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2018 CPT codes for heart failure with higher reimbursement

Good morning,

Has anyone heard of any new CPT codes for 2018 for heart failure treatment. I have some providers who said there are new codes that are coming out in 2018 which would allow higher reimbursement. I haven’t been able to find anything yet. I know that there is a new designation "C7" which specifies the provider specialty which would help with denials. But they are adamant that new CPT codes will also we out there. Has anyone heard anything?

Medical Billing and Coding Forum – Cardiology

Anesthesia Coding – Get the Correct Codes For Transesophageal Echocardiography

The most common problem in anesthesia coding associated with billing and obtaining reimbursement for transesophageal echocardiography or TEE is determining whether the procedure is for diagnostic or monitoring purposes. It is often difficult to tell whether the TEE was diagnostic or not unless your physician identifies the study’s purpose. If you wish to bill for a diagnostic TEE, attach a written report, or else it’s unlikely to withstand the scrutiny of an audit.

CPT contains two sets of codes for diagnostic transesophageal echocardiography or TEE. For a diagnostic test, pay attention to whether the anesthesiologist places the probe, interprets and reviews the study, or provides both services. When your anesthesiologist places the probe and does not provide a written report, use the placement-only diagnostic TEE codes. Your physician sometimes might interpret the findings while another physician places the probe. Provided your anesthesiologist is the only physician to issue a written report of the diagnostic TEE, you would code for the “image acquisition, interpretation and report” only with 93314 for real-time TEE and 93316 for TEE for congenital cardiac anomalies.

Avoid truncated diagnosis codes in anesthesia coding. Make sure your anesthesiologist is as specific as possible when reporting diagnoses attached to TEE use. Merely linking the TEE code to a payable ICD-9 code is not sufficient. Clinical signs or symptoms must be present and documented.

Transesophageal echocardiography for monitoring is never paid nor is it ever unbundled. When TEE is used in dissection or with valvular repair, your anesthesiologist is diagnosing whether surgery fixed the lesion. Your anesthesiologist is then not monitoring, but telling the surgeon whether his repair has corrected the problem to an acceptable level. Here, he is playing an active role in management and doing more than just monitoring. If you include a full report in this case, you can bill a reimbursable code like 93312 or 93314, but make sure you do not label this report as monitoring, else you’ll not be entitled to reimbursement.

Stay on top of the CPT codes with the latest updates and expert tips on anesthesia coding, by attending anesthesia coding seminars. 

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2016 Deleted CPT codes


0099T   Implantation of intrastromal corneal ring segments

0103T   Holotranscobalamin, quantitative

0123T   Fistulization of sclera for glaucoma, through ciliary body

0182T   High dose rate electronic brachytherapy, per fraction

0223T   Acoustic cardiography, including automated analysis of combined acoustic and electrical intervals; single, with interpretation and report

0224T   Acoustic cardiography, including automated analysis of combined acoustic and electrical intervals; multiple, including serial trended analysis and limited reprogramming of device parameter, AV or VV delays only, with interpretation and report

0225T   Acoustic cardiography, including automated analysis of combined acoustic and electrical intervals; multiple, including serial trended analysis and limited reprogramming of device parameter, AV and VV delays, with interpretation and report

0233T   Skin advanced glycation endproducts (AGE) measurement by multi-wavelength fluorescent spectroscopy

0240T   Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with high resolution esophageal pressure topography

0241T   Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion during high resolution esophageal pressure topography study (eg, stimulant, acid or alkali perfusion) (List separately in addition to code for primary procedure)

0243T   Intermittent measurement of wheeze rate for bronchodilator or bronchial-challenge diagnostic evaluation(s), with interpretation and report

0244T   Continuous measurement of wheeze rate during treatment assessment or during sleep for documentation of nocturnal wheeze and cough for diagnostic evaluation 3 to 24 hours, with interpretation and report

0262T   Implantation of catheter-delivered prosthetic pulmonary valve, endovascular approach

0311T   Non-invasive calculation and analysis of central arterial pressure waveforms with interpretation and report

21805   Open treatment of rib fracture without fixation, each

31620   Endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) (List separately in addition to code for primary procedure[s])

37202   Transcatheter therapy, infusion other than for thrombolysis, any type (eg, spasmolytic, vasoconstrictive)

37250   Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure)

