CPT 2016 Updates Recap

New Year, New CPT Codes!

CPT’s New Year’s Resolution isn’t to trim the fat, in fact, it’s expanding! New codes are being added for a variety of services as a result of data collected by the AMA. These new CPT changes are conducive to bundling services together, and to eliminate ambiguity with certain procedures that did not previously have their own codes.

CPT Code Changes by Chapter

Some of our favorite changes are as follows:

Revised: Evaluation & Management 99354 & 99355

Excellent revision made here. Providers are pleased with this update, psychotherapy services do often run long. There is often a great deal of face to face time spent. Speaking of time make sure it is appropriately documented prior to coding for prolonged service.

Code Descriptor Change

• 99354; Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient Evaluation and Management or psychotherapy service)
• 99355; each additional 30 minutes (List separately in addition to code for prolonged service)

Remember, The time spent for prolonged services are for services that extend beyond the customary service provided in both inpatient or outpatient settings.

One Code Deleted: 21805

• The 2016 code set deleted 21805 for the open treatment of a rib fracture without fixation. CPT® indicates that this procedure has a low volume and is no longer current practice.
• CPT® further advises to report this service on the rare occasion it is done using an unlisted code. Consider 21899-Unlisted procedure, neck or thorax; or check with individual payers for their policies on codes to report for this service.

Remember to send supporting documentation to payers with any claim containing an unlisted code. Keep in mind that CPT® does not recommend the use of unlisted procedures on a regular basis.

Percutaneous GU Procedures

Extensive changes have been made to the code set for reporting percutaneous GU procedures. The majority of these changes were prompted by the mandate of the Relative Value Scale Update Committee (RUC) of the American Medical Association (AMA) to bundle imaging with the surgical portion of the procedures.

• A large number of changes have been made to the Urinary System subsection, including some revisions that are editorial in nature pertaining to anatomy and the assignment of primary and secondary procedures. Other revisions include the deletion of codes: 50392, 50393, 50394, and 50398, and the additions of new codes, headings and guidelines for reporting genitourinary catheter procedures and associated nephrostogram, nephrostomy and nephroureteral services.
• Some of the new codes added describe biopsy and dilation of the ureter, nonendoscopic endoluminal biopsy of the ureter and/or renal pelvis, and the percutaneous placement of ureteral stent and embolization and balloon dilation of the ureter using nonendoscopic imaging guidance.
• In addition, the Male Genital System subsection contains two new codes (54437, 54438) to report traumatic penile injury repairs.

Finally, a quick tip from our Coders and Auditors to you: Don’t forget, you will want to transfer notes from your current CPT 2015 books to the new CPT 2016 books. Happy 2016!