www.medicalbillingcodings.org/2015/03/cardiology-cardiovascular-cptcodechangesupdates.html">Cardiology/ Cardiovascular CPT Code Changes</a> in detail. In this post, we have highlighted the new, revised and deleted CPT codes for for Gastroenterology, Neurology, Ophthalmology and Urology in the following:<br /> <br /> <h3>Gastroenterology (GI) Surgery CPT Codes Changes</h3>New notes were added to Endoscopy, Small Intestine, including a note advising, “When bleeding occurs as the result of an endoscopic procedure the control of the bleeding is not reported separately during the same operative session.”<br /> <br /> A new subheading for Endoscopy, Stomal was added this year. New notes provide guidance on coding when the intended procedure is unable to be completed. These notes also address the correct code assignment when reporting colonoscopy through a stoma. Ten new codes were added in this area: 44381, 44384, 44401-44408. They include codes for balloon dilation, placements of stents, ablation of tumors, mucosal resection, injection procedures, and decompression all conducted through a stoma.<br /> <br /> Under the Endoscopy subheading additional notes and clarification was added for coding the extent of the procedure. A valuable new tool has been added in the form of a colonoscopy decision tree. Eight new codes were included this year. Two of the new codes replaced deleted codes.<br /> <br /> Several of the new codes replaced deleted codes and added the terms “includes pre- and post-dilations and guide wire passage, when performed.” There are new codes for band ligations as well (45350, 45398).<br /> <br /> Two new anoscopy codes—46601, 46607—were added to capture the use of high-resolution magnification (HRA).<br /> <br /> Finishing up the new codes added in the Surgery Section, Digestive System Subsection in the Subheading of Other Procedures is a new code to represent Ablation of one or more liver tumor(s) by percutaneous cryoablation, 47383.<br /> <br /> <table class=table style="width:100%;border-collapse:collapse;"><tbody> <tr><td colspan="2"><h4>New CPT Codes for Esophagus (Endoscopic Procedure)</h4></td></tr> <tr><td width="7%">43180</td><td width="93%">Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker’s diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed</td></tr> <tr><td colspan="2"><h4>New CPT Codes for Colonoscopy</h4></td></tr> <tr><td width="7%">45388</td><td width="93%">Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)</td></tr> <tr><td width="7%">45389</td><td width="93%">Colonoscopy; with endoscopic stent placement (includes pre and post-dilation and guide wire passage, when performed)</td></tr> <tr><td width="7%">45390</td><td width="93%">Colonoscopy; with endoscopic mucosal resection</td></tr> <tr><td width="7%">45393</td><td width="93%">Colonoscopy; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed</td></tr> <tr><td width="7%">45398</td><td width="93%">Colonoscopy; with band ligation(s) (eg, hemorrhoids)</td></tr> <tr><td width="7%">45399</td><td width="93%">Unlisted procedure, colon</td></tr> <tr><td colspan="2"><h4>New CPT Codes for Colonoscopy Via Stoma</h4></td></tr> <tr><td width="7%">44401</td><td width="93%">Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed)</td></tr> <tr><td width="7%">44402</td><td width="93%">Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with endoscopic stent placement (including pre and post-dilation and guide wire passage, when performed)</td></tr> <tr><td width="7%">44403</td><td width="93%">Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with endoscopic mucosal resection</td></tr> <tr><td width="7%">44404</td><td width="93%">Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with endoscopic mucosal resection with directed submucosal injection(s), any substance</td></tr> <tr><td width="7%">44405</td><td width="93%">Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with transendoscopic balloon dilation</td></tr> <tr><td width="7%">44406</td><td width="93%">Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures</td></tr> <tr><td width="7%">44407</td><td width="93%">Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures</td></tr> <tr><td width="7%">44408</td><td