2016 CPT Change by Advanced Billing Consultants

1. January 1, 2016
2016 CPT Changes

2. Advanced Billing Consultants, Inc.
• This presentation was designed with the clients of
Advanced Billing Consultants in mind. It is not all inclusive.
Please refer to CPT and AMA for a complete listing of all
deletions, additions, and revisions to the code sets.
Disclaimer

3. Advanced Billing Consultants, Inc.
• New:
▫ 99415, 99416: prolonged clinical staff service direct pt
contact w/ phys supervision; beyond 45 mins, plus each
additional 30 mins (not counting the services done like
PT/INR, ect.)
E/M changes

4. Advanced Billing Consultants, Inc.
• New:
▫ 43210: Trans-oral approach for Esophagogastroduodenoscopy
▫ 47537: injection procedure for cholangiography, percutaneous through an existing access
site
▫ 47532: same as 47537 but new access
▫ 47534: placement of biliary drainage catheter
▫ 47535: conversion of external biliary drainage catheter to internal-external biliary
drainage catheter
▫ 47536: exchange of biliary drainage catheter
▫ 47537: removal of biliary drainage catheter
▫ 47538, 47539, 47540: placement of stent into a bile duct
▫ 47541: placement of access through the biliary tree to assist with an endoscopic biliary
procedure
▫ 47542: balloon dilation of biliary ducts to allow for passage of stones (add on code)
▫ 47543: endoluminal biopsy of biliary tree (add on)
▫ 47544: removal of calculi/debris from biliary ducts or gallbladder, any method (add on
code)
▫ 49185: sclerotherapy of a fluid collections, percutaneous
Digestive System

5. Advanced Billing Consultants, Inc.
• Deleted:
▫ 50392, 50393, 50394, 50398
• New
▫ 50430 injection procedure for antegrade nephrostogram and or ureterogram, new access
▫ 50431; existing access
▫ 50432: placement of nephrostomy catheter, percutaneous
▫ 50433; new access
▫ 50434: Convert nephrostomy catheter to nephroureteral catheter
▫ 50435: Exchange nephrostomy
▫ 50606: Endoluminal biopsy of ureter non-endoscopic (add on)
▫ 50693: placement of ureteral stent, percutaneous; pre-existing nephrostomy tract
▫ 50694; new acces, w/o separate nephrostomy catheter
▫ 50695; new acces, with separate nephrostomy catheter
▫ 50705: ureteral occlusion (add on)
▫ 50706: balloon dilation, ureteral stricture (add on)
▫ 54437: repair of traumatic corporeal tear (penis fracture)
▫ 54438: replantation, penis
Urinary System

6. Advanced Billing Consultants, Inc.
• Deleted: 64412-64999
• New:
▫ 64461: paravertebral block, thoracic
▫ 64462; second and any additional injection sites (add on)
▫ 64463; continuous infusion by catheter
Nervous System

7. Advanced Billing Consultants, Inc.
• New
▫ 69209: removal impacted cerumen using irrigation/lavage,
unilateral (when no instrument used- use 69210 if instrument
is used.) Mod 50 allowed
Auditory System

8. Advanced Billing Consultants, Inc.
• There are many changes to Lab codes, for complete list see:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/ClinicalLabFeeSched/Downloads/CLFS-CY2016-
Preliminary-Payment-Determinations.pdf
• Deleted: G0431, G0434
• New
▫ G0477-G0483: drug screens
Lab Codes

9. Advanced Billing Consultants, Inc.
• Deleted: 13 outdated vaccine codes
• New:
▫ 90625: cholera vaccine
▫ 90697: (DTap-IPV-Hib-HepB)
▫ 90620: Men B 2 dose
▫ 90621: MenB 3 dose
Medicine: Vaccines

10. Advanced Billing Consultants, Inc.
• Deleted: 95973 (95972 revised to remove time element)
• New:
▫ 93050: arterial pressure waveform analysis (replaced 0311T)
▫ 96931-96936: reflectance confocal microscopy imaging of
skin (RCM)
Cardiovascular and Pulmonary

11. Advanced Billing Consultants, Inc.
• There are many changes to drug codes (Q and J). Complete
list can be found at: CMS Level II HCPCS Coding Decisions
for the 2015-2016 Coding Cycle [ZIP, 43KB]
• Deleted: J7302
• New:
▫ J7297: Levonorgestrel-releasing intrauterine contraceptive
system, 52 mg, 3 year duration
▫ J7298; 5 year duration
▫ J1575: Injection, immune globulin/hyaluronidase, 100 mg
immunoglobulin
▫ J0695: Injection, ceftolozane 50 mg and tazobactam 25 mg
Drug Codes

12. Advanced Billing Consultants, Inc.
• There are a lot of new PQRS reporting codes. The complete
list can be found at: 2016 PQRS Measures List
Reporting Codes (G-codes)

13. Advanced Billing Consultants, Inc.
• New
▫ 0381T: external heart rate recordings
▫ 0385T/0386T: more external heart rate recordings
▫ 0387T-0391T: permanent leadless pacemaker
Category III codes

14. Advanced Billing Consultants, Inc.
30021 Tomas, Suite 250
Rancho Santa Margarita, CA 92688
Phone: 888-222-2125
Fax: 949-713-2931
info@advancedbillingconsultants.com