37251   Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; each additional vessel (List separately in addition to code for primary procedure)

39400   Mediastinoscopy, includes biopsy(ies), when performed

47136   Liver allotransplantation; heterotopic, partial or whole, from cadaver or living donor, any age

47500   Injection procedure for percutaneous transhepatic cholangiography

47505   Injection procedure for cholangiography through an existing catheter (eg, percutaneous transhepatic or T-tube)

47510   Introduction of percutaneous transhepatic catheter for biliary drainage

47511   Introduction of percutaneous transhepatic stent for internal and external biliary drainage

47525   Change of percutaneous biliary drainage catheter

47530   Revision and/or reinsertion of transhepatic tube

47560   Laparoscopy, surgical; with guided transhepatic cholangiography, without biopsy

47561   Laparoscopy, surgical; with guided transhepatic cholangiography with biopsy

47630   Biliary duct stone extraction, percutaneous via T-tube tract, basket, or snare (eg, Burhenne technique)

50392   Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous

50393   Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous

50394   Injection procedure for pyelography (as nephrostogram, pyelostogram, antegrade pyeloureterograms) through nephrostomy or pyelostomy tube, or indwelling ureteral catheter

50398   Change of nephrostomy or pyelostomy tube

64412   Injection, anesthetic agent; spinal accessory nerve

67112   Repair of retinal detachment; by scleral buckling or vitrectomy, on patient having previous ipsilateral retinal detachment repair(s) using scleral buckling or vitrectomy techniques

70373   Laryngography, contrast, radiological supervision and interpretation

72010   Radiologic examination, spine, entire, survey study, anteroposterior and lateral

72069   Radiologic examination, spine, thoracolumbar, standing (scoliosis)

72090   Radiologic examination, spine; scoliosis study, including supine and erect studies

73500   Radiologic examination, hip, unilateral; 1 view

73510   Radiologic examination, hip, unilateral; complete, minimum of 2 views

73520   Radiologic examination, hips, bilateral, minimum of 2 views of each hip, including anteroposterior view of pelvis

73530   Radiologic examination, hip, during operative procedure

73540   Radiologic examination, pelvis and hips, infant or child, minimum of 2 views

73550   Radiologic examination, femur, 2 views

74305   Cholangiography and/or pancreatography; through existing catheter, radiological supervision and interpretation

74320   Cholangiography, percutaneous, transhepatic, radiological supervision and interpretation

74327   Postoperative biliary duct calculus removal, percutaneous via T-tube tract, basket, or snare (eg, Burhenne technique), radiological supervision and interpretation

74475   Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous, radiological supervision and interpretation

74480   Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous, radiological supervision and interpretation

75896   Transcatheter therapy, infusion, other than for thrombolysis, radiological supervision and interpretation

75945   Intravascular ultrasound (non-coronary vessel), radiological supervision and interpretation; initial vessel

75946   Intravascular ultrasound (non-coronary vessel), radiological supervision and interpretation; each additional non-coronary vessel (List separately in addition to code for primary procedure)

75980   Percutaneous transhepatic biliary drainage with contrast monitoring, radiological supervision and interpretation

75982   Percutaneous placement of drainage catheter for combined internal and external biliary drainage or of a drainage stent for internal biliary drainage in patients with an inoperable mechanical biliary obstruction, radiological supervision and interpretation

77776   Interstitial radiation source application; simple

77777   Interstitial radiation source application; intermediate

77785   Remote afterloading high dose rate radionuclide brachytherapy; 1 channel

77786   Remote afterloading high dose rate radionuclide brachytherapy; 2-12 channels

77787   Remote afterloading high dose rate radionuclide brachytherapy; over 12 channels

82486   Chromatography, qualitative; column (eg, gas liquid or HPLC), analyte not elsewhere specified

82487   Chromatography, qualitative; paper, 1-dimensional, analyte not elsewhere specified

82488   Chromatography, qualitative; paper, 2-dimensional, analyte not elsewhere specified

82489   Chromatography, qualitative; thin layer, analyte not elsewhere specified

82491   Chromatography, quantitative, column (eg, gas liquid or HPLC); single analyte not elsewhere specified, single stationary and mobile phase

82492   Chromatography, quantitative, column (eg, gas liquid or HPLC); multiple analytes, single stationary and mobile phase