width="93%">Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed); with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed</td></tr> <tr><td colspan="2"><h4>New CPT Codes for Sigmoidoscopy</h4></td></tr> <tr><td width="7%">45346</td><td width="93%">Sigmoidoscopy, flexible;with ablation of tumor(s), polyp(s), or otherlesion(s) (includes pre- and post-dilation and guide wire passage, when performed)</td></tr> <tr><td width="7%">45347</td><td width="93%">Sigmoidoscopy; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)</td></tr> <tr><td width="7%">45349</td><td width="93%">Sigmoidoscopy; with endoscopic mucosal resection</td></tr> <tr><td width="7%">45350</td><td width="93%">Sigmoidoscopy; with band ligation(s) (eg, hemorrhoids)</td></tr> <tr><td colspan="2"><h4>New CPT Codes for Anoscopy</h4></td></tr> <tr><td width="7%">46601</td><td width="93%">Anoscopy; diagnostic, with high-resolution magnification (HRA) (eg, colposcope, operating microscope) and chemical agent enhancement, including collection of specimen(s) by brushing or washing, when performed</td></tr> <tr><td width="7%">46607</td><td width="93%">Anoscopy; with high-resolution magnification (HRA) (eg, colposcope, operating microscope) and chemical agent enhancement, with biopsy, single or multiple</td></tr> <tr><td colspan="2"><h4>New CPT Codes for Small Intestine (Endoscopic Procedure)</h4></td></tr> <tr><td width="7%">44381</td><td width="93%">Ileoscopy, through stoma; with transendoscopic balloon dilation</td></tr> <tr><td width="7%">44384</td><td width="93%">Ileoscopy, through stoma; with transendoscopic balloon dilation; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)</td></tr> <tr><td colspan="2"><h4>New CPT Codes for Ablation Liver Tumors</h4></td></tr> <tr><td width="7%">47383</td><td width="93%">Ablation, 1 or more liver tumor(s), percutaneous, cryoablation</td></tr> <tr><td colspan="2"><h4>Revised CPT Codes for Esophagoscopy (Endoscopic Procedure)</h4></td></tr> <tr><td width="7%">43194</td><td width="93%">Esophagoscopy, rigid, transoral; with removal of foreign body(s</td></tr> <tr><td width="7%">43197</td><td width="93%">Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure)</td></tr> <tr><td width="7%">43215</td><td width="93%">Esophagoscopy; with removal of foreign body(s)</td></tr> <tr><td width="7%">43216</td><td width="93%">Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps.</td></tr> <tr><td width="7%">43247</td><td width="93%">Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)</td></tr> <tr><td width="7%">43250</td><td width="93%">Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s); with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps.</td></tr> <tr><td colspan="2"><h4>Revised CPT Codes for Small Intestine Endoscopy</h4></td></tr> <tr><td width="7%">44360</td><td width="93%">Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)</td></tr> <tr><td width="7%">44363</td><td width="93%">Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure); with removal of foreign body(s)</td></tr> <tr><td width="7%">44380</td><td width="93%">Ileoscopy, through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)</td></tr> <tr><td width="7%">44385</td><td width="93%">Endoscopic evaluation of small intestinal pouch (eg, Kock pouch, ileal reservoir [S or J]); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)</td></tr> <tr><td width="7%">44386</td><td width="93%">Endoscopic evaluation of small intestinal pouch (eg, Kock pouch, ileal reservoir [S or J]); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure); with biopsy, single or multiple</td></tr> <tr><td width="7%">44799</td><td width="93%">Unlisted procedure, small intestine</td></tr> <tr><td colspan="2"><h4>Revised CPT Codes for Colonoscopy Via Stoma</h4></td></tr> <tr><td width="7%">44388</td><td width="93%">Colonoscopy through stoma; diagnostic,including collection of specimen(s) by brushing or washing, when performed (separate procedure)</td></tr> <tr><td width="7%">44390</td><td width="93%">Colonoscopy through stoma; diagnostic,including collection of specimen(s) by brushing or washing, when performed (separate procedure); with removal of foreign body(s)</td></tr> <tr><td width="7%">44391</td><td width="93%">Colonoscopy through stoma; diagnostic,including collection of specimen(s) by brushing or