By Melissa Okerson
December 15, 2016
It’s the time of year when changes are introduced to Current Procedural Terminology (CPT). With more than 700 updates being implemented in 2017, coders need to diligently review and research the 149 code additions, 81 deletions and 498 revisions. The following is an overview of significant modifications for next year. For complete descriptions of the new, deleted and revised codes, review the 2017 CPT book.
New: Proprietary Laboratory Analyses
CPT introduced a new section called Proprietary Laboratory Analyses. This section will include Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs) as defined under the Protecting Access to Medicare Act of 2014 (PAMA). The codes in this section will be released quarterly via the American Medical Association website.
New modifier 95 should be used to indicate a service generally reported as a face-to-face service that is performed via a real-time interactive audio and video telecommunications system. In addition to this new modifier, Appendix P has been created to list current CPT codes with evidence of some payer approval for use when provided via interactive audio and video telecommunications system.
The Surgery section has the most prominent changes, mainly affecting procedures like laryngoscopy/laryngoplasty, bunionectomy, and cardiovascular and spinal surgeries.
- Three new codes (31572-31574) have been created in the Larynx Endoscopy subsection and five codes (31575-31579) have been revised to allow for differentiation of reporting for rigid versus flexible laryngoscopy services.
- Six new laryngoplasty codes (31551-31554 and 31591-31592) have been created to describe different treatment of laryngeal stenosis according to age, for medialization, and for crichotracheal resection. In addition to these new codes, CPT codes 31580, 31584, and 31587 have been revised and codes 31582 and 31588 have been deleted.
- Two new codes (28291 and 28295) have been created to report bunionectomy procedures specifically to describe with implant (28291) and with proximal metatarsal osteotomy, any method (28295). Six bunionectomy codes (28289, 28292, 28296, 28297, 28298, and 28299) have been revised to remove the legacy name procedures (e.g., Keller, McBride, or Mayo). CPT codes 28290, 28293, and 28294 have been deleted.
- Category III code 0281T has been deleted and replaced by a Category I CPT code 33340 which describes percutaneous transcatheter closure of left atrial appendage with endocardial implant.
- Two codes (33390 and 33391) have been added to adequately describe surgical techniques for aortic valve repair and three codes (33405, 33406, and 33410) have been revised to indicate open procedures. CPT codes 33400, 33401, and 33403 have been deleted.
- Within the spine section, CPT code 22851 has been deleted and replaced with three new codes: 22853, 22854, and 22859 which now offer differentiation of biomechanical device insertion. With these new codes there have been 30 revisions to code instructions for spinal instrumentation.
- Four new codes (22867-22870) were added to report interlaminar/interspinous process stabilization/distraction device insertion with and without decompression. These four new codes have been added to replace two Category III codes 0171T and 0172T which are now deleted.
- Epidural and subarachnoid injections have four new codes (62321, 62323, 62325, and 62327) which allow for concurrent reporting of imaging guidance (i.e., fluoroscopy or CT). In addition CPT codes 62310, 62311, 62318, and 62319 have been revised and renumbered as new codes 62320, 62322, 62324, and 62326 to indicate epidural and subarachnoid injections without imaging guidance.
- CPT code 76706 has been established for abdominal aortic ultrasound screening in support of the recommendations of the US Preventive Service Task Force. This service was previously reported with G0389.
- CPT codes 77002 and 77003 have been revised as add-on codes and inclusionary parenthetical notes have been added to direct users to the appropriate base codes. Additionally, an exclusionary parenthetical note has been added following code 77003 to instruct that this code should not be reported in addition to the new epidural/subarachnoid injections codes (62321, 62323, 62325 and 62327) as imaging guidance is included.
- Mammography codes 77055-77057 and computer aided detection [CAD] codes 77051-77052 have been deleted and bundled into three new codes (77065, 77066, and 77067). These codes combine mammography and CAD into single codes.
- Nine CPT codes for Influenza virus vaccine have been revised to remove the age indications and replaced with dosage amounts of either 0.25 mL or 0.5 mL.
- The verbiage “and/or family” has been removed from eight CPT codes for Psychotherapy services (90832-90838), however, the guidelines for these services state that the involvement of “informants” in the treatment process may be included. The patient is required to be present for all or a majority of these services. The “Time Rule” is clearly defined in the guidelines for time based Psychotherapy codes.
- Six Endoscopic Laryngeal Evaluation CPT codes (92612-92617) have been revised to have the term “fiberoptic” removed. This is due to the revisions to the Larynx Endoscopy subsection located in the Surgery Section.
- Six Physical Medicine & Rehabilitation CPT codes (97001-97006) have been deleted and 12 new CPT codes has been created to new subsections for Physical Therapy (97161-97164), Occupational Therapy (97165-97168), and Athletic Training (97169-97172). These new codes will provide detail regarding the severity of the patient’s condition or the complexity of the medical decision making.
- There have been significant changes to Moderate Sedation codes. Moderate (or Conscious) Sedation will now be considered unbundled from other services and are to be reported separately. Due to this change, Appendix G has been archived and the Moderate Sedation Symbol has been deleted affecting 180 CPT codes. Six Moderate Sedation CPT codes (99143-99145, and 99148-99150) were deleted and six new CPT codes have been introduced.
- 99151-99153: provided by the same physician/qualified health professional performing supported service
- 99155-99157: provided by physician/qualified health professional not performing supported service
The new initial moderate sedation CPT codes (99151, 99152 and 99155, 99156) now require a minimum initial service of only 15 minutes. This has been reduced from the minimum of 30 minutes required by the deleted initial moderate sedation codes. The add-on code time increments continue to be 15 minutes for CPT codes 99153 and 99157.
In addition to the new moderate sedation CPT codes, CMS has created a new HCPCS code G0500 for Gastroenterologists to report the initial 15 minutes of moderate sedation for patients age five years and older provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that supports sedation. This service would require the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status. HCPCS code G0500 would be reported by Gastroenterologists in place of CPT code 99152. Additional time may be reported with CPT code 99153 as appropriate.
- New section of CPT – Proprietary Laboratory Analyses
- Five Presumptive Drug Class Screening CPT codes (80300-80304) were deleted and replaced with three new CPT codes (80305-80307).
Each of these new codes are reported only once, irrespective of the number of procedures or drugs tested on any date of service.
- There have been revisions to Molecular Pathology Guidelines as well as the deletion of three Tier 1 Molecular Pathology CPT codes (81280-81282) and a new Tier 1 CPT code (81327) to report SEPT9 (Septin9) methylation analysis.
- Five new Genomic Sequencing Procedures CPT codes (81413, 81414, 81422, 81439,
While the above information regarding 2017 CPT code changes is quite cumbersome, it’s important to remember this is not a comprehensive listing of all additions, deletions, and revisions. We recommend coding and billing staff refer to the 2017 CPT Code Book for all updates and make the necessary adjustments to edit billing and EMR systems.