82541   Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), non-drug analyte not elsewhere specified; qualitative, single stationary and mobile phase

82543   Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), non-drug analyte not elsewhere specified; stable isotope dilution, single analyte, quantitative, single stationary and mobile phase

82544   Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), non-drug analyte not elsewhere specified; stable isotope dilution, multiple analytes, quantitative, single stationary and mobile phase

83788   Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte not elsewhere specified; qualitative, each specimen

88347   Immunofluorescent study, each antibody; indirect method

90645   Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule), for intramuscular use

90646   Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster use only, intramuscular use

90669   Pneumococcal conjugate vaccine, 7 valent (PCV7), for intramuscular use

90692   Typhoid vaccine, heat- and phenol-inactivated (H-P), for subcutaneous or intradermal use

90693   Typhoid vaccine, acetone-killed, dried (AKD), for subcutaneous use (U.S. military)

90703   Tetanus toxoid adsorbed, for intramuscular use

90704   Mumps virus vaccine, live, for subcutaneous use

90705   Measles virus vaccine, live, for subcutaneous use

90706   Rubella virus vaccine, live, for subcutaneous use

90708   Measles and rubella virus vaccine, live, for subcutaneous use

90712   Poliovirus vaccine, (any type[s]) (OPV), live, for oral use

90719   Diphtheria toxoid, for intramuscular use

90720   Diphtheria, tetanus toxoids, and whole cell pertussis vaccine and Haemophilus influenzae b vaccine (DTwP-Hib), for intramuscular use

90721   Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Haemophilus influenzae b vaccine (DTaP/Hib), for intramuscular use

90725   Cholera vaccine for injectable use

90727   Plague vaccine, for intramuscular use

90735   Japanese encephalitis virus vaccine, for subcutaneous use

92543   Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes 4 tests), with recording

95973   Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)



Coding Ahead

2016 New CPT codes


0381T   External heart rate and 3-axis accelerometer data recording up to 14 days to assess changes in heart rate and to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; includes report, scanning analysis with report, review and interpretation by a physician or other qualified health care professional

0382T   External heart rate and 3-axis accelerometer data recording up to 14 days to assess changes in heart rate and to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; review and interpretation only

0383T   External heart rate and 3-axis accelerometer data recording from 15 to 30 days to assess changes in heart rate and to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; includes report, scanning analysis with report, review and interpretation by a physician or other qualified health care professional

0384T   External heart rate and 3-axis accelerometer data recording from 15 to 30 days to assess changes in heart rate and to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; review and interpretation only

0385T   External heart rate and 3-axis accelerometer data recording more than 30 days to assess changes in heart rate and to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; includes report, scanning analysis with report, review and interpretation by a physician or other qualified health care professional

0386T   External heart rate and 3-axis accelerometer data recording more than 30 days to assess changes in heart rate and to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; review and interpretation only

0387T   Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular

0388T   Transcatheter removal of permanent leadless pacemaker, ventricular

0389T   Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report, leadless pacemaker system

0390T   Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure or test with analysis, review and report, leadless pacemaker system

0391T   Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, leadless pacemaker system

0392T   Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band)

0393T   Removal of esophageal sphincter augmentation device

0394T   High dose rate electronic brachytherapy, skin surface application, per fraction, includes basic dosimetry, when performed

0395T   High dose rate electronic brachytherapy, interstitial or intracavitary treatment, per fraction, includes basic dosimetry, when performed

0396T   Intra-operative use of kinetic balance sensor for implant stability during knee replacement arthroplasty (List separately in addition to code for primary procedure)

0397T   Endoscopic retrograde cholangiopancreatography (ERCP), with optical endomicroscopy (List separately in addition to code for primary procedure)

0398T   Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation lesion, intracranial for movement disorder including stereotactic navigation and frame placement when performed

0399T   Myocardial strain imaging (quantitative assessment of myocardial mechanics using image-based analysis of local myocardial dynamics) (List separately in addition to code for primary procedure)

0400T   Multi-spectral digital skin lesion analysis of clinically atypical cutaneous pigmented lesions for detection of melanomas and high risk melanocytic atypia; one to five lesions

0401T   Multi-spectral digital skin lesion analysis of clinically atypical cutaneous pigmented lesions for detection of melanomas and high risk melanocytic atypia; six or more lesions