washing, when performed (separate procedure); with control of bleeding, any method</td></tr> <tr><td width="7%">44392</td><td width="93%">Colonoscopy through stoma; diagnostic,including collection of specimen(s) by brushing or washing, when performed (separate procedure); with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps</td></tr> <tr><td colspan="2"><h4>Revised CPT Codes for Sigmoidoscopy</h4></td></tr> <tr><td width="7%">45330</td><td width="93%">Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)</td></tr> <tr><td width="7%">45332</td><td width="93%">Sigmoidoscopy; with removal of foreign body(s)</td></tr> <tr><td width="7%">45333</td><td width="93%">Sigmoidoscopy; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps</td></tr> <tr><td width="7%">45334</td><td width="93%">Sigmoidoscopy; with control of bleeding, any method</td></tr> <tr><td width="7%">45337</td><td width="93%">Sigmoidoscopy; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed</td></tr> <tr><td width="7%">45340</td><td width="93%">Sigmoidoscopy; with transendoscopic balloon, dilation</td></tr> <tr><td colspan="2"><h4>Revised CPT Codes for Anoscopy</h4></td></tr> <tr><td width="7%">46600</td><td width="93%">Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)</td></tr> <tr><td colspan="2"><h4>Deleted Code for Gastroenterology (GI)</h4></td></tr> <tr><td width="7%">43350</td><td width="93%">Esophagostomy, fistulization of esophagus, external; abdominal approach</td></tr> <tr><td width="7%">42508</td><td width="93%">Parotid duct diversion, bilateral (Wilke type procedure); with excision of 1 submandibular gland</td></tr> <tr><td width="7%">44383</td><td width="93%">Ileoscopy, through stoma; with transendoscopic stent placement (includes predilation)</td></tr> <tr><td width="7%">44393</td><td width="93%">Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique</td></tr> <tr><td width="7%">44397</td><td width="93%">Colonoscopy through stoma; with transendoscopic stent placement (includes predilation)</td></tr> <tr><td width="7%">45339</td><td width="93%">Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique</td></tr> <tr><td width="7%">45345</td><td width="93%">Sigmoidoscopy; with transendoscopic stent placement (includes predilation)</td></tr> <tr><td width="7%">45355</td><td width="93%">Colonoscopy, rigid or flexible, transabdominal via colotomy, single or multiple</td></tr> <tr><td width="7%">45383</td><td width="93%">Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique</td></tr> <tr><td width="7%">45387</td><td width="93%">Colonoscopy; with transendoscopic stent placement (includes predilation)</td></tr> <tr><td width="7%">45378</td><td width="93%">Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)</td></tr> <tr><td width="7%">45379</td><td width="93%">Colonoscopy; with removal of foreign body(s)</td></tr> <tr><td width="7%">45380</td><td width="93%">Colonoscopy; with biopsy, single or multiple</td></tr> <tr><td width="7%">45381</td><td width="93%">Colonoscopy; with directed submucosal injection(s), any substance</td></tr> <tr><td width="7%">45382</td><td width="93%">Colonoscopy; with control of bleeding, any method</td></tr> <tr><td width="7%">45384</td><td width="93%">Colonoscopy; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps</td></tr> <tr><td width="7%">45385</td><td width="93%">Colonoscopy; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique</td></tr> <tr><td width="7%">45386</td><td width="93%">Colonoscopy; with transendoscopic balloon, dilation</td></tr> <tr><td width="7%">45391</td><td width="93%">Colonoscopy; with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures</td></tr> <tr><td width="7%">45392</td><td width="93%">Colonoscopy; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures</td></tr> </tbody></table><br /> <h3>Neurology/Neuro Surgery CPT Codes Changes</h3>The Spine and Spinal Cord subheading, Injection, Drainage, or Aspiration Category includes the addition of four new codes:<br /> <ul><li>62302, Myelography via lumbar injection, coded according to the spinal region, cervical</li> <li>62303, Thoracic</li> <li>62304, Lumbosacral</li> <li>62305, Two or more regions</li> </ul>Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System, Introduction/Injection Category includes four new codes to capture Transversus abdominis plane blocks, unilateral (64486-64487) or bilateral (64488-64489).