2018 Cpt Coding Changes

2018 CPT CODING CHANGES | 17 2018 CPT coding changes by Samuel Smith, MD, FACS; Megan McNally, MD, FACS; and Jan Nagle, MS, RPh JAN 2018 BULLETIN American College of Surgeons 2018 CPT CODING CHANGES ignificant changes in Current Procedural Termi- data, it was determined that the code did not clearly nology (CPT)* coding will be implemented in define the intended use, leading to misreporting. There- S2018. Notably, considerable changes have been fore, the code descriptor was revised to remove the made to codes for reporting endovascular repair of terminology “sinus or fistula” from the parenthetical abdominal aorta and/or iliac arteries. This article pro- instructions and to clearly define the intended use of vides reporting information about the codes that are the code term “proud flesh” as follows ( = revised relevant to general surgery and its related specialties. code for 2018): 17250, Chemical cauterization of granulation tissue (i.e., Flaps proud flesh) Code 15732, Muscle, myocutaneous, or fasciocutaneous flap; head and neck (i.e., temporalis, masseter muscle, New exclusionary parentheticals were added to this sternocleidomastoid, levator scapulae), was deleted and code that direct reporting for this service, including replaced with new code 15733 to more clearly describe an instruction regarding exclusion of reporting 17250 a muscle, myocutaneous, or fasciocutaneous flap that for chemical cauterization for wound hemostasis and involves one of six different named vascular pedicles. excluding use in conjunction with active wound care In addition, new code 15730 was established to describe management services (97597, 97598, 97602). 18 | a midface flap that does not involve a named vascular pedicle. The two new codes, along with one related code, include the following ( = new code for 2018): Strapping Code 29582, Application of multilayer compression system; 15730, Midface flap (i.e., zygomaticofacial flap) with pres- thigh and leg, including ankle and foot, when performed, ervation of vascular pedicle(s) was deleted from the CPT code set for 2018 because it was determined that 29582 was being misreported 15731, Forehead flap with preservation of vascular pedicle in conjunction with codes for sclerotherapy, endove- (i.e., axial pattern flap, paramedian forehead flap) nous ablation, and vascular embolization/occlusion. These codes already include compression stockings 15733, Muscle, myocutaneous, or fasciocutaneous flap; as inherent practice expense supplies, and therefore, a head and neck with named vascular pedicle (i.e., buccina- multilayer compression system may not be addition- tors, genioglossus, temporalis, masseter, sternocleidomastoid, ally reported. Separately, several surgical society CPT levator scapulae) advisors, including representatives from the American College of Surgeons (ACS) and the Society for Vascular Surgery, argued that to be effective, compression would Chemical cauterization always need to begin at the toes, as described by code Code 17250 was identified by the American Medical 29581, Application of multilayer compression system; leg Association (AMA)/Specialty Society Relative Value (below knee), including ankle and foot, which is included Scale Update Committee (RUC) as potentially misval- in the 2018 CPT code set. ued through a screen of codes that had high utilization Code 29583, Application of multilayer compres- growth; Medicare utilization grew from 50,368 in sion system; upper arm and forearm, was deleted from 2006 to 150,342 in 2015 for code 17250. Upon review the CPT code set for 2018 due to unusual Medicare of detailed specialty utilization data and place of service reporting for this very low-volume code, including 20 percent reporting by dermatologists. To be effec- *All specific references to CPT codes and descriptions are ©2017 Ameri- can Medical Association. All rights reserved. CPT and CodeManager are tive, compression would need to begin at the fingers, registered trademarks of the American Medical Association. as described by code 29584, Application of multilayer V103 No 1 BULLETIN American College of Surgeons 2018 CPT CODING CHANGES compression system; upper arm, forearm, hand, and fin- limb(s), and/or extension(s)—is deployed. Procedures gers, which is included in the 2018 CPT code set. performed outside of the treatment zone, such as angioplasty or embolization, may be reported separately. For example, when an endograft terminates Endovascular repair of abdominal in the common iliac artery, any additional treatment aorta and/or iliac arteries performed in that artery is not reported separately; For 2018, endovascular repair of abdominal aorta and/ however, treatment that is performed in the external or iliac arteries codes (34800–34806, 34825, 34826, and or internal iliac artery may be reported separately. 