0402T   Collagen cross-linking of cornea (including removal of the corneal epithelium and intraoperative pachymetry when performed)

0403T   Preventive behavior change, intensive program of prevention of diabetes using a standardized diabetes prevention program curriculum, provided to individuals in a group setting, minimum 60 minutes, per day

0404T   Transcervical uterine fibroid(s) ablation with ultrasound guidance, radiofrequency

0405T   Oversight of the care of an extracorporeal liver assist system patient requiring review of status, review of laboratories and other studies, and revision of orders and liver assist care plan (as appropriate), within a calendar month, 30 minutes or more of non-face-to-face time

0406T   Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant;

0407T   Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant; with biopsy, polypectomy or debridement

10035   Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion

10036   Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; each additional lesion (List separately in addition to code for primary procedure)

31652   Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures

31653   Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures

31654   Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s) (List separately in addition to code for primary procedure[s])

33477   Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed

37252   Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure)

37253   Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (List separately in addition to code for primary procedure)

39401   Mediastinoscopy; includes biopsy(ies) of mediastinal mass (eg, lymphoma), when performed

39402   Mediastinoscopy; with lymph node biopsy(ies) (eg, lung cancer staging)

43210   Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed

47531   Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; existing access

47532   Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; new access (eg, percutaneous transhepatic cholangiogram)

47533   Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; external

47534   Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; internal-external

47535   Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation

47536   Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation

47537   Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (eg, with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation

47538   Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each stent; existing access

47539   Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each stent; new access, without placement of separate biliary drainage catheter

47540   Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each stent; new access, with placement of separate biliary drainage catheter (eg, external or internal-external)

47541   Placement of access through the biliary tree and into small bowel to assist with an endoscopic biliary procedure (eg, rendezvous procedure), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation, new access

47542   Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each duct (List separately in addition to code for primary procedure)

47543   Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (eg, brush, forceps, and/or needle), including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, single or multiple (List separately in addition to code for primary procedure)

47544   Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

49185   Sclerotherapy of a fluid collection (eg, lymphocele, cyst, or seroma), percutaneous, including contrast injection(s), sclerosant injection(s), diagnostic study, imaging guidance (eg, ultrasound, fluoroscopy) and radiological supervision and interpretation when performed

50430   Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access

50431   Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access

50432   Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation

50433   Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access

50434   Convert nephrostomy catheter to nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, via pre-existing nephrostomy tract

50435   Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation

50606   Endoluminal biopsy of ureter and/or renal pelvis, non-endoscopic, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

50693   Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; pre-existing nephrostomy tract

50694   Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, without separate nephrostomy catheter

50695   Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, with separate nephrostomy catheter

50705   Ureteral embolization or occlusion, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

50706   Balloon dilation, ureteral stricture, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

54437   Repair of traumatic corporeal tear(s)

54438   Replantation, penis, complete amputation including urethral repair

61645   Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s)

61650   Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory

61651   Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; each additional vascular territory (List separately in addition to code for primary procedure)

64461   Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)

64462   Paravertebral block (PVB) (paraspinous block), thoracic; second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary procedure)

64463   Paravertebral block (PVB) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging guidance, when performed)

65785   Implantation of intrastromal corneal ring segments

69209   Removal impacted cerumen using irrigation/lavage, unilateral

72081   Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view

72082   Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 2 or 3 views

72083   Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 4 or 5 views

72084   Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); minimum of 6 views

73501   Radiologic examination, hip, unilateral, with pelvis when performed; 1 view

73502   Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views

73503   Radiologic examination, hip, unilateral, with pelvis when performed; minimum of 4 views

73521   Radiologic examination, hips, bilateral, with pelvis when performed; 2 views

73522   Radiologic examination, hips, bilateral, with pelvis when performed; 3-4 views

73523   Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views

73551   Radiologic examination, femur; 1 view

73552   Radiologic examination, femur; minimum 2 views

74712   Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single or first gestation

74713   Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; each additional gestation (List separately in addition to code for primary procedure)

77767   Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter up to 2.0 cm or 1 channel

77768   Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter over 2.0 cm and 2 or more channels, or multiple lesions