<br /> <br /> <table class=table style="width:100%;border-collapse:collapse;"><tbody> <tr><td colspan="2"><h4>New Neurology CPT Codes</h4></td></tr> <tr><td width="7%">62302</td><td width="93%">Myelography via lumbar injection, including radiological supervision and interpretation; cervical</td></tr> <tr><td width="7%">62303</td><td width="93%">Myelography via lumbar injection, including radiological supervision and interpretation; thoracic</td></tr> <tr><td width="7%">62304</td><td width="93%">Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacral</td></tr> <tr><td width="7%">62305</td><td width="93%">Myelography via lumbar injection, including radiological supervision and interpretation; 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)</td></tr> <tr><td width="7%">64486</td><td width="93%">Transversus abdominis plane (TAP) block( abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)</td></tr> <tr><td width="7%">64487</td><td width="93%">Myelography via lumbar injection, including radiological supervision and interpretation; by continuous infusion(s) (includes imaging guidance, when performed)</td></tr> <tr><td width="7%">64488</td><td width="93%">Myelography via lumbar injection, including radiological supervision and interpretation; bilateral</td></tr> <tr><td width="7%">64489</td><td width="93%">Myelography via lumbar injection, including radiological supervision and interpretation; by continuous infusions (includes imaging guidance, when performed)</td></tr> <tr><td colspan="2"><h4>Revised Neurology CPT Codes</h4></td></tr> <tr><td width="7%">61055</td><td width="93%">Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment</td></tr> <tr><td width="7%">62284</td><td width="93%">Injection procedure for myelography and/or computed tomography, lumbar (other than C1-C2 and posterior fossa)</td></tr> <tr><td colspan="2"><h4>Deleted Neurology CPT Codes</h4></td></tr> <tr><td width="7%">61334</td><td width="93%">Exploration of orbit (transcranial approach); with removal of foreign body</td></tr> <tr><td width="7%">61440</td><td width="93%">Craniotomy for section of tentorium cerebelli (separate procedure)</td></tr> <tr><td width="7%">61470</td><td width="93%">Craniectomy, suboccipital; for medullary tractotomy</td></tr> <tr><td width="7%">61490</td><td width="93%">Craniotomy for lobotomy, including cingulotomy</td></tr> <tr><td width="7%">61542</td><td width="93%">Craniotomy with elevation of bone flap; for total hemispherectomy</td></tr> <tr><td width="7%">61609</td><td width="93%">Transection or ligation, carotid artery in cavernous sinus; without repair (List separately in addition to code for primary procedure)</td></tr> <tr><td width="7%">61875</td><td width="93%">Craniectomy for implantation of neurostimulator electrodes, cerebellar; subcortical</td></tr> <tr><td width="7%">62116</td><td width="93%">Reduction of craniomegalic skull (eg, treated hydrocephalus); with simple cranioplasty</td></tr> <tr><td width="7%">64752</td><td width="93%">Transection or avulsion of; vagus nerve (vagotomy), transthoracic</td></tr> <tr><td width="7%">64761</td><td width="93%">Transection or avulsion of; pudendal nerve</td></tr> <tr><td width="7%">64870</td><td width="93%">Anastomosis; facial-phrenic</td></tr> </tbody> </table><br /> <h3>Eye/ Ophthalmology Surgery CPT Codes Changes</h3>Eye/ Ophthalmology changes include Eye and Ocular Adnexa Subsection Changes. Anterior Sclera subheading, Aqueous Shunt Category includes a new code for aqueous shunt to extraocular plate reservoir, 66179, and a revision code, 66184.