34900) have been deleted; 16 new codes (34701–34716) Add-on code 34709, which describes placement of have been added; and four related codes (34812, 34820, an extension prosthesis(es) distal to the common iliac 34833, and 34834) have been revised. A substantial artery(ies) or proximal to the renal artery(ies), may be number of new guidelines have been added and par- reported in conjunction with codes 34701–34708. How- enthetical notes have been added, deleted, and revised ever, endograft extension(s) that terminate(s) within to assist with correct reporting of these services. These the common iliac arteries are included in codes 34703– changes were prompted by identification of code pairs 34708 and are not reported separately. as potentially misvalued by a RUC screen for services Codes 34710 and 34711 describe delayed placement frequently billed together. of an extension prosthesis(es). Codes 34701–34708 are structured based on the Code 34712 describes delivery of an enhanced fix- | 19 vascular anatomy involved (i.e., infrarenal aorta and/ ation device(s) to an endograft, such as an anchor, or iliac arteries) and the type of endograft deployed. screw, or tack. It is reported once per operative ses- The new codes also distinguish between endovascu- sion, regardless of the number of fixation devices lar repair “with rupture” and for “other than rupture.” deployed, and includes radiological supervision and This distinction is based on evidence that repair of a interpretation. ruptured vessel will involve more complexity, inten- Add-on code 34713 describes percutaneous access sity, and physician work, including placement of a and closure of the femoral artery for delivery of an temporary aortic and/or iliac occlusion balloon when endograft through a sheath size 12 French or larger. necessary. This balloon would be inflated in the event Code 34713 may be reported with endovascular repair the patient goes into hemorrhagic shock. of the descending thoracic aorta codes 33880–33886, Many services have been bundled into 34701–34708, endovascular repair of abdominal aorta and/or iliac including angioplasty and stenting performed within arteries codes 34701–34708, or endovascular fenestrated the treatment zone, placement of endografts, place- repair of the visceral aorta/infrarenal abdominal aorta ment of extensions in the aorta from the renal arteries codes 34841–34848, as appropriate. Code 34713 is not to the iliac bifurcation, and nonselective catheteriza- reported separately if a sheath smaller than 12 French tion. Codes 34701–34708 also include the time-intensive is used. preoperative work of sizing the aneurysm and selecting Open arterial exposure is performed during endo- the appropriate type of endograft to be deployed. Codes vascular repair of abdominal aorta and/or iliac artery 75952–75954, which describe radiological supervision procedures when a vessel is too small in diameter and interpretation for endovascular repair of abdomi- to accommodate passage of the endograft. Before nal aorta and/or iliac arteries, have been deleted, as this 2018, the open arterial exposure codes were stand- work also has been bundled into 34701–34708. alone codes with a global period. For 2018, the arterial For 2018, the new guidelines for endovascular repair exposure codes (34812, 34820, 34833, 34834) have been of abdominal aorta and/or iliac arteries include a defi- revised to be add-on codes because they will never be nition of “treatment zone” as the vessel(s) in which performed as standalone procedures. In addition, new an endograft(s)—including the main body, docking add-on codes have been established to describe open JAN 2018 BULLETIN American College of Surgeons 2018 CPT CODING CHANGES TABLE 1. ENDOVASCULAR REPAIR OF ABDOMINAL AORTA AND/OR ILIAC ARTERIES CODES CPT Global Code Descriptor Period Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the 34701 090 renal arteries to the aortic bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the aortic bifurcation; for other than rupture (e.g., for aneurysm, pseudoaneurysm, dissection, penetrating ulcer) for rupture including temporary aortic and/or iliac balloon occlusion, when performed (e.g., for 34702 090 aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption) Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection,

Load more