77770   Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel

77771   Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 2-12 channels

77772   Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels

78265   Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit

78266   Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days

80081   Obstetric panel (includes HIV testing) This panel must include the following: Blood count, complete (CBC), and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Hepatitis B surface antigen (HBsAg) (87340) HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result (87389) Antibody, rubella (86762) Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) (86592) Antibody screen, RBC, each serum technique (86850) Blood typing, ABO (86900) AND Blood typing, Rh (D) (86901)

81162   BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis

81170   ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) (eg, acquired imatinib tyrosine kinase inhibitor resistance), gene analysis, variants in the kinase domain

81218   CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (eg, acute myeloid leukemia), gene analysis, full gene sequence

81219   CALR (calreticulin) (eg, myeloproliferative disorders), gene analysis, common variants in exon 9

81272   KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, gastrointestinal stromal tumor [GIST], acute myeloid leukemia, melanoma), gene analysis, targeted sequence analysis (eg, exons 8, 11, 13, 17, 18)

81273   KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, mastocytosis), gene analysis, D816 variant(s)

81276   KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; additional variant(s) (eg, codon 61, codon 146)

81311   NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) (eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, codon 61)

81314   PDGFRA (platelet-derived growth factor receptor, alpha polypeptide) (eg, gastrointestinal stromal tumor [GIST]), gene analysis, targeted sequence analysis (eg, exons 12, 18)

81412   Ashkenazi Jewish associated disorders (eg, Bloom syndrome, Canavan disease, cystic fibrosis, familial dysautonomia, Fanconi anemia group C, Gaucher disease, Tay-Sachs disease), genomic sequence analysis panel, must include sequencing of at least 9 genes, including ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, and SMPD1

81432   Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); genomic sequence analysis panel, must include sequencing of at least 14 genes, including ATM, BRCA1, BRCA2, BRIP1, CDH1, MLH1, MSH2, MSH6, NBN, PALB2, PTEN, RAD51C, STK11, and TP53

81433   Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); duplication/deletion analysis panel, must include analyses for BRCA1, BRCA2, MLH1, MSH2, and STK11

81434   Hereditary retinal disorders (eg, retinitis pigmentosa, Leber congenital amaurosis, cone-rod dystrophy), genomic sequence analysis panel, must include sequencing of at least 15 genes, including ABCA4, CNGA1, CRB1, EYS, PDE6A, PDE6B, PRPF31, PRPH2, RDH12, RHO, RP1, RP2, RPE65, RPGR, and USH2A

81437   Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma); genomic sequence analysis panel, must include sequencing of at least 6 genes, including MAX, SDHB, SDHC, SDHD, TMEM127, and VHL

81438   Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma); duplication/deletion analysis panel, must include analyses for SDHB, SDHC, SDHD, and VHL

81442   Noonan spectrum disorders (eg, Noonan syndrome, cardio-facio-cutaneous syndrome, Costello syndrome, LEOPARD syndrome, Noonan-like syndrome), genomic sequence analysis panel, must include sequencing of at least 12 genes, including BRAF, CBL, HRAS, KRAS, MAP2K1, MAP2K2, NRAS, PTPN11, RAF1, RIT1, SHOC2, and SOS1

81490   Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity score

81493   Coronary artery disease, mRNA, gene expression profiling by real-time RT-PCR of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score

81525   Oncology (colon), mRNA, gene expression profiling by real-time RT-PCR of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence score

81528   Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result

81535   Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; first single drug or drug combination

81536   Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; each additional single drug or drug combination (List separately in addition to code for primary procedure)

81538   Oncology (lung), mass spectrometric 8-protein signature, including amyloid A, utilizing serum, prognostic and predictive algorithm reported as good versus poor overall survival

81540   Oncology (tumor of unknown origin), mRNA, gene expression profiling by real-time RT-PCR of 92 genes (87 content and 5 housekeeping) to classify tumor into main cancer type and subtype, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a probability of a predicted main cancer type and subtype

81545   Oncology (thyroid), gene expression analysis of 142 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (eg, benign or suspicious)

81595   Cardiology (heart transplant), mRNA, gene expression profiling by real-time quantitative PCR of 20 genes (11 content and 9 housekeeping), utilizing subfraction of peripheral blood, algorithm reported as a rejection risk score

88350   Immunofluorescence, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure)

90620   Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB), 2 dose schedule, for intramuscular use

90621   Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB), 3 dose schedule, for intramuscular use