<br /> <br /> <table class=table style="width:100%;border-collapse:collapse;"><tbody> <tr><td colspan="2"><h4>New Ophthalmology CPT Codes</h4></td></tr> <tr><td width="7%">66179</td><td width="91%">Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft</td></tr> <tr><td width="7%">66184</td><td width="91%">Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft</td></tr> <td colspan="2"><h4>Revised Ophthalmology CPT Codes</h4></td></tr> <tr><td width="7%">66180</td><td width="93%">Aqueous shunt to extraocular equatorial plate reservoir, external approach;with graft</td></tr> <tr><td width="7%">66185</td><td width="93%">Revision of aqueous shunt to extraocular equatorial plate reservoir with graft</td></tr> <tr><td width="7%">67399</td><td width="93%">Unlisted procedure, extraocular muscle</td></tr> <tr><td colspan="2"><h4>Deleted Ophthalmology CPT Codes</h4></td></tr> <tr><td width="7%">66165</td><td width="93%">Fistulization of sclera for glaucoma; iridencleisis or iridotasis</td></tr> <tr><td width="7%">69400</td><td width="93%">Eustachian tube inflation, transnasal; with catheterization</td></tr> <tr><td width="7%">69401</td><td width="93%">Eustachian tube inflation, transnasal; without catheterization</td></tr> <tr><td width="7%">69405</td><td width="93%">Eustachian tube catheterization, transtympanic</td></tr> </tbody></table><br /> <h3>Urology Surgery CPT Codes Changes</h3>Two new codes were added in the Vesical Neck and Prostate subheading. Cystourethroscopy with insertion of transprostatic implant single, 52441, and each additional, 52442:<br /> <ul><li>52441 Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant</li> <li>52442 Each additional permanent adjustable transprostatic implant</li> </ul></div>

GI, Neurology, Ophthalmology, Urology Surgery CPT Codes Changes

Learn surgery CPT code changes in Gastroenterology (GI), Neurology, Ophthalmology and Urology specialties. Current Procedural Terminology ...

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Evaluation and Management (E&M) Codes Changes and Updates

<div dir="ltr" style="text-align: justify;" trbidi="on">Evaluation and Management Codes (commonly known as E/M Codes or E&M Codes) are Medical Billing Codes, used in processing health insurance claims by the health care providers in the USA, in order to get reimbursements by Medicare, Medicaid or private insurance for patient encounters.<br /> <br /> Evaluation and Management standards and guidelines were established by Congress in 1995, revised in 1997. E&M Codes have been adopted by medical insurance companies as the standard guidelines for determining type and severity of patient conditions. <br /> <br /> Evaluation and Management Codes are based on the Current Procedural Terminology (CPT) codes established by the American Medical Association (AMA).<br /> <br /> In Medical Billing Evaluation and Management Codes, CPT codes, HCPCS codes and ICD-9-CM codes are used by medical coders to report patient treatment. The ICD-9-CM codes are also set to be replaced by <a href="http://www.medicalbillingcodings.org/search/label/ICD%2010%20Codes">ICD 10 Codes</a> soon. The table below presents the commonly used codes during the various phases of treatment: <br /> <ul><li>Assessment/ Brief Intervention</li> <li>Diagnosis</li> <li>Induction Day 1 and additional days</li> <li>Follow-up, Stabilization, and Maintenance</li> <li>Other coding options</li> </ul><div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2015/04/em-evaluationandmanagement-codes-changesandupdates.html"><img alt="Evaluation and Management (E&M) Codes Changes and Updates" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuRl0IcCifJ3c7UdDcanPlo9yDna_4CIh4BXUzyZ9plHyG7vXOTZOSEoEoJzdzRhY2j4ie_iglL7Bl5sH3uPta4qBdYGuA7E6NMkn3fLIvYEVdo-3HUBsCz7g6mJEdKAbqN_IMNFNz2nA/s1600/em-evaluationandmanagement-codeschangesandupdates.jpg" /></a></div><br /> In 2010, new codes were added to the E&M Code set, for prolonged services without direct face-to-face contact. The new year brings changes to many evaluation and management codes physicians use, including chronic care management and advanced planning<br /> <br /> <h2>Evaluation and Management Codes Changes 2015</h2>Three new codes have been added to the Evaluation and Management (E&M) section in 2015. These are in the Care Management and Advance Care planning subsections.<br /> <br /> <h3>Care Management Section</h3>Care Management Services is new this year with extensive notes. This subcategory is for the management and support services provided by clinical staff, under the direction of a physician, to patients at home, in a domiciliary, or in assisted living.