The American Medical Association released its 2014 Current Procedural Terminology 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 Medical Consulting, explains some of the most significant changes affecting ambulatory surgery center specialties.
CPT Code Changes and Additions
Cardiovascular surgery
Though not many ambulatory surgery centers perform cardiovascular procedures, there are a few additions to the Medicare ASC list. These include two new codes and two new add-on codes in relation to transcatheter placement of an intravascular stent.
• Codes 37236-37239
Endocrinology
Previously reimbursed only in hospitals, there are two significant additions to the ASC Medicare list:
• Code 60240: Thyroidectomy with an average Medicare payment of $2,160
• Code 60500: Parathyroidectomy with an average Medicare payment of $1,938
"ASCs only can perform these codes on healthy Medicare beneficiaries, because Medicare doesn’t pay for overnight stays" says Ms. Ellis. Patient selection is very important.
General surgery
Breast biopsy codes have under 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 restrictive 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, esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography and image-guided fluid collection drainage by catheter.
• Codes 43191-43918
• Codes 43211-43214
• Code 43229
• Code 43233
• Codes 43253-43254
• Code 43266
• Codes 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 anterior 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 foreign bodies, prosthesis removal and knee procedures. 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. "Medicare 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 arthroscopic shoulder procedures.
Urology
Code 52356 is new to urology. The code covers cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent, says Ms. Ellis. Medicare pays an average of $1,796. This new code combines previous codes for standard lithotripsy and stent insertion, as these procedures are commonly 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 laparoscopy, 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
ACSs do not frequently bill for these codes, but there are few that Medicare pays for. For example, code J1602 refers to an injection of Golimumab, 1 mg. This code has been added to the Medicare ASC list and generates an average Medicare payment of $24. "Be sure to read the code descriptor carefully," says Ms. Ellis. "If a code descriptor says 1 mg and you are giving 3 mgs., 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 chemodenervation 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.
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