90625   Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use

90697   Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV-Hib-HepB), for intramuscular use

92537   Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations)

92538   Caloric vestibular test with recording, bilateral; monothermal (ie, one irrigation in each ear for a total of two irrigations)

93050   Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform(s), digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity artery, non-invasive

96931   Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition and interpretation and report, first lesion

96932   Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition only, first lesion

96933   Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; interpretation and report only, first lesion

96934   Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition and interpretation and report, each additional lesion (List separately in addition to code for primary procedure)

96935   Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition only, each additional lesion (List separately in addition to code for primary procedure)

96936   Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; interpretation and report only, each additional lesion (List separately in addition to code for primary procedure)

99177   Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with on-site analysis

99415   Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)

99416   Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (List separately in addition to code for prolonged service)


Coding Ahead

Twelve Codes of Christmas: On the Seventh Day of the Coder’s Christmas (F40.00)

I have decided to start limiting my daily news intake to no more than 30 minutes per day.  This is mainly because the news has been so depressing lately and although I think it’s important to be informed, I think there comes a point when you just have to tune out before you decide to never leave your house again. 

I was looking through some old photos recently  and came across this old one of my dog Ginger.  Ginger is no longer with us, but I still have some great pics of her sweet little face.  This one struck me not only because of her expression, but also because of the bows.  No, I didn’t put bows in my dog’s ears on a regular basis.  I would take her to the groomer before the holidays and she always came back looking frilly and cute – with bows. It was always a test to see how long those bows would last before she shook her head enough or tried to pull them out with her paws.  Taking Ginger to the groomer was an event.  She was okay as long as we got in the car and headed north, because that meant she was on her way to see my parents and her favorite person – Grandpa.  But if we headed west, there were only two options: the vet and the groomer.  She wasn’t a fan of either.

So for the seventh day of Christmas, I dug out this picture of my Christmas pup for our daily carol and code:

  • I Heard the Bells on Christmas Day but Wouldn’t Leave my House (F40.00, Agoraphobia, unspecified).

Incidentally, Ginger was always up for leaving the house on Christmas if food was being carted to the car.  She always expected that once the food was packed up, she would be leashed up and we would join the party at a family member’s house!
Coder Coach

Twelve Codes of Christmas: On the Eighth Day of the Coder’s Christmas (F40.10)

What is Christmas – or any holiday celebration – like for you?  Is is a small intimate affair or is it a madhouse?  Do you get along with your family, or do you leave the celebration giving thanks for the fact that you didn’t choke anyone to death for another year?

I am blessed with a large and happy family.  A very loud and rambunctious group.  Our holiday traditions have undergone some adaptations over the years, but there are a few constants:  there will be lots of food; there will be many goofy white elephant gifts; and there most likely will be a pet or two present.

In case you can’t tell, I’m a bit of an animal lover.  And while looking through pictures to match my 12 Days of Codes, I found this gem.  This is Beau, my aunt’s cat.  And while I have a cat who is really more like a dog and can be found in the mix during family get togethers (and probably looking for a stationary lap to dominate), Beau has a tendency to do a cursory survey of the situation before retiring elsewhere.

So Beau, this carol and code are for you:

  • Have Yourself a Merry Little Christmas While I Sit Here and Hyperventilate (F40.10, Social phobia, unspecified)

Coder Coach

Medical Billing Codes Key to Fraud Case Against 2 Erie Oral Surgeons

John F. Lehrian, who is retired, and David E. Palo, of what was known as Lehrian & Palo Oral Surgery, 100 State St., pleaded not guilty to federal charges that they the defrauded insurance companies of more than $ 323,000. They were indicted July 12 on charges of health care fraud. The government is alleging Lehrian and Palo charged the insurance companies for pulling teeth using surgical extractions. Those extractions, the government said, were unnecessary and more expensive than what should have been the necessary procedures for removing the teeth.

A grand jury in Erie indicted the two separately. The U.S. attorney’s office is alleging their bills were fraudulent because they never needed to surgically extract many teeth — 26 for Palo and 20 for Lehrian. The government said nine of the teeth Palo said he pulled were baby teeth, and that some of the teeth Lehrian said he pulled were decayed and did not need surgical extraction for removal.

You can read the full article on GoErie.com here.

 

 

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