<br /> <br /> <h4>Chronic Care Management Services</h4>"Complex Chronic Care Coordination" title has been changed to "Care Management Services" with an addition of a new subsection, “Chronic Care Management Services” to better reflect the management services described by new code 99490. This E&M code will be utilized to capture chronic care management services for the establishment, implementation, revision, or monitoring of the care plan for patients with at least two chronic conditions, expected to last at least 12 months, and may place the patient at risk of death, exacerbation, or functional decline. This code is reported if, during the calendar month, at least 20 minutes of clinical staff time is spent on care management activities.<br /> <br /> <h4>Advance Care Planning E&M Section</h4>The two new advanced care planning codes (99497 and 99498) are used to report the face-to-face service between a physician or other qualified healthcare professional (QHCP) and a patient, family member, or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms. The CPT manual defines advanced directive as:<br /> <blockquote>A document appointing an agent and/or recording the wishes of a patient pertaining to his/her medical treatment at a future time should he/she lack decisional capacity at that time.</blockquote>Advance Care Planning is a new subsection in the E/M section. Two E&M codes were placed in this subsection. The codes are used to report face-to-face discussion of advance directives:<br /> <ul><li>E&N Code 99497: Advanced care planning for the first 30 minutes</li> <li>E&N Code 99498: Add-on code assigned for each additional 30 minutes</li> </ul>These are time-based codes, with 99497 to be billed for the first 30 minutes, and 99498 for each additional 30 minutes. Because the purpose of the visit is the discussion, no active management of the patient’s problem(s) is performed during the time of these visits. Additionally, these code(s) can be billed in for the following E/M services:<br /> <ul><li>New and established patient office visits (99201-99215)</li> <li>Observation initial, subsequent and discharge care codes (99217-99220, 99224-99226)</li> <li>Initial, subsequent and discharge hospital service codes (99221-99233, 99238-99239)</li> <li>Observation or inpatient admit and discharge on the same date (99234-99236)</li> <li>Outpatient and inpatient consultations (99241-99255)</li> <li>Emergency department visit codes (99281-99285)</li> <li>Initial, subsequent and discharge nursing facility care codes (99304-99316)</li> <li>Annual nursing facility assessment code (99318)</li> <li>New, established and discharge domiciliary or rest home visit codes (99234-99337)</li> <li>New and established patient home visit codes (99341-99350)</li> <li>initial and periodic preventive medicine codes (99381-99397)</li> <li>Transitional Care Management Service codes (99495-99496)</li> </ul>However, these codes cannot be billed with:<br /> <ul><li>Critical care codes (99291, 99292)</li> <li>Inpatient neonatal and pediatric critical care codes (99468-99476)</li> <li>Initial and continuing intensive care services (99477-99480)</li> </ul>Please be careful that Medicare has indicated that it will NOT pay for codes 99497 or 99498 in 2015. Check with your commercial payers to see if they are reimbursing for these codes.<br /> <br /> <h3>Prenatal Visit Guidelines</h3>The maternity care and delivery guidelines were revised to specify the following:<br /> <ul><li>Pregnancy confirmation during a problem-oriented or preventive visit is not considered a part of antepartum care. Report using the appropriate E/M code for that visit.</li> <li>Antepartum care includes the initial prenatal history and physical examination.</li> </ul><h3>Social History Guidelines</h3>E&M Guidelines for Social History has been expanded and will now include a bullet for Military History.<br /> <br /> You can also learn correct use of CPT <a href="http://www.medicalbillingcodings.org/2014/08/CPTCode-99214-99213-EM-Established-Office-Patient-Correctly.html">Code 99214 instead 99213 or 99212 for Evaluation and Management</a> (E/M) Coding of Established Office Patient to increase revenue through legitimate Medicare reimbursement.<br /> </div>

Evaluation and Management (E&M) Codes Changes and Updates

Evaluation and Management Codes (commonly known as E/M Codes or E&M Codes) are Medical Billing Codes, used in processing health insuranc...

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